[Title 38 CFR ]
[Code of Federal Regulations (annual edition) - July 1, 2021 Edition]
[From the U.S. Government Publishing Office]



[[Page i]]

          

          Title 38

Pensions, Bonuses, and Veterans' Relief


________________________

Parts 0 to 17

                         Revised as of July 1, 2021

          Containing a codification of documents of general 
          applicability and future effect

          As of July 1, 2021
                    Published by the Office of the Federal Register 
                    National Archives and Records Administration as a 
                    Special Edition of the Federal Register

[[Page ii]]

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[[Page iii]]




                            Table of Contents



                                                                    Page
  Explanation.................................................       v

  Title 38:
          Chapter I--Department of Veterans Affairs                  3
  Finding Aids:
      Table of CFR Titles and Chapters........................     923
      Alphabetical List of Agencies Appearing in the CFR......     943
      List of CFR Sections Affected...........................     953

[[Page iv]]





                     ----------------------------

                     Cite this Code: CFR
                     To cite the regulations in 
                       this volume use title, 
                       part and section number. 
                       Thus, 38 CFR 0.600 refers 
                       to title 38, part 0, 
                       section 600.

                     ----------------------------

[[Page v]]



                               EXPLANATION

    The Code of Federal Regulations is a codification of the general and 
permanent rules published in the Federal Register by the Executive 
departments and agencies of the Federal Government. The Code is divided 
into 50 titles which represent broad areas subject to Federal 
regulation. Each title is divided into chapters which usually bear the 
name of the issuing agency. Each chapter is further subdivided into 
parts covering specific regulatory areas.
    Each volume of the Code is revised at least once each calendar year 
and issued on a quarterly basis approximately as follows:

Title 1 through Title 16.................................as of January 1
Title 17 through Title 27..................................as of April 1
Title 28 through Title 41...................................as of July 1
Title 42 through Title 50................................as of October 1

    The appropriate revision date is printed on the cover of each 
volume.

LEGAL STATUS

    The contents of the Federal Register are required to be judicially 
noticed (44 U.S.C. 1507). The Code of Federal Regulations is prima facie 
evidence of the text of the original documents (44 U.S.C. 1510).

HOW TO USE THE CODE OF FEDERAL REGULATIONS

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OMB CONTROL NUMBERS

    The Paperwork Reduction Act of 1980 (Pub. L. 96-511) requires 
Federal agencies to display an OMB control number with their information 
collection request.

[[Page vi]]

Many agencies have begun publishing numerous OMB control numbers as 
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that volume.

[[Page vii]]

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    Oliver A. Potts,
    Director,
    Office of the Federal Register
    July 1, 2021







[[Page ix]]



                               THIS TITLE

    Title 38--Pensions, Bonuses, and Veterans' Relief is composed of two 
volumes. The parts in these volumes are arranged in the following order: 
parts 0-17 and part 18 to end. The contents of these volumes represent 
all current regulations codified by the Department of Veterans Affairs 
and the Armed Forces Retirement Home under this title of the CFR as of 
July 1, 2021.

    For this volume, Michele Bugenhagen was Chief Editor. The Code of 
Federal Regulations publication program is under the direction of John 
Hyrum Martinez, assisted by Stephen J. Frattini.

[[Page 1]]



            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF




                   (This book contains parts 0 to 17)

  --------------------------------------------------------------------
                                                                    Part

chapter i--Department of Veterans Affairs...................           0

[[Page 3]]



                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS




  --------------------------------------------------------------------


  Editorial Note: Nomenclature changes to chapter I appear at 64 FR 
30244, June 7, 1999; 66 FR 44053, Aug. 22, 2001; and 66 FR 66767, Dec. 
27, 2001.
Part                                                                Page
0               Values, standards of ethical conduct, and 
                    related responsibilities................           5
1               General provisions..........................           7
2               Delegations of authority....................         141
3               Adjudication................................         149
4               Schedule for rating disabilities............         401
5               Administrative procedures: guidance 
                    documents...............................         534
6               United States Government life insurance.....         537
7               Soldiers' and sailors' civil relief.........         542
8               National Service Life Insurance.............         544
8a              Veterans Mortgage Life Insurance............         564
9               Servicemembers' Group Life Insurance and 
                    Veterans' Group Life Insurance..........         567
10              Adjusted compensation.......................         586
11              Loans by banks on and payment of adjusted 
                    service certificates....................         594
12              Disposition of veteran's personal funds and 
                    effects.................................         600
13              Fiduciary Activities........................         612
14              Legal services, General Counsel, and 
                    miscellaneous claims....................         632
15              Enforcement of nondiscrimination on the 
                    basis of handicap in programs or 
                    activities conducted by the Department 
                    of Veterans Affairs.....................         683
16              Protection of human subjects................         689
17              Medical.....................................         707

[[Page 5]]



PART 0_VALUES, STANDARDS OF ETHICAL CONDUCT, AND RELATED RESPONSIBILITIES-
-Table of Contents



    Subpart A_Core Values, Characteristics, and Customer Experience 
                      Principles of the Department

Sec.
0.600 General.
0.601 Core Values.
0.602 Core Characteristics.
0.603 Customer Experience principles.

                      Subpart B_General Provisions

0.735-1 Agency ethics officials.
0.735-2 Government-wide standards.

 Subpart C_Standards of Ethical Conduct and Related Responsibilities of 
                                Employees

0.735-10 Cross-reference to employee ethical and other conduct standards 
          and financial disclosure regulations.
0.735-11 Other conduct on the job.
0.735-12 Standards of conduct in special areas.

    Authority: 5 U.S.C. 301; 38 U.S.C. 501; see sections 201, 301, and 
502(a) of E.O. 12674, 54 FR 15159, 3 CFR, 1989 Comp., p. 215 as modified 
by E.O. 12731, 55 FR 42547, 3 CFR, 1990 Comp., p. 306.

    Source: 31 FR 5828, Apr. 15, 1966, unless otherwise noted.



    Subpart A_Core Values, Characteristics, and Customer Experience 
                      Principles of the Department

    Source: 77 FR 41275, July 13, 2012, unless otherwise noted.



Sec.  0.600  General.

    This section describes the Core Values, Characteristics, and 
Customer Experience Principles that serve as internal guidelines for 
employees of the Department of Veterans Affairs (VA). These Core Values, 
Characteristics, and Customer Experience Principles define VA employees, 
articulate what VA stands for, and underscore its moral obligation to 
veterans, their families, and other beneficiaries. They are intended to 
establish one overarching set of guidelines that apply to all VA 
Administrations and staff offices, confirming the values already 
instilled in many VA employees and enforcing their commitment to provide 
the best experience possible to veterans, servicemembers, their 
families, caregivers, and survivors.

[ 84 FR 22710, May 20, 2019]



Sec.  0.601  Core Values.

    VA's Core Values define VA employees. They describe the 
organization's culture and character, and serve as the foundation for 
the way VA employees should interact with each other, as well as with 
people outside the organization. They also serve as a common bond 
between all employees regardless of their grade, specialty area, or 
location. These Core Values are Integrity, Commitment, Advocacy, 
Respect, and Excellence. Together, the first letters of the Core Values 
spell ``I CARE,'' and VA employees should adopt this motto and these 
Core Values in their day-to-day operations.
    (a) Integrity. VA employees will act with high moral principle, 
adhere to the highest professional standards, and maintain the trust and 
confidence of all with whom they engage.
    (b) Commitment. VA employees will work diligently to serve veterans 
and other beneficiaries, be driven by an earnest belief in VA's mission, 
and fulfill their individual responsibilities and organizational 
responsibilities.
    (c) Advocacy. VA employees will be truly veteran-centric by 
identifying, fully considering, and appropriately advancing the 
interests of veterans and other beneficiaries.
    (d) Respect. VA employees will treat all those they serve and with 
whom they work with dignity and respect, and they will show respect to 
earn it.
    (e) Excellence. VA employees will strive for the highest quality and 
continuous improvement, and be thoughtful and decisive in leadership, 
accountable for their actions, willing to admit mistakes, and rigorous 
in correcting them.



Sec.  0.602  Core Characteristics.

    While Core Values define VA employees, the Core Characteristics 
define what VA stands for and what VA strives to be as an organization. 
These are aspirational goals that VA wants

[[Page 6]]

its employees, veterans, and the American people to associate with the 
Department and with its workforce. These Core characteristics describe 
the traits all VA organizations should possess and demonstrate, and they 
identify the qualities needed to successfully accomplish today's 
missions and also support the ongoing transformation to a 21st Century 
VA. These characteristics are:
    (a) Trustworthy. VA earns the trust of those it serves, every day, 
through the actions of its employees. They provide care, benefits, and 
services with compassion, dependability, effectiveness, and 
transparency.
    (b) Accessible. VA engages and welcomes veterans and other 
beneficiaries, facilitating their use of the entire array of its 
services. Each interaction will be positive and productive.
    (c) Quality. VA provides the highest standard of care and services 
to veterans and beneficiaries while managing the cost of its programs 
and being efficient stewards of all resources entrusted to it by the 
American people. VA is a model of unrivalled excellence due to employees 
who are empowered, trusted by their leaders, and respected for their 
competence and dedication.
    (d) Innovative. VA prizes curiosity and initiative, encourages 
creative contributions from all employees, seeks continuous improvement, 
and adapts to remain at the forefront in knowledge, proficiency, and 
capability to deliver the highest standard of care and services to all 
of the people it serves.
    (e) Agile. VA anticipates and adapts quickly to current challenges 
and new requirements by continuously assessing the environment in which 
it operates and devising solutions to better serve veterans, other 
beneficiaries, and Service members.
    (f) Integrated. VA links care and services across the Department; 
other federal, state, and local agencies; partners; and Veterans 
Services Organizations to provide useful and understandable programs to 
veterans and other beneficiaries. VA's relationship with the Department 
of Defense is unique, and VA will nurture it for the benefit of veterans 
and Service members.



Sec.  0.603  Customer Experience principles.

    VA will provide the best customer experience in its delivery of 
care, benefits, and memorial services to veterans, servicemembers, their 
families, caregivers, and survivors. The delivery of exceptional 
customer experience is the responsibility of all VA employees and will 
be guided by VA's Core Values and Characteristics. Customer experience 
is the product of interactions between an organization and a customer 
over the duration of their relationship. VA measures these interactions 
through Ease, Effectiveness, and Emotion, all of which impact the 
overall trust the customer has in the organization.
    (a) Ease. VA will make access to VA care, benefits, and memorial 
services smooth and easy.
    (b) Effectiveness. VA will deliver care, benefits, and memorial 
services to the customer's satisfaction.
    (c) Emotion. VA will deliver care, benefits, and memorial services 
in a manner that makes customers feel honored and valued in their 
interactions with VA. VA will use customer experience data and insights 
in strategy development and decision-making to ensure that the voice of 
veterans, servicemembers, their families, caregivers, and survivors 
inform how VA delivers care, benefits, and memorial services.

[84 FR 22710, May 20, 2019]



                      Subpart B_General Provisions

    Source: Redesignated at 77 FR 41275, July 13, 2012, unless otherwise 
noted.



Sec.  0.735-1  Agency ethics officials.

    (a) Designated Agency Ethics Official (DAEO). The Assistant General 
Counsel (023) is the designated agency ethics official (DAEO) for the 
Department of Veterans Affairs. The Deputy Assistant General Counsel 
(023C) is the alternate DAEO, who is designated to act in the DAEO's 
absence. The DAEO has primary responsibility for the administration, 
coordination, and management of the VA ethics program, pursuant to 5 CFR 
2638.201-204.

[[Page 7]]

    (b) Deputy ethics officials. (1) The Regional Counsel are deputy 
ethics officials. They have been delegated the authority to act for the 
DAEO within their jurisdiction, under the DAEO's supervision, pursuant 
to 5 CFR 2638.204.
    (2) The alternate DAEO, the DAEO's staff, and staff in the Offices 
of Regional Counsel, may also act as deputy ethics officials pursuant to 
delegations of one or more of the DAEO's duties from the DAEO or the 
Regional Counsel.

[58 FR 61813, Nov. 23, 1993. Redesignated at 61 FR 11309, Mar. 20, 1996]



Sec.  0.735-2  Government-wide standards.

    For government-wide standards of ethical conduct and related 
responsibilities for Federal employees, see 5 CFR Part 735 and Chapter 
XVI.

[61 FR 11309, Mar. 20, 1996. Redesignated at 63 FR 33579, June 19, 1998]



 Subpart C_Standards of Ethical Conduct and Related Responsibilities of 
                                Employees

    Source: 58 FR 61814, Nov. 23, 1993, unless otherwise noted. 
Redesignated at 77 FR 41275, July 13, 2012.



Sec.  0.735-10  Cross-reference to employee ethical and other conduct 
standards and financial disclosure regulations.

    Employees of the Department of Veterans Affairs (VA) should refer to 
the executive branch-wide Standards of Ethical Conduct at 5 CFR part 
2635, the executive branch-wide Employee Responsibilities and Conduct at 
5 CFR part 735, and the executive branch-wide financial disclosure 
regulation at 5 CFR part 2634.



Sec.  0.735-11  Other conduct on the job.

    Relationship with beneficiaries and claimants. Employees are 
expected to be helpful to beneficiaries, patients and claimants, but:
    (a) An employee shall not procure intoxicants or drugs for, or 
attempt to sell intoxicants or drugs to, patients or members, or give or 
attempt to give intoxicants or drugs to them unless officially 
prescribed for medical use;
    (b) An employee shall not abuse patients, members, or other 
beneficiaries, whether or not provoked.



Sec.  0.735-12  Standards of conduct in special areas.

    (a) Safety. (1) Employees will observe safety instructions, signs, 
and normal safety practices and precautions, including the use of 
protective clothing and equipment.
    (2) An employee shall report each work-connected injury, accident or 
disease he or she suffers.
    (b) Furnishing testimony. Employees will furnish information and 
testify freely and honestly in cases respecting employment and 
disciplinary matters. Refusal to testify, concealment of material facts, 
or willfully inaccurate testimony in connection with an investigation or 
hearing may be ground for disciplinary action. An employee, however, 
will not be required to give testimony against himself or herself in any 
matter in which there is indication that he or she may be or is involved 
in a violation of law wherein there is a possibility of self-
incrimination.



PART 1_GENERAL PROVISIONS--Table of Contents



  Department of Veterans Affairs Official Seal and Distinguishing Flag

Sec.
1.9 Description, use, and display of VA seal and flag.

               The United States Flag for Burial Purposes

1.10 Eligibility for and disposition of the United States flag for 
          burial purposes.

     Quarters for Department of Veterans Affairs Employees Overseas

1.11 Quarters for Department of Veterans Affairs employees in 
          Government-owned or -rented buildings overseas.

                           Program Evaluation

1.15 Standards for program evaluation.
1.17 Evaluation of studies relating to health effects of radiation 
          exposure.
1.18 Guidelines for establishing presumptions of service connection for 
          former prisoners of war.

         Referrals of Information Regarding Criminal Violations

1.200 Purpose.
1.201 Employee's duty to report.

[[Page 8]]

1.203 Information to be reported to VA Police.
1.204 Information to be reported to the Office of Inspector General.
1.205 Notification to the Attorney General or United States Attorney's 
          Office.

     Security and Law Enforcement at Department of Veterans Affairs 
                               Facilities

1.218 Security and law enforcement at VA facilities.
1.220 On-site activities by pharmaceutical company representatives at VA 
          medical facilities.

                  Parking Fees at VA Medical Facilities

1.300 Purpose.
1.301 Definitions.
1.302 Applicability and scope.
1.303 Policy.

Release of Information from Department of Veterans Affairs (VA) Records 
Relating to Drug Abuse, Alcoholism or Alcohol Abuse, Infection With the 
        Human Immunodeficiency Virus (HIV), or Sickle Cell Anemia

1.460 Definitions.
1.461 Applicability.
1.462 Confidentiality restrictions.
1.463 Criminal penalty for violations.
1.464 Minor patients.
1.465 Incompetent and deceased patients.
1.466 Security for records.
1.467 Restrictions on the use of identification cards and public signs.
1.468 Relationship to Federal statutes protecting research subjects 
          against compulsory disclosure of their identity.
1.469 Patient access and restrictions on use.
1.470-1.474 [Reserved]

                   Disclosures With Patient's Consent

1.475 Form of written consent.
1.476 Prohibition on redisclosure.
1.477 Disclosures permitted with written consent.
1.478 Disclosures to prevent multiple enrollments in detoxification and 
          maintenance treatment programs; not applicable to records 
          relating to sickle cell anemia or infection with the human 
          immunodeficiency virus.
1.479 Disclosures to elements of the criminal justice system which have 
          referred patients.
1.480 [Reserved]

                   Disclosures Without Patient Consent

1.481 Disclosure of medical records of veterans who receive non-VA 
          health care.
1.482 Disclosure of medical records to recover or collect reasonable 
          charges.
1.483 Disclosure of information to participate in state prescription 
          drug monitoring programs.
1.484 Disclosure of medical information to the surrogate of a patient 
          who lacks decision-making capacity.
1.485 Medical emergencies.
1.485a Eye, organ and tissue donation.
1.486 Disclosure of information related to infection with the human 
          immunodeficiency virus to public health authorities.
1.487 Disclosure of information related to infection with the human 
          immunodeficiency virus to the spouse or sexual partner of the 
          patient.
1.488 Research activities.
1.489 Audit and evaluation activities.

              Court Orders Authorizing Disclosures and Use

1.490 Legal effect of order.
1.491 Confidential communications.
1.492 Order not applicable to records disclosed without consent to 
          researchers, auditors and evaluators.
1.493 Procedures and criteria for orders authorizing disclosures for 
          noncriminal purposes.
1.494 Procedures and criteria for orders authorizing disclosure and use 
          of records to criminally investigate or prosecute patients.
1.495 Procedures and criteria for orders authorizing disclosure and use 
          of records to investigate or prosecute VA or employees of VA.
1.496 Orders authorizing the use of undercover agents and informants to 
          criminally investigate employees or agents of VA.
1.497-1.499 [Reserved]

  Release of Information From Department of Veterans Affairs Claimant 
                                 Records

1.500 General.
1.501 Release of information by the Secretary.
1.502 Disclosure of the amount of monetary benefits.
1.503 Disclosure of information to a veteran or his or her duly 
          authorized representative as to matters concerning the veteran 
          alone.
1.504 Disclosure of information to a widow, child, or other claimant.
1.505 Genealogy.
1.506 Disclosure of records to Federal Government departments, State 
          unemployment compensation agencies, and the Office of 
          Servicemembers' Group Life Insurance.
1.507 Disclosures to members of Congress.
1.508 Disclosure in cases where claimants are charged with or convicted 
          of criminal offenses.
1.509 Disclosure to courts in proceedings in the nature of an inquest.

[[Page 9]]

1.510 Disclosure to insurance companies cooperating with the Department 
          of Justice in the defense of insurance suits against the 
          United States.
1.511 Disclosure of claimant records in connection with judicial 
          proceedings generally.
1.512 Disclosure of loan guaranty information.
1.513 Disclosure of information contained in Armed Forces service and 
          related medical records in Department of Veterans Affairs 
          custody.
1.514 Disclosure to private physicians and hospitals other than 
          Department of Veterans Affairs.
1.514a Disclosure to private psychologists.
1.514b Disclosures to procurement organizations.
1.515 Disclosure of information to participate in state prescription 
          drug monitoring programs.
1.516 Disclosure of information to undertaker concerning burial of a 
          deceased veteran.
1.517 Disclosure of vocational rehabilitation and education information 
          to educational institutions cooperating with the Department of 
          Veterans Affairs.
1.518 Addresses of claimants.
1.519 Lists of names and addresses.
1.520 Confidentiality of social data.
1.521 Special restrictions concerning social security records.
1.522 Determination of the question as to whether disclosure will be 
          prejudicial to the mental or physical health of claimant.
1.523 To commanding officers of State soldiers' homes.
1.524 Persons authorized to represent claimants.
1.525 Inspection of records by or disclosure of information to 
          recognized representatives of organizations and recognized 
          attorneys.
1.526 Copies of records and papers.
1.527 Administrative review.

 Procedures for Disclosure of Records Under the Freedom of Information 
                                   Act

1.550 Purpose.
1.551 Definitions.
1.552 General provisions.
1.553 Public reading rooms and discretionary disclosures.
1.554 Requirements for making requests.
1.555 Responsibility for responding to requests.
1.556 Timing of responses to requests.
1.557 Responses to requests.
1.558 Business information.
1.559 Appeals.
1.560 Maintenance and preservation of records.
1.561 Fees.
1.562 Other rights and services.

  Safeguarding Personal Information in Department of Veterans Affairs 
                                 Records

1.575 Social security numbers in veterans' benefits matters.
1.576 General policies, conditions of disclosure, accounting of certain 
          disclosures, and definitions.
1.577 Access to records.
1.578 [Reserved]
1.579 Amendment of records.
1.580 Administrative review.
1.581 [Reserved]
1.582 Exemptions.
1.583-1.584 [Reserved]

   Expanded Remote Access to Computerized Veterans Claims Records by 
                       Accredited Representatives

1.600 Purpose.
1.601 Qualifications for access.
1.602 Utilization of access.
1.603 Disqualification.

        Inventions by Employees of Department of Veterans Affairs

1.650 Purpose.
1.651 Definitions.
1.652 Criteria for determining rights to employee inventions.
1.653 Delegation of authority.
1.654 Patenting of inventions.
1.655 Government license in invention of employee.
1.656 Information to be submitted by inventor.
1.657 Determination of rights.
1.658 Right of appeal.
1.659 Relationship to incentive awards program.
1.660 Expeditious handling.
1.661 Information to be kept confidential.
1.662 Provisions of regulations made a condition of employment.
1.663 Licensing of Government-owned inventions.
1.664-1.666 [Reserved]

                     Administrative Control of Funds

1.670 Purpose.
1.671 Definitions.
1.672 Responsibilities.
1.673 Responsibility for violations of the administrative subdivision of 
          funds.

  Use of Official Mail in the Location and Recovery of Missing Children

1.700 Purpose.
1.701 Contact person for missing children official mail program.
1.702 Policy.
1.703 Percentage estimate.
1.704 [Reserved]
1.705 Restrictions on use of missing children information.

[[Page 10]]

                           Homeless Claimants

1.710 Homeless claimants: Delivery of benefit payments and 
          correspondence.
1.780-1.783 [Reserved]

                   Part-Time Career Employment Program

1.891 Purpose of program.
1.892 Review of positions.
1.893 Establishing and converting part-time positions.
1.894 Annual goals and timetables.
1.895 Review and evaluation.
1.896 Publicizing vacancies.
1.897 Exceptions.

   Standards for Collection, Compromise, Suspension or Termination of 
  Collection Effort, and Referral of Civil Claims for Money or Property

1.900 Prescription of standards.
1.901 No private rights created.
1.902 Antitrust, fraud, and tax interagency claims.
1.903 Settlement, waiver, or compromise under other statutory or 
          regulatory authority.
1.904 Form of payment.
1.905 Subdivision of claims not authorized.
1.906 Required administrative proceedings.
1.907 Definitions.

                   Standards for Collection of Claims

1.910 Aggressive collection action.
1.911 Collection of debts owed by reason of participation in a benefits 
          program.
1.911a Collection of non-benefit debts.
1.912 Collection by offset.
1.912a Collection by offset--from VA benefit payments.
1.913 Liquidation of collateral.
1.914 Collection in installments.
1.915 Interest, administrative costs, and penalties.
1.916 Disclosure of debt information to consumer reporting agencies 
          (CRA).
1.917 Contracting for collection services.
1.918 Use and disclosure of mailing addresses.
1.919 Administrative offset against amounts payable from Civil Service 
          Retirement and Disability Fund, Federal Employees Retirement 
          System (FERS), final salary check, and lump sum leave 
          payments.
1.920 Referral of VA debts.
1.921 Analysis of costs.
1.922 Exemptions.
1.923 Administrative wage garnishment.
1.924 Suspension or revocation of eligibility for federal loans, loan 
          insurance, loan guarantees, licenses, permits, or privileges.

                   Standards for Compromise of Claims

1.930 Scope and application.
1.931 Bases for compromise.
1.932 Enforcement policy.
1.933 Joint and several liability.
1.934 Further review of compromise offers.
1.935 Consideration of tax consequences to the Government.
1.936 Mutual releases of the debtor and VA.

        Standards for Suspending or Terminating Collection Action

1.940 Scope and application.
1.941 Suspension of collection activity.
1.942 Termination of collection activity.
1.943 Exception to termination.
1.944 Discharge of indebtedness; reporting requirements.
1.945 Authority to suspend or terminate collection action on certain 
          benefit indebtedness; authority for refunds.

             Referrals to GAO, Department of Justice, or IRS

1.950 Prompt referral.
1.951 Claims Collection Litigation Report (CCLR).
1.952 Preservation of evidence.
1.953 Minimum amount of referrals to the Department of Justice.

          Regional Office Committees on Waivers and Compromises

1.955 Regional office Committees on Waivers and Compromises.
1.956 Jurisdiction.
1.957 Committee authority.
1.958 Finality of decisions.
1.959 Records and certificates.
1.960 Legal and technical assistance.
1.961 Releases.
1.962 Waiver of overpayments.
1.963 Waiver; other than loan guaranty.
1.963a Waiver; erroneous payments of pay and allowances.
1.964 Waiver; loan guaranty.
1.965 Application of standard.
1.966 Scope of waiver decisions.
1.967 Refunds.
1.968 [Reserved]
1.969 Revision of waiver decisions.
1.970 Standards for compromise.

                        Salary Offset Provisions

1.980 Scope.
1.981 Definitions.
1.982 Salary offsets of debts involving benefits under the laws 
          administered by VA.
1.983 Notice requirements before salary offsets of debts not involving 
          benefits under the laws administered by VA.
1.984 Request for a hearing.
1.985 Form, notice of, and conduct of hearing.
1.986 Result if employee fails to meet deadlines.
1.987 Review by hearing official or administrative law judge.

[[Page 11]]

1.988 Written decision following a hearing requested under Sec.  1.984.
1.989 Review of VA records related to the debt.
1.990 Written agreement to repay debt as alternative to salary offset.
1.991 Procedures for salary offset: when deductions may begin.
1.992 Procedures for salary offset.
1.993 Non-waiver of rights.
1.994 Refunds.
1.995 Requesting recovery through centralized administrative offset.

 Procedures for Financial Institutions Regarding Garnishment of Benefit 
                       Payments After Disbursement

1.1000 Garnishment of payments after disbursement.

    Authority: 38 U.S.C. 501, and as noted in specific sections.
    Sections 1.460 and 1.461 also issued under 38 U.S.C. 7332 and 7334.
    Sections 1.462, 1.464, 1.466-1.469, 1.476, 1.478, 1.479, 1.491-
1.493, 1.495 and 1.496 also issued under 38 U.S.C. 7334.
    Sections 1.463, 1.465, 1.475, 1.477, 1.481, 1.482, 1.483, 1.485, 
1.486-1.490, and 1.494 also issued under 38 U.S.C. 7332.
    Section 1.484 also issued under 38 U.S.C. 7331 and 7332.
    Section 1.485a also issued under 38 U.S.C. 5701 and 7332.

  Department of Veterans Affairs Official Seal and Distinguishing Flag



Sec.  1.9  Description, use, and display of VA seal and flag.

    (a) General. This section describes the official seal and 
distinguishing flag of the of the Department of Veterans Affairs, and 
prescribes the rules for their custody and use.
    (b) Definitions. (1) VA means all organizational units of the 
Department of Veterans Affairs.
    (2) Embossed seal means an image of the official seal made on paper 
or other medium by using an embosser with a negative and positive die to 
create a raised impression.
    (3) Official seal means the original(s) of the VA seal showing the 
exact form, content, and colors thereof.
    (4) Replica means a copy of the official seal displaying the 
identical form, content, and colors thereof.
    (5) Reproduction means a copy of the official seal displaying the 
identical form and content, reproduced in only one color.
    (6) Secretary means the Secretary of Veterans Affairs.
    (7) Deputy Secretary means the Deputy Secretary of Veterans Affairs.
    (c) Custody of official seal and distinguishing flags. The Secretary 
or designee shall:
    (1) Have custody of:
    (i) The official seal and prototypes thereof, and masters, molds, 
dies, and other means of producing replicas, reproductions, and 
embossing seals and
    (ii) Production, inventory, and loan records relating to items 
specified in paragraph (c)(1)(i) of this section, and
    (2) Have custody of distinguishing flags, and be responsible for 
production, inventory, and loan records thereof.
    (d) Official Seal--(1) Description of official seal. The Department 
of Veterans Affairs prescribes as its official seal, of which judicial 
notice shall be taken pursuant to 38 U.S.C. 302, the imprint illustrated 
below:
[GRAPHIC] [TIFF OMITTED] TC04NO91.000

    (i) The official seal includes an American eagle clutching a cord in 
its talons. The cord binds a 13-star U.S. flag and a 50-star U.S. flag. 
In the field over the eagle is a pentagon formation of stars, with one 
point down. The words Department of Veterans Affairs and United States 
of America surround the eagle, stars, and flags. A rope motif makes up 
the outermost ring of the seal.
    (ii) The eagle represents the eternal vigilance of all our nation's 
veterans. The stars represent the five branches of

[[Page 12]]

military service. The crossed flags represent our nation's history. The 
gold cord that binds the two flags, which is shown clutched in the 
eagle's talons is symbolic of those who have fallen in the defense of 
liberty. Each of the various individual items placed together in the 
seal is a salute to the past, present, and future.
    (iii) The colors used in the configuration are gold, brown, blue, 
white, silver, yellow, black, and red.
    (iv) The colors are derived from the American flag and from nature. 
By invoking this symbolism, the color scheme represents the Nation's 
commitment to its veterans.
    (2) Use of the official seal, replicas, reproductions, and embossing 
seals. (i) The Secretary or designees are authorized to affix replicas, 
reproductions, and embossed seals to appropriate documents, 
certifications, and other material for all purposes as authorized by 
this section.
    (ii) Replicas may be used only for:
    (A) Display in or adjacent to VA facilities, in Department 
auditoriums, presentation rooms, hearing rooms, lobbies, and public 
document rooms.
    (B) Offices of senior officials.
    (C) Official VA distinguishing flags, adopted and utilized pursuant 
to paragraph (e)(2) of this section.
    (D) Official awards, certificates, medals, and plaques.
    (E) Motion picture film, video tape, and other audiovisual media 
prepared by or for VA and attributed thereto.
    (F) Official prestige publications which represent the achievements 
or mission of VA.
    (G) For other similar official purposes.
    (H) For such other purposes as will tend to advance the aims, 
purposes and mission of the Department of Veterans Affairs as determined 
by the Secretary or Deputy Secretary.
    (iii) Reproductions may be used only on:
    (A) VA letterhead stationery.
    (B) Official VA identification cards and security credentials.
    (C) Business cards for VA employees.
    (D) Official VA signs.
    (E) Official publications or graphics issued by and attributed to 
VA, or joint statements of VA with one or more Federal agencies, State 
or local governments, or foreign governments.
    (F) Official awards, certificates, and medals.
    (G) Motion picture film, video tape, and other audiovisual media 
prepared by and for VA and attributed thereto.
    (H) For other similar official purposes.
    (I) For such other purposes as will tend to advance the aims, 
purposes and mission of the Department of Veterans Affairs as determined 
by the Secretary or Deputy Secretary.
    (iv) Use of the official seal and embossed seals:
    (A) Embossed seals may be used only on VA legal documents, including 
interagency or intergovernmental agreements with States, foreign patent 
applications, and similar official documents.
    (B) The official seal may be used only for those purposes related to 
the conduct of Departmental affairs in furtherance of the VA mission.
    (e) Distinguishing flag. (1) Description of distinguishing flag.
    (i) The base or field of the flag shall be blue and a replica of the 
official seal shall appear on both sides thereof.
    (ii) A Class 1 flag shall be of nylon banner, measure 
4[foot]4 on the hoist by 5[foot]6 on the fly, 
exclusive of heading and hems, and be fringed on three edges with nylon 
fringe, 2\1/2\ wide.
    (iii) A Class 2 flag shall be of nylon banner, measure 3[foot] on 
the hoist by 5[foot] on the fly, exclusive of heading and hems, and be 
fringed on three edges with nylon fringe, 2\1/2\ wide.
    (iv) Each flag shall be manufactured in accordance with Department 
of Veterans Affairs Specification X-497G. The replica of the official 
seal shall be screen printed or embroidered on both sides.
    (2) Use of distinguishing flag. (i) VA distinguishing flags may be 
used only:
    (A) In the offices of the Secretary, Deputy Secretary, Assistant 
Secretaries, Deputy Assistant Secretaries and heads of field locations 
designated below:
    (1) Regional Offices.
    (2) Medical Centers and Outpatient Clinics.
    (3) Domiciliaries.

[[Page 13]]

    (4) Marketing Centers and Supply Depots.
    (5) Data Processing Centers.
    (6) National Cemetery Offices.
    (7) Other locations as designated by the Deputy Assistant Secretary 
for Administration.
    (B) At official VA ceremonies.
    (C) In Department auditoriums, official presentation rooms, hearing 
rooms, lobbies, public document rooms, and in non-VA facilities in 
connection with events or displays sponsored by VA, and public 
appearances of VA officials.
    (D) On or in front of VA installation buildings.
    (E) Other such official VA purposes or purposes as will tend to 
advance the aims, purposes and mission of the Department of Veterans 
Affairs as determined by the Deputy Assistant Secretary for 
Administration.
    (f) Unauthorized uses of the seal and flag. (1) The official seal, 
replicas, reproductions, embossed seals, and the distinguished flag 
shall not be used, except as authorized by the Secretary or Deputy 
Secretary, in connection with:
    (i) Contractor-operated facilities.
    (ii) Souvenir or novelty items.
    (iii) Toys or commercial gifts or premiums.
    (iv) Letterhead design, except on official Departmental stationery.
    (v) Matchbook covers, calendars and similar items.
    (vi) Civilian clothing or equipment.
    (vii) Any article which may disparage the seal or flag or reflect 
unfavorably upon VA.
    (viii) Any manner which implies Departmental endorsement of 
commercial products or services, or of the commercial user's policies or 
activities.
    (2) Penalties for unauthorized use. Any person who uses the 
distinguishing flag, or the official seal, replicas, reproductions or 
embossed seals in a manner inconsistent with this section shall be 
subject to the penalty provisions of 18 U.S.C. 506, 701, or 1017, 
providing penalties for their wrongful use, as applicable.

(Authority: 38 U.S.C. 302, 38 U.S.C. 501)

[55 FR 49518, Nov. 29, 1990]

               The United States Flag for Burial Purposes



Sec.  1.10  Eligibility for and disposition of the United States flag
for burial purposes.

    (a) Eligibility for burial flags--(1) Persons eligible. (i) A 
veteran of any war, of Mexican border service, or of service after 
January 31, 1955, discharged or released from active duty under 
conditions other than dishonorable. (For the purpose of this section, 
the term Mexican border service means active military, naval, or air 
service during the period beginning on January 1, 1911, and ending on 
April 5, 1917, in Mexico, on the borders thereof, or in the waters 
adjacent thereto.)
    (ii) A peacetime veteran discharged or released, before June 27, 
1950, from the active military, naval, or air service, under conditions 
other than dishonorable, after serving at least one enlistment, or for a 
disability incurred or aggravated in line of duty.
    (iii) Any person who has died while in military or naval service of 
the United States after May 27, 1941. This subdivision authorizes and 
requires the furnishing of a flag only where the military or naval 
service does not furnish a flag immediately. The only cases wherein a 
flag is not supplied immediately are those of persons whose remains are 
interred outside the continental limits of the United States, or whose 
remains are not recovered or are recovered and not identified.
    (iv) Any person who served in the organized military forces of the 
Commonwealth of the Philippines while such forces were in the service of 
the Armed Forces of the United States pursuant to the military order of 
the President of the United States, dated July 26, 1941, including among 
such military forces organized guerrilla forces under commanders 
appointed, designated, or subsequently recognized by the Commander in 
Chief, Southwest Pacific Area, or other competent authority in the Army 
of the United States, and who dies after separation from such service 
under conditions other than dishonorable, on or after April 25, 1951.


(Authority: 38 U.S.C. 107(a))


[[Page 14]]


    (v) Any deceased member or former member of the Selected Reserve (as 
described in section 10143 of title 10) who is not otherwise eligible 
for a flag under this section or section 1482(a) of title 10 and who:
    (A) Completed at least one enlistment as a member of the Selected 
Reserve or, in the case of an officer, completed the period of initial 
obligated service as a member of the Selected Reserve;
    (B) Was discharged before completion of the person's initial 
enlistment as a member of the Selected Reserve or, in the case of an 
officer, period of initial obligated service as a member of the Selected 
Reserve, for a disability incurred or aggravated in the line of duty; or
    (C) Died while a member of the Selected Reserve.


(Authority: 38 U.S.C. 2301(f)(1))

    (b) Disposition of burial flags. (1) When a flag is actually used to 
drape the casket of a deceased veteran, it must be delivered to the next 
of kin following interment. Where the flag is not claimed by the next of 
kin it may be given upon request to a close friend or associate of the 
deceased veteran. Such action will constitute final and conclusive 
determination of rights under this section. (38 U.S.C. 2301)
    (2) The phrase next of kin for the purpose of disposing of the flag 
used for burial purposes is defined as follows, with preference to 
entitlement in the order listed:
    (i) Widow or widower.
    (ii) Children, according to age (minor child may be issued a flag on 
application signed by guardian).
    (iii) Parents, including adoptive, stepparents, and foster parents.
    (iv) Brothers or sisters, including brothers or sisters of the 
halfblood.
    (v) Uncles or aunts.
    (vi) Nephews or nieces.
    (vii) Others--cousins, grandparents, etc. (but not in-laws).
    (3) The phrase close friend or associate for the purpose of 
disposing of the burial flag means any person who because of his or her 
relationship with the deceased veteran arranged for the burial or 
assisted in the burial arrangements. In the absence of a person falling 
in either of these categories, any person who establishes by evidence 
that he or she was a close friend or associate of the veteran may be 
furnished the burial flag. Where more than one request for the burial 
flag is received and each is accompanied by satisfactory evidence of 
relationship or association, the head of the field facility having 
jurisdiction of the burial flag quota will determine which applicant is 
the one most equitably entitled to the burial flag.

(Authority: 72 Stat. 1114, 1169, as amended; 38 U.S.C. 501, 2301)

[13 FR 6999, Nov. 27, 1948, as amended at 20 FR 8350, Nov. 8, 1955; 24 
FR 10106, Dec. 15, 1959; 31 FR 4959, Mar. 26, 1966; 42 FR 27245, May 27, 
1977; 66 FR 27598, May 18, 2001]

     Quarters for Department of Veterans Affairs Employees Overseas



Sec.  1.11  Quarters for Department of Veterans Affairs employees in 
Government-owned or -rented buildings overseas.

    Pursuant to the provisions of 5 U.S.C. 5912, a U.S. citizen employee 
of the Department of Veterans Affairs permanently stationed in a foreign 
country may be furnished, without cost to him or her, living quarters, 
including heat, fuel, and light, in a Government-owned or -rented 
building. When in the interest of the service and when administratively 
feasible, an agreement may be entered into by the Under Secretary for 
Benefits or designee with another Federal agency, which is authorized to 
furnish quarters, to provide such quarters for Department of Veterans 
Affairs employees under the provisions of 31 U.S.C. 686. Quarters 
provided will be in lieu of any living quarters allowance to which the 
employee may otherwise be entitled.

(Authority: 72 Stat. 1114; 38 U.S.C. 501)

[33 FR 362, Jan. 10, 1968]

[[Page 15]]

                           Program Evaluation



Sec.  1.15  Standards for program evaluation.

    (a) The Department of Veterans Affairs will evaluate all programs 
authorized under title 38 U.S.C. These evaluations will be conducted so 
as to determine each program's effectiveness in achieving its stated 
goals and in achieving such goals in relation to their cost. In 
addition, these evaluations will determine each program's impact on 
related programs and its structure and mechanism for delivery of 
services. All programs will be evaluated on a continuing basis and all 
evaluations will be conducted by Department of Veterans Affairs staff 
assigned to an organizational entity other than those responsible for 
program administration. These evaluations will be conducted with 
sufficient frequency to allow for an assessment of the continued 
effectiveness of the programs.
    (b) The program evaluation will be designed to determine if the 
existing program supports the intent of the law. A program evaluation 
must identify goals and objectives that support this intent, contain a 
method to measure fulfillment of the objectives, ascertain the degree to 
which goals and objectives are met, and report the findings and 
conclusions to Congress, as well as make them available to the public.
    (c) The goals must be clear, specific, and measurable. To be clear 
they must be readily understood, free from doubt or confusion, and 
specific goals must be explicitly set forth. They must be measurable by 
objective means. These means can include use of existing record systems, 
observations, and information from other sources.
    (d) All program evaluations require a detailed evaluation plan. The 
evaluation plan must clearly state the objectives of the program 
evaluation, the methodology to be used, resources to be committed, and a 
timetable of major phases.
    (e) Each program evaluation must be objective. It must report the 
accomplishments as well as the shortcomings of the program in an 
unbiased way. The program evaluation must have findings that give 
decision-makers information which is of a level of detail and importance 
to enable decisions to be made affecting either direction or operation. 
The information in the program evaluation must be timely, and must 
contain information of sufficient currency that decisions based on the 
data in the evaluation can be made with a high degree of confidence in 
the data.
    (f) Each program evaluation requires a systematic research design to 
collect the data necessary to measure the objectives. This research 
design should conform to the following:
    (1) Rationale. The research design for each evaluation should 
contain a specific rationale and should be structured to determine 
possible cause and effect relationships.
    (2) Relevancy. It must deal with issues currently existing within 
the program, within the Department, and within the environment in which 
the program operates.
    (3) Validity. The degree of statistical validity should be assessed 
within the research design. Alternatives include an assessment of cost 
of data collection vs. results necessary to support decisions.
    (4) Reliability. Use of the same research design by others should 
yield the same findings.
    (g) The final program evaluation report will be reviewed for 
comments and concurrence by relevant organizations within the Department 
of Veterans Affairs, but in no case should this review unreasonably 
delay the results of the evaluation. Where disagreement exists, the 
dissenting organization's position should be summarized for a decision 
by the Secretary.
    (h) The final program evaluation report will be forwarded, with 
approved recommendations, to the concerned organization. An action plan 
to accomplish the approved recommendations will be forwarded for 
evaluation by the evaluating entity.
    (i) Program evaluation results should be integrated to the maximum 
extent possible into Department of Veterans Affairs plans and budget 
submissions to ensure continuity with other Department of Veterans 
Affairs management processes.

(Authority: 38 U.S.C. 527)

[47 FR 53735, Nov. 29, 1982, as amended at 54 FR 34980, Aug. 23, 1989]

[[Page 16]]



Sec.  1.17  Evaluation of studies relating to health effects of radiation
exposure.

    (a) From time to time, the Secretary shall publish evaluations of 
scientific or medical studies relating to the adverse health effects of 
exposure to ionizing radiation in the ``Notices'' section of the Federal 
Register.
    (b) Factors to be considered in evaluating scientific studies 
include:
    (1) Whether the study's findings are statistically significant and 
replicable.
    (2) Whether the study and its findings have withstood peer review.
    (3) Whether the study methodology has been sufficiently described to 
permit replication of the study.
    (4) Whether the study's findings are applicable to the veteran 
population of interest.
    (5) The views of the appropriate panel of the Scientific Council of 
the Veterans' Advisory Committee on Environmental Hazards.
    (c) When the Secretary determines, based on the evaluation of 
scientific or medical studies and after receiving the advice of the 
Veterans' Advisory Committee on Environmental Hazards and applying the 
reasonable doubt doctrine as set forth in paragraph (d)(1) of this 
section, that a significant statistical association exists between any 
disease and exposure to ionizing radiation, Sec.  3.311 of this chapter 
shall be amended to provide guidelines for the establishment of service 
connection.
    (d)(1) For purposes of paragraph (c) of this section a significant 
statistical association shall be deemed to exist when the relative 
weights of valid positive and negative studies permit the conclusion 
that it is at least as likely as not that the purported relationship 
between exposure to ionizing radiation and a specific adverse health 
effect exists.
    (2) For purposes of this paragraph a valid study is one which:
    (i) Has adequately described the study design and methods of data 
collection, verification and analysis;
    (ii) Is reasonably free of biases, such as selection, observation 
and participation biases; however, if biases exist, the investigator has 
acknowledged them and so stated the study's conclusions that the biases 
do not intrude upon those conclusions; and
    (iii) Has satisfactorily accounted for known confounding factors.
    (3) For purposes of this paragraph a valid positive study is one 
which satisfies the criteria in paragraph (d)(2) of this section and 
whose findings are statistically significant at a probability level of 
.05 or less with proper accounting for multiple comparisons and subgroup 
analyses.
    (4) For purposes of this paragraph a valid negative study is one 
which satisfies the criteria in paragraph (d)(2) of this section and has 
sufficient statistical power to detect an association between exposure 
to ionizing radiation and a specific adverse health effect if such an 
association were to exist.
    (e) For purposes of assessing the relative weights of valid positive 
and negative studies, other studies affecting epidemiological 
assessments including case series, correlational studies and studies 
with insufficient statistical power as well as key mechanistic and 
animal studies which are found to have particular relevance to an effect 
on human organ systems may also be considered.
    (f) Notwithstanding the provisions of paragraph (d) of this section, 
a significant statistical association may be deemed to exist between 
exposure to ionizing radiation and a specific disease if, in the 
Secretary's judgment, scientific and medical evidence on the whole 
supports such a decision.

(Authority: 38 U.S.C. 501; Pub. L. 98-542, as amended by Pub. L. 102-4)

[54 FR 40391, Oct. 2, 1989; 54 FR 46187, Nov. 1, 1989; 75 FR 17859, Apr. 
8, 2010]



Sec.  1.18  Guidelines for establishing presumptions of service connection
for former prisoners of war.

    (a) Purpose. The Secretary of Veterans Affairs will establish 
presumptions of service connection for former prisoners of war when 
necessary to prevent denials of benefits in significant numbers of 
meritorious claims.
    (b) Standard. The Secretary may establish a presumption of service 
connection for a disease when the Secretary finds that there is at least 
limited/suggestive evidence that an increased risk of such disease is 
associated with service involving detention or internment as a prisoner 
of war and

[[Page 17]]

an association between such detention or internment and the disease is 
biologically plausible.
    (1) Definition. The phrase ``limited/suggestive evidence'' refers to 
evidence of a sound scientific or medical nature that is reasonably 
suggestive of an association between prisoner-of-war experience and the 
disease, even though the evidence may be limited because matters such as 
chance, bias, and confounding could not be ruled out with confidence or 
because the relatively small size of the affected population restricts 
the data available for study.
    (2) Examples. ``Limited/suggestive evidence'' may be found where one 
high-quality study detects a statistically significant association 
between the prisoner-of-war experience and disease, even though other 
studies may be inconclusive. It also may be satisfied where several 
smaller studies detect an association that is consistent in magnitude 
and direction. These examples are not exhaustive.
    (c) Duration of detention or internment. In establishing a 
presumption of service connection under paragraph (b) of this section, 
the Secretary may, based on sound scientific or medical evidence, 
specify a minimum duration of detention or internment necessary for 
application of the presumption.
    (d) Association. The requirement in paragraph (b) of this section 
that an increased risk of disease be ``associated'' with prisoner-of-war 
service may be satisfied by evidence that demonstrates either a 
statistical association or a causal association.
    (e) Evidence. In making determinations under paragraph (b) of this 
section, the Secretary will consider, to the extent feasible:
    (1) Evidence regarding the increased incidence of disease in former 
prisoners of war;
    (2) Evidence regarding the health effects of circumstances or 
hardships similar to those experienced by prisoners of war (such as 
malnutrition, torture, physical abuse, or psychological stress);
    (3) Evidence regarding the duration of exposure to circumstances or 
hardships experienced by prisoners of war that is associated with 
particular health effects; and
    (4) Any other sound scientific or medical evidence the Secretary 
considers relevant.
    (f) Evaluation of studies. In evaluating any study for the purposes 
of this section, the Secretary will consider:
    (1) The degree to which the study's findings are statistically 
significant;
    (2) The degree to which any conclusions drawn from the study data 
have withstood peer review;
    (3) Whether the methodology used to obtain the data can be 
replicated;
    (4) The degree to which the data may be affected by chance, bias, or 
confounding factors; and
    (5) The degree to which the data may be relevant to the experience 
of prisoners of war in view of similarities or differences in the 
circumstances of the study population.
    (g) Contracts for Scientific Review and Analysis. To assist in 
making determinations under this section, the Secretary may contract 
with an appropriate expert body to review and summarize the scientific 
evidence, and assess the strength thereof, concerning the association 
between detention or internment as a prisoner of war and the occurrence 
of any disease, or for any other purpose relevant to the Secretary's 
determinations.

(Authority: 38 U.S.C. 501(a), 1110)

[69 FR 60089, Oct. 7, 2004]

         Referrals of Information Regarding Criminal Violations



Sec.  1.200  Purpose.

    This subpart establishes a duty upon and sets forth the mechanism 
for VA employees to report information about actual or possible criminal 
violations to appropriate law enforcement entities.

(Authority: 5 U.S.C. App. 3, 38 U.S.C. 902)

[68 FR 17550, Apr. 10, 2003]



Sec.  1.201  Employee's duty to report.

    All VA employees with knowledge or information about actual or 
possible violations of criminal law related to VA programs, operations, 
facilities, contracts, or information technology systems shall 
immediately report such knowledge or information to their supervisor, 
any management official, or

[[Page 18]]

directly to the Office of Inspector General.

(Authority: 5 U.S.C. App. 3, 38 U.S.C. 902)

[68 FR 17550, Apr. 10, 2003]



Sec.  1.203  Information to be reported to VA Police.

    Information about actual or possible violations of criminal laws 
related to VA programs, operations, facilities, or involving VA 
employees, where the violation of criminal law occurs on VA premises, 
will be reported by VA management officials to the VA police component 
with responsibility for the VA station or facility in question. If there 
is no VA police component with jurisdiction over the offense, the 
information will be reported to Federal, state or local law enforcement 
officials, as appropriate.

(Authority: 38 U.S.C. 902)

[68 FR 17550, Apr. 10, 2003]



Sec.  1.204  Information to be reported to the Office of Inspector General.

    Criminal matters involving felonies will also be immediately 
referred to the Office of Inspector General, Office of Investigations. 
VA management officials with information about possible criminal matters 
involving felonies will ensure and be responsible for prompt referrals 
to the OIG. Examples of felonies include but are not limited to, theft 
of Government property over $1000, false claims, false statements, drug 
offenses, crimes involving information technology systems and serious 
crimes against the person, i.e., homicides, armed robbery, rape, 
aggravated assault and serious physical abuse of a VA patient.

(Authority: 5 U.S.C. App. 3)

[68 FR 17550, Apr. 10, 2003]



Sec.  1.205  Notification to the Attorney General or United States 
Attorney's Office.

    VA police and/or the OIG, whichever has primary responsibility 
within VA for investigation of the offense in question, will be 
responsible for notifying the appropriate United States Attorney's 
Office, pursuant to 28 U.S.C. 535.

(Authority: 5 U.S.C. App. 3, 38 U.S.C. 902)

[68 FR 17550, Apr. 10, 2003]

     Security and Law Enforcement at Department of Veterans Affairs 
                               Facilities



Sec.  1.218  Security and law enforcement at VA facilities.

    (a) Authority and rules of conduct. Pursuant to 38 U.S.C. 901, the 
following rules and regulations apply at all property under the charge 
and control of VA (and not under the charge and control of the General 
Services Administration) and to all persons entering in or on such 
property. The head of the facility is charged with the responsibility 
for the enforcement of these rules and regulations and shall cause these 
rules and regulations to be posted in a conspicuous place on the 
property.
    (1) Closing property to public. The head of the facility, or 
designee, shall establish visiting hours for the convenience of the 
public and shall establish specific hours for the transaction of 
business with the public. The property shall be closed to the public 
during other than the hours so established. In emergency situations, the 
property shall be closed to the public when reasonably necessary to 
ensure the orderly conduct of Government business. The decision to close 
a property during an emergency shall be made by the head of the facility 
or designee. The head of the facility or designee shall have authority 
to designate areas within a facility as closed to the public.
    (2) Recording presence. Admission to property during periods when 
such property is closed to the public will be limited to persons 
authorized by the head of the facility or designee. Such persons may be 
required to sign a register and/or display identification documents when 
requested to do so by VA police, or other authorized individual. No 
person, without authorization, shall enter upon or remain on such 
property while the property is closed. Failure to leave such premises by 
unauthorized persons shall constitute an offense under this paragraph.

[[Page 19]]

    (3) Preservation of property. The improper disposal of rubbish on 
property; the spitting on the property; the creation of any hazard on 
property to persons or things; the throwing of articles of any kind from 
a building; the climbing upon the roof or any part of the building, 
without permission; or the willful destruction, damage, or removal of 
Government property or any part thereof, without authorization, is 
prohibited. The destruction, mutilation, defacement, injury, or removal 
of any monument, gravestone, or other structure within the limits of any 
national cemetery is prohibited.
    (4) Conformity with signs and emergency conditions. The head of the 
facility, or designee, shall have authority to post signs of a 
prohibitory and directory nature. Persons, in and on property, shall 
comply with such signs of a prohibitory or directory nature, and during 
emergencies, with the direction of police authorities and other 
authorized officials. Tampering with, destruction, marring, or removal 
of such posted signs is prohibited.
    (5) Disturbances. Conduct on property which creates loud or unusual 
noise; which unreasonably obstructs the usual use of entrances, foyers, 
lobbies, corridors, offices, elevators, stairways, or parking lots; 
which otherwise impedes or disrupts the performance of official duties 
by Government employees; which prevents one from obtaining medical or 
other services provided on the property in a timely manner; or the use 
of loud, abusive, or otherwise improper language; or unwarranted 
loitering, sleeping, or assembly is prohibited. In addition to measures 
designed to secure voluntary terminations of violations of this 
paragraph the head of the facility or designee may cause the issuance of 
orders for persons who are creating a disturbance to depart the 
property. Failure to leave the premises when so ordered constitutes a 
further disturbance within the meaning of this rule, and the offender is 
subject to arrest and removal from the premises.
    (6) Gambling. Participating in games for money or for tangible or 
intangible things, or the operating of gambling devices, the conduct of 
a lottery or pool, or the selling or purchasing of numbers tickets, in 
or on property is prohibited.
    (7) Alcoholic beverages and narcotics. Operating a motor vehicle on 
property by a person under the influence of alcoholic beverages, 
narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines 
is prohibited. Entering property under the influence of any narcotic 
drug, hallucinogen, marijuana, barbiturate, amphetamine, or alcoholic 
beverage (unless prescribed by a physician) is prohibited. The use on 
property of any narcotic drug, hallucinogen, marijuana, barbiturate, or 
amphetamine (unless prescribed by a physician) is prohibited. The 
introduction or possession of alcoholic beverages or any narcotic drug, 
hallucinogen, marijuana, barbiturate, and amphetamine on property is 
prohibited, except for liquor or drugs prescribed for use by medical 
authority for medical purposes. Provided such possession is consistent 
with the laws of the State in which the facility is located, liquor may 
be used and maintained in quarters assigned to employees as their normal 
abode, and away from the abode with the written consent of the head of 
the facility which specifies a special occasion for use and limits the 
area and period for the authorized use.
    (8) Soliciting, vending, and debt collection. Soliciting alms and 
contributions, commercial soliciting and vending of all kinds, 
displaying or distributing commercial advertising, or collecting private 
debts in or on property is prohibited. This rule does not apply to (i) 
national or local drives for funds for welfare, health, or other 
purposes as authorized under Executive Order 12353, Charitable Fund 
Raising (March 23, 1982), as amended by Executive Order 12404 (February 
10, 1983), and regulations issued by the Office of Personnel Management 
implementing these Executive Orders; (ii) concessions or personal 
notices posted by employees on authorized bulletin boards; and (iii) 
solicitation of labor organization membership or dues under 5 U.S.C. 
chapter 71.
    (9) Distribution of handbills. The distributing of materials such as 
pamphlets, handbills, and/or flyers, and the

[[Page 20]]

displaying of placards or posting of materials on bulletin boards or 
elsewhere on property is prohibited, except as authorized by the head of 
the facility or designee or when such distributions or displays are 
conducted as part of authorized Government activities.
    (10) Photographs for news, advertising, or commercial purposes. 
Photographs for advertising or commercial purposes may be taken only 
with the written consent of the head of the facility or designee. 
Photographs for news purposes may be taken at entrances, lobbies, 
foyers, or in other places designated by the head of the facility or 
designee.
    (11) Animals. (i) Service animals, as defined in paragraph 
(a)(11)(viii) of this section, are permitted on VA property when those 
animals accompany individuals with disabilities and are trained for that 
purpose. A service animal shall be under the control of the person with 
the disability or an alternate handler at all times while on VA 
property. A service animal shall have a harness, leash, or other tether, 
unless either the handler is unable because of a disability to use a 
harness, leash, or other tether, or the use of a harness, leash, or 
other tether would interfere with the service animal's safe, effective 
performance of work or tasks, in which case the service animal must be 
otherwise under the handler's control (e.g., voice control, signals, or 
other effective means). VA is not responsible for the care or 
supervision of a service animal. Service animal presence on VA property 
is subject to the same terms, conditions, and regulations as generally 
govern admission of the public to the property.
    (ii) A service animal will be denied access to VA property or 
removed from VA property if:
    (A) The animal is not under the control of the individual with a 
disability or an alternate handler;
    (B) The animal is not housebroken. The animal must be trained to 
eliminate its waste in an outdoor area; or
    (C) The animal otherwise poses a risk to the health or safety of 
people or other service animals. In determining whether an animal poses 
a risk to the health or safety of people or other service animals, VA 
will make an individualized assessment based on objective indications to 
ascertain the severity of the risk. Such indications include but are not 
limited to:
    (1) External signs of aggression from the service animal, such as 
growling, biting or snapping, baring its teeth, lunging; or
    (2) External signs of parasites on the service animal (e.g. fleas, 
ticks), or other external signs of disease or bad health (e.g. diarrhea 
or vomiting).
    (iii) Service animals will be restricted from accessing certain 
areas of VA property under the control of the Veterans Health 
Administration (VHA properties) to ensure patient care, patient safety, 
or infection control standards are not compromised. Such areas include 
but are not limited to:
    (A) Operating rooms and surgical suites;
    (B) Areas where invasive procedures are being performed;
    (C) Acute inpatient hospital settings when the presence of the 
service animal is not part of a documented treatment plan;
    (D) Decontamination, sterile processing, and sterile storage areas;
    (E) Food preparation areas (not to include public food service 
areas); and
    (F) Any areas where personal protective clothing must be worn or 
barrier protective measures must be taken to enter.
    (iv) Service animals will be restricted from accessing certain areas 
of VA property under the control of the National Cemetery Administration 
(NCA properties) to ensure that public safety, facilities and grounds 
care, and maintenance control are not compromised. Such areas include 
but are not limited to:
    (A) Open interment areas, except as approved to observe an 
individual interment or inurnment.
    (B) Construction or maintenance sites; and
    (C) Grounds keeping and storage facilities.
    (v) If a service animal is denied access to VA property or removed 
from VA property in accordance with (a)(11)(ii) of this section, or 
restricted from accessing certain VA property in accordance with 
paragraphs (a)(11)(iii) and (iv) of this section, then VA will

[[Page 21]]

give the individual with a disability the opportunity to obtain services 
without having the service animal on VA property.
    (vi) Unless paragraph (a)(11)(vii) of this section applies, an 
individual with a disability must not be required to provide 
documentation, such as proof that an animal has been certified, trained, 
or licensed as a service animal, to gain access to VA property 
accompanied by the service animal. However, an individual may be asked 
if the animal is required because of a disability, and what work or task 
the animal has been trained to perform.
    (vii) An individual with a disability, if such individual will be 
accompanied by the service animal while receiving treatment in a VHA 
residential program, must provide VA with documentation that confirms 
the service animal has had a current rabies vaccine as determined by 
state and local public health requirements, and current core canine 
vaccines as dictated by local veterinary practice standards (e.g. 
distemper, parvovirus, and adenovirus-2).
    (viii) A service animal means any dog that is individually trained 
to do work or perform tasks for the benefit of an individual with a 
disability, including a physical, sensory, psychiatric, intellectual, or 
other mental disability. Other species of animals, whether wild or 
domestic, trained or untrained, are not service animals for the purposes 
of this definition. The work or tasks performed by a service animal must 
be directly related to the individual's disability. The crime deterrent 
effects of an animal's presence and the provision of emotional support, 
well-being, comfort, or companionship do not constitute work or tasks 
for the purposes of this definition. Service dogs in training are not 
considered service animals. This definition applies regardless of 
whether VA is providing benefits to support a service dog under 38 CFR 
17.148.
    (ix) Generally, animals other than service animals (``non-service 
animals'') are not permitted to be present on VA property, and any 
individual with a non-service animal must remove it. However, a VA 
facility head or designee may permit certain non-service animals to be 
present on VA property for the following reasons:
    (A) Animals may be permitted to be present on VA property for law 
enforcement purposes;
    (B) Animals under the control of the VA Office of Research and 
Development may be permitted to be present on VA property;
    (C) Animal-assisted therapy (AAT) animals may be permitted to be 
present on VHA property when the presence of such animals would not 
compromise patient care, patient safety, or infection control standards. 
AAT is a goal-directed clinical intervention, as provided or facilitated 
by a VA therapist or VA clinician, that incorporates the use of an 
animal into the treatment regimen of a patient. Any AAT animal present 
on VHA property must facilitate achievement of patient-specific 
treatment goals, as documented in the patient's treatment plan. AAT 
animals must be up to date with all core vaccinations or immunizations, 
prophylactic parasite control medications, and regular health screenings 
as determined necessary by a licensed veterinarian consistent with local 
veterinary practice standards. Proof of compliance with these 
requirements must be documented and accessible in the area(s) where 
patients receive AAT.
    (D) Animal-assisted activity (AAA) animals may be permitted to be 
present on VHA property when the presence of such animals would not 
compromise patient care, patient safety, or infection control standards. 
AAA involves animals in activities to provide patients with casual 
opportunities for motivational, educational, recreational, and/or 
therapeutic benefits. AAA is not a goal-directed clinical intervention 
that must be provided or facilitated by a VA therapist or clinician, and 
therefore is not necessarily incorporated into the treatment regimen of 
a patient or documented in the patient's medical record as treatment. 
AAA animals must be up to date with all core vaccinations or 
immunizations, prophylactic parasite control medications, and regular 
health screenings as determined necessary by a licensed veterinarian 
consistent with local veterinary practice standards.

[[Page 22]]

Proof of compliance with these requirements must be documented and 
accessible in the area(s) where patients may participate in AAA.
    (E) Animals participating in a VA Community Living Center (CLC) 
residential animal program or a Mental Health Residential Rehabilitation 
Treatment Program (MHRRTP) may be permitted to be present on VHA 
property, when the presence of such animals would not compromise patient 
care, patient safety, or infection control standards. A residential 
animal program in a VA CLC or a MHRRTP is a program that uses the 
presence of animals to create a more homelike environment to foster 
comfort for veterans, while also stimulating a sense of purpose, 
familiarity, and belonging. Any VA CLC or MHRRTP residential animal 
present on VHA property must facilitate achievement of therapeutic 
outcomes (such as described above), as documented in patient treatment 
plans. Residential animals in a VA CLC or MHRRTP must be up to date with 
all core vaccinations and immunizations, prophylactic parasite control 
medications, and regular health screenings as determined necessary by a 
licensed veterinarian consistent with local veterinary practice 
standards. Proof of compliance with these requirements must be 
documented and accessible in the VA CLC or MHRRTP.
    (F) Animals may be present on NCA property for ceremonial purposes 
during committal services, interments, and other memorials, if the 
presence of such animals would not compromise public safety, facilities 
and grounds care, and maintenance control standards.
    (x) For purposes of this section, a disability means, with respect 
to an individual, a physical or mental impairment that substantially 
limits one or more major life activities of the individual; a record of 
such an impairment; or being regarded as having such an impairment.
    (12) Vehicular and pedestrian traffic. Drivers of all vehicles in or 
on property shall drive in a careful and safe manner at all times and 
shall comply with the signals and directions of police and all posted 
traffic signs. The blocking of entrances, driveways, walks, loading 
platforms, or fire hydrants in or on property is prohibited; parking in 
unauthorized locations or in locations reserved for other persons or 
contrary to the direction of posted signs is prohibited. Creating 
excessive noise on hospital or cemetery premises by muffler cut out, the 
excessive use of a horn, or other means is prohibited. Operation of a 
vehicle in a reckless or unsafe manner, drag racing, bumping, overriding 
curbs, or leaving the roadway is prohibited.
    (13) Weapons and explosives. No person while on property shall carry 
firearms, other dangerous or deadly weapons, or explosives, either 
openly or concealed, except for official purposes.
    (14) Demonstrations. (i) All visitors are expected to observe proper 
standards of decorum and decency while on VA property. Toward this end, 
any service, ceremony, or demonstration, except as authorized by the 
head of the facility or designee, is prohibited. Jogging, bicycling, 
sledding and other forms of physical recreation on cemetery grounds is 
prohibited.
    (ii) For the purpose of the prohibition expressed in this paragraph, 
unauthorized demonstrations or services shall be defined as, but not 
limited to, picketing, or similar conduct on VA property; any oration or 
similar conduct to assembled groups of people, unless the oration is 
part of an authorized service; the display of any placards, banners, or 
foreign flags on VA property unless approved by the head of the facility 
or designee; disorderly conduct such as fighting, threatening, violent, 
or tumultuous behavior, unreasonable noise or coarse utterance, gesture 
or display or the use of abusive language to any person present; and 
partisan activities, i.e., those involving commentary or actions in 
support of, or in opposition to, or attempting to influence, any current 
policy of the Government of the United States, or any private group, 
association, or enterprise.
    (15) Key security. The head of the facility of designee, will 
determine which employees, by virtue of their duties, shall have access 
to keys or barrier-card keys which operate locks to rooms or areas on 
the property. The unauthorized possession, manufacture, and/or use of 
such keys or barrier cards is

[[Page 23]]

prohibited. The surreptitious opening or attempted opening of locks or 
card-operated barrier mechanisms is prohibited.
    (16) Sexual misconduct. Any act of sexual gratification on VA 
property involving two or more persons, who do not reside in quarters on 
the property, is prohibited. Acts of prostitution or solicitation for 
acts of prostitution on VA property is prohibited. For the purposes of 
this paragraph, an act of prostitution is defined as the performance or 
the offer or agreement to perform any sexual act for money or payment.
    (b) Schedule of offenses and penalties. Conduct in violation of the 
rules and regulations set forth in paragraph (a) of this section 
subjects an offender to arrest and removal from the premises. Whomever 
shall be found guilty of violating these rules and regulations while on 
any property under the charge and control of VA is subject to a fine as 
stated in the schedule set forth herein or, if appropriate, the payment 
of fixed sum in lieu of appearance (forfeiture of collateral) as may be 
provided for in rules of the United States District Court. Violations 
included in the schedule of offenses and penalties may also subject an 
offender to a term of imprisonment of not more than six months, as may 
be determined appropriate by a magistrate or judge of the United States 
District Court:
    (1) Improper disposal of rubbish on property, $200.
    (2) Spitting on property, $25.
    (3) Throwing of articles from a building or the unauthorized 
climbing upon any part of a building, $50.
    (4) Willful destruction, damage, or removal of Government property 
without authorization, $500.
    (5) Defacement, destruction, mutilation or injury to, or removal, or 
disturbance of, gravemarker or headstone, $500.
    (6) Failure to comply with signs of a directive and restrictive 
nature posted for safety purposes, $50.
    (7) Tampering with, removal, marring, or destruction of posted 
signs, $150.
    (8) Entry into areas posted as closed to the public or others 
(trespass), $50.
    (9) Unauthorized demonstration or service in a national cemetery or 
on other VA property, $250.
    (10) Creating a disturbance during a burial ceremony, $250.
    (11) Disorderly conduct which creates loud, boisterous, and unusual 
noise, or which obstructs the normal use of entrances, exits, foyers, 
offices, corridors, elevators, and stairways or which tends to impede or 
prevent the normal operation of a service or operation of the facility, 
$250.
    (12) Failure to depart premises by unauthorized persons, $50.
    (13) Unauthorized loitering, sleeping or assembly on property, $50.
    (14) Gambling-participating in games of chance for monetary gain or 
personal property; the operation of gambling devices, a pool or lottery; 
or the taking or giving of bets, $200.
    (15) Operation of a vehicle under the influence of alcoholic 
beverages or nonprescribed narcotic drugs, hallucinogens, marijuana, 
barbiturates, or amphetamines, $500.
    (16) Entering premises under the influence of alcoholic beverages or 
narcotic drugs, hallucinogens, marijuana, barbiturates or amphetamines, 
$200.
    (17) Unauthorized use on property of alcoholic beverages or narcotic 
drugs, hallucinogens, marijuana, barbiturates, or amphetamines, $300.
    (18) Unauthorized introduction on VA controlled property of 
alcoholic beverages or narcotic drugs, hallucinogens, marijuana, 
barbiturates, or amphetamines or the unauthorized giving of same to a 
patient or beneficiary, $500.
    (19) Unauthorized solicitation of alms and contributions on 
premises, $50.
    (20) Commercial soliciting or vending, or the collection of private 
debts on property, $50.
    (21) Distribution of pamphlets, handbills, and flyers, $25.
    (22) Display of placards or posting of material on property, $25.
    (23) Unauthorized photography on premises, $50.
    (24) Failure to comply with traffic directions of VA police, $25.
    (25) Parking in spaces posted as reserved for physically disabled 
persons, $50.

[[Page 24]]

    (26) Parking in no-parking areas, lanes, or crosswalks so posted or 
marked by yellow borders or yellow stripes, $25.
    (27) Parking in emergency vehicle spaces, areas and lanes bordered 
in red or posted as EMERGENCY VEHICLES ONLY or FIRE LANE, or parking 
within 15 feet of a fire hydrant, $50.
    (28) Parking within an intersection or blocking a posted vehicle 
entrance or posted exit lane, $25.
    (29) Parking in spaces posted as reserved or in excess of a posted 
time limit, $15.
    (30) Failing to come to a complete stop at a STOP sign, $25.
    (31) Failing to yield to a pedestrian in a marked and posted 
crosswalk, $25.
    (32) Driving in the wrong direction on a posted one-way street, $25.
    (33) Operation of a vehicle in a reckless or unsafe manner, too fast 
for conditions, drag racing, overriding curbs, or leaving the roadway, 
$100.
    (34) Exceeding posted speed limits:
    (i) By up to 10 mph, $25.
    (ii) By up to 20 mph, $50.
    (iii) By over 20 mph, $100.
    (35) Creating excessive noise in a hospital or cemetery zone by 
muffler cut out, excessive use of a horn, or other means, $50.
    (36) Failure to yield right of way to other vehicles, $50.
    (37) Possession of firearms, carried either openly or concealed, 
whether loaded or unloaded (except by Federal or State law enforcement 
officers on official business, $500.
    (38) Introduction or possession of explosives, or explosive devices 
which fire a projectile, ammunition, or combustibles, $500.
    (39) Possession of knives which exceed a blade length of 3 inches; 
switchblade knives; any of the variety of hatchets, clubs and hand-held 
weapons; or brass knuckles, $300.
    (40) The unauthorized possession of any of the variety of 
incapacitating liquid or gas-emitting weapons, $200.
    (41) Unauthorized possession, manufacture, or use of keys or barrier 
card-type keys to rooms or areas on the property, $200.
    (42) The surreptitious opening, or attempted opening, of locks or 
card-operated barrier mechanisms on property, $500.
    (43) Soliciting for, or the act of, prostitution, $250.
    (44) Any unlawful sexual activity, $250.
    (45) Jogging, bicycling, sledding or any recreational physical 
activity conducted on cemetery grounds, $50.
    (c) Enforcement procedures. (1) VA administration directors will 
issue policies and operating procedures governing the proper exercise of 
arrest and other law enforcement actions, and limiting the carrying and 
use of weapons by VA police officers. VA police officers found qualified 
under respective VA administration directives and duly appointed heads 
of facilities for the purposes of 38 U.S.C. 902(b)(1), will enforce 
these rules and regulations and other Federal laws on VA property in 
accordance with the policies and operating procedures issued by 
respective VA administration directors and under the direction of the 
head of the facility.
    (2) VA administration directors will prescribe training for VA 
police officers of the scope and duration necessary to assure the proper 
exercise of the law enforcement and arrest authority vested in them and 
to assure their abilities in the safe handling of situations involving 
patients and the public in general. VA police officers will successfully 
complete prescribed training in law enforcement procedures and the safe 
handling of patients as a condition of their retention of statutory law 
enforcement and arrest authority.
    (3) Nothing contained in the rules and regulations set forth in 
paragraph (a) of this section shall be construed to abrogate any other 
Federal laws or regulations, including assimilated offenses under 18 
U.S.C. 13, or any State or local laws and regulations applicable to the 
area in which the property is situated.

[50 FR 29226, July 18, 1985, as amended at 80 FR 49162, Aug. 17, 2015]



Sec.  1.220  On-site activities by pharmaceutical company representatives
at VA medical facilities.

    (a) Scope. This rule governs on-site, in-person promotional 
activities, including educational activities, by pharmaceutical company 
representatives at

[[Page 25]]

VA medical facilities. It does not apply to the distribution of 
information and materials through other means.
    (b) Definitions. For the purposes of this section:
    Criteria-for-use means clinical criteria developed by the Department 
of Veterans Affairs (VA) at a National level that describe how certain 
drugs may be used. VA's criteria-for-use are available to the public at 
www.pbm.va.gov. Exceptions may be applied at the local level for 
operational reasons.
    Drug or drugs means:
    (1) Articles recognized in the official United States Pharmacopoeia, 
official Homeopathic Pharmacopoeia of the United States, official 
National Formulary, or any supplement to any of them;
    (2) Articles intended for use in the diagnosis, cure, mitigation, 
treatment, or prevention of disease in man or other animals;
    (3) Articles (other than food) intended to affect the structure or 
any function of the body of man or other animals; and
    (4) Articles intended for use as a component of any article 
specified in paragraphs (1), (2), or (3) of this definition.
    Drug-related supplies means supplies related to the use of a drug, 
such as test strips or testing devices, inhalers, spacers, insulin 
syringes, and tablet splitters.
    New molecular entity refers to a drug product containing an active 
ingredient that has never before received U.S. Food and Drug 
Administration approval.
    Non-promotable drugs are drugs designated by VA as non-promotable on 
http://www.pbm.va.gov. A list of the drugs or drug-related supplies 
classified by VA as non-promotable may be requested by contacting the VA 
medical facility's Chief of Pharmacy Services.
    Non-VANF drugs or drug-related supplies means drugs or drug-related 
supplies that do not appear on the VANF.
    Pharmaceutical company representative means any individual employed 
by or contracted to represent a pharmaceutical manufacturer or retailer.
    VA medical facility means any property under the charge and control 
of VA used to provide medical benefits, including Community-Based 
Outpatient Clinics and similar facilities.
    VA National Formulary (VANF) drugs and/or drug-related supplies 
means any drug or drug-related supply that appears on the VA National 
Formulary (VANF). The VANF is available at www.pbm.va.gov, or may be 
requested by contacting the VA medical facility's Chief of Pharmacy 
Services.
    Veterans Integrated Service Network (VISN) means one of the networks 
of VA medical facilities located in a particular region as designated by 
VA.
    (c) Promotion of drugs and drug-related supplies. Notwithstanding 
Sec.  1.218(a)(8), VA will allow promotion of VANF drugs and drug-
related supplies, and non-VANF drugs and drug-related supplies with 
criteria-for-use, on-site and in-person at VA medical facilities if all 
of the following are true:
    (1) Drugs or drug-related supplies are discussed, displayed and 
represented accurately;
    (2) The promotion has significant educational value and does not 
inappropriately divert VA staff from other activities that VA staff 
would otherwise perform during duty hours, including patient care and 
other educational activities; and
    (3) The drug or drug-related supply has not been classified by VA as 
non-promotable.
    (d) Promotion of non-VANF drugs and drug-related supplies without 
criteria-for-use. Non-VANF drugs and drug-related supplies without 
criteria-for-use may be promoted only if the requirements of paragraphs 
(c)(1) through (3) of this section are met and the promotion is 
specifically permitted by the VISN Pharmacist Executive, or Chief of 
Pharmacy Services, or designee.
    (e) Promotion of a new molecular entity. A new molecular entity may 
be promoted only if the requirements of paragraphs (c)(1) through (3) of 
this section are met and the promotion is specifically permitted by the 
VISN Pharmacist Executive, or Chief of Pharmacy Services, or designee. 
Such permission will be automatically revoked if the new molecular 
entity is subsequently designated non-promotable. Such permission must 
be reconsidered if the new molecular entity is denied VANF status.

[[Page 26]]

    (f) Educational programs and associated materials. For purposes of 
this section, an educational program is a pre-scheduled event or meeting 
during which a pharmaceutical company representative provides 
information about a drug or drug-related supply. All educational 
programs and associated materials must receive prior approval from the 
person at the VA medical facility to whom such approval authority has 
been delegated under local policy, usually the Chief of Pharmacy 
Services. All materials associated with a proposed educational program 
must be provided at least 60 days before the proposed date of the 
educational program or distribution of associated materials, unless VA 
agrees in an individual case to a different date, so that a 
determination of their suitability can be made. The approval authority 
will deem suitable any educational program and associated materials if 
it is part of a risk evaluation and mitigation strategy or other duty 
imposed by the Food and Drug Administration. Otherwise, educational 
programs and associated materials will be deemed suitable if the 
approval authority determines that they conform to the following 
requirements:
    (1) Industry sponsorship must be disclosed in the introductory 
remarks and in the announcement brochure. Sponsorship includes any 
contribution, whether in the form of staple goods, personnel, or 
financing, intended to support the educational program.
    (2) If industry-sponsored and non-sponsored sources of data or other 
analytical information exist for FDA-approved uses of a particular drug, 
a direct comparison between the two sources must be disclosed in the 
introductory remarks and in the announcement brochure.
    (3) The educational program does not solicit protected health 
information or patient participation in pharmaceutical company-sponsored 
programs, except as may be required by Federal laws and regulations such 
as an educational program that is part of a risk evaluation and 
mitigation strategy required by the Food and Drug Administration.
    (4) Patient educational materials must not contain the name or logo 
of the pharmaceutical manufacturer or be used for promotion of a 
specific medication, unless the VA Pharmacy Benefits Management Service 
determines that the logo or name is inconspicuous and legal requirements 
(e.g., trademark requirements) make their removal impractical. However, 
this requirement does not apply to labeling required by the Food and 
Drug Administration.
    (5) Educational programs and associated materials regarding a drug, 
drug-related supply, or a new therapeutic indication for a drug that is 
already on the VANF but has not yet been reviewed by VA, must be 
submitted by the pharmaceutical company or pharmaceutical company 
representative to the VA medical facility's Chief of Pharmacy Services 
or designee.
    (6) Educational programs and associated materials focusing primarily 
on non-VANF drugs or drug-related supplies without criteria-for-use are 
permitted only if those drugs or drug-related supplies may be promoted 
under paragraph (d) of this section.
    (g) Providing gifts, drugs or other promotional items to VA 
employees or facilities--(1) General. No pharmaceutical company 
representative may give, and no VA employee may receive, any item 
(including but not limited to promotional materials, continuing 
education materials, textbooks, entertainment, and gratuities) that 
exceeds the value permissible for acceptance under government ethical 
rules (5 CFR 2635.204(a)). However, such items may be donated to a 
medical center library or individual department for use by all 
employees, in accordance with medical center policy. Gifts in support of 
VA staff official travel may be accepted by the Department subject to 
advance legal review in accordance with 31 U.S.C. 1353, 41 CFR part 304, 
and VA policy regarding such gifts.
    (2) Samples of drugs and drug-related supplies. Pharmaceutical 
company representatives must submit samples of drugs and drug-related 
supplies for approval to the person at the medical facility to whom such 
responsibility is delegated under local policy, usually the Director. 
All usage information pertaining to these drugs or drug-related supplies 
must be forwarded to the

[[Page 27]]

VISN Pharmacist Executive or VISN Formulary Committee. All samples of 
drugs or drug-related supplies must be delivered to the Office of the 
Chief of Pharmacy Services for proper storage, documentation and 
dispensing. Drug or drug-related supply samples may not be provided to 
VA staff for their personal use.
    (3) Donations of food. Pharmaceutical company representatives may 
not provide food items of any type or any value to VA staff (including 
volunteers and without compensation employees) or bring food items into 
VA medical facilities for use by non-VA staff (e.g., employees of 
affiliates).
    (h) Conduct of pharmaceutical company representatives. In addition 
to the other provisions in this section, pharmaceutical company 
representatives must conform to the following:
    (1) Contacts must be by appointment only. In order to minimize the 
potential for disruption of patient care activities, a pharmaceutical 
company representative must schedule an appointment before each visit. 
Access to VA medical facilities by a pharmaceutical company 
representative without an appointment is not permitted under any 
circumstances. VA medical facilities may develop a list of individuals 
or departments that may not be called-on by pharmaceutical company 
representatives. A pharmaceutical company representative must not 
attempt to make appointments with, or leave any materials for, 
individuals or departments on the list. The list may be obtained at the 
VA medical facility office of the Chief of Pharmacy Services. A 
pharmaceutical company representative visiting a VA medical facility for 
a scheduled appointment may not leave promotional materials for, or 
initiate requests for meetings with, other VA staff; however, 
pharmaceutical company representatives may respond to requests initiated 
by VA staff during the visit.
    (2) Paging VA employees. A pharmaceutical company representative may 
not use the public address (paging) system to locate any VA employee. 
Contacts using the electronic paging system (beepers) are permissible 
only if specifically requested by the VA employee.
    (3) Marketing to students. Pharmaceutical company representatives 
are prohibited from marketing to medical, pharmacy, nursing and other 
health profession students, including residents. Exceptions may be 
permitted when approved by, and conducted in the presence of, the staff 
member providing clinical supervision.
    (4) Attendance at conferences. A pharmaceutical company 
representative may not attend a medical center conference where 
information regarding individual patients is discussed or presented.
    (5) Patient care areas. Pharmaceutical company representatives 
generally may not wait for scheduled appointments or make presentations 
in patient-care areas, but may briefly travel through them, when 
necessary, to meet in a staff member's office. Patient-care areas 
include, but are not limited to:
    (i) Patient rooms and ward areas where patients may be encountered;
    (ii) Clinic examination rooms;
    (iii) Nurses stations;
    (iv) Intensive care units;
    (v) Operating room suites;
    (vi) Urgent care centers;
    (vii) Emergency rooms (but not staff offices that may be located in 
them); or
    (viii) Ambulatory treatment centers.
    (6) Distribution of materials. Pharmaceutical company 
representatives may only distribute materials on-site at the time and 
location of a scheduled appointment or educational program. In no 
circumstances may materials be left in patient care areas.
    (i) Non-compliance. (1) General. The visiting privileges of a 
pharmaceutical company representative or multiple representatives may be 
limited, suspended, or revoked by the written order of the Director of 
the VA medical center of jurisdiction if the Director determines the 
pharmaceutical company representative(s) failed to comply with the 
requirements of this section.
    (2) Notice of interim action. The Director will notify the 
pharmaceutical company representative of the noncompliance and of the 
Director's interim action under paragraph (i)(4) of this section. The 
Director will also notify the supervisor of the pharmaceutical company 
representative(s) if there have been multiple instances of

[[Page 28]]

misconduct. The notice will offer 30 days to provide a response; 
however, the interim action will be enforced effective the date of the 
notice.
    (3) Final written order. At the end of the 30-day period for a 
response, or after the Director receives a timely response, the Director 
will issue to the pharmaceutical company representative and supervisor a 
final written order either confirming the action taken as indicated in 
the notice, or specifying another action to be taken under paragraph 
(i)(4) of this section. The written order may also state that the 
Director has determined that no further action is required. Any final 
written order issued by the Director shall include a summary of the 
circumstances of the violation, a listing of the specific provisions of 
this section that the pharmaceutical company representative(s) violated, 
and the bases for the Director's determination regarding the appropriate 
action. Notice concerning a final written order suspending or 
permanently revoking the visiting privileges of multiple pharmaceutical 
company representatives shall include specific notice concerning the 
right to review of the Director's order by the Under Secretary for 
Health.
    (4) Actions. Actions that may be imposed under this section include 
limitation, suspension, or permanent revocation of visiting privileges 
at one or more VA medical facilities. In determining the appropriate 
action, the Director shall consider the requirements of this section, 
the circumstances of the improper conduct, any prior acts of misconduct 
by the same pharmaceutical company representative, any response 
submitted by the pharmaceutical company representative or their 
supervisor under paragraph (i)(2) of this section, and any prior written 
orders issued or other actions taken with respect to similar acts of 
misconduct.
    (5) Review. The pharmaceutical company may request the Under 
Secretary's review within 30 days of the date of the Director's final 
written order by submitting a written request to the Director. The 
Director shall forward the initial notice, any response, the final 
written order, and the request for review to the Under Secretary for a 
final VA decision. VA will enforce the Director's final written order 
while it is under review by the Under Secretary. The Director will 
provide the individual who made the request written notice of the Under 
Secretary's decision.

(Authority: 38 U.S.C. 501)

[77 FR 13007, Mar. 5, 2012]

                  Parking Fees at VA Medical Facilities



Sec.  1.300  Purpose.

    Sections 1.300 through 1.303 prescribe policies and procedures for 
establishing parking fees for the use of Department of Veterans Affairs 
controlled parking spaces at VA medical facilities.

(Authority: 38 U.S.C. 501, 8109)

[53 FR 25490, July 7, 1988]



Sec.  1.301  Definitions.

    As used in Sec. Sec.  1.300 through 1.303 of this title:
    (a) Secretary means the Secretary of Veterans Affairs.
    (b) Eligible person means any individual to whom the Secretary is 
authorized to furnish medical examination or treatment.
    (c) Garage means a structure or part of a structure in which 
vehicles may be parked.
    (d) Medical facility means any facility or part thereof which is 
under the jurisdiction of the Secretary for the provision of health-care 
services, including any necessary buildings and structures, garage or 
parking facility.
    (e) Parking facilities includes all surface and garage parking 
spaces at a VA medical facility.
    (f) Volunteer worker means an individual who performs services, 
without compensation, under the auspices of VA Voluntary Service (VAVS) 
at a VA medical facility, for the benefit of veterans receiving care at 
that medical facility.

(Authority: 38 U.S.C. 8109)

[53 FR 25490, July 7, 1988]

[[Page 29]]



Sec.  1.302  Applicability and scope.

    (a) The provisions of Sec. Sec.  1.300 through 1.303 apply to VA 
medical facility parking facilities in the United States, its 
territories and possessions, and the Commonwealth of Puerto Rico, and to 
such parking facilities for the use of VA medical facilities jointly 
shared by VA and another Federal agency when the facility is operated by 
the VA. Sections 1.300 through 1.303 apply to all users of those parking 
facilities. Fees shall be assessed and collected at medical facilities 
where parking garages are constructed, acquired, or altered at a cost 
exceeding $500,000 (or, in the case of acquisition by lease, $100,000 
per year). The Secretary, in the exercise of official discretion, may 
also determine that parking fees shall be charged at any other VA 
medical facility.
    (b) All fees established shall be reasonable under the circumstances 
and shall cover all parking facilities used in connection with such VA 
medical facility.

(Authority: 38 U.S.C. 8109)

[53 FR 25490, July 7, 1988]



Sec.  1.303  Policy.

    (a) General. Parking spaces at VA medical facilities shall only be 
provided under the following conditions:
    (1) VA and its employees shall not be liable for any damages to 
vehicles (or their contents) parked in VA parking facilities, unless 
such damages are directly caused by such employees acting in the course 
of their VA employment.
    (2) Parking facilities at VA medical facilities shall only be made 
available at each medical facility for such periods and under such terms 
as prescribed by the facility director, consistent with Sec. Sec.  1.300 
through 1.303.
    (3) VA will limit parking facilities at VA medical facilities to the 
minimum necessary, and administer those parking facilities in full 
compliance with ridesharing regulations and Federal laws.
    (b) Fees. (1) As provided in Sec.  1.302, VA will assess VA 
employees, contractor employees, tenant employees, visitors, and other 
individuals having business at a VA medical facility where VA parking 
facilities are available, a parking fee for the use of that parking 
facility. All parking fees shall be set at a rate which shall be 
equivalent to one-half of the appropriate fair rental value (i.e., 
monthly, weekly, daily, hourly) for the use of equivalent commercial 
space in the vicinity of the medical facility, subject to the terms and 
conditions stated in paragraph (a) of this section. Fair rental value 
shall include an allowance for the costs of management of the parking 
facilities. The Secretary will determine the fair market rental value 
through use of generally accepted appraisal techniques. If the appraisal 
establishes that there is no comparable commercial rate because of the 
absence of commercial parking facilities within a two-mile radius of the 
medical facility, then the rate established shall be not less than the 
lowest rate charged for parking at the VA medical facility with the 
lowest established parking fees. Rates established shall be reviewed 
biannually by the Secretary to reflect any increase or decrease in value 
as determined by appraisal updating.
    (2) No parking fees shall be established or collected for parking 
facilities used by or for vehicles of the following:
    (i) Volunteer workers in connection with such workers performing 
services for the benefit of veterans receiving care at the medical 
facility;
    (ii) A veteran or an eligible person in connection with such veteran 
or eligible person receiving examination or treatment;
    (iii) An individual transporting a veteran or eligible person 
seeking examination or treatment; and
    (iv) Federal Government employees using Government owned or leased 
or private vehicles for official business.

(Authority: 38 U.S.C. 8109)

[53 FR 25490, July 7, 1988]

[[Page 30]]

Release of Information From Department of Veterans Affairs (VA) Records 
Relating to Drug Abuse, Alcoholism or Alcohol Abuse, Infection With the 
        Human Immunodeficiency Virus (HIV), or Sickle Cell Anemia

    Note: Sections 1.460 through 1.499 of this part concern the 
confidentiality of information relating to drug abuse, alcoholism or 
alcohol abuse, infection with the human immunodeficiency virus, or 
sickle cell anemia in VA records and are applicable in combination with 
other regulations pertaining to the release of information from VA 
records. Sections 1.500 through 1.527, Title 38, Code of Federal 
Regulations, implement the provisions of 38 U.S.C. Sec. Sec.  5701 and 
5702. Sections 1.550 through 1.559 implement the provisions of 5 U.S.C. 
Sec.  552 (The Freedom of Information Act). Sections 1.575 through 1.584 
implement the provisions of 5 U.S.C. Sec.  552a (The Privacy Act of 
1974).
    The provisions of Sec. Sec.  1.460 through 1.499 of this part 
pertain to any program or activity, including education, treatment, 
rehabilitation or research, which relates to drug abuse, alcoholism or 
alcohol abuse, infection with the human immunodeficiency virus, or 
sickle cell anemia. The statutory authority for the drug abuse 
provisions and alcoholism or alcohol abuse provisions of Sec. Sec.  
1.460 through 1.499 is Sec. 111 of Pub. L. 94-581, the Veterans Omnibus 
Health Care Act of 1976 (38 U.S.C. Sec. Sec.  7331 through 7334), the 
authority for the human immunodeficiency virus provisions is Sec. 121 of 
Pub. L. 100-322, the Veterans' Benefits and Services Act of 1988 (38 
U.S.C. Sec.  7332); the authority for the sickle cell anemia provisions 
is Sec. 109 of Pub. L. 93-82, the Veterans Health Care Expansion Act of 
1973 (38 U.S.C. Sec. Sec.  1751-1754).

    Authority: 38 U.S.C. 1751-1754 and 7331-7334.

    Source: 60 FR 63929, Dec. 13, 1995, unless otherwise noted.



Sec.  1.460  Definitions.

    For purposes of Sec. Sec.  1.460 through 1.499 of this part, the 
following definitions apply:
    Agreement. The term ``agreement'' means a document that a VA health 
care facility develops in collaboration with an Organ Procurement 
Organization, eye bank or tissue bank with written, detailed 
responsibilities and obligations of the parties with regard to 
identifying potential donors and facilitating the donation process.
    Alcohol abuse. The term ``alcohol abuse'' means the use of an 
alcoholic beverage which impairs the physical, mental, emotional, or 
social well-being of the user.
    Contractor. The term ``contractor'' means a person who provides 
services to VA such as data processing, dosage preparation, laboratory 
analyses or medical or other professional services. Each contractor 
shall be required to enter into a written agreement subjecting such 
contractor to the provisions of Sec. Sec.  1.460 through 1.499 of this 
part; 38 U.S.C. 5701 and 7332; and 5 U.S.C. 552a and 38 CFR 1.576(g).
    Deceased. The term ``deceased'' means death established by either 
neurological criteria (brain death) or cardiopulmonary criteria (cardiac 
death). Brain death is the irreversible cessation of all brain function. 
Cardiac death is the irreversible cessation of circulatory and 
respiratory function. In both cases, ``irreversible'' means that 
function will not resume spontaneously and will not be restarted 
artificially.
    Decision-making capacity. The term ``decision-making capacity'' has 
the same meaning set forth in 38 CFR 17.32(a).
    Diagnosis. The term ``diagnosis'' means any reference to an 
individual's alcohol or drug abuse or to a condition which is identified 
as having been caused by that abuse or any reference to sickle cell 
anemia or infection with the human immunodeficiency virus which is made 
for the purpose of treatment or referral for treatment. A diagnosis 
prepared for the purpose of treatment or referral for treatment but 
which is not so used is covered by Sec. Sec.  1.460 through 1.499 of 
this part. These regulations do not apply to a diagnosis of drug 
overdose or alcohol intoxication which clearly shows that the individual 
involved is not an alcohol or drug abuser (e.g., involuntary ingestion 
of alcohol or drugs or reaction to a prescribed dosage of one or more 
drugs).
    Disclose or disclosure. The term ``disclose'' or ``disclosure'' 
means a communication of patient identifying information, the 
affirmative verification of another person's communication of patient 
identifying information, or the communication of any information from 
the record of a patient who has been identified.

[[Page 31]]

    Drug abuse. The term ``drug abuse'' means the use of a psychoactive 
substance for other than medicinal purposes which impairs the physical, 
mental, emotional, or social well-being of the user.
    Eye bank and tissue bank. The term ``eye bank and tissue bank'' 
means an ``establishment'' as defined in 21 CFR 1271.3, pursuant to 
section 361 of the Public Health Service Act (42 U.S.C. 264) that has a 
valid, current registration with the Federal Food and Drug 
Administration (FDA) as required under 21 CFR part 1271.
    Health care. The term ``health care'' has the same meaning as 
provided in 45 CFR 160.103.
    Health care-related activities or functions. The term ``health care-
related activities or functions'' means the actions required for the 
delivery of health care, including hospital care, medical services, and 
extended care services. Health care-related activities or functions 
includes: Treatment as defined by 45 CFR 164.501; activities related to 
reimbursement for care and treatment by a health care provider; 
activities related to participation in health information exchanges for 
the delivery of health care; health care operations as defined by 45 CFR 
164.501; and activities related to a patient's exercise of privacy 
rights regarding health information.
    Individual. The term ``individual'' means a veteran, as defined in 
38 U.S.C. 101(2), or a dependent of a veteran, as defined in 38 U.S.C. 
101(3) and (4)(A).
    Infection with the human immunodeficiency virus (HIV). The term 
``infection with the human immunodeficiency virus (HIV)'' means the 
presence of laboratory evidence for human immunodeficiency virus 
infection. The term does not include negative results from the testing 
of an individual for the presence of the virus or antibodies to the 
virus, or such testing of an individual where the results are negative.
    Informant. The term ``informant'' means an individual who is a 
patient or employee or who becomes a patient or employee at the request 
of a law enforcement agency or official and who at the request of a law 
enforcement agency or official observes one or more patients or 
employees for the purpose of reporting the information obtained to the 
law enforcement agency or official.
    Near death. The term ``near death'' means that in the clinical 
judgment of the patient's health care provider based on defined clinical 
triggers, the patient's death is imminent.
    Organ Procurement Organization. The term ``Organ Procurement 
Organization'' (OPO) means an organization that performs or coordinates 
the procurement, preservation, and transportation of organs and 
maintains a system of locating prospective recipients for available 
organs.
    Patient. The term ``patient'' means any individual or subject who 
has been given a diagnosis or treatment for drug abuse, alcoholism or 
alcohol abuse, infection with the human immunodeficiency virus, or 
sickle cell anemia and includes any individual who, after arrest on a 
criminal charge, is interviewed and/or tested in connection with drug 
abuse, alcoholism or alcohol abuse, infection with the human 
immunodeficiency virus, or sickle cell anemia in order to determine that 
individual's eligibility to participate in a treatment or rehabilitation 
program if the result of such testing is positive. The term ``patient'' 
includes an individual who has been diagnosed or treated for alcoholism, 
drug abuse, HIV infection, or sickle cell anemia for purposes of 
participation in a VA program or activity relating to those four 
conditions, including a program or activity consisting of treatment, 
rehabilitation, education, training, evaluation, or research. For the 
purpose of infection with the human immunodeficiency virus or sickle 
cell anemia, the term ``patient'' includes one tested positive for the 
disease even if no treatment is provided, offered, or requested. The 
term does not include a patient who has tested negative for the disease.
    Patient identifying information. The term ``patient identifying 
information'' means the name, address, social security number, 
fingerprints, photograph, or similar information by which the identity 
of a patient can be determined with reasonable accuracy and speed either 
directly or by reference to other publicly available information.

[[Page 32]]

The term does not include a number assigned to a patient by a treatment 
program, if that number does not consist of, or contain numbers (such as 
social security, or driver's license number) which could be used to 
identify a patient with reasonable accuracy and speed from sources 
external to the treatment program.
    Person. The term ``person'' means an individual, partnership, 
corporation, Federal, State or local government agency, or any other 
legal entity.
    Practitioner. The term ``practitioner'' has the same meaning set 
forth in 38 CFR 17.32(a).
    Procurement organization. The term ``procurement organization'' 
means an organ procurement organization, eye bank, and/or tissue bank as 
defined in this section.
    Records. The term ``records'' means any information received, 
obtained or maintained, whether recorded or not, by an employee or 
contractor of VA, for the purpose of seeking or performing VA program or 
activity functions relating to drug abuse, alcoholism, tests for or 
infection with the human immunodeficiency virus, or sickle cell anemia 
regarding an identifiable patient. A program or activity function 
relating to drug abuse, alcoholism, infection with the human 
immunodeficiency virus, or sickle cell anemia includes evaluation, 
treatment, education, training, rehabilitation, research, or referral 
for one of these conditions. Sections 1.460 through 1.499 of this part 
apply to a primary or other diagnosis, or other information which 
identifies, or could reasonably be expected to identify, a patient as 
having a drug or alcohol abuse condition, infection with the human 
immunodeficiency virus, or sickle cell anemia (e.g., alcoholic 
psychosis, drug dependence), but only if such diagnosis or information 
is received, obtained or maintained for the purpose of seeking or 
performing one of the above program or activity functions. Sections 
1.460 through 1.499 of this part do not apply if such diagnosis or other 
information is not received, obtained or maintained for the purpose of 
seeking or performing a function or activity relating to drug abuse, 
alcoholism, infection with the human immunodeficiency virus, or sickle 
cell anemia for the patient in question. Whenever such diagnosis or 
other information, not originally received or obtained for the purpose 
of obtaining or providing one of the above program or activity 
functions, is subsequently used in connection with such program or 
activity functions, those original entries become a ``record'' and 
Sec. Sec.  1.460 through 1.499 of this part thereafter apply to those 
entries. Segregability: these regulations do not apply to records or 
information contained therein, the disclosure of which (the 
circumstances surrounding the disclosure having been considered) could 
not reasonably be expected to disclose the fact that a patient has been 
connected with a VA program or activity function relating to drug abuse, 
alcoholism, infection with the human immunodeficiency virus, or sickle 
cell anemia.
    (1) The following are examples of instances whereby records or 
information related to alcoholism or drug abuse are covered by the 
provisions of Sec. Sec.  1.460 through 1.499 of this part:
    (i) A patient with alcoholic delirium tremens is admitted for 
detoxification. The patient is offered treatment in a VA alcohol 
rehabilitation program which he declines.
    (ii) A patient who is diagnosed as a drug abuser applies for and is 
provided VA drug rehabilitation treatment.
    (iii) While undergoing treatment for an unrelated medical condition, 
a patient discusses with the physician his use and abuse of alcohol. The 
physician offers VA alcohol rehabilitation treatment which is declined 
by the patient.
    (2) The following are examples of instances whereby records or 
information related to alcoholism or drug abuse are not covered by the 
provisions of Sec. Sec.  1.460 through 1.499 of this part:
    (i) A patient with alcoholic delirium tremens is admitted for 
detoxification, treated and released with no counseling or treatment for 
the underlying condition of alcoholism.
    (ii) While undergoing treatment for an unrelated medical condition, 
a patient informs the physician of a history of drug abuse fifteen years 
earlier with no ingestion of drugs since. The history and diagnosis of 
drug abuse is documented in the hospital summary and

[[Page 33]]

no treatment is sought by the patient or offered or provided by VA 
during the current period of treatment.
    (iii) While undergoing treatment for injuries sustained in an 
accident, a patient's medical record is documented to support the 
judgment of the physician to prescribe certain alternate medications in 
order to avoid possible drug interactions in view of the patient's 
enrollment and treatment in a non-VA methadone maintenance program. The 
patient states that continued treatment and follow-up will be obtained 
from private physicians and VA treatment for the drug abuse is not 
sought by the patient nor provided or offered by the staff.
    (iv) A patient is admitted to the emergency room suffering from a 
possible drug overdose. The patient is treated and released; a history 
and diagnosis of drug abuse may be documented in the hospital summary. 
The patient is not offered treatment for the underlying conditions of 
drug abuse, nor is treatment sought by the patient for that condition.
    Surrogate. The term ``surrogate'' has the same meaning set forth in 
38 CFR 17.32(a).
    Third party payer. The term ``third party payer'' means a person who 
pays, or agrees to pay, for diagnosis or treatment furnished to a 
patient on the basis of a contractual relationship with the patient or a 
member of his or her family or on the basis of the patient's eligibility 
for Federal, State, or local governmental benefits.
    Treatment. The term ``treatment'' means the management and care of a 
patient for drug abuse, alcoholism or alcohol abuse, or the diagnosis, 
management and care of a patient for infection with the human 
immunodeficiency virus, or sickle cell anemia, or a condition which is 
identified as having been caused by one or more of these conditions, in 
order to reduce or eliminate the adverse effects upon the patient. The 
term does not include negative test results for the human 
immunodeficiency virus, antibodies to the virus, or sickle cell anemia, 
or such testing of an individual where the results are negative.
    Undercover agent. The term ``undercover agent'' means an officer of 
any Federal, State, or local law enforcement agency who becomes a 
patient or employee for the purpose of investigating a suspected 
violation of law or who pursues that purpose after becoming a patient or 
becoming employed for other purposes.
    VHA health care facilty. The term ``VHA health care facility'' means 
a VA medical center, VA emergency room, VA nursing home or other 
facility as defined in 38 U.S.C. 1701(3).

[60 FR 63929, Dec. 13, 1995, as amended at 72 FR 48241, Aug. 23, 2007; 
73 FR 65260, Nov. 3, 2008; 76 FR 6696, Feb. 8, 2011; 82 FR 14822, Mar. 
23, 2017; 85 FR 64043, Oct. 9, 2020]



Sec.  1.461  Applicability.

    (a) General--(1) Restrictions on disclosure. The restrictions on 
disclosure in these regulations apply to any information whether or not 
recorded, which:
    (i) Would identify a patient as an alcohol or drug abuser, an 
individual who tested positive for or is infected with the human 
immunodeficiency virus (HIV), hereafter referred to as HIV, or an 
individual who tested positive for or has sickle cell anemia, either 
directly, by reference to other publicly available information, or 
through verification of such an identification by another person; and
    (ii) Is provided or obtained for the purpose of treating alcohol or 
drug abuse, infection with the HIV, or sickle cell anemia, making a 
diagnosis for that treatment, or making a referral for that treatment as 
well as for education, training, evaluation, rehabilitation and research 
program or activity purposes.
    (2) Restriction on use. The restriction on use of information to 
initiate or substantiate any criminal charges against a patient or to 
conduct any criminal investigation of a patient applies to any 
information, whether or not recorded, which is maintained for the 
purpose of treating drug abuse, alcoholism or alcohol abuse, infection 
with the HIV, or sickle cell anemia, making a diagnosis for that 
treatment, or making a referral for that treatment as well as for 
education, training, evaluation, rehabilitation, and research program or 
activity purposes.
    (b) Period covered as affecting applicability. The provisions of 
Sec. Sec.  1.460 through

[[Page 34]]

1.499 of this part apply to records of identity, diagnosis, prognosis, 
or treatment pertaining to any given individual maintained over any 
period of time which, irrespective of when it begins, does not end 
before March 21, 1972, in the case of diagnosis or treatment for drug 
abuse; or before May 14, 1974, in the case of diagnosis or treatment for 
alcoholism or alcohol abuse; or before September 1, 1973, in the case of 
testing, diagnosis or treatment of sickle cell anemia; or before May 20, 
1988, in the case of testing, diagnosis or treatment for an infection 
with the HIV.
    (c) Exceptions--(1) Department of Veterans Affairs and Armed Forces. 
The restrictions on disclosure in Sec. Sec.  1.460 through 1.499 of this 
part do not apply to communications of information between or among 
those components of VA who have a need for the information in connection 
with their duties in the provision of health care, adjudication of 
benefits, or in carrying out administrative responsibilities related to 
those functions, including personnel of the Office of the Inspector 
General who are conducting audits, evaluations, healthcare inspections, 
or non-patient investigations, or between such components and the Armed 
Forces. Information obtained by VA components under these circumstances 
may be disclosed outside of VA to prosecute or investigate a non-patient 
only in accordance with Sec.  1.495 of this part. Similarly, the 
restrictions on disclosure in Sec. Sec.  1.460 through 1.499 of this 
part do not apply to communications of information to the Department of 
Justice or U.S. Attorneys who are providing support in civil litigation 
or possible litigation involving VA.
    (2) Contractor. The restrictions on disclosure in Sec. Sec.  1.460 
through 1.499 of this part do not apply to communications between VA and 
a contractor of information needed by the contractor to provide his or 
her services.
    (3) Crimes on VA premises or against VA personnel. The restrictions 
on disclosure and use in Sec. Sec.  1.460 through 1.499 of this part do 
not apply to communications from VA personnel to law enforcement 
officers which:
    (i) Are directly related to a patient's commission of a crime on the 
premises of the facility or against personnel of VA or to a threat to 
commit such a crime; and
    (ii) Are limited to the circumstances of the incident, including the 
patient status of the individual committing or threatening to commit the 
crime, that individual's name and address to the extent authorized by 38 
U.S.C. 5701(f)(2), and that individual's last known whereabouts.
    (4) Undercover agents and informants. (i) Except as specifically 
authorized by a court order granted under Sec.  1.495 of this part, VA 
may not knowingly employ, or admit as a patient, any undercover agent or 
informant in any VA drug abuse, alcoholism or alcohol abuse, HIV 
infection, or sickle cell anemia treatment program.
    (ii) No information obtained by an undercover agent or informant, 
whether or not that undercover agent or informant is placed in a VA drug 
abuse, alcoholism or alcohol abuse, HIV infection, or sickle cell anemia 
treatment program pursuant to an authorizing court order, may be used to 
criminally investigate or prosecute any patient unless authorized 
pursuant to the provisions of Sec.  1.494 of this part.
    (iii) The enrollment of an undercover agent or informant in a 
treatment unit shall not be deemed a violation of this section if the 
enrollment is solely for the purpose of enabling the individual to 
obtain treatment for drug or alcohol abuse, HIV infection, or sickle 
cell anemia.
    (d) Applicability to recipients of information--(1) Restriction on 
use of information. In the absence of a proper Sec.  1.494 court order, 
the restriction on the use of any information subject to Sec. Sec.  
1.460 through 1.499 of this part to initiate or substantiate any 
criminal charges against a patient or to conduct any criminal 
investigation of a patient applies to any person who obtains that 
information from VA, regardless of the status of the person obtaining 
the information or of whether the information was obtained in accordance 
with Sec. Sec.  1.460 through 1.499 of this part. This restriction on 
use bars, among other things, the introduction of that information as 
evidence in a criminal proceeding and any other use of the information 
to investigate or prosecute a

[[Page 35]]

patient with respect to a suspected crime. Information obtained by 
undercover agents or informants (see paragraph (c) of this section) or 
through patient access (see Sec.  1.469 of this part) is subject to the 
restriction on use.
    (2) Restrictions on disclosures--third-party payers and others. The 
restrictions on disclosure in Sec. Sec.  1.460 through 1.499 of this 
part apply to third-party payers and persons who, pursuant to a consent, 
receive patient records directly from VA and who are notified of the 
restrictions on redisclosure of the records in accordance with Sec.  
1.476 of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 76 FR 65135, Oct. 20, 2011; 
82 FR 14822, Mar. 23, 2017; 85 FR 64043, Oct. 9, 2020]



Sec.  1.462  Confidentiality restrictions.

    (a) General. The patient records to which Sec. Sec.  1.460 through 
1.499 of this part apply may be disclosed or used only as permitted by 
these regulations and may not otherwise be disclosed or used in any 
civil, criminal, administrative, or legislative proceedings conducted by 
any Federal, State, or local authority. Any disclosure made under these 
regulations must be limited to that information which is necessary to 
carry out the purpose of the disclosure.
    (b) Unconditional compliance required. The restrictions on 
disclosure and use in Sec. Sec.  1.460 through 1.499 of this part apply 
whether the person seeking the information already has it, has other 
means of obtaining it, is a law enforcement or other official, has 
obtained a subpoena, or asserts any other justification for a disclosure 
or use which is not permitted by Sec. Sec.  1.460 through 1.499 of this 
part. These provisions do not prohibit VA from acting accordingly when 
there is no disclosure of information.
    (c) Acknowledging the presence of patients: responding to requests. 
(1) The presence of an identified patient in a VA facility for the 
treatment or other VA program activity relating to drug abuse, 
alcoholism or alcohol abuse, infection with the HIV, or sickle cell 
anemia may be acknowledged only if the patient's written consent is 
obtained in accordance with Sec.  1.475 of this part or if an 
authorizing court order is entered in accordance with Sec. Sec.  1.490 
through 1.499 of this part. Acknowledgment of the presence of an 
identified patient in a facility is permitted if the acknowledgment does 
not reveal that the patient is being treated for or is otherwise 
involved in a VA program or activity concerning drug abuse, alcoholism 
or alcohol abuse, infection with the HIV, or sickle cell anemia.
    (2) Any answer to a request for a disclosure of patient records 
which is not permissible under Sec. Sec.  1.460 through 1.499 of this 
part must be made in a way that will not affirmatively reveal that an 
identified individual has been, or is being diagnosed or treated for 
drug abuse, alcoholism or alcohol abuse, infection with the HIV, or 
sickle cell anemia. These regulations do not restrict a disclosure that 
an identified individual is not and never has been a patient.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.463  Criminal penalty for violations.

    Under 38 U.S.C. 7332(g), any person who violates any provision of 
this statute or Sec. Sec.  1.460 through 1.499 of this part shall be 
fined not more than $5,000 in the case of a first offense, and not more 
than $20,000 for a subsequent offense.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.464  Minor patients.

    (a) Definition of minor. As used in Sec. Sec.  1.460 through 1.499 
of this part the term ``minor'' means a person who has not attained the 
age of majority specified in the applicable State law, or if no age of 
majority is specified in the applicable State law, the age of eighteen 
years.
    (b) State law not requiring parental consent to treatment. If a 
minor patient acting alone has the legal capacity under the applicable 
State law to apply for and obtain treatment for drug abuse, alcoholism 
or alcohol abuse, infection with the HIV, or sickle cell anemia, any 
written consent for disclosure authorized under Sec.  1.475 of this part 
may be given only by the minor patient. This restriction includes, but 
is not limited to, any disclosure of patient identifying information to 
the parent or guardian of a minor patient

[[Page 36]]

for the purpose of obtaining financial reimbursement. Sections 1.460 
through 1.499 of this part do not prohibit a VA facility from refusing 
to provide nonemergent treatment to an otherwise ineligible minor 
patient until the minor patient consents to the disclosure necessary to 
obtain reimbursement for services from a third party payer.
    (c) State law requiring parental consent to treatment. (1) Where 
State law requires consent of a parent, guardian, or other person for a 
minor to obtain treatment for drug abuse, alcoholism or alcohol abuse, 
infection with the HIV, or sickle cell anemia, any written consent for 
disclosure authorized under Sec.  1.475 of this part must be given by 
both the minor and his or her parent, guardian, or other person 
authorized under State law to act in the minor's behalf.
    (2) Where State law requires parental consent to treatment, the fact 
of a minor's application for treatment may be communicated to the 
minor's parent, guardian, or other person authorized under State law to 
act in the minor's behalf only if:
    (i) The minor has given written consent to the disclosure in 
accordance with Sec.  1.475 of this part; or
    (ii) The minor lacks the capacity to make a rational choice 
regarding such consent as judged by the appropriate VA facility director 
under paragraph (d) of this section.
    (d) Minor applicant for service lacks capacity for rational choice. 
Facts relevant to reducing a threat to the life or physical well being 
of the applicant or any other individual may be disclosed to the parent, 
guardian, or other person authorized under State law to act in the 
minor's behalf if the appropriate VA facility director judges that:
    (1) A minor applicant for services lacks capacity because of extreme 
youth or mental or physical condition to make a rational decision on 
whether to consent to a disclosure under Sec.  1.475 of this part to his 
or her parent, guardian, or other person authorized under State law to 
act in the minor's behalf, and
    (2) The applicant's situation poses a substantial threat to the life 
or physical well-being of the applicant or any other individual which 
may be reduced by communicating relevant facts to the minor's parent, 
guardian, or other person authorized under State law to act in the 
minor's behalf.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.465  Incompetent and deceased patients.

    (a) Incompetent patients other than minors. In the case of a patient 
who has been adjudicated as lacking the capacity, for any reason other 
than insufficient age, to manage his or her own affairs, any consent 
which is required under Sec. Sec.  1.460 through 1.499 of this part may 
be given by a court appointed legal guardian.
    (b) Deceased patients--(1) Vital statistics. Sec. 1.460 through 
1.499 of this part do not restrict the disclosure of patient identifying 
information relating to the cause of death of a patient under laws 
requiring the collection of death or other vital statistics or 
permitting inquiry into the cause of death.
    (2) Consent by personal representative. Any other disclosure of 
information identifying a deceased patient as being treated for drug 
abuse, alcoholism or alcohol abuse, infection with the HIV, or sickle 
cell anemia is subject to Sec. Sec.  1.460 through 1.499 of this part. 
If a written consent to the disclosure is required, the Under Secretary 
for Health or designee may, upon the prior written request of the next 
of kin, executor/executrix, administrator/administratrix, or other 
personal representative of such deceased patient, disclose the contents 
of such records, only if the Under Secretary for Health or designee 
determines such disclosure is necessary to obtain survivorship benefits 
for the deceased patient's survivor. This would include not only VA 
benefits, but also payments by the Social Security Administration, 
Worker's Compensation Boards or Commissions, or other Federal, State, or 
local government agencies, or nongovernment entities, such as life 
insurance companies.
    (3) Information related to sickle cell anemia. Information related 
to sickle cell anemia may be released to a blood

[[Page 37]]

relative of a deceased veteran for medical follow-up or family planning 
purposes.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.466  Security for records.

    (a) Written records which are subject to Sec. Sec.  1.460 through 
1.499 of this part must be maintained in a secure room, locked file 
cabinet, safe or other similar container when not in use. Access to 
information stored in computers will be limited to authorized VA 
employees who have a need for the information in performing their 
duties. These security precautions shall be consistent with the Privacy 
Act of 1974 (5 U.S.C. 552a).
    (b) Each VA facility shall adopt in writing procedures related to 
the access to and use of records which are subject to Sec. Sec.  1.460 
through 1.499 of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.467  Restrictions on the use of identification cards and 
public signs.

    (a) No facility may require any patient to carry on their person 
while away from the facility premises any card or other object which 
would identify the patient as a participant in any VA drug abuse, 
alcoholism or alcohol abuse, HIV infection, or sickle cell anemia 
treatment program. A facility may require patients to use or carry cards 
or other identification objects on the premises of a facility. Patients 
may not be required to wear clothing or colored identification bracelets 
or display objects openly to all facility staff or others which would 
identify them as being treated for drug or alcohol abuse, HIV infection, 
or sickle cell anemia.
    (b) Treatment locations should not be identified by signs that would 
identify individuals entering or exiting these locations as patients 
enrolled in a drug or alcohol abuse, HIV infection, or sickle cell 
anemia program or activity.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.468  Relationship to Federal statutes protecting research subjects 
against compulsory disclosure of their identity.

    (a) Research privilege description. There may be concurrent coverage 
of patient identifying information by the provisions of Sec. Sec.  1.460 
through 1.499 of this part and by administrative action taken under Sec. 
303(a) of the Public Health Service Act (42 U.S.C. 241(d) and the 
implementing regulations at 42 CFR Part 2a); or Sec. 502(c) of the 
Controlled Substances Act (21 U.S.C. 872(c) and the implementing 
regulations at 21 CFR 1316.21). These ``research privilege'' statutes 
confer on the Secretary of Health and Human Services and on the Attorney 
General, respectively, the power to authorize researchers conducting 
certain types of research to withhold from all persons not connected 
with the research the names and other identifying information concerning 
individuals who are the subjects of the research.
    (b) Effect of concurrent coverage. Sections 1.460 through 1.499 of 
this part restrict the disclosure and use of information about patients, 
while administrative action taken under the research privilege statutes 
and implementing regulations protects a person engaged in applicable 
research from being compelled to disclose any identifying 
characteristics of the individuals who are the subjects of that 
research. The issuance under Sec. Sec.  1.490 through 1.499 of this part 
of a court order authorizing a disclosure of information about a patient 
does not affect an exercise of authority under these research privilege 
statutes. However, the research privilege granted under 21 CFR 
291.505(g) to treatment programs using methadone for maintenance 
treatment does not protect from compulsory disclosure any information 
which is permitted to be disclosed under those regulations. Thus, if a 
court order entered in accordance with Sec. Sec.  1.490 through 1.499 of 
this part authorizes a VA facility to disclose certain information about 
its patients, the facility may not invoke the research privilege under 
21 CFR 291.505(g) as a defense to a subpoena for that information.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]

[[Page 38]]



Sec.  1.469  Patient access and restrictions on use.

    (a) Patient access not prohibited. Sections 1.460 through 1.499 of 
this part do not prohibit a facility from giving a patient access to his 
or her own records, including the opportunity to inspect and copy any 
records that VA maintains about the patient, subject to the provisions 
of the Privacy Act (5 U.S.C. 552a(d)(1)) and 38 CFR 1.577. If the 
patient is accompanied, giving access to the patient and the 
accompanying person will require a written consent by the patient which 
is provided in accordance with Sec.  1.475 of this part.
    (b) Restrictions on use of information. Information obtained by 
patient access to patient record is subject to the restriction on use of 
this information to initiate or substantiate any criminal charges 
against the patient or to conduct any criminal investigation of the 
patient as provided for under Sec.  1.461(d)(1) of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec. Sec.  1.470-1.474  [Reserved]

                   Disclosures With Patient's Consent



Sec.  1.475  Form of written consent.

    (a) Required elements. A written consent to a disclosure under 
Sec. Sec.  1.460 through 1.499 of this part must include:
    (1) The name of the facility permitted to make the disclosure (such 
a designation does not preclude the release of records from other VA 
health care facilities unless a restriction is stated on the consent).
    (2) The name or title of the individual or the name of the 
organization to which disclosure is to be made.
    (3) The name of the patient.
    (4) The purpose of the disclosure.
    (5) How much and what kind of information is to be disclosed.
    (6) The signature of the patient and, when required for a patient 
who is a minor, the signature of a person authorized to give consent 
under Sec.  1.464 of this part; or, when required for a patient who is 
incompetent or deceased, the signature of a person authorized to sign 
under Sec.  1.465 of this part in lieu of the patient.
    (7) The date on which the consent is signed.
    (8) A statement that the consent is subject to revocation at any 
time except to the extent that the facility which is to make the 
disclosure has already acted in reliance on it. Acting in reliance 
includes the provision of treatment services in reliance on a valid 
consent to disclose information to a third party payer.
    (9) The date, event, or condition upon which the consent will expire 
if not revoked before. This date, event, or condition must ensure that 
the consent will last no longer than reasonably necessary to serve the 
purpose for which it is given.
    (b) Expired, deficient, or false consent. A disclosure may not be 
made on the basis of a consent which:
    (1) Has expired;
    (2) On its face substantially fails to conform to any of the 
requirements set forth in paragraph (a) of this section;
    (3) Is known to have been revoked; or
    (4) Is known, or through a reasonable effort could be known, by 
responsible personnel of VA to be materially false.
    (c) Notification of deficient consent. Other than the patient, no 
person or entity may be advised that a special consent is required in 
order to disclose information relating to an individual participating in 
a drug abuse, alcoholism or alcohol abuse, HIV, or sickle cell anemia 
program or activity. Where a person or entity presents VA with an 
insufficient written consent for information protected by 38 U.S.C. 
7332, VA must, in the process of obtaining a legally sufficient consent, 
correspond only with the patient whose records are involved, or the 
legal guardian of an incompetent patient or next of kin of a deceased 
patient, and not with any other person.
    (d) It is not necessary to use any particular form to establish a 
consent referred to in paragraph (a) of this section, however, VA Form 
10-5345, titled Request for and Consent to Release of Medical Records 
Protected by 38 U.S.C. 7332, may be used for such purpose.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]

[[Page 39]]



Sec.  1.476  Prohibition on redisclosure.

    Each disclosure under Sec. Sec.  1.460 through 1.499 of this part 
made with the patient's written consent must be accompanied by a written 
statement similar to the following:

    This information has been disclosed to you from records protected by 
Federal confidentiality rules (38 CFR Part 1). The Federal rules 
prohibit you from making any further disclosure of this information 
unless further disclosure is expressly permitted by the written consent 
of the person to whom it pertains or as otherwise permitted by 38 CFR 
Part 1. A general authorization for the release of medical or other 
information is NOT sufficient for this purpose. The Federal rules 
restrict any use of the information to criminally investigate or 
prosecute any alcohol or drug abuse patient or patient with sickle cell 
anemia or HIV infection.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.477  Disclosures permitted with written consent.

    If a patient consents to a disclosure of his or her records under 
Sec.  1.475 of this part, a facility may disclose those records in 
accordance with that consent to any individual or organization named in 
the consent, except that disclosures to central registries and in 
connection with criminal justice referrals must meet the requirements of 
Sec. Sec.  1.478 and 1.479 of this part, respectively.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.478  Disclosures to prevent multiple enrollments in detoxification 
and maintenance treatment programs; not applicable to records relating
to sickle cell anemia or infection with the human immunodeficiency virus.

    (a) Definitions. For purposes of this section:
    (1) Central registry means an organization which obtains from two or 
more member programs patient identifying information about individuals 
applying for maintenance treatment or detoxification treatment for the 
purpose of avoiding an individual's concurrent enrollment in more than 
one program.
    (2) Detoxification treatment means the dispensing of a narcotic drug 
in decreasing doses to an individual in order to reduce or eliminate 
adverse physiological or psychological effects incident to withdrawal 
from the sustained use of a narcotic drug.
    (3) Maintenance treatment means the dispensing of a narcotic drug in 
the treatment of an individual for dependence upon heroin or other 
morphine-like drugs.
    (4) Member program means a non-VA detoxification treatment or 
maintenance treatment program which reports patient identifying 
information to a central registry and which is in the same State as that 
central registry or is not more than 125 miles from any border of the 
State in which the central registry is located.
    (b) Restrictions on disclosure. VA may disclose patient records to a 
central registry which is located in the same State or is not more than 
125 miles from any border of the State or to any non-VA detoxification 
or maintenance treatment program not more than 200 miles away for the 
purpose of preventing the multiple enrollment of a patient only if:
    (1) The disclosure is made when:
    (i) The patient is accepted for treatment;
    (ii) The type or dosage of the drug is changed; or
    (iii) The treatment is interrupted, resumed or terminated.
    (2) The disclosure is limited to:
    (i) Patient identifying information;
    (ii) Type and dosage of the drug; and
    (iii) Relevant dates.
    (3) The disclosure is made with the patient's written consent 
meeting the requirements of Sec.  1.475 of this part, except that:
    (i) The consent must list the name and address of each central 
registry and each known non-VA detoxification or maintenance treatment 
program to which a disclosure will be made; and
    (ii) The consent may authorize a disclosure to any non-VA 
detoxification or maintenance treatment program established within 200 
miles after the consent is given without naming any such program.
    (c) Use of information limited to prevention of multiple 
enrollments. A central registry and any non-VA detoxification or 
maintenance treatment program to

[[Page 40]]

which information is disclosed to prevent multiple enrollments may not 
redisclose or use patient identifying information for any purpose other 
than the prevention of multiple enrollments unless authorized by a court 
order under Sec. Sec.  1.490 through 1.499 of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.479  Disclosures to elements of the criminal justice system which
have referred patients.

    (a) VA may disclose information about a patient from records covered 
by Sec. Sec.  1.460 through 1.499 of this part to those persons within 
the criminal justice system which have made participation in a VA 
treatment program a condition of the disposition of any criminal 
proceedings against the patient or of the patient's parole or other 
release from custody if:
    (1) The disclosure is made only to those individuals within the 
criminal justice system who have a need for the information in 
connection with their duty to monitor the patient's progress (e.g., a 
prosecuting attorney who is withholding charges against the patient, a 
court granting pretrial or posttrial release, probation or parole 
officers responsible for supervision of the patient); and
    (2) The patient has signed a written consent as a condition of 
admission to the treatment program meeting the requirements of Sec.  
1.475 of this part (except paragraph (a)(8) which is inconsistent with 
the revocation provisions of paragraph (c) of this section) and the 
requirements of paragraphs (b) and (c) of this section.
    (b) Duration of consent. The written consent must state the period 
during which it remains in effect. This period must be reasonable, 
taking into account:
    (1) The anticipated length of the treatment recognizing that 
revocation of consent may not generally be effected while treatment is 
ongoing;
    (2) The type of criminal proceeding involved, the need for the 
information in connection with the final disposition of that proceeding, 
and when the final disposition will occur; and
    (3) Such other factors as the facility, the patient, and the 
person(s) who will receive the disclosure consider pertinent.
    (c) Revocation of consent. The written consent must state that it is 
revocable upon the passage of a specified amount of time or the 
occurrence of a specified, ascertainable event. The time or occurrence 
upon which consent becomes revocable may be no earlier than the 
individual's completion of the treatment program and no later than the 
final disposition of the conditional release or other action in 
connection with which consent was given.
    (d) Restrictions on redisclosure and use. A person who receives 
patient information under this section may redisclose and use it only to 
carry out that person's official duties with regard to the patient's 
conditional release or other action in connection with which the consent 
was given, including parole.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.480  [Reserved]

                   Disclosures Without Patient Consent



Sec.  1.481  Disclosure of medical records of veterans who receive 
non-VA health care.

    (a) VA may disclose records referred to in 38 U.S.C. 7332(a) to a 
non-VA entity (including private entities and other Federal agencies) 
for purposes of providing health care to patients or performing other 
health care-related activities or functions.
    (b) An entity to which a record is disclosed under this section may 
not disclose or use such record for a purpose other than that for which 
the disclosure was made or as permitted by law.

[85 FR 64043, Oct. 9, 2020]



Sec.  1.482  Disclosure of medical records to recover or collect reasonable
charges.

    VA may disclose records described in 38 U.S.C. 7332(a) to a third 
party in order to recover or collect reasonable charges for care 
furnished to, or paid on behalf of, a patient in connection with a non-
service connected disability as permitted by 38 U.S.C. 1729, or for a 
condition for which recovery is authorized, or with respect to which the

[[Page 41]]

United States is deemed to be a third-party beneficiary under the 
Federal Medical Care Recovery Act (Public Law 87-693, 42 U.S.C. 2651 et 
seq.).

[85 FR 64043, Oct. 9, 2020]



Sec.  1.483  Disclosure of information to participate in state prescription
drug monitoring programs.

    Information covered by Sec. Sec.  1.460 through 1.499 of this part 
may be disclosed to State Prescription Drug Monitoring Programs pursuant 
to the limitations set forth in Sec.  1.515 of this part.

[78 FR 9592, Feb. 11, 2013]



Sec.  1.484  Disclosure of medical information to the surrogate of a patient
who lacks decision-making capacity.

    A VA medical practitioner may disclose the content of any record of 
the identity, diagnosis, prognosis, or treatment of a patient that is 
maintained in connection with the performance of any VA program or 
activity relating to drug abuse, alcoholism or alcohol abuse, infection 
with the human immunodeficiency virus, or sickle cell anemia to a 
surrogate of the patient who is the subject of such record if:
    (a) The patient lacks decision-making capacity; and
    (b) The practitioner deems the content of the given record necessary 
for the surrogate to make an informed decision regarding the patient's 
treatment.

[76 FR 6696, Feb. 8, 2011, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.485  Medical emergencies.

    (a) General rule. Under the procedures required by paragraph (c) of 
this section, patient identifying information from records covered by 
Sec. Sec.  1.460 through 1.499 of this part may be disclosed to medical 
personnel who have a need for information about a patient for the 
purpose of treating a condition which poses an immediate threat to the 
health of any individual and which requires immediate medical 
intervention.
    (b) Special rule. Patient identifying information may be disclosed 
to medical personnel of the Food and Drug Administration (FDA) who 
assert a reason to believe that the health of any individual may be 
threatened by an error in the manufacture, labeling, or sale of a 
product under FDA jurisdiction, and that the information will be used 
for the exclusive purpose of notifying patients or their physicians of 
potential dangers.
    (c) Procedures. Immediately following disclosure, any VA employee 
making an oral disclosure under authority of this section shall make an 
accounting of the disclosure in accordance with the Privacy Act (5 
U.S.C. 552a(c) and 38 CFR 1.576(c)) and document the disclosure in the 
patient's records setting forth in writing:
    (1) The name and address of the medical personnel to whom disclosure 
was made and their affiliation with any health care facility;
    (2) The name of the individual making the disclosure;
    (3) The date and time of the disclosure;
    (4) The nature of the emergency (or error, if the report was to 
FDA);
    (5) The information disclosed; and
    (6) The authority for making the disclosure (Sec.  1.485 of this 
part).

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.485a  Eye, organ and tissue donation.

    A VHA health care facility may disclose the individually-identified 
medical record information of an individual covered by Sec. Sec.  1.460 
through 1.499 of this part to an authorized representative of a 
procurement organization for the purpose of facilitating determination 
of whether the individual is a suitable potential organ, eye, or tissue 
donor if:
    (a) The individual is currently an inpatient in a VHA health care 
facility;
    (b) The individual is, in the clinical judgment of the individual's 
primary health care provider, near death or deceased;
    (c) The VHA health care facility has a signed agreement with the 
procurement organization in accordance with the applicable requirements 
of the United States Department of Health and Human Services (HHS); and

[[Page 42]]

    (d) The VHA health care facility has confirmed with HHS that it has 
certified or recertified the organ procurement organization as provided 
in the applicable HHS regulations. VA medical centers must verify 
annually in January of each calendar year with the Food and Drug 
Administration (FDA) that an eye bank or tissue bank has complied with 
the FDA registration requirements of 21 CFR part 1271 and that the 
registration status is active before permitting an eye bank or tissue 
bank to receive protected health information.

[72 FR 48242, Aug. 23, 2007, as amended at 73 FR 65260, Nov. 3, 2008; 85 
FR 64043, Oct. 9, 2020]



Sec.  1.486  Disclosure of information related to infection with the human
immunodeficiency virus to public health authorities.

    (a) In the case of any record which is maintained in connection with 
the performance of any program or activity relating to infection with 
the HIV, information may be disclosed to a Federal, State, or local 
public health authority, charged under Federal or State law with the 
protection of the public health, and to which Federal or State law 
requires disclosure of such record, if a qualified representative of 
such authority has made a written request that such record be provided 
as required pursuant to such law for a purpose authorized by such law. 
In the case of a State law, such law must, in order for VA to be able to 
release patient name and address information in accordance with 38 
U.S.C. 5701(f)(2), provide for a penalty or fine or other sanction to be 
assessed against those individuals who are subject to the jurisdiction 
of the public health authority but fail to comply with the reporting 
requirements.
    (b) A person to whom a record is disclosed under this section may 
not redisclose or use such record for a purpose other than that for 
which the disclosure was made.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.487  Disclosure of information related to infection with the human
immunodeficiency virus to the spouse or sexual partner of the patient.

    (a) Subject to paragraph (b) of this section, a physician or a 
professional counselor may disclose information or records indicating 
that a patient is infected with the HIV if the disclosure is made to the 
spouse of the patient, or to an individual whom the patient has, during 
the process of professional counseling or of testing to determine 
whether the patient is infected with such virus, identified as being a 
sexual partner of such patient.
    (b) A disclosure under this section may be made only if the 
physician or counselor, after making reasonable efforts to counsel and 
encourage the patient to provide the information to the spouse or sexual 
partner, reasonably believes that the patient will not provide the 
information to the spouse or sexual partner and that the disclosure is 
necessary to protect the health of the spouse or sexual partner.
    (c) A disclosure under this section may be made by a physician or 
counselor other than the physician or counselor referred to in paragraph 
(b) of this section if such physician or counselor is unavailable by 
reason of extended absence or termination of employment to make the 
disclosure.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.488  Research activities.

    Subject to the provisions of 38 U.S.C. 5701, 38 CFR 1.500-1.527, the 
Privacy Act (5 U.S.C. 552a), 38 CFR 1.575-1.584 and the following 
paragraphs, patient medical record information covered by Sec. Sec.  
1.460 through 1.499 of this part may be disclosed for the purpose of 
conducting scientific research.
    (a) Information in individually identifiable form may be disclosed 
from records covered by Sec. Sec.  1.460 through 1.499 of this part for 
the purpose of conducting scientific research if the Under Secretary for 
Health or designee makes a determination that the recipient of the 
patient identifying information:
    (1) Is qualified to conduct the research.

[[Page 43]]

    (2) Has a research protocol under which the information:
    (i) Will be maintained in accordance with the security requirements 
of Sec.  1.466 of this part (or more stringent requirements); and
    (ii) Will not be redisclosed except as permitted under paragraph (b) 
of this section.
    (3) Has furnished a written statement that the research protocol has 
been reviewed by an independent group of three or more individuals who 
found that the rights of patients would be adequately protected and that 
the potential benefits of the research outweigh any potential risks to 
patient confidentiality posed by the disclosure of records.
    (b) A person conducting research may disclose information obtained 
under paragraph (a) of this section only back to VA and may not identify 
any individual patient in any report of that research or otherwise 
disclose patient identities.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.489  Audit and evaluation activities.

    Subject to the provisions of 38 U.S.C. 5701, 38 CFR 1.500-1.527, the 
Privacy Act (5 U.S.C. 552a), 38 CFR 1.575-1.584, and the following 
paragraphs, patient medical records covered by Sec. Sec.  1.460 through 
1.499 of this part may be disclosed outside VA for the purposes of 
conducting audit and evaluation activities.
    (a) Records not copies. If patient records covered by Sec. Sec.  
1.460 through 1.499 of this part are not copied, patient identifying 
information may be disclosed in the course of a review of records on VA 
facility premises to any person who agrees in writing to comply with the 
limitations on redisclosure and use in paragraph (d) of this section 
and:
    (1) Where audit or evaluation functions are performed by a State or 
Federal governmental agency on behalf of VA; or
    (2) Who is determined by the VA facility director to be qualified to 
conduct the audit or evaluation activities.
    (b) Copying of records. Records containing patient identifying 
information may be copied by any person who:
    (1) Agrees in writing to:
    (i) Maintain the patient identifying information in accordance with 
the security requirements provided in Sec.  1.466 of this part (or more 
stringent requirements);
    (ii) Destroy all the patient identifying information upon completion 
of the audit or evaluation; and
    (iii) Comply with the limitations on disclosure and use in paragraph 
(d) of this section.
    (2) The VA medical facility director determines to be qualified to 
conduct the audit or evaluation activities.
    (c) Congressional oversight. Records subject to Sec. Sec.  1.460 
through 1.499 of this part upon written request may be released to 
congressional committees or subcommittees for program oversight and 
evaluation if such records pertain to any matter within the jurisdiction 
of such committee or subcommittee.
    (d) Limitation on disclosure and use. Records containing patient 
identifying information disclosed under this section may be disclosed 
only back to VA and used only to carry out an audit or evaluation 
purpose, or, to investigate or prosecute criminal or other activities as 
authorized by a court order entered under Sec.  1.494 of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]

              Court Orders Authorizing Disclosures and Use



Sec.  1.490  Legal effect of order.

    The records to which Sec. Sec.  1.460 through 1.499 of this part 
apply may be disclosed if authorized by an appropriate order of a court 
of competent jurisdiction granted after application showing good cause 
therefore. In assessing good cause the court is statutorily required to 
weigh the public interest and the need for disclosure against the injury 
to the patient or subject, to the physician-patient relationship, and to 
the treatment services. Upon the granting of such order, the court, in 
determining the extent to which any disclosure of all or any part of any 
record is necessary, is required by statute to impose appropriate 
safeguards against unauthorized disclosure. An order of a court of 
competent jurisdiction to produce records subject to Sec. Sec.  1.460 
through 1.499 of this part will not be sufficient unless

[[Page 44]]

the order reflects that the court has complied with the requirements of 
38 U.S.C. 7332(b)(2)(D). Such an order from a Federal court compels 
disclosure. However, such an order from a State court only acts to 
authorize the Secretary to exercise discretion pursuant to 38 U.S.C. 
5701(b)(5) and 38 CFR 1.511 to disclose such records. It does not compel 
disclosure.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.491  Confidential communications.

    (a) A court order under Sec. Sec.  1.490 through 1.499 of this part 
may authorize disclosure of confidential communications made by a 
patient to a treatment program in the course of diagnosis, treatment, or 
referral for treatment only if:
    (1) The disclosure is necessary to protect against an existing 
threat to life or of serious bodily injury, including circumstances 
which constitute suspected child abuse and neglect and verbal threats 
against third parties;
    (2) The disclosure is necessary in connection with investigation or 
prosecution of an extremely serious crime, such as one which directly 
threatens loss of life or serious bodily injury, including homicide, 
rape, kidnapping, armed robbery, assault with a deadly weapon, or child 
abuse and neglect; or
    (3) The disclosure is in connection with litigation or an 
administrative proceeding in which the patient offers testimony or other 
evidence pertaining to the content of the confidential communications.
    (b) [Reserved]

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.492  Order not applicable to records disclosed without consent
to researchers, auditors and evaluators.

    A court order under Sec. Sec.  1.460 through 1.499 of this part may 
not authorize qualified personnel, who have received patient identifying 
information from VA without consent for the purpose of conducting 
research, audit or evaluation, to disclose that information or use it to 
conduct any criminal investigation or prosecution of a patient. However, 
a court order under Sec.  1.495 of this part may authorize disclosure 
and use of records to investigate or prosecute VA personnel.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.493  Procedures and criteria for orders authorizing disclosures
for noncriminal purposes.

    (a) Application. An order authorizing the disclosure of patient 
records covered by Sec. Sec.  1.460 through 1.499 of this part for 
purposes other than criminal investigation or prosecution may be applied 
for by any person having a legally recognized interest in the disclosure 
which is sought. The application may be filed separately or as part of a 
pending civil action in which it appears that the patient records are 
needed to provide evidence. An application must use a fictitious name, 
such as John Doe, to refer to any patient and may not contain or 
otherwise disclose any patient identifying information unless the 
patient is the applicant or has given a written consent (meeting the 
requirements of Sec.  1.475 of this part) to disclosure or the court has 
ordered the record of the proceeding sealed from public scrutiny.
    (b) Notice. The patient and VA facility from whom disclosure is 
sought must be given:
    (1) Adequate notice in a manner which will not disclose patient 
identifying information to other persons; and
    (2) An opportunity to file a written response to the application, or 
to appear in person, for the limited purpose of providing evidence on 
whether the statutory and regulatory criteria for the issuance of the 
court order are met.
    (c) Review of evidence: Conduct of hearing. Any oral argument, 
review of evidence, or hearing on the application must be held in the 
judge's chambers or in some manner which ensures that patient 
identifying information is not disclosed to anyone other than a party to 
the proceeding, the patient, or VA, unless the patient requests an open 
hearing in a manner which meets the written consent requirements of 
Sec.  1.475 of this part. The proceeding may include an examination by 
the judge of the patient records referred to in the application.
    (d) Criteria for entry of order. An order under this section may be 
entered only

[[Page 45]]

if the court determines that good cause exists. To make this 
determination the court must find that:
    (1) Other ways of obtaining the information are not available or 
would not be effective; and
    (2) The public interest and need for the disclosure outweigh the 
potential injury to the patient, the physician-patient relationship and 
the treatment services.
    (e) Content of order. An order authorizing a disclosure must:
    (1) Limit disclosure to those parts of the patient's record which 
are essential to fulfill the objective of the order;
    (2) Limit disclosure to those persons whose need for information is 
the basis for the order; and
    (3) Include such other measures as are necessary to limit disclosure 
for the protection of the patient, the physician-patient relationship 
and the treatment services; for example, sealing from public scrutiny 
the record of any proceeding for which disclosure of a patient's record 
has been ordered.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.494  Procedures and criteria for orders authorizing disclosure and
use of records to criminally investigate or prosecute patients.

    (a) Application. An order authorizing the disclosure or use of 
patient records covered by Sec. Sec.  1.460 through 1.499 of this part 
to criminally investigate or prosecute a patient may be applied for by 
VA or by any person conducting investigative or prosecutorial activities 
with respect to the enforcement of criminal laws. The application may be 
filed separately, as part of an application for a subpoena or other 
compulsory process, or in a pending criminal action. An application must 
use a fictitious name such as John Doe, to refer to any patient and may 
not contain or otherwise disclose patient identifying information unless 
the court has ordered the record of the proceeding sealed from public 
scrutiny.
    (b) Notice and hearing. Unless an order under Sec.  1.495 of this 
part is sought with an order under this section, VA must be given:
    (1) Adequate notice (in a manner which will not disclose patient 
identifying information to third parties) of an application by a person 
performing a law enforcement function;
    (2) An opportunity to appear and be heard for the limited purpose of 
providing evidence on the statutory and regulatory criteria for the 
issuance of the court order; and
    (3) An opportunity to be represented by counsel.
    (c) Review of evidence: Conduct of hearings. Any oral argument, 
review of evidence, or hearing on the application shall be held in the 
judge's chambers or in some other manner which ensures that patient 
identifying information is not disclosed to anyone other than a party to 
the proceedings, the patient, or VA. The proceeding may include an 
examination by the judge of the patient records referred to in the 
application.
    (d) Criteria. A court may authorize the disclosure and use of 
patient records for the purpose of conducting a criminal investigation 
or prosecution of a patient only if the court finds that all of the 
following criteria are met:
    (1) The crime involved is extremely serious, such as one which 
causes or directly threatens loss of life or serious bodily injury 
including, but not limited to, homicide, rape, kidnapping, armed 
robbery, assault with a deadly weapon, and child abuse and neglect.
    (2) There is a reasonable likelihood that the records will disclose 
information of substantial value in the investigation or prosecution.
    (3) Other ways of obtaining the information are not available or 
would not be effective.
    (4) The potential injury to the patient, to the physician-patient 
relationship and to the ability of VA to provide services to other 
patients is outweighed by the public interest and the need for the 
disclosure.
    (5) If the applicant is a person performing a law enforcement 
function, VA has been represented by counsel independent of the 
applicant.
    (e) Content of order. Any order authorizing a disclosure or use of 
patient records under this section must:
    (1) Limit disclosure and use to those parts of the patient's record 
which are essential to fulfill the objective of the order;

[[Page 46]]

    (2) Limit disclosure to those law enforcement and prosecutorial 
officials who are responsible for, or are conducting, the investigation 
or prosecution, and limit their use of the records to investigation and 
prosecution of extremely serious crime or suspected crime specified in 
the applications; and
    (3) Include such other measures as are necessary to limit disclosure 
and use to the fulfillment on only that public interest and need found 
by the court.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.495  Procedures and criteria for orders authorizing disclosure
and use of records to investigate or prosecute VA or employees of VA.

    (a) Application. (1) An order authorizing the disclosure or use of 
patient records covered by Sec. Sec.  1.460 through 1.499 of this part 
to criminally or administratively investigate or prosecute VA (or 
employees or agents of VA) may be applied for by an administrative, 
regulatory, supervisory, investigative, law enforcement, or 
prosecutorial agency having jurisdiction over VA activities.
    (2) The application may be filed separately or as part of a pending 
civil or criminal action against VA (or agents or employees of VA) in 
which it appears that the patient records are needed to provide material 
evidence. The application must use a fictitious name, such as John Doe, 
to refer to any patient and may not contain or otherwise disclose any 
patient identifying information unless the court has ordered the record 
of the proceeding sealed from public scrutiny or the patient has given a 
written consent (meeting the requirements of Sec.  1.475 of this part) 
to that disclosure.
    (b) Notice not required. An application under this section may, in 
the discretion of the court, be granted without notice. Although no 
express notice is required to VA or to any patient whose records are to 
be disclosed, upon implementation of an order so granted VA or the 
patient must be afforded an opportunity to seek revocation or amendment 
of that order, limited to the presentation of evidence on the statutory 
and regulatory criteria for the issuance of the court order.
    (c) Requirements for order. An order under this section must be 
entered in accordance with, and comply with the requirements of, Sec.  
1.493(d) and (e) of this part.
    (d) Limitations on disclosure and use of patient identifying 
information. (1) An order entered under this section must require the 
deletion of patient identifying information from any documents made 
available to the public.
    (2) No information obtained under this section may be used to 
conduct any investigation or prosecution of a patient, or be used as the 
basis for an application for an order under Sec.  1.494 of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec.  1.496  Orders authorizing the use of undercover agents and informants
to criminally investigate employees or agents of VA.

    (a) Application. A court order authorizing the placement of an 
undercover agent or informant in a VA drug or alcohol abuse, HIV 
infection, or sickle cell anemia treatment program as an employee or 
patient may be applied for by any law enforcement or prosecutorial 
agency which has reason to believe that employees or agents of the VA 
treatment program are engaged in criminal misconduct.
    (b) Notice. The VA facility director must be given adequate notice 
of the application and an opportunity to appear and be heard (for the 
limited purpose of providing evidence on the statutory and regulatory 
criteria for the issuance of the court order), unless the application 
asserts a belief that:
    (1) The VA facility director is involved in the criminal activities 
to be investigated by the undercover agent or informant; or
    (2) The VA facility director will intentionally or unintentionally 
disclose the proposed placement of an undercover agent or informant to 
the employees or agents who are suspected of criminal activities.
    (c) Criteria. An order under this section may be entered only if the 
court determines that good cause exists. To make this determination the 
court must find:

[[Page 47]]

    (1) There is reason to believe that an employee or agent of a VA 
treatment program is engaged in criminal activity;
    (2) Other ways of obtaining evidence of this criminal activity are 
not available or would not be effective; and
    (3) The public interest and need for the placement of an undercover 
agent or informant in the VA treatment program outweigh the potential 
injury to patients of the program, physician-patient relationships and 
the treatment services.
    (d) Content of order. An order authorizing the placement of an 
undercover agent or informant in a VA treatment program must:
    (1) Specifically authorize the placement of an undercover agent or 
an informant;
    (2) Limit the total period of the placement to six months;
    (3) Prohibit the undercover agent or informant from disclosing any 
patient identifying information obtained from the placement except as 
necessary to criminally investigate or prosecute employees or agents of 
the VA treatment program; and
    (4) Include any other measures which are appropriate to limit any 
potential disruption of the program by the placement and any potential 
for a real or apparent breach of patient confidentiality; for example, 
sealing from public scrutiny the record of any proceeding for which 
disclosure of a patient's record has been ordered.
    (e) Limitation on use of information. No information obtained by an 
undercover agent or informant placed under this section may be used to 
criminally investigate or prosecute any patient or as the basis for an 
application for an order under Sec.  1.494 of this part.

[60 FR 63929, Dec. 13, 1995, as amended at 85 FR 64043, Oct. 9, 2020]



Sec. Sec.  1.497-1.499  [Reserved]

  Release of Information From Department of Veterans Affairs Claimant 
                                 Records

    Note: Sections 1.500 through 1.527 concern the availability and 
release of information from files, records, reports, and other papers 
and documents in Department of Veterans Affairs custody pertaining to 
claims under any of the laws administered by the Department of Veterans 
Affairs. As to the release of information from Department of Veterans 
Affairs records other than claimant records, see Sec. Sec.  1.550 
through 1.558. Sections 1.500 through 1.526 implement the provisions of 
38 U.S.C. 5701, 5702.

[32 FR 10848, July 25, 1967]

    Authority: Sections 1.500 to 1.527 issued under 72 Stat. 1114, 1236, 
as amended; 38 U.S.C. 501, 5701.



Sec.  1.500  General.

    (a) Files, records, reports, and other papers and documents 
pertaining to any claim filed with the Department of Veterans Affairs, 
whether pending or adjudicated, and the names and addresses of present 
or former personnel of the armed services, and their dependents, in the 
possession of the Department of Veterans Affairs, will be deemed 
confidential and privileged, and no disclosure therefrom will be made 
except in the circumstances and under the conditions set forth in 
Sec. Sec.  1.501 through 1.526.
    (b) A claimant may not have access to or custody of official 
Department of Veterans Affairs records concerning himself or herself nor 
may a claimant inspect records concerning himself or herself. Disclosure 
of information from Department of Veterans Affairs records to a claimant 
or his or her duly authorized agent or representative may be made, 
however, under the provisions of Sec. Sec.  1.501 through 1.526.
    (c) Each administration, staff office, and field facility head will 
designate an employee(s) who will be responsible for initial action on 
(granting or denying) requests to inspect or obtain information from or 
copies of records under their jurisdiction and within the purview of 
Sec. Sec.  1.501 through 1.526 unless the regulations in this part 
currently contain such designations. The request should be made to the 
office concerned (having jurisdiction of the record desired) or, if not 
known, to the Director or Veterans Assistance Officer in the nearest VA 
regional office, or to the VA Central Office, 810 Vermont Avenue NW., 
Washington, DC 20420. Personal contacts should normally be made during 
the regular duty hours of the office concerned, which are 8 a.m. to 4:30 
p.m., Monday through Friday, for VA

[[Page 48]]

Central Office and most field facilities. Any legal question arising in 
a field facility concerning the release of information will be referred 
to the appropriate Regional Counsel for disposition as contemplated by 
Sec.  13.401 of this chapter. In central office such legal questions 
will be referred to the General Counsel. Any administrative question 
will be referred through administrative channels to the appropriate 
administration or staff office head.
    (d) Upon denial of a request under paragraph (c) of this section, 
the responsible Department of Veterans Affairs official or designated 
employee will inform the requester in writing of the denial and advise 
him or her that he or she may appeal the denial. The requester will also 
be furnished the title and address of the Department of Veterans Affairs 
official to whom the appeal should be addressed. (See Sec.  1.527.) In 
each instance of denial of a request, the denial will be made a matter 
of record and the record will contain a citation to the specific 
provision of Department of Veterans Affairs regulations upon which the 
denial is based.

[24 FR 8174, Oct. 8, 1959, as amended at 32 FR 10848, July 25, 1967; 38 
FR 15601, June 14, 1973]



Sec.  1.501  Release of information by the Secretary.

    The Secretary of Veterans Affairs or the Deputy Secretary may 
release information, statistics, or reports to individuals or 
organizations when in the Secretary's or Deputy Secretary's judgment 
such release would serve a useful purpose.

[32 FR 10848, July 25, 1967, as amended at 54 FR 34980, Aug. 23, 1989]



Sec.  1.502  Disclosure of the amount of monetary benefits.

    The monthly rate of pension, compensation, dependency and indemnity 
compensation, retirement pay, subsistence allowance, or educational 
assistance allowance of any beneficiary shall be made known to any 
person who applies for such information.

[32 FR 10848, July 25, 1967]



Sec.  1.503  Disclosure of information to a veteran or his or her duly
authorized representative as to matters concerning the veteran alone.

    Information may be disclosed to a veteran or his or her duly 
authorized representative as to matters concerning himself or herself 
alone when such disclosure would not be injurious to the physical or 
mental health of the veteran. If the veteran be deceased, matters 
concerning him or her may be disclosed to his widow, children, or next 
of kin if such disclosure will not be injurious to the physical or 
mental health of the person in whose behalf information is sought or 
cause repugnance or resentment toward the decedent.

[13 FR 6999, Nov. 27, 1948]



Sec.  1.504  Disclosure of information to a widow, child, or other
claimant.

    Information may be disclosed to a widow, widower, child, or other 
dependent parent or other claimant, or the duly authorized 
representative of any of these persons as to matters concerning such 
person alone when such disclosure will not be injurious to the physical 
or mental health of the person to whom the inquiry relates. If the 
person concerning whom the information is sought is deceased, matters 
concerning such person may be disclosed to the next of kin if the 
disclosures will not be injurious to the physical or mental health of 
the person in whose behalf the information is sought or cause repugnance 
or resentment toward the decedent.

[13 FR 6999, Nov. 27, 1948, as amended at 54 FR 34980, Aug. 23, 1989]



Sec.  1.505  Genealogy.

    Information of a genealogical nature when its disclosure will not be 
detrimental to the memory of the veteran and not prejudicial, so far as 
may be apparent, to the interests of any living person or to the 
interests of the Government may be released by the Department of 
Veterans Affairs or in the case of inactive records may be released by 
the Archivist of the United States if in the Archivist's custody.

[13 FR 6999, Nov. 27, 1948]

[[Page 49]]



Sec.  1.506  Disclosure of records to Federal Government departments,
State unemployment compensation agencies, and the Office of Servicemembers'
Group Life Insurance.

    (a) All records or documents required for official purposes by any 
department or other agency of the U.S. Government or any state 
unemployment compensation agency acting in an official capacity for the 
Department of Veterans Affairs shall be furnished in response to an 
official request, written, or oral, from such department or agency. If 
the requesting department or agency does not indicate the purpose for 
which the records or documents are requested and there is doubt as to 
whether they are to be used for official purposes, the requesting 
department or agency will be asked to specify the purpose for which they 
are to be used.
    (b) The Under Secretary for Benefits, Director of Insurance Service, 
or designee of either in Central Office, is authorized to release 
information to OSGLI (Office of Servicemembers' Group Life Insurance) 
for the purpose of aiding in the settlement of a particular insurance 
case.

[33 FR 2994, Feb. 15, 1968]



Sec.  1.507  Disclosures to members of Congress.

    Members of Congress shall be furnished in their official capacity in 
any case such information contained in the Department of Veterans 
Affairs files as may be requested for official use. However, in any 
unusual case, the request will be presented to the Secretary, Deputy 
Secretary, or staff or administration head for personal action. When the 
requested information is of a type which may not be furnished a 
claimant, the member of Congress shall be advised that the information 
is furnished to him or her confidentially in his official capacity and 
should be so treated by him or her. (See 38 U.S.C. 5701.) Information 
concerning the beneficiary designation of a United States Government 
Life Insurance or National Service Life Insurance policy is deemed 
confidential and privileged and during the insured's lifetime shall not 
be disclosed to anyone other than the insured or his or her duly 
appointed fiduciary unless the insured or the fiduciary authorizes the 
release of such information.

[32 FR 10848, July 25, 1967]



Sec.  1.508  Disclosure in cases where claimants are charged with or
convicted of criminal offenses.

    (a) Where incompetent claimants are charged with, or convicted of, 
offenses other than those growing out of their relationship with the 
Department of Veterans Affairs and in which it is desired to disclose 
information from the files and records of the Department of Veterans 
Affairs, the Regional Counsel, Under Secretary for Benefits, Veterans 
Benefits Administration, or the General Counsel if the General Counsel 
deems it necessary and proper, may disclose to the court having 
jurisdiction so much of the information from the files and records of 
the Department of Veterans Affairs relating to the mental condition of 
such beneficiaries, the same to be available as evidence, as may be 
necessary to show the mental condition of the accused and the time of 
its onset. This provision, however, does not alter the general procedure 
for handling offenses growing out of relations with the Department of 
Veterans Affairs.
    (b) When desired by a U.S. district court, the Regional Counsel or 
the General Counsel may supply information as to whether any person 
charged with crime served in the military or naval service of the United 
States and whether the Department of Veterans Affairs has a file on such 
person. If the file is desired either by the court or by the prosecution 
or defense, it may be produced only in accord with Sec. Sec.  1.501 
through 1.526.

[21 FR 10375, Dec. 28, 1956, as amended at 32 FR 10848, July 25, 1967; 
54 FR 34980, Aug. 23, 1989]



Sec.  1.509  Disclosure to courts in proceedings in the nature of an
inquest.

    The Under Secretary for Benefits, Veterans Benefits Administration, 
Regional Counsels, and facility heads are authorized to make disclosures 
to courts of competent jurisdiction of such files, records, reports, and 
other documents as are necessary and proper

[[Page 50]]

evidence in proceedings in the nature of an inquest into the mental 
competency of claimants and other proceedings incident to the 
appointment and discharge of guardians, curators, or conservators to any 
court having jurisdiction of such fiduciaries in all matters of 
appointment, discharge, or accounting in such courts.

[32 FR 10848, July 25, 1967]



Sec.  1.510  Disclosure to insurance companies cooperating with the 
Department of Justice in the defense of insurance suits against the
United States.

    Copies of records from the files of the Department of Veterans 
Affairs will, in the event of litigation involving commercial insurance 
policies issued by an insurance company cooperating with the Department 
of Justice in defense of insurance suits against the United States, be 
furnished to such companies without charge, provided the claimant or his 
or her duly authorized representative has authorized the release of the 
information contained in such records. If the release of information is 
not authorized in writing by the claimant or his or her duly authorized 
representative, information contained in the files may be furnished to 
such company if to withhold same would tend to permit the accomplishment 
of a fraud or miscarriage of justice. However, before such information 
may be released without the consent of the claimant, the request 
therefor must be accompanied by an affidavit of the representative of 
the insurance company, setting forth that litigation is pending, the 
character of the suit, and the purpose for which the information desired 
is to be used. If such information is to be used adversely to the 
claimant, the affidavit must set forth facts from which it may be 
determined by the General Counsel or Regional Counsel whether the 
furnishing of the information is necessary to prevent the perpetration 
of a fraud or other injustice. The averments contained in such affidavit 
should be considered in connection with the facts shown by the 
claimant's file, and, if such consideration shows the disclosure of the 
record is necessary and proper to prevent a fraud or other injustice, 
information as to the contents thereof may be furnished to the insurance 
company or copies of the records may be furnished to the court, 
workmen's compensation, or similar board in which the litigation is 
pending upon receipt of a subpoena duces tecum addressed to the 
Secretary of Veterans Affairs, or the head of the office in which the 
records desired are located. In the event the subpoena requires the 
production of the file, as distinguished from the copies of the records, 
no expense to the Department of Veterans Affairs may be involved in 
complying therewith, and arrangements must be made with the 
representative of the insurance company causing the issuance of the 
subpoena to insure submission of the file to the court without expense 
to the Department of Veterans Affairs.

[32 FR 10848, July 25, 1967]



Sec.  1.511  Disclosure of claimant records in connection with judicial
proceedings generally.

    (a)(1) Where a suit (or legal proceeding) has been threatened or 
instituted against the Government, or a prosecution against a claimant 
has been instituted or is being contemplated, the request of the 
claimant or his or her duly authorized representative for information, 
documents, reports, etc., shall be acted upon by the General Counsel in 
Central Office, or the Regional Counsel for the field facility, who 
shall determine the action to be taken with respect thereto. Where the 
records have been sent to the Department of Justice in connection with 
any such suit (or legal proceeding), the request will be referred to the 
Department of Justice, Washington, DC, through the office of the General 
Counsel, for attention. Where the records have been sent to an Assistant 
U.S. Attorney, the request will be referred by the appropriate Regional 
Counsel to the Assistant U.S. Attorney. In all other cases where copies 
of documents or records are desired by or on behalf of parties to a suit 
(or legal proceeding), whether in a Federal court or any other, such 
copies shall be disclosed as provided in paragraphs (b) and (c) of this 
section where the request is accompanied by court process, or paragraph 
(e) of this section where the request is not accompanied by court

[[Page 51]]

process. A court process, such as a court order or subpoena duces tecum 
should be addressed to either the Secretary of Veterans Affairs or to 
the head of the field facility at which the records desired are located. 
The determination as to the action to be taken upon any request for the 
disclosure of claimant records received in this class of cases shall be 
made by the component having jurisdiction over the subject matter in 
Central Office, or the division having jurisdiction over the subject 
matter in the field facility, except in those cases in which 
representatives of the component or division have determined that the 
records desired are to be used adversely to the claimant, in which event 
the process will be referred to the General Counsel in Central Office or 
to the Regional Counsel for the field facility for disposition.
    (2) Where a claim under the provisions of the Federal Tort Claims 
Act has been filed, or where such a claim can reasonably be anticipated, 
no information, documents, reports, etc., will be disclosed except 
through the Regional Counsel having jurisdiction, who will limit the 
disclosure of information to that which would be available under 
discovery proceedings, if the matter were in litigation. Any other 
information may be disclosed only after concurrence in such disclosure 
is provided by the General Counsel.
    (b) Disclosures in response to Federal court process--(1) Court 
order. Except for drug and alcohol abuse, human immunodeficiency virus 
and sickle cell anemia treatment records, which are protected under 38 
U.S.C. 7332, where the records sought are maintained in a VA Privacy Act 
system of records, and are retrieved by the name or other personal 
identifier of a living claimant who is a citizen of the United States or 
an alien lawfully admitted for permanent residence, a Federal court 
order is the process necessary for the disclosure of such records. Upon 
receipt of a Federal court order directing disclosure of claimant 
records, such records will be disclosed. Disclosure of records protected 
under 38 U.S.C. 7332 will be made in accordance with provisions of 
paragraph (g) of this section.
    (2) Subpoena. Except for drug and alcohol abuse, human 
immunodeficiency virus and sickle cell anemia treatment records, which 
are protected under 38 U.S.C. 7332, where the records sought are 
maintained in a VA Privacy Act system of records, and are retrieved by 
the name or other personal identifier of a claimant, a subpoena is not 
sufficient authority for the disclosure of such records and such records 
will not be disclosed, unless the claimant is deceased, or either is not 
a citizen of the United States, or is an alien not lawfully admitted for 
permanent residence. Where one of these exceptions applies, upon receipt 
of a Federal court subpoena, such records will be disclosed. 
Additionally, where the subpoena is accompanied by authorization from 
the claimant, disclosure will be made. Regarding the disclosure of 
medical records pertaining to drug and alcohol abuse, human 
immunodeficiency virus and sickle cell anemia treatment, a subpoena is 
insufficient for such disclosure. Specific provisions for the disclosure 
of these records are set forth in paragraph (g) of this section.
    (3) A disclosure of records in response to the receipt of a Federal 
court process will be made to those individuals designated in the 
process to receive such records, or to the court from which the process 
issued. Where original records are produced, they must remain at all 
times in the custody of a representative of the Department of Veterans 
Affairs, and, if offered and received in evidence, permission should be 
obtained to substitute a copy so that the original may remain intact in 
the record. Where a court process is issued by or on behalf of a party 
litigant other than the United States, such party litigant must prepay 
the costs of copies in accordance with fees prescribed by Sec.  1.526(i) 
and any other costs incident to producing the records.
    (c) Disclosures in response to state or local court process--(1) 
State or local court order. Except for drug and alcohol abuse, human 
immunodeficiency virus and sickle cell anemia treatment records, which 
are protected under 38 U.S.C. 7332, where the records sought are 
maintained in a VA Privacy Act system of records, and are retrieved by 
the name or other personal identifier of a living claimant who is a 
citizen of the United States or an alien lawfully

[[Page 52]]

admitted for permanent residence, a State or local court order is the 
process necessary for disclosure of such records. Upon receipt of a 
State or local court order directing disclosure of claimant records, 
disclosure of such records will be made in accordance with the 
provisions set forth in paragraph (c)(3) of this section. Disclosure of 
records protected under 38 U.S.C. 7332 will be made in accordance with 
provisions of paragraph (g) of this section.
    (2) State or local court subpoena. Except for drug and alcohol 
abuse, human immunodeficiency virus and sickle cell anemia treatment 
records, which are protected under 38 U.S.C. 7332, where the records 
sought are maintained in a VA Privacy Act system of records, and are 
retrieved by the name or other personal identifier of a claimant, a 
subpoena is not sufficient authority for disclosure of such records and 
such records will not be disclosed unless the claimant is deceased, or, 
either is not a citizen of the United States, or is an alien not 
lawfully admitted for permanent residence. Where one of these exceptions 
applies, upon receipt of a State or local court subpoena directing 
disclosure of claimant records, disclosure of such records will be made 
in accordance with the provisions set forth in paragraph (c)(3), of this 
section. Regarding the disclosure of 7332 records, a subpoena is 
insufficient for such disclosure. Specific provisions for the disclosure 
of these records are set forth in paragraph (g) of this section.
    (3) Where the disclosure provisions of paragraph (c) (1) or (2) of 
this section apply, disclosure will be made as follows:
    (i) When the process presented is accompanied by authority from the 
claimant; or,
    (ii) In the absence of claimant disclosure authority, the Regional 
Counsel having jurisdiction must determine whether the disclosure of the 
records is necessary to prevent the perpetration of fraud or other 
injustice in the matter in question. To make such a determination, the 
Regional Counsel may require such additional documentation, e.g., 
affidavit, letter of explanation, or such other documentation which 
would detail the need for such disclosure, set forth the character of 
the pending suit, and the purpose for which the documents or records 
sought are to be used as evidence. The claimant's record may also be 
considered in the making of such determination. Where a court process is 
received, and the Regional Counsel finds that additional documentation 
will be needed to make the foregoing determination, the Regional 
Counsel, or other employee having reasonable knowledge of the 
requirements of this regulation, shall contact the person causing the 
issuance of such court process, and advise that person of the need for 
additional documentation. Where a court appearance is appropriate, and 
the Regional Counsel has found that there is an insufficient basis upon 
which to warrant a disclosure of the requested information, the Regional 
Counsel, or other employee having reasonable knowledge of the 
requirement of this regulation and having consulted with the Regional 
Counsel, shall appear in court and advise the court that VA records are 
confidential and privileged and may be disclosed only in accordance with 
applicable Federal regulations, and to further advise the court of such 
regulatory requirements and how they have not been satisified. Where 
indicated, the Regional Counsel will take appropriate action to have the 
matter of disclosure of the affected records removed to Federal court.
    (4) Any disclosure of records in response to the receipt of State or 
local court process will be made to those individuals designated in the 
process to receive such records, or to the court from which such process 
issued. Payment of the fees as prescribed by Sec.  1.526(i), as well as 
any other cost incident to producing the records, must first be 
deposited with the Department of Veterans Affairs by the party who 
caused the process to be issued. The original records must remain at all 
times in the custody of a representative of the Department of Veterans 
Affairs, and, if there is an offer and admission of any record or 
document contained therein, permission should be obtained to substitute 
a copy so that the original may remain intact in the record.

[[Page 53]]

    (d) Notice requirements where disclosures are made pursuant to court 
process. Whenever a disclosure of Privacy Act protected records is made 
in response to the process of a Federal, State, or local court, the 
custodian of the records disclosed will make reasonable efforts to 
notify the subject of such records that such subject's records were 
disclosed to another person under compulsory legal process. Such notice 
should be accomplished when the process compelling disclosure becomes a 
matter of public record. Generally, a notice sent to the last known 
address of the subject would be sufficient to comply with this 
requirement.
    (e) Disclosures in response to requests when not accompanied by 
court process. Requests received from attorneys or others for copies of 
records for use in suits in which the Government is not involved, not 
accompanied by a court process, will be handled by the component or 
division having jurisdiction over the subject matter. If the request can 
be complied with under Sec.  1.503 or Sec.  1.504, and under the Privacy 
Act (to the extent that such records are protected by the Privacy Act), 
the records requested will be disclosed upon receipt of the required 
fee. If, however, the records cannot be furnished under such authority, 
the applicant will be advised of the procedure to obtain copies of 
records as set forth in paragraphs (b) and (c) of this section.
    (f) Suits by or against the Secretary under 38 U.S.C. 3720. Records 
pertaining to the loan guaranteed, insured, or made by the Department of 
Veterans Affairs may be made available by the General Counsel or the 
Regional Counsel subject to the usual rules of evidence, and where 
authorized under the Privacy Act, after clearance with the Department of 
Justice or U.S. Attorney if appropriate.
    (g) Disclosure of drug abuse, alcohol abuse, human immunodeficiency 
virus and sickle cell anemia treatment or related records under court 
process. Disclosure of these types of records, which are protected from 
unauthorized disclosure under 38 U.S.C. 7332, may be made only in 
response to an appropriate order of a court of competent jurisdiction 
granted after application showing good cause therefore. In assessing 
good cause the court is required to weigh the public interest and the 
need for disclosure against the injury to the patient or subject, to the 
physician-patient relationship, and to the treatment services. The 
court, in determining the extent to which any disclosure of all or any 
part of any record is necessary, shall impose appropriate safeguards 
against unauthorized disclosure. As to a Federal court order satisfying 
the requirements of this paragraph, the records will be disclosed as 
provided in such order. As to a State or local court order satisfying 
the requirements of this subsection, the disclosure of the records 
involved is conditioned upon satisfying the provisions set forth in 
paragraph (c)(3) of this section. If the aforementioned section is 
satisfied, and a disclosure of records is to be forthcoming, the records 
will be disclosed as provided in the court order.

(Authority: 5 U.S.C. 552; 5 U.S.C. 552a; 38 U.S.C. 5701 and 38 U.S.C. 
7332)

[56 FR 15833, Apr. 18, 1991]



Sec.  1.512  Disclosure of loan guaranty information.

    (a) The disclosure of records or information contained in loan 
guaranty files is governed by the Freedom of Information Act, 5 U.S.C. 
552; the Privacy Act, 5 U.S.C. 552a; the confidentiality provisions of 
38 U.S.C. 5701, and the provisions of 38 CFR 1.500-1.584. In addition, 
the release of names and addresses and the release of certificates of 
reasonable value, appraisal reports, property inspection reports, or 
reports of inspection on individual water supply and sewage disposal 
systems shall be governed by paragraphs (b), (c), (d), and (e) of this 
section.
    (b)(1) Upon request, any person is entitled to obtain copies of 
certificates of reasonable value, appraisal reports, property inspection 
reports, or reports of inspection on individual water supply and sewage 
disposal systems provided that the individual identifiers of the 
veteran-purchaser(s) or dependents are deleted prior to release of such 
documents. However, individual identifiers may be disclosed in 
accordance with paragraph (b)(2) of this section. The address of the 
property being appraised or

[[Page 54]]

inspected shall not be considered an individual identifier.


(Authority: 38 U.S.C. 5701(a), (c))

    (2) Individual identifiers of veteran purchasers or dependents may 
be disclosed when disclosure is made to the following:
    (i) The individual purchasing the property;
    (ii) The current owner of the property;
    (iii) The individual that requested the appraisal or report;
    (iv) A person or entity which is considering making a loan to an 
individual with respect to the property concerned; or
    (v) An attorney, real estate broker, or any other agent representing 
any of these persons.


(Authority: 38 U.S.C. 5701(c), (h)(2)(D))

    (c)(1) The Secretary may release the name, address, or both, and may 
release other information relating to the identity of an applicant for 
or recipient of a Department of Veterans Affairs-guaranteed, insured, or 
direct loan, specially adapted housing grant, loan to finance 
acquisition of Department of Veterans Affairs-owned property, release of 
liability, or substitution of entitlement to credit reporting agencies, 
companies or individuals extending credit, depository institutions, 
insurance companies, investors, lenders, employers, landlords, utility 
companies and governmental agencies for any of the purposes specified in 
paragraph (c)(2) of this section.
    (2) A release may be made under paragraph (c)(1) of this section:
    (i) To enable such parties to provide the Department of Veterans 
Affairs with data which assists in determining the creditworthiness, 
credit capacity, income or financial resources of the applicant for or 
recipient of loan guaranty administered benefits, or verifying whether 
any such data previously received is accurate; or
    (ii) To enable the Secretary to offer for sale or other disposition 
any loan or installment sale contract.


(Authority: 38 U.S.C. 5701(h)(2)(A), (B), (C))

    (d) Upon request, the Secretary may release information relating to 
the individual's loan transaction to credit reporting agencies, 
companies or individuals extending credit, depository institutions, 
insurance companies, investors, lenders, employers, landlords, utility 
companies and governmental agencies where necessary in connection with a 
transfer of information on the status of a Department of Veterans 
Affairs loan account to persons or organizations proposing to extend 
credit or render services or other benefits to the borrower in order 
that the person or organization may determine whether to extend credit 
or render services or other benefits to the borrower. Such releases 
shall be made only if the person or organization seeking the information 
furnishes the individual's name, address or other information necessary 
to identify the individual.


(Authority: 38 U.S.C. 5701(e), (h)(2)(A) and (D))

    (e) The Secretary shall maintain information in the loan guaranty 
file consisting of the date, notice and purpose of each disclosure, and 
the name and address of the person to whom the disclosure is made from 
the loan guaranty files.

(Authority: 38 U.S.C. 5701(h)(2)(D), 5 U.S.C. 552a(c))

[47 FR 11279, Mar. 16, 1982]



Sec.  1.513  Disclosure of information contained in Armed Forces service
and related medical records in Department of Veterans Affairs custody.

    (a) Service records. Information received by the Department of 
Veterans Affairs from the Departments of the Army, Navy, Air Force, and 
the Department of Transportation relative to the military or naval 
service of a claimant is furnished solely for the official use of the 
Department of Veterans Affairs but such information may be disclosed 
under the limitations contained in Sec. Sec.  1.501 through 1.526.
    (b) Medical records. Information contained in the medical records 
(including clinical records and social data) may be released under the 
following conditions:
    (1) Complete transcript of r[eacute]sum[eacute] or medical records 
on request to:

[[Page 55]]

    (i) The Department of the Army.
    (ii) The Department of the Navy (including naval aviation and United 
States Marine Corps).
    (iii) The Department of the Air Force.
    (iv) The Department of Transportation (Coast Guard).
    (v) Selective Service (in case of registrants only).
    (vi) Federal or State hospitals or penal institutions when the 
veteran is a patient or inmate therein.
    (vii) United States Public Health Service, or other governmental or 
contract agency in connection with research authorized by, or conducted 
for, the Department of Veterans Affairs.
    (viii) Registered civilian physicians, on the request of the 
individual or his or her legal representative, when required in 
connection with the treatment of the veteran. (The transcript or resume 
should be accompanied by the statement ``it is expected that the 
information contained herein will be treated as confidential, as is 
customary in civilian professional medical practice.'')
    (ix) The veteran on request, except information contained in the 
medical record which would prove injurious to his or her physical or 
mental health.
    (x) The next of kin on request of the individual, or legal 
representative, when the information may not be disclosed to the veteran 
because it will prove injurious to his or her physical or mental health, 
and it will not be injurious to the physical or mental health of the 
next of kin or cause repugnance or resentment toward the veteran; and 
directly to the next of kin, or legal representative, when the veteran 
has been declared to be insane or is dead.
    (xi) Health and social agencies, on the authority of the veteran or 
his or her duly authorized representative.
    (2) In addition to the authorizations in paragraph (b)(1) of this 
section, the Department of Justice, the Department of the Treasury, and 
the U.S. Postal Service may, on request, be given pertinent information 
from medical records for use in connection with investigations conducted 
by these departments. Each such request shall be considered on its 
merits, and the information released should be the minimum necessary in 
connection with the investigation conducted by these departments.
    (3) Compliance with court orders calling for the production of 
medical records in connection with litigation or criminal prosecutions 
will be effected in accordance with Sec.  1.511.

[13 FR 7001, Nov. 27, 1948, as amended at 32 FR 10849, July 25, 1967; 60 
FR 63938, Dec. 13, 1995]



Sec.  1.514  Disclosure to private physicians and hospitals other than
Department of Veterans Affairs.

    (a) When a beneficiary elects to obtain medical attention as a 
private patient from a private practitioner or in a medical center other 
than a Department of Veterans Affairs hospital, there may be disclosed 
to such private practitioner or head of such medical center (Federal, 
State, municipal, or private), such information as to the medical 
history, diagnosis, findings, or treatment as is requested, including 
the loan of original X-ray films, whether Department of Veterans Affairs 
clinical X-rays or service department entrance and separation X-rays, 
provided there is also submitted a written authorization from the 
beneficiary or his or her duly authorized representative. The 
information will be supplied without charge directly to the private 
physician or medical center head and not through the beneficiary or 
representative. In forwarding this information, it will be accompanied 
by the stipulations that it is released with consent of or on behalf of 
the patient and that the information will be treated as confidential, as 
is customary in civilian professional medical practice.
    (b) Such information may be released without charge and without 
consent of the patient or his or her duly authorized representative when 
a request for such information is received from:
    (1) The superintendent of a State hospital for psychotic patients, a 
commissioner or head of a State department of mental hygiene, or head of 
a State, county, or city health department; or
    (2) Any fee basis physician or institution in connection with 
authorized

[[Page 56]]

treatment of the veteran as a Department of Veterans Affairs 
beneficiary; or
    (3) Any physician or medical installation treating the veteran under 
emergency conditions.

[34 FR 13368, Aug. 19, 1969, as amended at 54 FR 34980, Aug. 23, 1989]



Sec.  1.514a  Disclosure to private psychologists.

    When a beneficiary elects to obtain therapy or analysis as a private 
patient from a private psychologist, such information in the medical 
record as may be pertinent may be released. Generally, only information 
developed and documented by Department of Veterans Affairs psychologists 
will be considered pertinent, although other information from the 
medical record may be released if it is determined to be pertinent and 
will serve a useful purpose to the private psychologist in rendering his 
or her services. Information will be released under this section upon 
receipt of the written authorization of the beneficiary or his or her 
duly authorized representative. Information will be forwarded to private 
psychologists directly, not through the beneficiary or representative, 
without charge and with the stipulation that it is released with consent 
of or on behalf of the patient and must be treated as confidential as is 
customary in regular professional practice.

[34 FR 13368, Aug. 19, 1969]



Sec.  1.514b  Disclosures to procurement organizations.

    A VHA health care facility may disclose the name and home address of 
an ``individual'' as defined in Sec.  1.460 to an authorized 
representative of a ``procurement organization'' as also defined in 
Sec.  1.460 for the purpose of facilitating a determination by the 
procurement organization of whether the individual is a suitable 
potential organ, eye, or tissue donor if:
    (a) The individual is currently an inpatient in a VHA health care 
facility;
    (b) The individual is, in the clinical judgment of the individual's 
primary health care provider, near death or is deceased as defined in 
Sec.  1.460;
    (c) The VHA health care facility has a signed agreement with the 
procurement organization in accordance with the applicable requirements 
of the United States Department of Health and Human Services (HHS); and
    (d) The VHA health care facility has confirmed with HHS that it has 
certified or recertified the organ procurement organization as provided 
in the applicable HHS regulations. VA medical centers must verify 
annually in January of each calendar year with FDA that an eye bank or 
tissue bank has complied with the FDA registration requirements of 21 
CFR part 1271 and that the registration status is active before 
permitting an eye bank or tissue bank to receive protected health 
information.

(Authority: 38 U.S.C. 5701(k), 7332(b)(2)(E))

[72 FR 48242, Aug. 23, 2007, as amended at 73 FR 65260, Nov. 3, 2008]



Sec.  1.515  Disclosure of information to participate in state prescription
drug monitoring programs.

    (a) General. Information covered by Sec. Sec.  1.500 through 1.527 
of this part may be disclosed to State Prescription Drug Monitoring 
Programs pursuant to the limitations set forth in paragraph (c) of this 
section.
    (b) Definitions. For the purposes of this section:
    Controlled substance means any substance identified in 21 CFR part 
1308 as a schedule II, III, IV, or V controlled substance.
    State Prescription Drug Monitoring Program (PDMP) means a State 
controlled substance monitoring program, including a program approved by 
the Secretary of Health and Human Services under section 399O of the 
Public Health Service Act (42 U.S.C. 280g-3).
    (c) Participation in PDMPs. VA may disclose to PDMPs any of the 
following information concerning the prescription of controlled 
substances:
    (1) Demographic information of veterans and dependents of veterans 
who are prescribed a controlled substance. Examples include name, 
address, and telephone number.
    (2) Information about the prescribed controlled substances. Examples 
include the identification of the substance by a national drug code 
number,

[[Page 57]]

quantity dispensed, number of refills ordered, whether the substances 
were dispensed as a refill of a prescription or as a first-time request, 
and date of origin of the prescription.
    (3) Prescriber information. Examples include the prescriber's United 
States Drug Enforcement Administration-issued identification number 
authorizing the individual to prescribe controlled substances and United 
States Department of Health and Human Services-issued National Provider 
Identifier number.

(Authority: 5 U.S.C. 552a; 38 U.S.C. 5701, 7332; 45 CFR 164.512(b))

[78 FR 9593, Feb. 11, 2013]



Sec.  1.516  Disclosure of information to undertaker concerning burial of
a deceased veteran.

    When an undertaker requests information believed to be necessary in 
connection with the burial of a deceased veteran, such as the name and 
address of the beneficiary of the veteran's Government insurance policy, 
name and address of the next of kin, rank or grade of veteran and 
organization in which he or she served, character of the veteran's 
discharge, or date and place of birth of the veteran, and it appears 
that the undertaker is holding the body awaiting receipt of the 
information requested, the undertaker, in such instances, may be 
considered the duly authorized representative of the deceased veteran 
for the purpose of obtaining said information. In ordinary cases, 
however, the undertaker will be advised that information concerning the 
beneficiary of a Government insurance policy is confidential and cannot 
be disclosed; the beneficiary will be advised immediately of the 
inquiry, and the furnishing of the desired information will be 
discretionary with the beneficiary. In no case will the undertaker be 
informed of the net amount due under the policy or furnished information 
not specifically mentioned in this paragraph.

[46 FR 62059, Dec. 22, 1981]



Sec.  1.517  Disclosure of vocational rehabilitation and education 
information to educational institutions cooperating with the Department
of Veterans Affairs.

    Requests from educational institutions and agencies cooperating with 
the Department of Veterans Affairs in the vocational rehabilitation and 
education of veterans for the use of vocational rehabilitation and 
education records for research studies will be forwarded to central 
office with the facility head's recommendation for review by the Under 
Secretary for Benefits. Where the request to conduct a research study is 
approved by the Under Secretary for Benefits, the facility head is 
authorized by this section to release information for such studies from 
vocational rehabilitation and education records as required: Provided, 
however, That any data or information obtained shall not be published 
without prior approval of the Under Secretary for Benefits and that data 
contained in published material shall not identify any individual 
veteran.

[30 FR 6435, May 8, 1965]



Sec.  1.518  Addresses of claimants.

    (a) It is the general policy of the Department of Veterans Affairs 
to refuse to furnish addresses from its records to persons who desire 
such information for debt collection, canvassing, harassing or for 
propaganda purposes.
    (b) The address of a Department of Veterans Affairs claimant as 
shown by Department of Veterans Affairs files may be furnished to:
    (1) Duly constituted police or court officials upon official request 
and the submission of a certified copy either of the indictment returned 
against the claimant or of the warrant issued for his or her arrest.
    (2) Police, other law enforcement agencies, or Federal, State, 
county, or city welfare agencies upon official written request showing 
that the purpose of the request is to locate a parent who has deserted 
his or her child or children and that other reasonable efforts to obtain 
an address have failed. The address will not be released when such 
disclosure would be prejudicial to the mental or physical health of the 
claimant. When an address is furnished

[[Page 58]]

it will be accompanied by the stipulation that it is furnished on a 
confidential basis and may not be disclosed to any other individual or 
agency.
    (c) When an address is requested that may not be furnished under 
Sec. Sec.  1.500 through 1.526, the person making the request will be 
informed that a letter, or in those cases involving judicial actions, 
the process or notice in judicial proceedings, enclosed in an unsealed 
envelope showing no return address, with the name of the addressee 
thereon, and bearing sufficient postage to cover mailing costs will be 
forwarded by the Department of Veterans Affairs. If a request indicates 
that judicial action is involved in which a process or notice in 
judicial proceedings is required to be forwarded, the Department of 
Veterans Affairs will inform the person who requests the forwarding of 
such a document that the envelope must bear sufficient postage to cover 
costs of mailing and certified or registered mailing fees, including 
cost of obtaining receipt for the certified or registered mail when 
transmission by this type special mail is desired. At the time the 
letter, process, or notice in judicial proceedings is forwarded, the 
facility's return address will be placed on the envelope. When the 
receipt for certified or registered mail or the undelivered envelope is 
returned to the Department of Veterans Affairs, the original sender will 
be notified thereof: However, the receipt or the envelope will be 
retained by the Department of Veterans Affairs. This provision will be 
applicable only when it does not interfere unduly with the functions of 
the Service or division concerned. In no event will letters be forwarded 
to aid in the collection of debts or for the purpose of canvassing, 
harassing, or propaganda. Neither will a letter be forwarded if the 
contents could be harmful to the physical or mental health of the 
recipient.
    (d) Subject to the conditions set forth in Sec.  1.922, the 
Department of Veterans Affairs may disclose to consumer reporting 
agencies information contained in a debtor's claims folder. Such 
information may include the debtor's name and/or address, Department of 
Veterans Affairs file number, Social Security number, and date of birth.

(Authority: 38 U.S.C. 5701(g))

[33 FR 10516, July 24, 1968 and 35 FR 5176, Mar. 27, 1970, as amended at 
46 FR 62059, Dec. 22, 1981]



Sec.  1.519  Lists of names and addresses.

    (a) Any organization wanting a list of names and addresses of 
present or former personnel of the armed services and their dependents 
from the Department of Veterans Affairs must make written application to 
the Department of Veterans Affairs Controller, except lists of 
educationally disadvantaged veterans should be requested from the 
Director of the nearest regional office. The application must:
    (1) Clearly identify the type or category of names and addresses 
sought;
    (2) Furnish proof satisfactory to the Department of Veterans Affairs 
that the organization seeking the list is a ``nonprofit organization.'' 
Normally, evidence establishing that the organization is exempt from 
taxation in accordance with the provisions of 26 U.S.C. 501 or is a 
governmental body or institution will be accepted as satisfying this 
criteria;
    (3) Contain a statement clearly setting forth the purpose for which 
the list is sought, the programs and the resources the organization 
proposes to devote to this purpose, and establish how such purpose is 
``directly connected with the conduct of programs and the utilization of 
benefits'' under title 38, U.S.C.; and
    (4) Contain a certification that the organization, and all members 
thereof who will have access to the list, are aware of the penalty 
provisions of 38 U.S.C. 5701(f) and will not use the list for any 
purpose other than that stated in the application.
    (b) If the Director of the regional office concerned finds that the 
organization requesting the list of names and addresses of educationally 
disadvantaged veterans is a nonprofit organization and operates an 
approved program of special secondary, remedial, preparatory or other 
educational or supplementary assistance to veterans as provided under 
subchapter V, title 38 U.S.C., then he or she may authorize

[[Page 59]]

the release of such names and addresses to the organization requesting 
them.
    (c) The Associate Deputy Assistant Secretary for Information 
Resources Management is authorized to release lists of names and 
addresses to organizations which have applied for such lists in 
accordance with paragraph (a) of this section, if he or she finds that 
the purpose for which the organization desires the names and addresses 
is directly connected with conduct of programs and the utilization of 
benefits under title 38 U.S.C. Lists of names and addresses authorized 
to be released pursuant to this paragraph shall not duplicate lists 
released to other elements, segments, or chapters of the same 
organization.
    (d) If the list requested is one that the Department of Veterans 
Affairs has previously compiled or created, in the same format, to carry 
out one or more of its basic program responsibilities and it is 
determined that it can be released, the list may be furnished without 
charge. For other types of lists, a charge will be made in accordance 
with the provisions of Sec.  1.526.
    (e) Upon denial of a request, the Department of Veterans Affairs 
Controller or Regional Office Director will inform the requester in 
writing of the denial and the reasons therefor and advise the 
organization that it may appeal the denial to the General Counsel. In 
each instance of a denial of a request, the denial and the reasons 
therefor will be made a matter of record.
    (f) Section 5701(f), title 38 U.S.C., provides that any 
organization, or member thereof, which uses the names and addresses 
furnished it for any purpose other than one directly connected with the 
conduct of programs and the utilization of benefits under title 38 
U.S.C., shall be fined not more than $500 in the case of the first 
offense and not more than $5,000 in the case of the subsequent offenses. 
Any instance in which there is evidence of a violation of these penal 
provisions will be reported in accordance with Sec.  14.560.

(Approved by the Office of Management and Budget under control number 
2900-0438)

[38 FR 15601, June 14, 1973, as amended at 46 FR 62059, Dec. 22, 1981; 
49 FR 32848, Aug. 17, 1984; 56 FR 59218, Nov. 25, 1991; 84 FR 12125, 
Apr. 1, 2019]



Sec.  1.520  Confidentiality of social data.

    Persons having access to social data will be conscious of the fact 
that the family, acquaintances, and even the veteran have been willing 
to reveal these data only on the promise that they will be held in 
complete confidence. There will be avoided direct, ill-considered 
references which may jeopardize the personal safety of these individuals 
and the relationship existing among them, the patient, and the social 
worker, or may destroy their mutual confidence and influence, rendering 
it impossible to secure further cooperation from these individuals and 
agencies. Physicians in talking with beneficiaries will not quote these 
data directly but will regard them as indicating possible directions 
toward which they may wish to guide the patient's self-revelations 
without reproaching the patient for his or her behavior or arousing 
natural curiosity or suspicion regarding any informant's statement. The 
representatives of service organizations and duly authorized 
representatives of veterans will be especially cautioned as to their 
grave responsibility in this connection.

[46 FR 62059, Dec. 22, 1981]



Sec.  1.521  Special restrictions concerning social security records.

    Information received from the Social Security Administration may be 
filed in the veteran's claims folder without special provisions. Such 
information will be deemed privileged and may not be released by the 
Department of Veterans Affairs except that information concerning the 
amount of social security benefits paid to a claimant or the amount of 
social security tax contributions made by the claimant may be disclosed 
to the claimant or his or her duly authorized representative. Any 
request from outside the Department of Veterans Affairs for other social 
security information will be referred to the Social Security 
Administration for such action as they deem proper.

[27 FR 9599, Sept. 28, 1962]

[[Page 60]]



Sec.  1.522  Determination of the question as to whether disclosure will
be prejudicial to the mental or physical health of claimant.

    Determination of the question when disclosure of information from 
the files, records, and reports will be prejudicial to the mental or 
physical health of the claimant, beneficiary, or other person in whose 
behalf information is sought, will be made by the Chief Medical 
Director; Chief of Staff of a hospital; or the Director of an outpatient 
clinic.

[33 FR 19009, Dec. 20, 1968]



Sec.  1.523  To commanding officers of State soldiers' homes.

    When a request is received in a Department of Veterans Affairs 
regional office, center, or medical center from the commanding officer 
of a State soldiers' home for information other than information 
relative to the character of the discharge from a Department of Veterans 
Affairs center or medical center concerning a veteran formerly domiciled 
or hospitalized therein, the provisions of Sec.  1.500 are applicable, 
and no disclosure will be made unless the request is accompanied by the 
authorization outlined in Sec.  1.503. However, station heads, upon 
receipt of a request from the commanding officer of a State soldiers' 
home for the character of the discharge of a veteran from a period of 
hospital treatment or domiciliary care as a beneficiary of the 
Department of Veterans Affairs, will comply with the request, 
restricting the information disclosed solely to the character of the 
veteran's discharge from such treatment or care. Such information will 
be disclosed only upon receipt of a specific request therefor from the 
commanding officer of a State soldiers' home.

[30 FR 6435, May 8, 1965. Redesignated at 78 FR 9593, Feb. 11, 2013]



Sec.  1.524  Persons authorized to represent claimants.

    A duly authorized representative will be:
    (a) Any person authorized in writing by the claimant to act for him 
or her,
    (b) An attorney who has filed the declaration required by Sec.  
14.629(b)(1) of this chapter, or
    (c) His or her legally constituted fiduciary, if the claimant is 
incompetent. Where for proper reasons no legally constituted fiduciary 
has been or will be appointed, his or her spouse, his or her children, 
or, if the claimant is unmarried, either of his or her parents shall be 
recognized as the fiduciary of the claimant.

[33 FR 6536, Apr. 30, 1968]



Sec.  1.525  Inspection of records by or disclosure of information to
recognized representatives of organizations and recognized attorneys.

    (a)(1) The accredited representatives of recognized organizations 
(Sec.  14.627 of this chapter) holding appropriate power of attorney and 
recognized attorneys (Sec.  14.629(b) of this chapter) with the written 
authorization of the claimant may, subject to the restrictions imposed 
by paragraph (a)(2) of this section, inspect the claims, insurance and 
allied folders of any claimant upon the condition that only such 
information contained therein as may be properly disclosed under 
Sec. Sec.  1.500 through 1.526 will be disclosed by him or her to the 
claimant or, if the claimant is incompetent, to his or her legally 
constituted fiduciary. Under the same restrictions, it is permissible to 
release information from and permit inspection of loan guaranty folders 
in which a request for a waiver of the debt of a veteran or his or her 
spouse has been received, or where there has been a denial of basic 
eligibility for loan guaranty benefits. All other information in the 
files shall be treated as confidential and will be used only in 
determining the status of the cases inspected or in connection with the 
presentation to officials of the Department of Veterans Affairs of the 
claim of the claimant. The heads of field facilities and the directors 
of the services concerned in Central Office will each designate a 
responsible officer to whom requests for all files must be made, except 
that managers of centers with insurance activities will designate two 
responsible officials, recommended by the division chiefs concerned, one 
responsible for claims and allied folders and the other for insurance 
files. The term claimant as used in this paragraph includes insureds.

[[Page 61]]

    (2) In the case of a living veteran a representative acting under a 
power of attorney from any person not acting on behalf of the veteran 
will not be permitted to review the records of the veteran or be 
furnished any information therefrom to which the person is not entitled, 
i.e., information not relating to such person alone. Powers of attorney 
submitted by the other person will be considered ``Limited'' and will be 
so noted when associated with the veteran's records. The provisions of 
this subparagraph are also applicable to recognized attorneys and the 
requisite declarations filed by them.
    (3) When power of attorney does not obtain, the accredited 
representative will explain to the designated officer of the Department 
of Veterans Affairs the reason for requesting information from the file, 
and the information will be made available only when in the opinion of 
the designated officer it is justified; in no circumstances will such 
representatives be allowed to inspect the file; in such cases a contact 
report will be made out and attached to the case, outlining the reasons 
which justify the verbal or written release of the information to the 
accredited representative.
    (4) In any case where there is an unrevoked power of attorney or 
declaration of representation, no persons or organizations other than 
the one named in such document shall be afforded information from the 
file except under the conditions set forth in Sec.  14.629(b)(2) of this 
chapter. When any claimant has filed notice with the Department of 
Veterans Affairs that he or she does not want his or her file inspected, 
such file will not be made available for inspection.
    (b)(1) Inspection of folders by accredited representatives or 
recognized attorneys holding a written authorization where such cases 
are being processed shall be in space assigned for such inspection. 
Otherwise station heads may permit inspection of folders at the desks of 
the accredited representatives, in the office(s) which they regularly 
occupy.
    (2) An insured or after maturity of the insurance by death of the 
insured, the beneficiary, may authorize the release to a third person of 
such insurance information as the insured or the beneficiary would be 
entitled to receive, provided there is submitted to the Department of 
Veterans Affairs, a specific authorization in writing for this purpose.
    (3) Unless otherwise authorized by the insured or the beneficiary, 
as the case may be, such authorized representative, recognized attorney 
or accredited representative shall not release information as to the 
designated beneficiary to anyone other than the insured or to the 
beneficiary after death of the insured. Otherwise, information in the 
insurance file shall be subject to the provisions of Sec. Sec.  1.500 
through 1.526.
    (4) Clinical records and medical files, including files for 
outpatient treatment, may be inspected by accredited representatives or 
recognized attorneys holding a written authorization only to the extent 
such records or parts thereof are incorporated in the claims folder, or 
are made available to Department of Veterans Affairs personnel in the 
adjudication of the claim. Records or data in clinical or medical files 
which are not incorporated in the claims folder or which are not made 
available to Department of Veterans Affairs personnel for adjudication 
purposes will not be inspected by anyone other than those employees of 
the Department of Veterans Affairs whose duties require same for the 
purpose of clinical diagnosis or medical treatment.
    (5) Under no circumstances shall any paper be removed from a file, 
except by a Department of Veterans Affairs employee, for purpose of 
having an authorized copy made. Copying of material in a file shall not 
be permitted except in connection with the performance of authorized 
functions under the power of attorney or requisite declaration of a 
recognized attorney.
    (6) In any case involving litigation against the Government, whether 
contemplated or initiated, inspection, subject to the foregoing, shall 
be within the discretion of the General Counsel or Regional Counsel, 
except that in insurance suits under 38 U.S.C. 1975, 1984, inspection 
shall be within the discretion of the official having jurisdiction of 
the claim. Files in such cases may be

[[Page 62]]

released to the Department of Justice, but close liaison will be 
maintained to insure their return intact upon termination of the 
litigation.
    (c) Facility heads and the directors of the services concerned in 
central office will be responsible for the administrative compliance 
with and accomplishment of the foregoing within their jurisdiction, and 
any violations of the prescribed conditions for inspection of files or 
release of information therefrom will be brought to the immediate 
attention of the Secretary.
    (d) Any person holding power of attorney, a recognized attorney who 
has filed the requisite declaration, or the accredited representative of 
a recognized organization holding power of attorney shall be supplied 
with a copy of each notice to the claimant respecting the adjudication 
of the claim. If a claimant dies before action on the claim is 
completed, the person or organization holding power of attorney or the 
attorney who has filed the requisite declaration may continue to act 
until the action is completed except where the power of attorney or 
requisite declaration was filed on behalf of a dependent.
    (e) When in developing a claim the accredited representative of a 
recognized organization finds it necessary to call upon a local 
representative to assemble information or evidence, he or she may make 
such disclosures to the local representative as the circumstances of the 
case may warrant, provided the power of attorney to the recognized 
organization contains an authorization permitting such disclosure.

[13 FR 7002, Nov. 27, 1948, as amended at 31 FR 3459, Mar. 5, 1966; 32 
FR 10849, July 25, 1967; 33 FR 6536, Apr. 30, 1968]



Sec.  1.526  Copies of records and papers.

    (a) Any person desiring a copy of any record or document in the 
custody of the Department of Veterans Affairs, which is subject to be 
furnished under Sec. Sec.  1.501 through 1.526, must make written 
application for such copy to the Department of Veterans Affairs 
installation having custody of the subject matter desired, stating 
specifically: (1) The particular record or document the copy of which is 
desired and whether certified and validated, or uncertified, (2) the 
purpose for which such copy is desired to be used.
    (b) The types of services provided by the Department of Veterans 
Affairs for which fees will be charged are identified in paragraph (i) 
of this section.
    (c) This section applies to the services furnished in paragraph (b) 
of this section when rendered to members of the public by the Department 
of Veterans Affairs. It does not apply to such services when rendered to 
or for other agencies or branches of the Federal Government, or State 
and local governments when furnishing the service will help to 
accomplish an objective of the Department of Veterans Affairs, or when 
performed in connection with a special research study or compilation 
when the party requesting such services is charged an amount for the 
whole job.
    (d) When copies of a record or document are furnished under 
Sec. Sec.  1.506, 1.507, 1.510, and 1.514, such copies shall be supplied 
without charge. Moreover, free service may be provided, to the extent of 
one copy, to persons who have been required to furnish original 
documents for retention by the Department of Veterans Affairs.
    (e) The following are circumstances under which services may be 
provided free at the discretion of facility heads or responsible Central 
Office officials:
    (1) When requested by a court, when the copy will serve as a 
substitute for personal court appearance of a Government witness.
    (2) When furnishing the service free saves costs or yields income 
equal to the direct costs of the agency providing the service. This 
includes cases where the fee for the service would be included in a 
billing against the Government (for example, in cost-type contracts, or 
in the case of private physicians who are treating Government 
beneficiaries at Government expense).
    (3) When a service is occasional and incidental, not of a type that 
is requested often, and if it is administratively determined that a fee 
would be inappropriate in such an occasional case.
    (f) When information, statistics, or reports are released or 
furnished under Sec.  1.501 or Sec.  1.519, the fee charge, if any,

[[Page 63]]

will be determined upon the merits of each individual application.
    (g) In those cases where it is determined that a fee shall be 
charged, the applicant will be advised to deposit the amount of the 
lawful charge for the copy desired. The amount of such charge will be 
determined in accordance with the schedule of fees prescribed in 
paragraph (i) of this section. The desired copy will not be delivered, 
except under court subpoena, until the full amount of the lawful charge 
is deposited. Any excess deposit of $1 or more over the lawful charge 
will be returned to the applicant. Excess deposits of less than $1 will 
be returned upon request. When a deposit is received with an 
application, such a deposit will be returned to the applicant should the 
application be denied.
    (h) Copies of reports or records received from other Government 
departments or agencies will not be furnished except as provided in 
Sec.  1.513.
    (i) Fees to be charged--(1) Schedule of fees:

------------------------------------------------------------------------
              Activity                               Fees
------------------------------------------------------------------------
(i) Duplication of document by any   $0.15 per page after first 100 one-
 type of reproduction process to      sided pages.
 produce plain one-sided paper
 copies of a standard size (8\1/
 2\ x 11; 8\1/
 2\ x 14;
 11 x 14).
(ii) Duplication of non-paper        Actual direct cost to the Agency as
 records, such as microforms,         defined in Sec.   1.555(a)(2) of
 audiovisual materials (motion        this part to the extent that it
 pictures, slides, laser optical      pertains to the cost of
 disks, video tapes, audiotapes,      duplication.
 etc.) computer tapes and disks,
 diskettes for personal computers,
 and any other automated media
 output.
(iii) Duplication of documents by    Actual direct cost to the Agency as
 any type of reproduction process     defined in Sec.   1.555(a)(2) of
 not covered by paragraphs (i)(1)     this part to the extent that it
 (i) and (ii) of this section to      pertains to the cost of
 produce a copy in a form             duplication.
 reasonably usable by a requester.
(iv) Providing special information,  Actual cost to the Agency including
 statistics, reports, drawings,       computer and manual search costs,
 specifications, lists of names and   copying costs, labor, and material
 addresses (either in paper or        and overhead expenses.
 machine readable form), computer
 or other machine readable output.
(v) Attestation under the seal of    $3.00 per document so certified.
 the Agency.
(vi) Providing abstracts or copies   $10.00 per request.
 of medical and dental records to
 insurance companies for other than
 litigation purposes.
(vii) Providing files under court    Actual direct cost to the Agency.
 subpoena.
------------------------------------------------------------------------
(Note. If VA regularly contracts for duplicating services related to
  providing the requested records, such as the duplication of microfilm
  or architect's plans and drawings, the contractor fees may be included
  in the actual direct cost to the Agency)

    (2) Benefit records. When VA benefit records are requested by a VA 
beneficiary or applicant for VA benefits, the duplication fee for one 
complete set of such records will be waived.


(Authority: 38 U.S.C. 5702(b))

    (j) If the copy is to be transmitted by certified or registered 
mail, airmail, or special delivery mail, the postal fees therefor shall 
be added to the other fees provided in paragraph (i) of this section (or 
the order must include postage stamps or stamped return envelopes for 
the purpose).
    (k) Those Department of Veterans Affairs installations not having 
copying equipment are authorized to arrange with the nearest Department 
of Veterans Affairs installation having such equipment to make the 
necessary authorized copies of records or documents.
    (l) Administration, staff office, and field facility heads are 
authorized to designate employees to certify copies of records and 
papers furnished under the provisions of paragraph (a) of this section.

[19 FR 3224, June 2, 1954, as amended at 32 FR 10850, July 25, 1967; 33 
FR 9342, June 26, 1968; 35 FR 20001, Dec. 31, 1970; 37 FR 2676, Feb. 4, 
1972; 39 FR 3938, Jan. 31, 1974; 53 FR 10376, Mar. 31, 1988; 54 FR 
34980, Aug. 23, 1989]



Sec.  1.527  Administrative review.

    (a) Any person may, in the event of a denial of his or her request 
to inspect or obtain information from or copies of records within the 
purview of Sec. Sec.  1.501 through 1.526, appeal such denial. Such 
appeal, stating the circumstances of

[[Page 64]]

the denial, should be addressed, as appropriate, to the field facility, 
administration, or staff office head.
    (b) A denial action not reversed by a field facility, 
administration, or staff office head on appeal, will be referred through 
normal channels to the General Counsel.
    (c) The final agency decision in such appeals will be made by the 
General Counsel or the Deputy General Counsel.

[32 FR 10850, July 25, 1967, as amended at 55 FR 21546, May 25, 1990]

 Procedures for Disclosure of Records Under the Freedom of Information 
                                   Act



Sec.  1.550  Purpose.

    (a) Sections 1.550 through 1.562 contain the rules followed by VA in 
processing requests for records under the Freedom of Information Act 
(FOIA), 5 U.S.C. 552, as amended. These regulations should be read 
together with the FOIA, which provides the underlying legal basis for 
the regulations and other information regarding requests for records in 
the custody of a Federal agency. The regulations also should be read 
together with VA's FOIA Reference Guide, available on VA's FOIA home 
page (see Sec.  1.552(a) for the pertinent Internet address) and FOIA 
fee guidance provided by the Office of Management and Budget (OMB), 
Uniform Freedom of Information Act Fee Schedule and Guidelines, 
available at http://www.whitehouse.gov/sites/default/files/omb/assets/
omb/inforeg/foia_fee_schedule_1987.pdf.
    (b) Requests for records about an individual, protected under the 
Privacy Act, 5 U.S.C. 552a, including one's own records and records that 
pertain to an individual and that may be sensitive, will be processed 
under the FOIA and the Privacy Act. The FOIA applies to third-party 
requests for documents concerning the general activities of the 
Government and of VA in particular. When a U.S. citizen or an individual 
lawfully admitted for permanent residence requests access to his or her 
own records, it is considered a Privacy Act request. Such records are 
maintained by VA under the individual's name or personal identifier. 
Although requests are considered either FOIA requests or Privacy Act 
requests, agencies process requests in accordance with both laws, which 
provides the greatest degree of lawful access while safeguarding an 
individual's personal privacy. In addition to the following FOIA 
regulations, see 1.575 through 1.584 for regulations applicable of 
Privacy Act records.
    (c) Requests for records relating to a claim administered by VA 
pursuant to 38 U.S.C. 5701 will be processed under the FOIA and 38 
U.S.C. 5701. In addition to the following FOIA regulations, see 
Sec. Sec.  1.500 through 1.527 for regulations implementing 38 U.S.C. 
5701.
    (d) Requests for records relating to healthcare quality assurance 
reviews pursuant to 38 U.S.C. 5705 will be processed under the FOIA and 
38 U.S.C. 5705. In addition to the following FOIA regulations, see 38 
CFR 17.500 through 17.511 for regulations implementing 38 U.S.C. 5705.
    (e) Requests for records relating to treatment for the conditions 
specified in 38 U.S.C. 7332, such as drug abuse, alcoholism or alcohol 
abuse, infection with the Human Immunodeficiency Virus (HIV), or sickle 
cell anemia, will be processed under the FOIA and 38 U.S.C. 7332. In 
addition to the following FOIA regulations, see Sec. Sec.  1.460 through 
1.499 of this part for regulations implementing 38 U.S.C. 7332.

(Authority: Sections 1.550 to 1.562 issued under 72 Stat. 1114; 38 
U.S.C. 501, 552, 552a, 5701, 5705, 7332.)G1986

[76 FR 51892, Aug. 19, 2011, as amended at 84 FR 12125, Apr. 1, 2019]



Sec.  1.551  Definitions.

    As used in Sec. Sec.  1.550 through 1.562, the following definitions 
apply:
    Agency means any executive department, military department, 
government corporation, government controlled corporation, or other 
establishment in the executive branch of the Federal government, or 
independent regulatory entity.
    Appeal means a requester's written disagreement with an adverse 
determination under the FOIA.
    Beneficiary means a veteran or other individual who has received 
benefits (including medical benefits) or has applied for benefits 
pursuant to title 38, United States Code.

[[Page 65]]

    Benefits records means an individual's records, which pertain to 
programs under any of the benefits laws administered by the Secretary of 
Veterans Affairs.
    Business day means the time during which typical Federal government 
offices are open for normal business. It does not include Saturdays, 
Sundays, or Federal legal public holidays. The term ``day'' means 
business day unless otherwise specified.
    Business information means confidential or privileged commercial or 
financial information obtained by VA from a submitter that may be 
protected from disclosure under Exemption 4 of the FOIA, 5 U.S.C. 
552(b)(4).
    Component means each distinct VA entity, including Administrations, 
staff offices, services, or facilities.
    Expedited processing means giving a FOIA request priority for 
processing ahead of other pending requests because VA has determined 
that the requester has shown an exceptional need or urgency for the 
records as provided in these regulations.
    Fees. For fees and fee-related definitions, see Sec.  1.561.
    FOIA Officer means the individual within a VA component whose 
responsibilities include addressing and granting or denying requests for 
records under the FOIA.
    FOIA Public Liaison means a supervisory agency FOIA official who 
assists in the resolution of any disputes between the requester and the 
agency.
    Perfected request means a written FOIA request that meets the 
requirements set forth in Sec.  1.554 of this part and for which there 
are no remaining issues about the payment of applicable fees or any 
other matter that requires resolution prior to processing.
    Reading room means space made available, as needed, in VA components 
where records are available for review pursuant to 5 U.S.C. 552(a)(2). 
Ordinarily, the VA component providing a public reading room space will 
be the component that maintains the record.
    Record means a document, a portion of a document, and information 
contained within a document, and can include information derived from a 
document or a database. Such documents may be maintained in paper, 
electronic, and other forms, but do not include objects, such as tissue 
slides, blood samples, or computer hardware.
    Request means a written demand for records under the FOIA as 
described Sec.  1.554(a). The term request includes any action emanating 
from the initial demand for records, including any subsequent action 
related to the request.
    Requester means, generally, any individual, partnership, 
corporation, association, or foreign or state or local government, which 
has made a demand to access an agency record.
    Submitter means any person or entity (including corporations, state, 
local and tribal governments and foreign governments) from whom VA 
obtains trade secrets or confidential commercial or financial 
information either directly or indirectly.
    VA means the Department of Veterans Affairs.
    VA Central Office (VACO) means the headquarters of the Department of 
Veterans Affairs. The mailing address is 810 Vermont Avenue, NW., 
Washington, DC 20420.
    Written or in writing means communications such as letters, 
photocopies of letters, electronic mail, and facsimiles (faxes), and 
does not include any form of oral communication.

[76 FR 51892, Aug. 19, 2011, as amended at 84 FR 12125, Apr. 1, 2019]



Sec.  1.552  General provisions.

    (a) Additional information. Information regarding VA's FOIA and 
Privacy Act process generally, including how to file FOIA requests, and 
information made available by VA under the FOIA, is available at the 
following internet address: http://www.oprm.va.gov/foia/.
    (b) Public Liaisons. VA has made available FOIA Public Liaisons to 
assist in the resolution of disputes between the agency and the 
requester. Contact information for VA's FOIA Public Liaisons can be 
found on VA's FOIA home page. See Sec.  1.552(a) for the pertinent 
Internet address.
    (c) FOIA Annual Report. Under 5 U.S.C. 552(e), VA is required to 
prepare an annual report regarding its FOIA activities. The report 
includes information about FOIA requests and appeals. Copies of VA's 
annual FOIA report may

[[Page 66]]

be obtained from VA's Chief FOIA Officer or by visiting VA's FOIA Web 
site. See Sec.  1.552(a) for the pertinent Internet address.

[76 FR 51893, Aug. 19, 2011, as amended at 84 FR 12125, Apr. 1, 2019]



Sec.  1.553  Public reading rooms and discretionary disclosures.

    (a) VA maintains a public reading room electronically at its FOIA 
home page on the Internet, which contains the records that the FOIA 
requires to be regularly made available for public inspection and 
copying. See Sec.  1.552(a) for the pertinent Internet address. 
Information routinely provided to the public (press releases, for 
example) may be provided without following these sections. In addition, 
as a matter of policy, VA may make discretionary releases of records or 
information exempt from disclosure under the FOIA when permitted to do 
so in accordance with current law and governmental policy. Each VA 
component is responsible for determining which of its records are 
required to be made available and for making its records available 
electronically.
    (b) VA may process, in accordance with the FOIA, records that it 
makes publicly available. Information in a public reading room record 
will be redacted, for example, if its release would be a clearly 
unwarranted invasion of an individual's personal privacy.
    (c) Some VA components may also maintain physical public reading 
rooms. Information regarding these components and their contact 
information is available on VA's FOIA home page on the Internet. See 
Sec.  1.552(a) for the pertinent Internet address. If the requester does 
not have access to the Internet and wishes to obtain information 
regarding publicly available information or components that have a 
physical reading room, he or she may write VA's Chief FOIA Officer at 
the following address: Department of Veterans Affairs, FOIA Service 
(005R1C), 810 Vermont Avenue, NW., Washington, DC 20420.

[76 FR 51893, Aug. 19, 2011]



Sec.  1.554  Requirements for making requests.

    (a) Requests by letter and facsimile (fax). The FOIA request must be 
in writing and may be by letter or fax. To assist in processing, the 
request letter, envelope, or fax cover sheet of any FOIA request should 
be marked ``Freedom of Information Act Request.'' Information helpful 
for filing a request, such as a list of VA FOIA contacts, VA's FOIA 
Reference Guide, and the text of the FOIA, are available on VA's FOIA 
homepage on the internet. See Sec.  1.552(a) for the pertinent internet 
address. VA has a decentralized FOIA system, meaning that each VA 
component, i.e., administrations and staff offices, the Veterans Health 
Administration (VHA) medical centers, Veterans Benefits Administration 
(VBA) regional offices, or offices located within the VA Central Office 
in Washington, DC (e.g., the Office of the Secretary), maintain their 
own FOIA processes and respond to FOIA requests directly. Accordingly, 
requesters must write directly to the FOIA Officer for the VA component 
that maintains the records. If requesting records from a particular 
medical facility, regional office, or Central Office component, the 
request should be sent to the FOIA Office at the address listed for that 
component. A legible return address must be included with the FOIA 
request; the requester may wish to include other contact information as 
well, such as a telephone number and email address. If the requester is 
not sure where to send the request, he or she should seek assistance 
from the FOIA Contact for the office believed to manage the programs 
whose records are being requested or, if these efforts fail, he or she 
should send the request to the Director, FOIA Service (005R1C), 810 
Vermont Avenue NW, Washington, DC 20420, who will refer it for action to 
the FOIA contact at the appropriate component.
    (b) Requests by email. VA accepts email FOIA requests. To assure 
prompt processing, email FOIA requests must be sent to official VA FOIA 
mailboxes established for the purpose of receiving FOIA requests. An 
email FOIA request that is sent to an individual VA employee's mailbox, 
or to any other entity, will not be considered a perfected

[[Page 67]]

FOIA request. Mailbox addresses designated to receive email FOIA 
requests are available on VA's FOIA homepage. See Sec.  1.552(a) for the 
pertinent internet address.
    (c) The content of a request. Whether submitting the request by 
letter, fax, or email, the following applies: If the requester is 
seeking records about himself or herself or to which a confidentiality 
statute applies (38 U.S.C. 5701, e.g.), the requester must comply with 
the verification of identity requirements set forth in Sec.  1.577 of 
this part, which applies to requests for records maintained under the 
Privacy Act. If the requester is seeking records not covered by the 
Privacy Act, but which the requester believes may pertain to him or her, 
the requester may obtain greater access to the records by complying with 
the verification of identity requirements set forth in Sec.  1.577 of 
this part, by providing the image of the requester's signature (such as 
an attachment that shows the requester's handwritten signature), or by 
submitting a notarized, signed statement affirming his or her identity 
or a declaration made in compliance with 28 U.S.C. 1746. The suggested 
language for a statement under 28 U.S.C. 1746 is included on VA's FOIA 
homepage; see Sec.  1.552(a) for the pertinent internet address. If the 
requester is seeking records pertaining to another individual under the 
FOIA, whether by letter, fax, or email, the requester may obtain greater 
access to the records if he or she provides satisfactory authorization 
to act on behalf of the record subject to receive the records or by 
submitting proof that the record subject is deceased (e.g., a copy of a 
death certificate or an obituary). Each component has discretion to 
require that a requester supply additional information to verify that a 
record subject has consented to disclosure.
    (d) Description of records sought. (1) The requester must describe 
the records sought in enough detail to allow VA personnel to locate them 
with a reasonable amount of effort. To the extent possible, the 
requester should include specific information about each record sought, 
such as the date, title or name, author, recipient, and subject matter 
of the document. Generally, the more information the requester provides 
about the record sought, the more likely VA personnel will be able to 
locate any responsive records. Wide-ranging requests that lack 
specificity, or contain descriptions of very general subject matters, 
with no description of specific records, may be considered ``not 
reasonably described'' and thus not subject to further processing.
    (2) Requests for voluminous amounts of records may be placed in a 
complex track of a multitrack processing system pursuant to Sec.  
1.556(b); such requests also may meet the criteria for ``unusual 
circumstances,'' which are processed in accordance with Sec.  1.556(c) 
and may require more than 20 business days to process despite the 
agency's exercise of due diligence.
    (3) If the FOIA Officer determines that the request does not 
reasonably describe the records sought, the FOIA Officer will tell the 
requester why the request is insufficient. The FOIA Officer will also 
provide an opportunity to discuss the request by documented telephonic 
communication or written correspondence in order to modify it to meet 
the requirements of this section.
    (4) The time limit for VA to process the FOIA request will not start 
until the FOIA Officer determines that the requester has reasonably 
described the records sought in the FOIA request. If the FOIA Officer 
seeks additional clarification regarding the request and does not 
receive the requester's written response within 30 calendar days of the 
date of its communication with the requester, he or she will conclude 
that the requester is no longer interested in pursuing the request and 
will close VA's files on the request.
    (e) Agreement to pay fees. The time limit for processing a FOIA 
request will be tolled while any fee issue is unresolved. Depending on 
the circumstances, the FOIA Officer will notify the requester of the 
following: That the FOIA Officer anticipates that the fees for 
processing the request will exceed the amount that the requester has 
stated a willingness to pay or will amount to more than $25.00 or the 
amount set by Office of Management and Budget fee guidelines, whichever 
is

[[Page 68]]

higher; whether the FOIA Officer is requiring the requester to agree in 
writing to pay the estimated fee; or whether advance payment of the fee 
is required prior to processing the request (i.e., if the estimated fee 
amount exceeds $250 or the requester previously has failed to pay a FOIA 
fee in a timely manner). If the FOIA Officer does not receive the 
requester's written response to the notice regarding any of these items 
within 10 business days of the date of the FOIA Officer's written 
communication with the requester, the FOIA Officer will close the 
request. If requesting a fee waiver under Sec.  1.561, the requester 
nonetheless may state his or her willingness to pay a fee up to an 
identified amount in the event that the fee waiver is denied; this will 
allow the component to process the FOIA request while considering the 
fee waiver request. If the requester pays a fee in advance, and VA later 
determines that the requester overpaid or is entitled to a full or 
partial fee waiver, a refund will be made. (For more information on the 
collection of fees under the FOIA, see Sec.  1.561.)
    (f) The requester must meet all of the requirements of this section 
in order for the request to be perfected.

[76 FR 51893, Aug. 19, 2011, as amended at 84 FR 12125, Apr. 1, 2019]



Sec.  1.555  Responsibility for responding to requests.

    (a) General. Except as stated in paragraphs (c) and (d) of this 
section, the FOIA Officer of the component that first receives a request 
for records is responsible for either processing the request or 
referring it to the designated FOIA Officer for the appropriate 
component. Offices that are within the component responsible for 
processing the FOIA request shall provide the component FOIA Officer all 
documents responsive to the request that are in their possession as of 
the date the search for responsive records begins.
    (b) Authority to grant or deny requests. Each component shall 
designate a FOIA Officer who is responsible for making determinations 
pursuant to the FOIA.
    (c) Consultations and referrals. When a component FOIA Officer 
determines that the component maintains responsive records that either 
originated with another component or agency, or which contain 
information provided by, or of substantial interest to, another 
component or agency, then the FOIA Officer shall either:
    (1) Respond to the request, after consulting with the component or 
the agency that originated or has a substantial interest in the records 
involved; or
    (2) Refer the responsibility for responding to the request or 
portion of the request to the component best able to determine whether 
to disclose the relevant records, or to the agency that created or 
initially acquired the record as long as that agency is subject to the 
FOIA. Ordinarily, the component or agency that created or initially 
acquired the record will be presumed to be best able to make the 
disclosure assessment. The referring component shall document the 
referral and maintain a copy of the records that it refers.
    (d) Classified information. The FOIA Officer will refer requests for 
records containing classified information to the component or agency 
that classified the information for processing.
    (e) Notice of referral. Whenever a FOIA Officer refers all or part 
of a request and responsibility for processing the request to another 
component or agency, the FOIA Officer will notify the requester in 
writing of the referral and provide the requester the name and contact 
information of the entity to which the request has been referred, after 
consulting with the entity to which the request is to be referred to 
ensure that the request is being referred to the correct entity. If only 
part of the request was referred, the FOIA Officer will inform the 
requester and identify the referred part at the time of the referral or 
in the final response.

[76 FR 51894, Aug. 19, 2011]



Sec.  1.556  Timing of responses to requests.

    (a) General. Components ordinarily shall respond to requests 
according to their order of receipt and within the time frames 
established under the FOIA. If a request for expedited processing is 
granted in accordance with

[[Page 69]]

paragraph (d) of this section, such request will be processed prior to 
requests in either of the tracks described in paragraph (b) of this 
section.
    (b) Multitrack processing. (1) VA will use two processing tracks in 
addressing a request for records: Simple and complex, based upon the 
amount of work and/or time needed to process the request, including 
consideration of the number of pages involved.
    (2) The FOIA Officer shall advise the requester of the track into 
which the request has been placed and of the criteria of the faster 
track. The FOIA Officer will provide requesters in the slower track the 
opportunity to limit the scope of their requests in order to qualify for 
processing in the faster track. The FOIA Officer may contact the 
requester either by telephone or in writing, whichever the FOIA Officer 
determines is most efficient and expeditious; telephonic communication 
will be documented.
    (c) Unusual circumstances. (1) FOIA Officers may encounter ``unusual 
circumstances,'' where it is not possible to meet the statutory time 
limits for processing the request. In such cases, the FOIA Officer will 
extend the 20-business day time limit for 10 more business days and 
notify the requester in writing of the unusual circumstances and the 
date by which it expects to complete processing of the request. Where 
the extension exceeds 10 working days, the agency must, as described by 
the FOIA, provide the requester with an opportunity to modify the 
request or arrange an alternative time period for processing the 
original or modified request; notice of the availability of the VA FOIA 
Public Liaison, and the right to seek dispute resolution services from 
the Office of Government Information Services. Unusual circumstances 
consist of the following:
    (i) The need to search for and collect the requested records from 
field facilities or components other than the office processing the 
request;
    (ii) The need to search for, collect and examine a voluminous amount 
of separate and distinct records that are the subject of a single 
request; or
    (iii) The need for consultation with another agency or among two or 
more VA components or another agency having a substantial interest in 
the subject matter of a request.
    (2) Where the FOIA Officer reasonably believes that certain requests 
from the same requester, or a group of requesters acting in concert, 
actually constitute the same request that would otherwise satisfy the 
unusual circumstances specified in this paragraph, and the requests 
involve clearly related matters, the FOIA Officer may aggregate those 
requests. Multiple requests involving unrelated matters will not be 
aggregated.
    (d) Expedited processing. (1) Requests will be processed out of the 
order in which they were received by the component responsible for 
processing the FOIA request and given expedited treatment when VA 
determines that:
    (i) The failure to obtain the requested records on an expedited 
basis could reasonably be expected to pose an imminent threat to the 
life or physical safety of an individual;
    (ii) There is an urgency to inform the public concerning actual or 
alleged Federal government activity, if the request is made by a person 
primarily engaged in disseminating information;
    (iii) In the discretion of the FOIA Officer, the request warrants 
such treatment; or
    (iv) There is widespread and exceptional interest in which possible 
questions exist about the government's integrity which affect public 
confidence.
    (2) A requester who is seeking expedited processing must submit a 
statement, certified to be true to the best of the requester's knowledge 
and belief, providing a detailed basis for how there is a compelling 
need. VA may waive the requirement for certification of the statement of 
compelling need as a matter of administrative discretion.
    (3) Within 10 calendar days of its receipt of a request for 
expedited processing, the FOIA Officer shall determine whether to grant 
the request and will provide the requester written notice of the 
decision. If the FOIA Officer grants a request for expedited processing, 
the FOIA Officer shall give the request priority and process it as soon 
as practicable. If the FOIA Officer denies the request for expedited 
processing, the requester may appeal the

[[Page 70]]

denial, which appeal shall be addressed expeditiously.

[76 FR 51894, Aug. 19, 2011, as amended at 84 FR 12126, Apr. 1, 2019]



Sec.  1.557  Responses to requests.

    (a) Acknowledgement of requests. When a request for records is 
received by a component designated to receive requests, the component's 
FOIA Officer will assign a FOIA request number; the FOIA Officer will 
send the requester written acknowledgement of receipt of the request and 
will advise the requester of the assigned FOIA request number and how 
the requester may obtain the status of his or her request.
    (b) Processing of requests. Upon receipt of a perfected request by 
the appropriate component, the FOIA Officer will make a reasonable 
effort to search for records responsive to the request. The FOIA Officer 
ordinarily will include as responsive those records in its possession 
and control as of the date the search for responsive records began. This 
includes searching for records in electronic form or format, unless to 
do so would interfere significantly with the agency's automated 
information systems. If fees for processing the request are due under 
Sec.  1.561, the FOIA Officer shall inform the requester of the amount 
of the fee as provided in Sec.  1.554(e) and Sec.  1.561. When a request 
is granted in part, the FOIA Officer shall mark, redact, or annotate the 
records to be released to show the amount of information deleted and, 
where technically feasible, indicate the exemption at the place of 
redaction unless doing so would harm an interest protected by an 
applicable exemption. The FOIA Officer will provide the records in the 
form or format sought by the requester, if readily reproducible in that 
form or format.
    (c) Time limits for processing requests. A component must advise the 
requester within 20 business days from the date of VA's receipt of the 
request whether the request is granted in its entirety, granted in part, 
or denied in its entirety and provide the reasons therefor. If the 
request must be referred to another component, the response time will 
begin on the date that the request was received by the appropriate 
component, but in any event not later than 10 business days after the 
referring office receives the FOIA request; the referring component has 
an affirmative duty to refer the FOIA request within 10 business days.
    (d) Grants of requests in full. When a component makes a 
determination to grant a request in full, it shall notify the requester 
in writing. The component also shall inform the requester of any fees 
charged under Sec.  1.561. The component also must inform the requester 
of his or her right to appeal and to seek mediation or the assistance of 
the appropriate VA FOIA Public Liaison and provide the contact 
information for the Liaison.
    (e) Adverse determinations of requests. When a component makes an 
adverse determination denying the request in any respect, the component 
FOIA Officer shall promptly notify the requester of the adverse 
determination in writing. Adverse determinations include decisions that 
a requested record is exempt from release in whole or in part, does not 
exist or cannot be located, is not readily reproducible in the form or 
format sought by the requester, or is not a record subject to the FOIA; 
adverse determinations also include denials regarding requests for 
expedited processing and requests involving fees, such as requests for 
fee waivers. The adverse determination notice must be signed by the 
component head or the component's FOIA Officer, and shall include the 
following:
    (1) The name and title or position of the person responsible for the 
adverse determination;
    (2) A brief statement of the reason(s) for the denial, including any 
FOIA exemptions applied by the FOIA Officer in denying the request;
    (3) The amount of information withheld in number of pages or other 
reasonable form of estimation; an estimate is not necessary if the 
volume is indicated on redacted pages disclosed in part or if providing 
an estimate would harm an interest provided by an applicable exemption;
    (4) Notice that the requester may appeal the adverse determination 
and a description of the requirements for an appeal under Sec.  1.559 of 
this part; and
    (5) Notice that the requester may seek assistance or dispute 
resolution

[[Page 71]]

services from the VA FOIA Public Liaison or dispute resolution services 
from the Office of Government Information Services.

[76 FR 51894, Aug. 19, 2011, as amended at 84 FR 12127, Apr. 1, 2019]



Sec.  1.558  Business information.

    (a) General. Business information received by VA from a submitter 
will be considered under the FOIA pursuant to this section and in 
accordance with the requirements set forth in Sec.  1.557 of this part.
    (b) Designation of business information. The submitter of business 
information may designate that specific records or portions of records 
submitted are business information, at the time of submission or within 
a reasonable time thereafter. The submitter must use good faith efforts 
in designating records that the submitter claims could be expected to 
cause substantial competitive harm and thus warrant protection under 
Exemption 4 of the FOIA, 5 U.S.C. 552(b)(4). The submitter may mark the 
record submission as confidential or use the words ``business 
information'' or describe the specific records that contain business 
information. Such designation will be considered, but will not control, 
the FOIA Officer's decision on disclosing the material. A designation 
will remain in effect for a period of not more than 10 years after 
receipt by VA, unless the submitter provides acceptable justification 
for a longer period. The submitter may designate a shorter period by 
including an expiration date.
    (c) Notices to submitters. (1) The FOIA Officer shall promptly 
notify the submitter in writing of a FOIA request seeking the 
submitter's business information whenever the FOIA Officer has reason to 
believe that the information may be protected under FOIA Exemption 4, 5 
U.S.C. 552(b)(4), regarding business information. The written notice 
will provide the submitter an opportunity to object to disclosure of any 
specified portion of the records within the reasonable time period 
specified in the notice. The notice will either describe in detail the 
business information requested (e.g., an entire contract identified by a 
unique number) or shall provide copies of the requested record(s) or 
record portions containing the business information. When notification 
of a voluminous number of submitters is required, the FOIA Officer may 
notify the submitters by posting or publishing the notice in a place 
reasonably likely to accomplish notification.
    (2) If the FOIA Officer determines to release business information 
over the objection(s) of the submitter, the FOIA Officer will notify the 
submitter pursuant to paragraph (e) of this section.
    (3) Whenever the FOIA Officer notifies the submitter of VA's intent 
to disclose over the submitter's objections, the FOIA Officer will also 
notify the requester by separate correspondence.
    (4) Exceptions to this notice provision are contained in paragraph 
(f) of this section.
    (d) Opportunity to object to disclosure. When notification to a 
submitter is made pursuant to paragraph (c)(1) of this section, the 
submitter may object to the disclosure of any specified portion(s) of 
the record(s). The submitter's objection(s) must be in writing, 
addressed to the FOIA Officer, and must be received by the reasonable 
date specified in the FOIA Officer's notice in order for VA to consider 
such objections. If the submitter has any objection to disclosure of the 
record(s) requested, or any specified portion(s) thereof, the submitter 
must identify the specific record(s) or portion(s) of records for which 
objection(s) are made. The objection will specify in detail all grounds 
for withholding any record(s) or portion(s) of the record(s) upon which 
disclosure is opposed under any exemption of the FOIA. In particular, if 
the submitter is asserting that the record is protected under Exemption 
4, 5 U.S.C. 552(b)(4), it must show why the information is a trade 
secret or commercial or financial information that is privileged or 
confidential. The submitter must explain in detail how and why 
disclosure of the specified records would likely cause substantial 
competitive harm in the case of a required submission or state whether 
the records would customarily be disclosed by the submitter upon a 
request from the public in the case of a voluntary submission. The 
submitter's objections must be contained within a

[[Page 72]]

single written response; oral responses or subsequent, multiple 
responses generally will not be considered. If the submitter does not 
respond to the notice described in paragraph (c)(1) of this section 
within the specified time limit, the submitter will be considered to 
have no objection to disclosure of the information.
    (e) Consideration of objection(s) and notice of intent to disclose. 
The FOIA Officer will consider all pertinent factors, including but not 
limited to, the submitter's timely objection(s) to disclosure and the 
specific grounds provided by the submitter for non-disclosure in 
deciding whether to disclose business information. Information provided 
by the submitter after the specified time limit and after the component 
has made its disclosure decision generally will not be considered. In 
addition to meeting the requirements of Sec.  1.557, when a FOIA Officer 
decides to disclose business information over the objection of a 
submitter, the FOIA Officer will provide the submitter with written 
notice, which includes:
    (1) A statement of the reason(s) why each of the submitter's 
disclosure objections were not sustained;
    (2) A description of the business information to be disclosed; and
    (3) A specified disclosure date of not less than 10 days from the 
date of the notice (to allow the submitter time to take necessary legal 
action).
    (f) Exceptions to notice requirements. The notice requirements set 
forth in paragraphs (c) and (g) of this section will not apply if:
    (1) The FOIA Officer determines that the information should not be 
disclosed;
    (2) The information lawfully has been published or has been 
officially made available to the public; or
    (3) Disclosure of the information is required by statute, other than 
the FOIA, or by a regulation issued in accordance with the requirements 
of Executive Order 12600 or any other Executive Order.
    (g) Notice to requesters. When VA receives a request for records 
that may contain confidential commercial information protected by FOIA 
Exemption 4, 5 U.S.C. 552(b)(4), regarding business information, the 
requester will be notified that the request is being processed under the 
provisions of this regulation and, as a consequence, there may be a 
delay in receiving a response. The notice to the requester will not 
include any of the specific information contained in the records being 
requested.

[76 FR 51895, Aug. 19, 2011, as amended at 84 FR 12127, Apr. 1, 2019]



Sec.  1.559  Appeals.

    (a) Informal resolution prior to appeal. Before filing an appeal, 
the requester may wish to communicate with the contact person listed in 
the FOIA response or the component's FOIA Officer to see if the issue 
can be resolved informally. Informal resolution of the requester's 
concerns may be appropriate, for example, where additional details may 
be required for a search for responsive records. Communication with VA 
at this level does not toll the time limit for filing an administrative 
appeal.
    (b) How to file and address a written appeal. The requester may 
appeal an adverse determination denying the request, in any respect, 
except for those concerning Office of Inspector General records, to the 
VA Office of the General Counsel (024), 810 Vermont Avenue NW, 
Washington, DC 20420. Any appeals concerning Office of Inspector General 
records must be sent to the VA Office of Inspector General, Office of 
Counselor (50), 810 Vermont Avenue NW, Washington, DC 20420. The FOIA 
appeal must be in writing and may be by letter or facsimile (fax); 
whichever method is used, the appeal must comply with all requirements 
of this paragraph and paragraph (d). Information regarding where to fax 
the FOIA appeal is available on VA's FOIA homepage on the internet. See 
Sec.  1.552(a) of this part for the pertinent internet address.
    (c) How to file an email appeal. VA accepts email appeals; the 
appeal must comply with all requirements of this paragraph and paragraph 
(d) of this section. In order to assure initial processing of an appeal 
filed by email, the email must be sent to one of the official VA FOIA 
mailboxes established for the purpose of receiving FOIA appeals; an 
email FOIA appeal that is sent to an individual VA employee's mailbox, 
or

[[Page 73]]

to any other entity, will not be considered a perfected FOIA appeal. 
Mailbox addresses designated to receive email FOIA appeals are available 
on VA's FOIA homepage. See Sec.  1.552(a) of this part for the pertinent 
internet address.
    (d) Time limits and content of appeal. The appeal to the VA OGC 
(024) or VA Office of Inspector General (50) must be received or 
postmarked no later than 90 calendar days after the date of the adverse 
determination and must contain the following: A legible return address; 
clear identification of the determination being appealed, including any 
assigned request number (if no request number was assigned, other 
information must be provided such as the name of the FOIA officer, the 
address of the component, the date of the component's determination, if 
any, and the precise subject matter of the appeal); and identification 
of the part of the determination that is being appealed (if appealing 
only a portion of the determination). If the appeal involves records 
about the requester himself or herself or records to which a 
confidentiality statute applies, the requester must comply with the 
verification of identity requirements set forth in Sec.  1.577 of this 
part, which applies to requests for records maintained under the Privacy 
Act. If the appeal involves records not covered by the Privacy Act, but 
which the requester believes may pertain to him or her, the requester 
may obtain greater access to the records by complying with the 
verification of identity requirements set forth in Sec.  1.577 of this 
part, providing the image of the requester's signature (such as an 
attachment that shows the requester's handwritten signature), or 
submitting a notarized, signed statement affirming his or her identity 
or a declaration made in compliance with 28 U.S.C. 1746. The suggested 
language for a statement under 28 U.S.C. 1746 is included on VA's FOIA 
homepage. See Sec.  1.552(a) of this part for the pertinent internet 
address. If the appeal involves records pertaining to another individual 
(i.e., the requester is not the record subject), the requester may 
obtain greater access to the records if he or she provides satisfactory 
authorization to act on behalf of the record subject to receive the 
records or by submitting proof that the record subject is deceased 
(e.g., a copy of a death certificate or an obituary). Each component has 
discretion to require that a requester supply additional information to 
verify that a record subject has consented to disclosure. Appeals should 
be marked ``Freedom of Information Act Appeal.'' The requester may 
include other information as well, such as a telephone number and email 
address and a copy of the initial agency determination. An appeal is not 
perfected until VA either receives the required information identified 
above or the appeal is otherwise easily and sufficiently defined. The 
designated official within the Office of the General Counsel (024) will 
act on behalf of the Secretary on all appeals under this section, except 
those pertaining to the Office of Inspector General. The designated 
official in the Office of Inspector General will act on all appeals 
pertaining to Office of Inspector General records. A determination by 
the Office of General Counsel, or designated official within the Office 
of Inspector General, will be the final VA action.
    (e) Responses to appeals. The Office of the General Counsel or the 
Office of Inspector General, as applicable, will provide the requester a 
decision on the appeal in writing. The decision will include a brief 
statement of the reasons for the decision, including, if applicable, any 
FOIA exemptions applied and notice of the right to judicial review of 
the decision.
    (f) Court review. Unless the requester has been deemed to have 
exhausted all administrative remedies, he or she must first appeal the 
adverse determination in accordance with this section before seeking 
review by a court.

[76 FR 51895, Aug. 19, 2011, as amended at 84 FR 12127, Apr. 1, 2019]



Sec.  1.560  Maintenance and preservation of records.

    (a) Each component will preserve all correspondence pertaining to 
FOIA requests as well as copies of pertinent records, until disposition 
is authorized under title 44, U.S.C., or the National Archives and 
Records Administration's General Records Schedule 14.

[[Page 74]]

    (b) The FOIA Officer must maintain copies of records that are the 
subject of a pending request, appeal, or lawsuit under the FOIA. A copy 
of all records shall be provided promptly to the Office of the General 
Counsel upon request.

[76 FR 51895, Aug. 19, 2011]



Sec.  1.561  Fees.

    (a) General. VA will charge for processing requests under the FOIA, 
as amended, and in accordance with this section. Requesters must pay 
fees by check or money order made payable to the Treasury of the United 
States. Payment by credit card also may be acceptable; the requester 
should contact the FOIA Officer for instructions on credit card 
payments. Note that fees associated with requests from VA beneficiaries, 
applicants for VA benefits, or other individuals, for records 
retrievable by their names or individual identifiers processed under 38 
U.S.C. 5701 (records associated with claims for benefits) and 5 U.S.C. 
552a (the Privacy Act), will be assessed fees in accordance with the 
applicable regulatory fee provisions relating to VA benefits and VA 
Privacy Act records.
    (b) Definitions. For purposes of assessing or determining fees, the 
following definitions apply:
    (1) All other requests means a request that does not fit into any of 
the categories in this section.
    (2) Commercial use request means a request from or on behalf of one 
who seeks information for a use or purpose that furthers his or her 
commercial, trade, or profit interests, to include furthering those 
interests through litigation. To the extent possible, the FOIA Officer 
shall determine the use to which the requester will put the requested 
records. When the intended use of the records is unclear from the 
request or when there is reasonable cause to doubt the use to which the 
requester will put the records sought, the FOIA Officer will provide the 
requester a reasonable opportunity to submit further clarification.
    (3) Direct costs mean expenses that VA incurs in responding to a 
FOIA request; direct costs include searching for and duplicating (and in 
the case of commercial use requesters, reviewing) records to respond to 
a FOIA request, the hourly wage of the employee performing the work plus 
16 percent of the hourly wage, and the cost of operating duplication 
machinery. Direct costs do not include overhead expenses, such as the 
costs of space or heating and lighting of the facility where the records 
are kept.
    (4) Duplication means making a copy of a record necessary to respond 
to a FOIA request; copies may take the form of paper, microform, 
audiovisual materials or machine readable-documentation (e.g., magnetic 
tape or disk), among others. The copy provided must be in a form that is 
reasonably usable by requesters.
    (5) Educational institution means a pre-school, a public or private 
elementary or secondary school, an institution of undergraduate or 
graduate higher education, an institution of professional education, or 
an institution of vocational education, which operates a program or 
programs of scholarly research. To be in this category, the FOIA Officer 
must make a determination that the request is authorized by and made 
under the auspices of a qualifying institution and that the records are 
sought to further a scholarly research goal of the institution and not 
the individual goal of the requester or a commercial goal of the 
institution.
    (6) Non-commercial scientific institution means an institution that 
is not operated on a ``commercial'' basis (as that term is defined in 
paragraph (b)(2) of this section) and that is operated solely for the 
purpose of conducting scientific research, the results of which are not 
intended to promote any particular product or industry. To be in this 
category, the requester must show that the request is authorized by and 
is made under the auspices of a qualifying institution and that the 
records are sought to further scientific research and are not sought for 
a commercial use.
    (7) Representative of the news media means any person or entity that 
gathers information of potential interest to a segment of the public, 
uses its editorial skills to turn the raw materials into a distinct 
work, and distributes that work to an audience. The term

[[Page 75]]

news means information that is about current events or that would be of 
current interest to the public. Examples of news media entities include 
television or radio stations broadcasting to the public at large and 
publishers of periodicals (but only if such entities qualify as 
disseminators of ``news'') who make their products available for 
purchase or subscription or free distribution to the general public. 
These examples are not all-inclusive. As methods of news delivery evolve 
(for example, the adoption of the electronic dissemination of newspapers 
through telecommunications services), such alternative media that 
otherwise meet the criteria for news media shall be considered to be 
news-media entities. Freelance journalists may be regarded as working 
for a news-media entity if they can demonstrate a solid basis for 
expecting publication through that entity, even though not actually 
employed by it. A publication contract would be the clearest proof, but 
the requester's publication history may also be considered. To be in 
this category, the requester must not be seeking the requested records 
for a commercial use; a records request supporting the requester's news-
dissemination function shall not be considered to be for a commercial 
use.
    (8) Review means examining a record including audiovisual, 
electronic mail, data bases, documents and the like in response to a 
commercial use request to determine whether any portion of it is exempt 
from disclosure. Review includes the deletion of exempt material or 
other processing necessary to prepare the record(s) for disclosure. 
Review time includes time spent contacting any submitter and considering 
or responding to any objections to disclosure made by a submitter under 
Sec.  1.558(d) but does not include time spent resolving general legal 
or policy issues regarding the application of exemptions. Review costs 
are recoverable even if, after review, a record is not disclosed.
    (9) Search means the process of looking for and retrieving records 
that are responsive to a request, including line-by-line or page-by-page 
identification of responsive information within records. Search also 
includes reasonable efforts to locate and retrieve information from 
records maintained in electronic form or format. The component will 
conduct searches in the most efficient and least expensive manner 
reasonably possible. The FOIA Officer may charge for time spent 
searching even if he or she does not locate any responsive record(s) or 
if any record(s) located is withheld as entirely exempt from disclosure.
    (10) Fee waiver means waiving or reducing processing fees if a 
requester can demonstrate that certain statutory standards are 
satisfied, including that the information is in the public interest and 
is not requested for commercial interest.
    (c) Categories of requesters and fees to be charged each category. 
There are four categories of FOIA requesters: Commercial use requesters, 
educational and non-commercial scientific institutional requesters, 
representatives of the news media, and all other requesters. Unless a 
waiver or reduction of fees is granted under paragraph (n) of this 
section or is limited in accordance with paragraph (e) of this section, 
specific levels of fees will be charged for each category as follows:
    (1) Commercial use requesters. Subject to the limitations in 
paragraph (e) of this section, commercial use requesters will be charged 
the full direct costs of the search, review, and duplication of records 
sought. Commercial use requesters are not entitled to 2 hours of free 
search time or the first 100 pages of reproduced documents free of 
charge.
    (2) Duplication. When the agency provides duplicated records in 
response to a request, no more than one copy will be provided.
    (3) Representative of the news media. Subject to the limitations in 
paragraph (e) of this section, representatives of the news media will be 
charged for the cost of reproduction only, excluding charges for the 
first 100 pages.
    (4) All other requesters. Subject to the limitations in paragraph 
(e) of this section, a requester who does not fit into any of the 
categories in this section will be charged fees to recover the full, 
reasonable direct cost of searching for and reproducing records 
responsive to a request, except that the first 2 hours of

[[Page 76]]

search time and the first 100 pages of reproduction will be furnished 
without cost.
    (d) Fees to be charge.d The following fees will be used when 
calculating the fee owed pursuant to a request or appeal. The fees also 
apply to making documents available for public inspection and copying 
under Sec.  1.553 of this part.
    (1) Search--(i) Search fees. When a FOIA Officer determines that a 
search fee applies, the fee will be based on the hourly salary of VA 
personnel performing the search, plus 16 percent of the salary. The type 
and number of personnel involved in addressing the request or appeal 
depends on the nature and complexity of the request and responsive 
records. Fees are charged in quarter hour increments.
    (ii) Computer search. In cases where a computer search is required, 
the requester will be charged the direct costs of conducting the search, 
although certain requesters (as provided in paragraph (e)(1) of this 
section) will be charged no search fee and certain other requesters (as 
provided in paragraph (e)(4) of this section) will be entitled to the 
cost of 2 hours of employee search time without charge. When a computer 
search is required, VA will combine the hourly cost of operating the 
computer with the employee's salary, plus 16 percent of the salary. When 
the cost of the search (including the employee time, to include the cost 
of developing a search methodology, and the cost of the computer to 
process a request) equals the dollar amount of 2 hours of the salary of 
the employee performing the search, VA will begin to assess charges for 
a computer search.
    (2) Duplication. When a duplication fee applies, the FOIA Officer 
will charge a fee of 15 cents per one-sided page for a paper photocopy 
of a record; no more than one copy will be provided. For other forms of 
duplication, including electronic copies, the FOIA Officer will charge 
the direct costs of that duplication.
    (3) Review. When review fees apply, review fees will be charged at 
the initial level of review only, when the component responsible for 
processing the request determines whether an exemption applies to a 
record or portion of a record. For review at the appeal level, no fee 
will be charged for an exemption that has already been applied and is 
determined to still apply. However, record or record portions withheld 
under an exemption that is subsequently determined not to apply may be 
reviewed again to determine whether any other exemption not previously 
considered applies; the costs of that review are chargeable. Review fees 
will be charged at the same rates as those charged for search under 
paragraph (d)(1) of this section.
    (e) Limitations on charging fees. (1) When VA determines that a 
requester is an educational institution, a non-commercial scientific 
institution, or a representative of the news media, VA will not charge 
search fees.
    (2) VA charges fees in quarter hour increments; no search or review 
fee will be charged for a quarter hour period unless more than half of 
that period is required for search or review.
    (3) VA may provide free copies of records or free services in 
response to an official request from another government agency or a 
congressional office and when a component head or designee determines 
that doing so will assist in providing medical care to a VA patient or 
will otherwise assist in the performance of VA's mission.
    (4)(i) If VA fails to comply with the time limit to respond to a 
request, it may not charge search fees, or, in cases of requests from 
requesters described in paragraph (e)(1) of this section, may not charge 
duplication fees, except as described in paragraph (e)(4)(ii) through 
(iv) of this section.
    (ii) If VA has determined that unusual circumstances as defined by 
the FOIA apply and has provided timely written notice to the requester 
in accordance with the FOIA, a failure to comply with the time limit 
shall be excused for an additional 10 days.
    (iii) If VA has determined that unusual circumstances as defined by 
the FOIA apply and more than 5,000 pages are necessary to respond to the 
request, VA may charge search fees, or in the case of requesters 
described in paragraph (e)(1) of this section, may charge duplication 
fees, if the following steps are taken: VA must provide timely written 
notice of unusual

[[Page 77]]

circumstances to the requester in accordance with the FOIA and must 
discuss with the requester via written mail, email or telephone (and 
later confirmed in writing) (or have made not less than three good-faith 
attempts to do so) how the requester could effectively limit the scope 
of the request in accordance with 5 U.S.C. 552(a)(6)(B)(ii). If this 
exception is satisfied, the component may charge all applicable fees 
incurred in the processing of the request.
    (iv) if a court has determined that exceptional circumstances exist, 
as defined by the FOIA, a failure to comply with the time limits shall 
be excused for the length of time provided by the court order.
    (f) The following table summarizes the chargeable fees for each 
category of requester.

----------------------------------------------------------------------------------------------------------------
             Category                      Search fees                  Review fees            Duplication fees
----------------------------------------------------------------------------------------------------------------
(1) Commercial Use...............  Yes........................  Yes........................  Yes.
(2) Educational Institution and    No.........................  No.........................  Yes (100 pages or 1
 Non-Commercial Scientific                                                                    disc free).
 Institution.
(3) News Media...................  No.........................  No.........................  Yes (100 pages or 1
                                                                                              disc free).
(4) All other....................  Yes (2 hours free).........  No.........................  Yes (100 pages or 1
                                                                                              disc free).
----------------------------------------------------------------------------------------------------------------

    (g) Fee schedule. If it is determined that a fee will be charged for 
processing the FOIA request, VA will charge the direct cost to the 
agency and in accordance with the requester's fee category (see Sec.  
1.561(c)); to the extent possible, direct costs are itemized in 
paragraph 1 of this section. Duplication fees also are applicable to 
records provided in response to requests made under the Privacy Act (see 
Sec.  1.577(e),(f)).
    (1) Schedule of fees:

------------------------------------------------------------------------
                Activity                               Fees
------------------------------------------------------------------------
(i) Duplication of standard size (8\1/   Paper records: $0.15 per page.
 2\[sec] x 11[sec]; 8\1/2\[sec] x        Electronic media: $3.00 per
 14[sec]) paper records or records on     each compact disc (CD) or
 electronic media.                        digital versatile disc (DVD).
(ii) Duplication of non-paper items      Direct cost to VA.
 (e.g., x-rays), paper records which
 are not of a standard size (e.g.,
 architectural drawings/construction
 plans or EKG tracings).
(iii) Record search by manual (non-      Hourly wage of the employee(s),
 automated) methods.                      plus 16 percent.
(iv) Record search using automated       Direct cost to VA.
 methods, such as by computer.
(v) Record review (for Commercial Use    Hourly rate of employees
 Requesters only).                        performing review to determine
                                          whether to release records and
                                          to prepare them for release,
                                          plus 16 percent.
(vi) Other activities, such as:          Direct cost to VA.
 Attesting under seal or certifying
 that records are true copies; sending
 records by special methods; forwarding
 mail; compiling and providing special
 reports, drawings, specifications,
 statistics, lists, abstracts or other
 extracted information; generating
 computer output; providing files under
 court process where the Federal
 Government is not a party to, and does
 not have an interest in, the
 litigation.
------------------------------------------------------------------------

    Note to paragraph (g)(1): VA will charge fees consistent with the 
salary scale published by the Office of Personnel Management (OPM).

    (2) [Reserved]
    (h) Notification of fee estimate or other fee issues. (1) VA will 
not charge the requester if the fee is $25.00 or less.
    (2) When a FOIA Officer determines or estimates that the fees to be 
charged under this section will amount to more than $25.00 or the amount 
set by OMB fee guidelines, whichever is higher, the FOIA Officer will 
notify the requester in writing of the actual or estimated amount of 
fees and ask the requester to provide written assurance of the payment 
of all fees or fees up to a designated amount, unless he or she has 
indicated a willingness to pay fees as high as those anticipated. Any 
such

[[Page 78]]

agreement to pay the fees shall be memorialized in writing. When the 
requester does not provide sufficient information upon which VA can 
identify a fee category (see paragraphs (c)(1) through (c)(4) of this 
section), or a clarification is otherwise required regarding a fee, the 
FOIA Officer may notify the requester and seek clarification; the 
notification to the requester will state that if a written response is 
not received within 10 days, the request will be closed. The timeline 
for responding to the request will be tolled and no further work will be 
done on the request until the fee issue has been resolved.
    (i) Charges for other services. Apart from the other provisions of 
this section, VA will charge the requester the direct costs of providing 
any special handling or services requested, such as certifying that 
records are true copies or sending them by other than ordinary mail. The 
FOIA Officer may choose to provide such a service as a matter of 
administrative discretion.
    (j) Charging interest. The FOIA Officer may charge interest on any 
unpaid bill starting on the 31st day following the date of billing the 
requester. Interest charges will be assessed at the rate provided in 31 
U.S.C. 3717 and will accrue until payment is received by the component. 
Components will follow the provisions of the Debt Collection Act of 1982 
(Pub. L. 97-365, 96 Stat. 1749), as amended, and its administrative 
procedures, including the use of consumer reporting agencies, collection 
agencies, and offset.
    (k) Aggregating requests. Whenever a FOIA Officer reasonably 
believes that a requester or group of requesters acting together is 
attempting to divide a request into a series of requests for the purpose 
of avoiding fees, the FOIA Officer may aggregate those requests and 
charge accordingly. FOIA Officers may presume that multiple requests of 
this type made within a 30-day period have been made in order to avoid 
fees. Where requests are separated by a longer period, the FOIA Officer 
will aggregate them only where there exists a solid basis for 
determining that aggregation is warranted under all the circumstances 
involved. Multiple requests involving unrelated matters will not be 
aggregated.
    (l) Advance payments. (1) For requests other than those described in 
paragraphs (l)(2) and (l)(3) of this section, a FOIA Officer shall not 
require the requester to make an advance payment--in other words, a 
payment made before work is begun or continued on a request. Payment 
owed for work already completed (i.e., a prepayment before copies are 
sent to the requester) is not an advance payment.
    (2) Where a FOIA Officer determines or estimates that a total fee to 
be charged under this section will be more than $250.00, the FOIA 
Officer may require the requester to make an advance payment of an 
amount up to the amount of the entire anticipated fee before beginning 
to process the request.
    (3) Where the requester previously has failed to pay a properly 
charged FOIA fee to VA within 30 days of the date of billing, a FOIA 
Officer may require the requester to pay the full amount due, plus any 
applicable interest as specified in this section, and to make an advance 
payment of the full amount of any anticipated fee, before the FOIA 
Officer begins to process a new request or continues to process a 
pending request from that requester.
    (4) When the requester has a history of prompt payment, the FOIA 
Officer may accept a satisfactory assurance of full payment from the 
requester rather than an advance payment.
    (5) In cases in which a FOIA Officer requires advance payment or 
payment is due under this section, the time for responding to the 
request will be tolled and further work will not be done on the request 
until the required payment is received.
    (m) Other statutes specifically providing for fees. The fee schedule 
of this section does not apply to fees charged under any statute that 
specifically requires an agency to set and collect fees for particular 
types of records. Where records responsive to requests are maintained 
for distribution by agencies operating such statutorily-based fee 
schedule programs, the FOIA Officer will inform requesters of the steps 
for obtaining records from those sources so

[[Page 79]]

that they may do so most economically.
    (n) Requirements for waiver or reduction of fees. (1) Waiving or 
reducing fees. Fees for processing the request may be waived if the 
requester meets the criteria listed in this section. The requester must 
submit adequate justification for a fee waiver; without adequate 
justification, the request will be denied. The FOIA Officer may, at his 
or her discretion, communicate with the requester to seek additional 
information, if necessary, regarding the fee waiver request. If the 
additional information is not received from the requester within 10 days 
of the FOIA Officer's communication with the requester, VA will assume 
that the requester does not wish to pursue the fee waiver request and 
the fee waiver request will be closed. If the request for waiver or 
reduction is denied or closed, the underlying FOIA request will continue 
to be processed in accordance with the applicable provisions of this 
Part. Requests for fee waivers are decided on a case-by-case basis; 
receipt of a fee waiver in the past does not establish entitlement to a 
fee waiver each time a request is submitted.
    (2) Records responsive to a request will be furnished without charge 
or at a charge reduced below that established under paragraph (d) of 
this section where a FOIA Officer determines, based on all available 
evidence, that the requester has demonstrated that:
    (i) Disclosure of the requested information is in the public 
interest because it is likely to contribute significantly to public 
understanding of the operations or activities of the government, and
    (ii) Disclosure of the information is not primarily in the 
commercial interest of the requester.
    (3) To determine whether the fee waiver requirement under paragraph 
(n)(2)(i) of this section is met, the FOIA Officer will consider the 
following factors:
    (i) The subject of the request: Whether the subject of the requested 
records concerns ``the operations or activities of the government.'' The 
subject of the requested records must concern identifiable operations or 
activities of the federal government, with a connection that is direct 
and clear, not remote or attenuated.
    (ii) The informative value of the information to be disclosed: 
Whether the disclosure is ``likely to contribute'' to an understanding 
of government operations or activities. The disclosable portions of the 
requested records must be meaningfully informative about government 
operations or activities in order to be ``likely to contribute'' to an 
increased public understanding of those operations or activities. The 
disclosure of information that already is in the public domain, in 
either a duplicative or a substantially identical form, would not be as 
likely to contribute to such understanding where nothing new would be 
added to the public's understanding.
    (iii) The contribution to an understanding of the subject by the 
public likely to result from disclosure: Whether disclosure of the 
requested information will contribute to ``public understanding.'' The 
disclosure must contribute to the understanding of a reasonably broad 
audience of persons interested in the subject, as opposed to the 
individual understanding of the requester. The requester's expertise in 
the subject area and ability and intention to effectively convey 
information to the public shall be considered. It shall be presumed that 
a representative of the news media will satisfy this consideration.
    (iv) The significance of the contribution to public understanding: 
Whether the disclosure is likely to contribute ``significantly'' to 
public understanding of government operations or activities. The 
public's understanding of the subject in question, as compared to the 
level of public understanding existing prior to the disclosure, must be 
enhanced by the disclosure to a significant extent. The FOIA Officer 
will not make value judgments about whether information that would 
contribute significantly to public understanding of the operations or 
activities of the government is important enough to be made public.
    (4) To determine whether the fee waiver requirement under paragraph 
(n)(2)(ii) of this section is met, the FOIA Officer will consider the 
following factors:
    (i) The existence and magnitude of a commercial interest: Whether 
the requester has a commercial interest that

[[Page 80]]

would be furthered by the requested disclosure. The FOIA Officer shall 
consider any commercial interest of the requester (with reference to the 
definition of ``commercial use'' in paragraph (b)(2) of this section), 
or of any person on whose behalf the requester may be acting, that would 
be furthered by the requested disclosure. Requesters shall be given an 
opportunity in the administrative process to provide explanatory 
information regarding this consideration.
    (ii) The primary interest in disclosure: Whether any identified 
commercial interest of the requester is sufficiently large, in 
comparison with the public interest in disclosure, that disclosure is 
``primarily in the commercial interest of the requester.'' A fee waiver 
or reduction is justified where the public interest standard is 
satisfied and that public interest is greater in magnitude than that of 
any identified commercial interest in disclosure. The FOIA Officer 
ordinarily shall presume that where a news media requester has satisfied 
the public interest standard, the public interest will be the interest 
primarily served by disclosure to that requester. Disclosure to data 
brokers or others who merely compile and market government information 
for direct economic return will not be presumed to primarily serve the 
public interest.
    (5) Where only some of the records to be released satisfy the 
requirements for a waiver of fees, a fee waiver will be granted only for 
those records which so qualify.
    (6) Requests for the waiver or reduction of fees should address the 
factors listed in paragraph (n)(3) and (4) of this section, insofar as 
they apply to each request. FOIA Officers will exercise their discretion 
to consider the cost-effectiveness of their investment of administrative 
resources in this decision-making process, however, in deciding to grant 
waivers or reductions of fees.
    (7) An appeal from an adverse fee determination will be processed in 
accordance with Sec.  1.559.
    (8) When considering a request for fee waiver, VA may require proof 
of identity.

[76 FR 51895, Aug. 19, 2011, as amended at 84 FR 12128, Apr. 1, 2019; 84 
FR 14874, Apr. 12, 2019]



Sec.  1.562  Other rights and services.

    Nothing in this part shall be construed to entitle any person, as of 
right, to any service or to the disclosure of any record to which such 
person is not entitled under the FOIA.

(Authority:Sections 1.550 to 1.562 issued under 72 Stat. 1114; 38 U.S.C. 
501)

[76 FR 51895, Aug. 19, 2011]

  Safeguarding Personal Information in Department of Veterans Affairs 
                                 Records

    Note: Sections 1.575 through 1.584 concern the safeguarding of 
individual privacy from the misuse of information from files, records, 
reports, and other papers and documents in Department of Veterans 
Affairs custody. As to the release of information from Department of 
Veterans Affairs claimant records see Sec.  1.500 series. As to the 
release of information from Department of Veterans Affairs records other 
than claimant records see Sec.  1.550 series. Section 1.575 series 
implement the provisions of Pub. L. 93-579, December 31, 1974, adding a 
section 552a to title 5 U.S.C. providing that individuals be granted 
access to records concerning them which are maintained by Federal 
agencies, and for other purposes.

    Source: 40 FR 33944, Aug. 12, 1975, unless otherwise noted.



Sec.  1.575  Social security numbers in veterans' benefits matters.

    (a) Except as provided in paragraph (b) of this section, no one will 
be denied any right, benefit, or privilege provided by law because of 
refusal to disclose to the Department of Veterans Affairs a social 
security number.
    (b) VA shall require mandatory disclosure of a claimant's or 
beneficiary's social security number (including the social security 
number of a dependent of a claimant or beneficiary) on necessary forms 
as prescribed by the Secretary as a condition precedent to receipt or 
continuation of receipt of compensation or pension payable under the 
provisions of chapters 11, 13 and 15 of title 38, United States Code, 
provided, however, that a claimant shall not be required to furnish VA 
with a social security number for any person to whom a social security 
number has not been assigned. VA may also require mandatory disclosure 
of an applicant's social

[[Page 81]]

security number as a condition for receiving loan guaranty benefits and 
a social security number or other taxpayer identification number from 
existing direct and vendee loan borrowers and as a condition precedent 
to receipt of a VA-guaranteed loan, direct loan or vendee loan, under 
chapter 37 of title 38, United States Code. (Pub. L. 97-365, sec. 4)
    (c) A person requested by VA to disclose a social security number 
shall be told, as prescribed by Sec.  1.578(c), whether disclosure is 
voluntary or mandatory. The person shall also be told that VA is 
requesting the social security number under the authority of title 38 
U.S.C., or in the case of existing direct or vendee loan borrowers, 
under the authority of 26 U.S.C. 6109(a) in conjunction with sections 
145 and 148 of Pub. L. 98-369, or in the case of loan applicants, under 
the authority of section 4 of Pub. L. 97-365. The person shall also be 
told that it will be used in the administration of veterans' benefits in 
the identification of veterans or persons claiming or receiving VA 
benefits and their records, that it may be used in making reports to the 
Internal Revenue Service where required by law, and to determine whether 
a loan guaranty applicant has been identified as a delinquent taxpayer 
by the Internal Revenue Service, and that such taxpayers may have their 
loan applications rejected, and that it may be used to verify social 
security benefit entitlement (including amounts payable) with the Social 
Security Administration and, for other purposes where authorized by both 
title 38 U.S.C., and the Privacy Act of 1974, (Pub. L. 93-579), or, 
where required by another statute. (Pub. L. 97-365, sec. 4)

(Authority: 38 U.S.C. 5101)

[44 FR 22068, Apr. 13, 1979, as amended at 51 FR 21750, June 16, 1986; 
56 FR 25044, June 3, 1991]



Sec.  1.576  General policies, conditions of disclosure, accounting of
certain disclosures, and definitions.

    (a) The Department of Veterans Affairs will safeguard an individual 
against an invasion of personal privacy. Except as otherwise provided by 
law or regulation its officials and employees will:
    (1) Permit an individual to determine what records pertaining to him 
or her will be collected, maintained, used, or disseminated by the 
Department of Veterans Affairs.
    (2) Permit an individual to prevent records pertaining to him or 
her, obtained by the Department of Veterans Affairs for a particular 
purpose, from being used or made available for another purpose without 
his or her consent.
    (3) Permit an individual to gain access to information pertaining to 
him or her in Department of Veterans Affairs records, to have a copy 
made of all or any portion thereof, and to correct or amend such 
records.
    (4) Collect, maintain, use, or disseminate any record of 
identifiable personal information in a manner that assures that such 
action is for a necessary and lawful purpose, that the information is 
correct and accurate for its intended use, and that adequate safeguards 
are provided to prevent misuse of such information.
    (5) Permit exemptions from records requirements provided in 5 U.S.C. 
552a only where an important public policy need for such exemption has 
been determined pursuant to specific statutory authority.
    (b) The Department of Veterans Affairs will not disclose any record 
contained in a system of records by any means of communication to any 
person or any other agency except by written request of or prior written 
consent of the individual to whom the record pertains unless such 
disclosure is:
    (1) To those officers and employees of the agency which maintains 
the record and who have a need for the record in the performance of 
their duties;
    (2) Required under 5 U.S.C. 552;
    (3) For a routine use of the record compatible with the purpose for 
which it was collected;
    (4) To the Bureau of the Census for purposes of planning or carrying 
out a census or survey or related activity pursuant to title 13 U.S.C.;
    (5) To a recipient who has provided the Department of Veterans 
Affairs with advance adequate written assurance that the record will be 
used solely as a statistical research or reporting

[[Page 82]]

record, and the record is to be transferred in a form that is not 
individually identifiable;
    (6) To the National Archives of the United States as a record which 
has sufficient historical or other value to warrant its continued 
preservation by the U.S. Government, or for evaluation by the 
Administrator of General Services or designee to determine whether the 
record has such value;
    (7) To another agency or to an instrumentality of any governmental 
jurisdiction within or under the control of the United States for a 
civil or criminal law enforcement activity if the activity is authorized 
by law, and if the head of the agency or instrumentality has made a 
written request to the Department of Veterans Affairs specifying the 
particular portion desired and the law enforcement activity for which 
the record is sought;
    (8) To a person pursuant to a showing of compelling circumstances 
affecting the health or safety of an individual if upon such disclosure 
notification is transmitted to the last known address of such 
individual;
    (9) To either House of Congress, or, to the extent of matter within 
its jurisdiction, any committee or subcommittee thereof, any joint 
committee of Congress or subcommittee of any such joint committee;
    (10) To the Comptroller General, or any authorized representatives, 
in the course of the performance of the duties of the General Accounting 
Office; or
    (11) Pursuant to the order of a court of competent jurisdiction.
    (c) With respect to each system of records (i.e., a group of records 
from which information is retrieved by the name of the individual or by 
some identifying number, symbol, or other identifying particular 
assigned to the individual) under Department of Veterans Affairs 
control, the Department of Veterans Affairs will (except for disclosures 
made under paragraph (b)(1) or (2) of this section) keep an accurate 
accounting as follows:
    (1) For each disclosure of a record to any person or to another 
agency made under paragraph (b) of this section, maintain information 
consisting of the date, nature, and purpose of each disclosure, and the 
name and address of the person or agency to whom the disclosure is made;
    (2) Retain the accounting made under paragraph (c)(1) of this 
section for at least 5 years or the life of the record, whichever is 
longer, after the disclosure for which the accounting is made;
    (3) Except for disclosures made under paragraph (b)(7) of this 
section, make the accounting under paragraph (c)(1) of this section 
available to the individual named in the record at his or her request; 
and
    (4) Inform any person or other agency about any correction or 
notation of dispute made by the agency in accordance with Sec.  1.579 of 
any record that has been disclosed to the person or agency if an 
accounting of the disclosure was made.
    (d) For the purposes of Sec. Sec.  1.575 through 1.584, the parent 
of any minor, or the legal guardian of any individual who has been 
declared incompetent due to physical or mental incapacity or age by a 
court of competent jurisdiction, may act on behalf of the individual.
    (e) Section 552a(i), title 5 U.S.C., provides that:
    (1) Any officer or employee of the Department of Veterans Affairs, 
who by virtue of his or her employment or official position, has 
possession of, or access to, Department of Veterans Affairs records 
which contain individually identifiable information the disclosure of 
which is prohibited by 5 U.S.C. 552a or by Sec.  1.575 series 
established thereunder, and who knowing that disclosure of the specific 
material is so prohibited, willfully discloses the material in any 
manner to any person or agency not entitled to receive it, shall be 
guilty of a misdemeanor and fined not more than $5,000.
    (2) Any officer or employee of the Department of Veterans Affairs 
who willfully maintains a system of records without meeting the notice 
requirements of 5 U.S.C. 552a(e)(4) (see Sec.  1.578(d)) shall be guilty 
of a misdemeanor and fined not more than $5,000.
    (3) Any person who knowingly and willfully requests or obtains any 
record concerning an individual from the Department of Veterans Affairs 
under

[[Page 83]]

false pretenses shall be guilty of a misdemeanor and fined not more than 
$5,000.
    (f) For purposes of Sec.  1.575 series the following definitions 
apply:
    (1) The term agency includes any executive department, military 
department, Government corporation, Government controlled corporation, 
or other establishment in the executive branch of the government 
(including the Executive Office of the President), or any independent 
regulatory agency.
    (2) The term individual means a citizen of the United States or an 
alien lawfully admitted for permanent residence.
    (3) The term maintain includes maintain, collect, use, or 
disseminate.
    (4) The term record means any item, collection, or grouping of 
information about an individual that is maintained by an agency, 
including, but not limited to, his or her education, financial 
transactions, medical history, and criminal or employment history and 
that contains his or her name, or the identifying number, symbol, or 
other identifying particular assigned to the individual, such as a 
finger or voice print or a photograph.
    (5) The term system of records means a group of any records under 
the control of any agency from which information is retrieved by the 
name of the individual or by some identifying number, symbol, or other 
identifying particular assigned to the individual.
    (6) The term statistical record means a record in a system of 
records maintained for statistical research or reporting purposes only 
and not used in whole or in part in making any determination about an 
identifiable individual except as provided by section 8 of title 13 
U.S.C.
    (7) The term routine use means, with respect to the disclosure of a 
record, the use of such record for a purpose which is compatible with 
the purpose for which it was collected.
    (g) When the Department of Veterans Affairs provides by a contract 
for the operation by or on behalf of the Department of Veterans Affairs 
of a system of records to accomplish a Department of Veterans Affairs 
function, the Department of Veterans Affairs will, consistent with its 
authority, cause the requirements of 5 U.S.C. 552a (as required by 
subsection (m)) and those of the Sec.  1.575 series to be applied to 
such system. For the purposes of 5 U.S.C. 552a(i) and Sec.  1.576(e) any 
such contractor and any employee of such contractor, if such contract is 
agreed to on or after September 27, 1975, will be considered to be an 
employee of the Department of Veterans Affairs.
    (h) The Department of Veterans Affairs will, for the purposes of 5 
U.S.C. 552a, consider that it maintains any agency record which it 
deposits with the Administrator of General Services for storage, 
processing, and servicing in accordance with section 3103 of title 44 
U.S.C. Any such record will be considered subject to the provisions of 
Sec.  1.575 series implementing 5 U.S.C. 552a and any other applicable 
Department of Veterans Affairs regulations. The Administrator of General 
Services is not authorized to disclose such a record except to the 
Department of Veterans Affairs, or under regulations established by the 
Department of Veterans Affairs which are not inconsistent with 5 U.S.C. 
552a.
    (i) The Department of Veterans Affairs will, for the purposes of 5 
U.S.C. 552a, consider that a record is maintained by the National 
Archives of the United States if it pertains to an identifiable 
individual and was transferred to the National Archives prior to 
September 27, 1975, as a record which has sufficient historical or other 
value to warrant its continued preservation by the United States 
Government. Such records are not subject to the provisions of 5 U.S.C. 
552a except that a statement generally describing such records (modeled 
after the requirements relating to records subject to subsections 
(e)(4)(A) through (G) of 5 U.S.C. 552a) will be published in the Federal 
Register.
    (j) The Department of Veterans Affairs will also, for the purposes 
of 5 U.S.C. 552a, consider that a record is maintained by the National 
Archives of the United States if it pertains to an identifiable 
individual and is transferred to the National Archives on or after 
September 27, 1975, as a record which has sufficient historical or other

[[Page 84]]

value to warrant its continued preservation by the United States 
Government. Such records are exempt from the requirements of 5 U.S.C. 
552a except subsections (e)(4) (A) through (G) and (e)(9) thereof.

(Authority: 38 U.S.C. 501)

[40 FR 33944, Aug. 12, 1975, as amended at 40 FR 58644, Dec. 18, 1975; 
47 FR 16323, Apr. 16, 1982]



Sec.  1.577  Access to records.

    (a) Except as otherwise provided by law or regulation any individual 
upon request may gain access to his or her record or to any information 
pertaining to him or her which is contained in any system of records 
maintained by the Department of Veterans Affairs. The individual will be 
permitted, and upon his or her request, a person of his or her own 
choosing permitted to accompany him or her, to review the record and 
have a copy made of all or any portion thereof in a form comprehensible 
to him or her. The Department of Veterans Affairs will require, however, 
a written statement from the individual authorizing discussion of that 
individual's record in the accompanying person's presence.
    (b) Any individual will be notified, upon request, if any Department 
of Veterans Affairs system of records named contains a record pertaining 
to him or her. Such request must be in writing, over the signature of 
the requester. The request must contain a reasonable description of the 
Department of Veterans Affairs system or systems of records involved, as 
described at least annually by notice published in the Federal Register 
describing the existence and character of the Department of Veterans 
Affairs system or systems of records pursuant to Sec.  1.578(d). The 
request should be made to the office concerned (having jurisdiction over 
the system or systems of records involved) or, if not known, to the 
Director or Department of Veterans Affairs Officer in the nearest 
Department of Veterans Affairs regional office, or to the Department of 
Veterans Affairs Central Office, 810 Vermont Avenue, NW., Washington, DC 
20420. Personal contact should normally be made during the regular duty 
hours of the office concerned, which are 8:00 a.m. to 4:30 p.m., Monday 
through Friday for Department of Veterans Affairs Central Office and 
most field facilities. Identification of the individual requesting the 
information will be required and will consist of the requester's name, 
signature, address, and claim, insurance or other identifying file 
number, if any, as a minimum. Additional identifying data or documents 
may be required in specified categories as determined by operating 
requirements and established and publicized by the promulgation of 
Department of Veterans Affairs regulations. (5 U.S.C. 552a(f)(1))
    (c) The VA component or staff office having jurisdiction over the 
records subject to the Privacy Act request will establish appropriate 
disclosure procedures, including notifying the individual who filed the 
Privacy Act request of the time, place, and conditions under which the 
VA will comply with the request, in accordance with applicable laws and 
regulations. Access requests for Privacy Act records or information must 
be sent to the staff office that maintains the records; the individual 
seeking access may consult the system of record notice (https://
www.oprm.va.gov/privacy/systems_of_records.aspx) in order to identify 
the office to which the request should be sent. Each component has 
discretion to require that a requester supply additional information to 
verify his or her identity. If the Privacy Officer determines that the 
request does not reasonably describe the records being sought, the 
Privacy Officer will advise the requester how the request is 
insufficient; the Privacy Officer will provide an opportunity to discuss 
the request by documented telephonic communication or written 
correspondence in order to modify it to clearly identify the records 
being sought.
    (d) Nothing in 5 U.S.C. 552a, however, allows an individual access 
to any information compiled in reasonable anticipation of civil action 
or proceeding. (5 U.S.C. 552a(d)(5))
    (e) Fees to be charged, if any, to any individual for making copies 
of his or her record shall not include the cost of and search for and 
review of the record. Fees under $25.00 shall be waived. Fees to be 
charged are as follows:

[[Page 85]]



------------------------------------------------------------------------
                Activity                               Fees
------------------------------------------------------------------------
(1) Duplication of documents by any      $0.15 per page after first 100
 type of reproduction process to          one-sided pages or electronic
 produce plain one-sided paper copies     equivalent.
 of a standard size (8\1/2\[sec] x
 11[sec]; 8\1/2\[sec] x 14[sec];
 11[sec] x 14[sec]).
(2) Duplication of non-paper records,    Direct cost to the Agency as
 such as microforms, audiovisual          defined in Sec.   1.561(b)(3)
 materials (motion pictures, slides,      of this part to the extent
 laser optical disks, video tapes,        that it pertains to the cost
 audio tapes, etc.), computer tapes and   of duplication.
 disks, diskettes for personal
 computers, and any other automated
 media output.
(3) Duplication of document by any type  Direct cost to the Agency as
 of reproduction process not covered by   defined in Sec.   1.561(b)(3)
 paragraphs (e)(1) or (2) of this         of this part to the extent
 section to produce a copy in a form      that it pertains to the cost
 reasonably usable by the requester.      of duplication.
------------------------------------------------------------------------


    (f) When VA benefit records, which are retrievable by name or 
individual identifier of a VA beneficiary or applicant for VA benefits, 
are requested by the individual to whom the record pertains, the 
duplication fee for one complete set of such records will be waived.

(Authority: 5 U.S.C. 552a(f)(5)) (38 U.S.C. 501)

[40 FR 33944, Aug. 12, 1975, as amended at 47 FR 16323, Apr. 16, 1982; 
53 FR 10380, Mar. 31, 1988; 55 FR 21546, May 25, 1990; 78 FR 45457, July 
29, 2013; 84 FR 12130, Apr. 1, 2019]



Sec.  1.578  [Reserved]



Sec.  1.579  Amendment of records.

    (a) Any individual may request amendment of any Department of 
Veterans Affairs record pertaining to him or her. Not later than 10 days 
(excluding Saturdays, Sundays, and legal public holidays) after the date 
or receipt of such request, the Department of Veterans Affairs will 
acknowledge in writing such receipt. The Department of Veterans Affairs 
will complete the review to amend or correct a record as soon as 
reasonably possible, normally within 30 days from the receipt of the 
request (excluding Saturdays, Sundays, and legal public holidays) unless 
unusual circumstances preclude completing action within that time. The 
Department of Veterans Affairs will promptly either:
    (1) Correct any part thereof which the individual believes is not 
accurate, relevant, timely or complete; or
    (2) Inform the individual of the Department of Veterans Affairs 
refusal to amend the record in accordance with his or her request, the 
reason for the refusal, the procedures by which the individual may 
request a review of that refusal by the Secretary or designee, and the 
name and address of such official.


(Authority: 5 U.S.C. 552a(d)(2))

    (b) The administration or staff office having jurisdiction over the 
records involved will establish procedures for reviewing a request from 
an individual concerning the amendment of any record or information 
pertaining to the individual, for making a determination on the request, 
for an appeal within the Department of Veterans Affairs of an initial 
adverse Department of Veterans Affairs determination, and for whatever 
additional means may be necessary for each individual to be able to 
exercise fully, his or her right under 5 U.S.C. 552a.
    (1) Headquarters officials designated as responsible for the 
amendment of records or information located in Central Office and under 
their jurisdiction include, but are not limited to: Secretary; Deputy 
Secretary, as well as other appropriate individuals responsible for the 
conduct of business within the various Department of Veterans Affairs 
administrations and staff offices. These officials will determine and 
advise the requester of the identifying information required to relate 
the request to the appropriate record, evaluate and grant or deny 
requests to amend, review initial adverse determinations upon request, 
and assist requesters desiring to amend or appeal initial adverse 
determinations or learn further of the provisions for judicial review.
    (2) The following field officials are designated as responsible for 
the amendment of records or information located in facilities under 
their jurisdiction, as appropriate: The Director of

[[Page 86]]

each Center, Domiciliary, Medical Center, Outpatient Clinic, Regional 
Office, Supply Depot, and Regional Counsels. These officials will 
function in the same manner at field facilities as that specified in the 
preceding subparagraph for headquarters officials in Central Office.


(Authority: 5 U.S.C. 552a(f)(4))

    (c) Any individual who disagrees with the Department of Veterans 
Affairs refusal to amend his or her record may request a review of such 
refusal. The Department of Veterans Affairs will complete such review 
not later than 30 days (excluding Saturdays, Sundays, and legal public 
holidays) from the date on which the individual request such review and 
make a final determination unless, for good cause shown, the Secretary 
extends such 30-day period. If, after review, the Secretary or designee 
also refuses to amend the record in accordance with the request the 
individual will be advised of the right to file with the Department of 
Veterans Affairs a concise statement setting forth the reasons for his 
or her disagreement with the Department of Veterans Affairs refusal and 
also advise of the provisions for judicial review of the reviewing 
official's determination. (5 U.S.C. 552a(g)(1)(A))
    (d) In any disclosure, containing information about which the 
individual has filed a statement of disagreement, occurring after the 
filing of the statement under paragraph (c) of this section, the 
Department of Veterans Affairs will clearly note any part of the record 
which is disputed and provide copies of the statement (and, if the 
Department of Veterans Affairs deems it appropriate, copies of a concise 
statement of the Department of Veterans Affairs reasons for not making 
the amendments requested) to persons or other agencies to whom the 
disputed record has been disclosed. (5 U.S.C. 552a(d)(4)) (38 U.S.C. 
501)

[47 FR 16324, Apr. 16, 1982]



Sec.  1.580  Administrative review.

    (a) Upon consideration and denial of a request under Sec.  1.577 or 
Sec.  1.579 of this part, the responsible VA official or designated 
employee will inform the requester in writing of the denial. The adverse 
determination notice must be signed by the component head or the 
component's Privacy Officer, and shall include the following:
    (1) The name and title or position of the person responsible for the 
adverse determination;
    (2) A brief statement of the reason(s) for the denial and the policy 
upon which the denial is based; and
    (3) Notice that the requester may appeal the adverse determination 
under paragraph (b) of this section to the Office of General Counsel 
(providing the address as follows: Office of General Counsel (024), 810 
Vermont Avenue NW, Washington, DC 20420), and instructions on what 
information is required for an appeal, which includes why the individual 
disagrees with the initial denial with specific attention to one or more 
of the four standards (e.g., accuracy, relevance, timeliness, and 
completeness), and a copy of the denial letter and any supporting 
documentation that demonstrates why the individual believes the 
information does not meet these requirements.
    (b) The final agency decision in appeals of adverse determinations 
described in paragraph (a) of this section will be made by the 
designated official within the Office of General Counsel (024).
    (c) A written denial must have occurred to appeal to OGC. The 
absence of a response to an access or amendment request filed with a VA 
component is not a denial. If an individual has not received a response 
to a request for access to or amendment of records, the individual must 
pursue the request with the Privacy Officer of the administration office 
(e.g., the VHA, VBA, or National Cemetery Administration Privacy 
Officer) or staff office (e.g., the Office of Information Technology or 
Office of Inspector General Privacy Staff Officer) that has custody over 
the records.

[84 FR 12130, Apr. 1, 2019]



Sec.  1.581  [Reserved]



Sec.  1.582  Exemptions.

    (a) Certain systems of records maintained by the Department of 
Veterans Affairs are exempted from provisions of

[[Page 87]]

the Privacy Act in accordance with exemptions (j) and (k) of 5 U.S.C. 
552a.
    (b) Exemption of Inspector General Systems of Records. The 
Department of Veterans Affairs provides limited access to Inspector 
General Systems of Records as indicated.
    (1) The following systems of records are exempted pursuant to the 
provisions of 5 U.S.C. 552a(j)(2) from subsections (c)(3) and (4), (d), 
(e)(1), (2) and (3), (e)(4) (G), (H) and (I), (e)(5) and (8), (f) and 
(g) of 5 U.S.C. 552a; in addition, the following systems of records are 
exempted pursuant to the provisions of 5 U.S.C. 552a(k)(2) from 
subsections (c)(3), (d), (e)(1), (e)(4) (G), (H), and (I), and (f) of 5 
U.S.C. 552a:
    (i) Investigation Reports of Persons Allegedly Involved in 
Irregularities Concerning VA and Federal Laws, Regulations, Programs, 
etc.--VA (11 VA51); and
    (ii) Inspector General Complaint Center Records--VA (66VA53).
    (2) These exemptions apply to the extent that information in those 
systems is subject to exemptions pursuant to 5 U.S.C. 552a (j)(2) and 
(k)(2).
    (3) For the reasons set forth, the systems of records listed under 
paragraph (b)(1) of this section are exempted under sections 552a (j)(2) 
and (k)(2) from the following provisions of 5 U.S.C. 552a:
    (i) 5 U.S.C. 552a(c)(3) requires that upon request, an agency must 
give an individual named in a record an accounting which reflects the 
disclosure of the record to other persons or agencies. This accounting 
must state the date, nature and purpose of each disclosure of the record 
and the name and address of the recipient. The application of this 
provision would alert subjects to the existence of the investigation and 
identify that such persons are subject of that investigation. Since 
release of such information to subjects would provide them with 
significant information concerning the nature of the investigation, it 
could result in the altering or destruction of derivative evidence which 
is obtained from third parties, improper influencing of witnesses, and 
other activities that could impede or compromise the investigation.
    (ii) 5 U.S.C. 552a(c)(4), (d), (e)(4) (G) and (H), (f) and (g) 
relate to an individual's right to be notified of the existence of 
records pertaining to such individual; requirements for identifying an 
individual who requests access to records; the agency procedures 
relating to access to records and the amendment of information contained 
in such records; and the civil remedies available to the individual in 
the event of adverse determinations by an agency concerning access to or 
amendment of information contained in record systems. This system is 
exempt from the foregoing provisions for the following reasons: To 
notify an individual at the individual's request of the existence of 
records in an investigative file pertaining to such individual or to 
grant access to an investigative file could interfere with investigative 
and enforcement proceedings, threaten the safety of individuals who have 
cooperated with authorities, constitute an unwarranted invasion of 
personal privacy of others, disclose the identity of confidential 
sources, reveal confidential information supplied by these sources, and 
disclose investigative techniques and procedures.
    (iii) 5 U.S.C. 552a(e)(4)(I) requires the publication of the 
categories of sources of records in each system of records. The 
application of this provision could disclose investigative techniques 
and procedures and cause sources to refrain from giving such information 
because of fear of reprisal, or fear of breach of promises of anonymity 
and confidentiality. This could compromise the ability to conduct 
investigations and to identify, detect and apprehend violators. Even 
though the agency has claimed an exemption from this particular 
requirement, it still plans to generally identify the categories of 
records and the sources for these records in this system. However, for 
the reasons stated in paragraph (b)(3)(ii) of this section, this 
exemption is still being cited in the event an individual wants to know 
a specific source of information.
    (iv) 5 U.S.C. 552a(e)(1) requires each agency to maintain in its 
records only such information about an individual that is relevant and 
necessary to accomplish a purpose of the agency required by statute or 
Executive order.

[[Page 88]]

These systems of records are exempt from the foregoing provisions 
because:
    (A) It is not possible to detect the relevance or necessity of 
specific information in the early stages of a criminal or other 
investigation.
    (B) Relevance and necessity are questions of judgment and timing. 
What appears relevant and necessary may ultimately be determined to be 
unnecessary. It is only after the information is evaluated that the 
relevance and necessity of such information can be established.
    (C) In any investigation the Inspector General may obtain 
information concerning the violations of laws other than those within 
the scope of his/her jurisdiction. In the interest of effective law 
enforcement, the Inspector General should retain this information as it 
may aid in establishing patterns of criminal activity and provide leads 
for those law enforcement agencies charged with enforcing other segments 
of civil or criminal law.
    (v) 5 U.S.C. 552a(e)(2) requires an agency to collect information to 
the greatest extent practicable directly from the subject individual 
when the information may result in adverse determinations about an 
individual's rights, benefits, and privileges under Federal programs. 
The application of this provision would impair investigations of illegal 
acts, violations of the rules of conduct, merit system and any other 
misconduct for the following reasons:
    (A) In order to successfully verify a complaint, most information 
about a complainant or an individual under investigation must be 
obtained from third parties such as witnesses and informers. It is not 
feasible to rely upon the subject of the investigation as a source for 
information regarding his/her activities because of the subject's rights 
against self-incrimination and because of the inherent unreliability of 
the suspect's statements. Similarly, it is not always feasible to rely 
upon the complainant as a source of information regarding his/her 
involvement in an investigation.
    (B) The subject of an investigation will be alerted to the existence 
of an investigation if an attempt is made to obtain information from the 
subject. This would afford the individual the opportunity to conceal any 
criminal activities to avoid apprehension.
    (vi) 5 U.S.C. 552a(e)(3) requires that an agency must inform the 
subject of an investigation who is asked to supply information of:
    (A) The authority under which the information is sought and whether 
disclosure of the information is mandatory or voluntary;
    (B) The purposes for which the information is intended to be used;
    (C) The routine uses which may be made of the information; and
    (D) The effects on the subject, if any, of not providing the 
requested information. The reasons for exempting this system of records 
from the foregoing provision are as follows:
    (1) The disclosure to the subject of the purposes of the 
investigation as stated in paragraph (b)(3)(vi)(B) of this paragraph 
would provide the subject with substantial information relating to the 
nature of the investigation and could impede or compromise the 
investigation.
    (2) If the complainant or the subject were informed of the 
information required by this provision, it could seriously interfere 
with undercover activities requiring disclosure of the authority under 
which the information is being requested. This could conceivably 
jeopardize undercover agents' identities and impair their safety, as 
well as impair the successful conclusion of the investigation.
    (3) Individuals may be contacted during preliminary information 
gathering in investigations before any individual is identified as the 
subject of an investigation. Informing the individual of the matters 
required by this provision would hinder or adversely affect any present 
or subsequent investigations.
    (vii) 5 U.S.C. 552a(e)(5) requires that records be maintained with 
such accuracy, relevance, timeliness, and completeness as is reasonably 
necessary to assure fairness to the individual in making any 
determination about an individual. Since the law defines maintain to 
include the collection of information, complying with this provision 
would prevent the collection of any

[[Page 89]]

data not shown to be accurate, relevant, timely, and complete at the 
moment of its collection. In gathering information during the course of 
an investigation it is not always possible to determine this prior to 
collection of the information. Facts are first gathered and then placed 
into a logical order which objectively proves or disproves criminal 
behavior on the part of the suspect. Material which may seem unrelated, 
irrelevant, incomplete, untimely, etc., may take on added meaning as an 
investigation progresses. The restrictions in this provision could 
interfere with the preparation of a complete investigative report.
    (viii) 5 U.S.C. 552a(e)(8) requires an agency to make reasonable 
efforts to serve notice on an individual when any record on such 
individual is made available to any person under compulsory legal 
process when such process becomes a matter of public record. The notice 
requirement of this provision could prematurely reveal an ongoing 
criminal investigation to the subject of the investigation.
    (c) Exemption of Loan Guaranty Service, Veterans Benefits 
Administration, Systems of Records. The Department of Veterans Affairs 
provides limited access to Loan Guaranty Service, Veterans Benefits 
Administration, systems of records as indicated:
    (1) The following systems of records are exempted pursuant to the 
provisions of 5 U.S.C. 552a(k)(2) from subsections (c)(3), (d), (e)(1) 
and (e)(4) (G), (H) and (I) and (f):
    (i) Loan Guaranty Fee Personnel and Program Participant Records--VA 
(17VA26); and
    (ii) Loan Guaranty Home Condominium and Mobile Home Loan Applicant 
Records and Paraplegic Grant Application Records--VA (55VA26).
    (2) These exemptions apply to the extent that information in these 
systems is subject to exemption pursuant to 5 U.S.C. 552a(k)(2).
    (3) For the reasons set forth, the systems of records listed under 
paragraph (c)(1) of this section are exempted under 5 U.S.C. 552a(k)(2) 
from the following provisions of 5 U.S.C. 552a:
    (i) 5 U.S.C. 552a(c)(3) requires that an agency make accountings of 
disclosures of records available to individuals named in the records at 
their request. These accountings must state the date, nature and purpose 
of each disclosure of the record and the name and address of the 
recipient. The application of this provision would alert subjects of an 
investigation to the existence of the investigation and that such 
persons are subjects of that investigation. Since release of such 
information to subjects of an investigation would provide the subjects 
with significant information concerning the nature of the investigation, 
it could result in the altering or destruction of documentary evidence, 
improper influencing of witnesses and other activities that could impede 
or compromise the investigation.
    (ii) 5 U.S.C. 552a(d), (e)(4) (G) and (H) and (f) relate to an 
individual's right to be notified of the existence of records pertaining 
to such individual; requirements for identifying an individual who 
requests access to records; and the agency procedures relating to access 
to records and the contest of information contained in such records. 
This system is exempt from the foregoing provisions for the following 
reasons: To notify an individual at the individual's request of the 
existence of records in an investigative file pertaining to such 
individual or to grant access to an investigative file could interfere 
with investigative and enforcement proceedings; constitute an 
unwarranted invasion of the personal privacy of others; disclose the 
identity of confidential sources and reveal confidential information 
supplied by these sources and disclose investigative techniques and 
procedures.
    (iii) 5 U.S.C. 552a(e)(4)(I) requires the publication of the 
categories of sources of records in each system of records. The 
application of this provision could disclose investigative techniques 
and procedures and cause sources to refrain from giving such information 
because of fear of reprisal, or fear of breach of promises of anonymity 
and confidentiality. This would compromise the ability to conduct 
investigations. Even though the agency has claimed an exemption from 
this particular requirement, it still plans to generally identify the 
categories of records and the

[[Page 90]]

sources for these records in this system. However, for the reasons 
stated above, this exemption is still being cited in the event an 
individual wanted to know a specific source of information.
    (iv) 5 U.S.C. 552a(e)(1) requires each agency to maintain in its 
records only such information about an individual that is relevant and 
necessary to accomplish a purpose of the agency required by statute or 
Executive order. This system of records is exempt from the foregoing 
provision because:
    (A) It is not possible to detect relevance or necessity of specific 
information in the early stages of an investigation.
    (B) Relevance and necessity are questions of judgment and timing. 
What appears relevant and necessary when collected may ultimately be 
determined to be unnecessary. It is only after the information is 
evaluated that the relevance and necessity of such information can be 
established.
    (C) In interviewing persons or obtaining other forms of evidence 
during an investigation, information may be supplied to the investigator 
which relates to matters incidental to the main purpose of the 
investigation but which is appropriate in a thorough investigation. 
Oftentimes, such information cannot readily be segregated.
    (4) The following system of records is exempt pursuant to the 
provisions of 5 U.S.C. 552a(k)(5) from subsections (c)(3), (d), (e)(1), 
(e)(4) (G), (H) and (I) and (f): Loan Guaranty Fee Personnel and Program 
Participant Records--VA (17 VA 26).
    (5) This exemption applies to the extent that information in this 
system is subject to exemption pursuant to 5 U.S.C. 552a(k)(5).
    (6) For the reasons set forth, the system of records listed in 
paragraph (c)(4) of this section is exempt under 5 U.S.C. 552a(k)(5) 
from the following provisions of 5 U.S.C. 552a:
    (i) 5 U.S.C. 552a(c)(3) requires that an agency make accountings of 
disclosures of records available to individuals named in the records at 
their request. These accountings must state the date, nature and purpose 
of each disclosure of the record and the name and address of the 
recipient. The application of this provision would alert subjects of 
background suitability investigations to the existence of the 
investigation and reveal that such persons are subjects of that 
investigation. Since release of such information to subjects of an 
investigation would provide the subjects with significant information 
concerning the nature of the investigation, it could result in revealing 
the identity of a confidential source.
    (ii) 5 U.S.C. 552a(d), (e)(4) (G) and (H) and (f) relate to an 
individual's right to be notified of the existence of records pertaining 
to such individual; requirements for identifying an individual who 
requests access to records; and the agency procedures relating to access 
to records and the contest of information contained in such records. 
This system is exempt from the foregoing provisions for the following 
reasons: To notify an individual at the individual's request of the 
existence of records in an investigative file pertaining to such an 
individual or to grant access to an investigative file would disclose 
the identity of confidential sources and reveal confidential information 
supplied by these sources.
    (iii) 5 U.S.C. 552a(e)(4)(I) requires the publication of the 
categories of sources of records in each system of records. The 
application of this provision could disclose sufficient information to 
disclose the identity of a confidential source and cause sources to 
refrain from giving such information because of fear of reprisal, or 
fear of breach of promises of anonymity and confidentiality. This would 
compromise the ability to conduct background suitability investigations.
    (iv) 5 U.S.C. 552a(e)(1) requires each agency to maintain in its 
records only such information about an individual that is relevant and 
necessary to accomplish a purpose of the agency required by statute or 
Executive order. This system of records is exempt from the foregoing 
provision because:
    (A) It is not possible to detect relevance and necessity of specific 
information from a confidential source in the early stages of an 
investigation.

[[Page 91]]

    (B) Relevance and necessity are questions of judgment and timing. 
What appears relevant and necessary when collected may ultimately be 
determined to be unnecessary. It is only after the information is 
evaluated that the relevance and necessity of such information can be 
established regarding suitability for VA approval as a fee appraiser or 
compliance inspector.
    (C) In interviewing persons or obtaining other forms of evidence 
during an investigation for suitability for VA approval, information may 
be supplied to the investigator which relates to matters incidental to 
the main purpose of the investigation but which is appropriate in a 
thorough investigation. Oftentimes, such information cannot readily be 
segregated and disclosure might jeopardize the identity of a 
confidential source.
    (d) Exemption of Police and Security Records. VA provides limited 
access to one Security and Law Enforcement System of Records, Police and 
Security Records--VA (103VA07B).
    (1) The investigations records and reports contained in this System 
of Records are exempted [pursuant to 5 U.S.C. 552a(j)(2) of the Privacy 
Act of 1974] from Privacy Act subsections (c)(3) and (c)(4); (d); (e)(1) 
through (e)(3), (e)(4)(G) through (e)(4)(I), (e)(5), and (e)(8); (f); 
and (g); in addition, they are exempted [pursuant to 5 U.S.C. 552a(k)(2) 
of the Privacy Act of 1974] from Privacy Act subsections (c)(3); (d); 
(e)(1), (e)(4)(G) through (e)(4)(I); and (f).
    (2) These records contained in the Police and Security Records--VA 
(103VA076B) are exempted for the following reasons:
    (i) The application of Privacy Act subsection (c)(3) would alert 
subjects to the existence of the investigation and reveal that they are 
subjects of that investigation. Providing subjects with information 
concerning the nature of the investigation could result in alteration or 
destruction of evidence which is obtained from third parties, improper 
influencing of witnesses, and other activities that could impede or 
compromise the investigation.
    (ii) The application of Privacy Act subsections (c)(4); (d); 
(e)(4)(G) and (e)(4)(H); (f); and (g) could interfere with investigative 
and enforcement proceedings, threaten the safety of individuals who have 
cooperated with authorities, constitute an unwarranted invasion of 
personal privacy of others, disclose the identity of confidential 
sources, reveal confidential information supplied by these sources, and 
disclose investigative techniques and procedures.
    (iii) The application of Privacy Act subsection (e)(4)(I) could 
disclose investigative techniques and procedures and cause sources to 
refrain from giving such information because of fear of reprisal, or 
fear of breach of promises of anonymity and confidentiality. This could 
compromise the ability to conduct investigations and to identify, detect 
and apprehend violators. Even though the agency has claimed an exemption 
from this particular requirement, it still plans to generally identify 
the categories of records and the sources of these records in this 
system. However, for the reason stated in paragraph (d)(2)(ii) of this 
section, this exemption is still being cited in the event an individual 
wants to know a specific source of information.
    (iv) These records contained in the Police and Security Records--VA 
(103VA076B) are exempt from Privacy Act subsection (e)(1) because it is 
not possible to detect the relevance or necessity of specific 
information in the early stages of a criminal or other investigation. 
Relevance and necessity are questions of judgment and timing. What 
appears relevant and necessary may ultimately be determined to be 
unnecessary. It is only after the information is evaluated that the 
relevance and necessity of such information can be established. In any 
investigation, the Office of Security and Law Enforcement may obtain 
information concerning violations of laws other than those within the 
scope of its jurisdiction. In the interest of effective law enforcement, 
the Office of Security and Law Enforcement should retain this 
information as it may aid in establishing patterns of criminal activity 
and provide leads for those law enforcement agencies charged with 
enforcing other segments of civil or criminal law.

[[Page 92]]

    (v) The application of Privacy Act subsection (e)(2) would impair 
investigations of illegal acts, violations of the rules of conduct, 
merit system and any other misconduct for the following reasons:
    (A) In order to successfully verify a complaint, most information 
about a complainant or an individual under investigation must be 
obtained from third parties such as witnesses and informers. It is not 
feasible to rely upon the subject of the investigation as a source for 
information regarding his/her activities because of the subject's rights 
against self-incrimination and because of the inherent unreliability of 
the suspect's statements. Similarly, it is not always feasible to rely 
upon the complainant as a source of information regarding his/her 
involvement in an investigation.
    (B) The subject of an investigation will be alerted to the existence 
of an investigation if an attempt is made to obtain information from the 
subject. This would afford the individual the opportunity to conceal any 
criminal activities to avoid apprehension.
    (vi) The reasons for exempting these records in the Police and 
Security Records--VA (103VA07B) from Privacy Act subsection (e)(3) are 
as follows:
    (A) The disclosure to the subject of the purposes of the 
investigation would provide the subject with substantial information 
relating to the nature of the investigation and could impede or 
compromise the investigation.
    (B) Informing the complainant or the subject of the information 
required by this provision could seriously interfere with undercover 
activities, jeopardize the identities of undercover agents and impair 
their safety, and impair the successful conclusion of the investigation.
    (C) Individuals may be contacted during preliminary information 
gathering in investigations before any individual is identified as the 
subject of an investigation. Informing the individual of the matters 
required by this provision would hinder or adversely affect any present 
or subsequent investigations.
    (vii) Since the Privacy Act defines ``maintain'' to include the 
collection of information, complying with subsection (e)(5) would 
prevent the collection of any data not shown to be accurate, relevant, 
timely, and complete at the moment of its collection. In gathering 
information during the course of an investigation, it is not always 
possible to make this determination prior to collecting the information. 
Facts are first gathered and then placed into a logical order which 
objectively proves or disproves criminal behavior on the part of the 
suspect. Material that may seem unrelated, irrelevant, incomplete, 
untimely, etc., may take on added meaning as an investigation 
progresses. The restrictions in this provision could interfere with the 
preparation of a complete investigative report.
    (viii) The notice requirement of Privacy Act subsection (e)(8) could 
prematurely reveal an ongoing criminal investigation to the subject of 
the investigation.

(Authority: 5 U.S.C. 552a (j) and (k); 38 U.S.C. 501)

[48 FR 29847, June 29, 1983, as amended at 68 FR 35298, June 13, 2003]



Sec. Sec.  1.583-1.584  [Reserved]

        Inventions by Employees of Department of Veterans Affairs

    Authority: Sections 1.650 to 1.666 issued under sect. 1, 66 Stat. 
811, 72 Stat. 1114; 35 U.S.C. 266; 15 U.S.C. 3710a; 38 U.S.C. 501; E.O. 
10096, E.O. 10930, 15 FR 389; 3 CFR 1949-1953 Comp.

   Expanded Remote Access to Computerized Veterans Claims Records by 
                       Accredited Representatives



Sec.  1.600  Purpose.

    (a) Sections 1.600 through 1.603 establish policy, assign 
responsibilities and prescribe procedures with respect to:
    (1) When, and under what circumstances, VA will grant authorized 
claimants' representatives read-only access to the automated Veterans 
Benefits Administration (VBA) claims records of those claimants whom 
they represent;
    (2) The exercise of authorized access by claimants' representatives; 
and
    (3) The bases and procedures for disqualification of a 
representative for violating any of the requirements for access.
    (b) VBA will grant access to its automated claimants' claims records 
from

[[Page 93]]

locations outside Regional Offices under the following conditions. 
Access will be provided:
    (1) Only to individuals and organizations granted access to 
automated claimants' records under Sec. Sec.  1.600 through 1.603;
    (2) Only to the claims records of VA claimants whom the organization 
or individual represents as reflected in the claims file;
    (3) Solely for the purpose of the representative assisting the 
individual claimant whose records are accessed in a claim for benefits 
administered by VA; and
    (4) On a read-only basis. Individuals authorized access to VBA 
automated claims records under Sec. Sec.  1.600 through 1.603 will not 
be permitted to modify the data.
    (c)(1) Access will be authorized only to the inquiry commands of the 
Benefits Delivery Network which provide access to the following 
categories of data:
    (i) Beneficiary identification data such as name, social security 
number, sex, date of birth, service number and related service data; and
    (ii) Claims history and processing data such as folder location, 
claim status, claim establishment date, claim processing history, award 
data, rating data, including service-connected medical conditions, 
income data, dependency data, deduction data, payment data, educational 
facility and program data (except chapter 32 benefits), and education 
program contribution and delimiting data (except chapter 32 benefits).
    (2) Access to this information will currently be through the inquiry 
commands of BINQ (BIRLS (Beneficiaries Identification and Records 
Location Subsystem) Inquiry), SINQ (Status Inquiry), MINQ (Master Record 
Inquiry), PINQ (Pending Issue Inquiry) and TINQ (Payment History 
Inquiry). The identifying information received from BIRLS to 
representative inquiries will be limited to file number, veteran's name, 
date of death, folder location and transfer date of folder, insurance 
number, insurance type, insurance lapse date and insurance folder 
jurisdiction.
    (d) Sections 1.600 through 14.603 are not intended to, and do not:
    (1) Waive the sovereign immunity of the United States; or
    (2) Create, and may not be relied upon to create, any right or 
benefit, substantive or procedural, enforceable at law against the 
United States or the Department of Veterans Affairs.

[59 FR 47084, Sept. 14, 1994. Redesignated and amended at 73 FR 29870, 
29879, May 22, 2008]



Sec.  1.601  Qualifications for access.

    (a) An applicant for read-only access to VBA automated claims 
records from a location other than a VA Regional Office must be:
    (1) An organization, representative, attorney or agent approved or 
accredited by VA under Sec. Sec.  14.626 through 14.635; or
    (2) An attorney of record for a claimant in proceedings before the 
Court of Veterans Appeals or subsequent proceedings who requests access 
to the claimant's automated claims records as part of the representation 
of the claimant.
    (b) The hardware, modem and software utilized to obtain access, as 
well as their location, must be approved in advance by VBA.
    (c) Each individual and organization approved for access must sign 
and return a notice provided by the Regional Office Director (or the 
Regional Office Director's designee) of the Regional Office of 
jurisdiction for the claim. The notice will specify the applicable 
operational and security requirements for access and an acknowledgment 
that the breach of any of these requirements is grounds for 
disqualification from access.

[59 FR 47084, Sept. 14, 1994. Redesignated at 73 FR 29870, May 22, 2008]



Sec.  1.602  Utilization of access.

    (a) Once an individual or organization has been issued the necessary 
passwords to obtain read-only access to the automated claims records of 
individuals represented, access will be exercised in accordance with the 
following requirements:
    (1) The individual or organization will obtain access only from 
equipment and software approved in advance by the Regional Office from 
the location where the individual or organization

[[Page 94]]

primarily conducts its representation activities which also has been 
approved in advance;
    (2) The individual will use only his or her assigned password to 
obtain access;
    (3) The individual will not reveal his or her password to anyone 
else, or allow anyone else to use his or her password;
    (4) The individual will access only the VBA automated claims records 
of VA claimants who are represented by the person obtaining access or by 
the organization employing the person obtaining access;
    (5) The individual will access a claimant's automated claims record 
solely for the purpose of representing that claimant in a claim for 
benefits administered by VA;
    (6) Upon receipt of the password, the individual will destroy the 
hard copy; no written or printed record containing the password will be 
retained; and
    (7) The individual and organization will comply with all security 
requirements VBA deems necessary to ensure the integrity and 
confidentiality of the data and VBA's automated computer systems.
    (b) An organization granted access shall ensure that all employees 
provided access in accordance with these regulations will receive 
regular, adequate training on proper security, including the items 
listed in Sec.  1.603(a). Where an individual such as an attorney or 
registered agent is granted access, he or she will regularly review the 
security requirements for the system as set forth in these regulations 
and in any additional materials provided by VBA.
    (c) VBA may, at any time without notice:
    (1) Inspect the computer hardware and software utilized to obtain 
access and their location;
    (2) Review the security practices and training of any individual or 
organization granted access under these regulations; and
    (3) Monitor an individual's or organization's access activities. By 
applying for, and exercising, the access privileges under Sec. Sec.  
1.600 through 1.603, the applicant expressly consents to VBA monitoring 
the access activities of the applicant at any time.

[59 FR 47084, Sept. 14, 1994. Redesignated and amended at 73 FR 29870, 
29879, May 22, 2008]



Sec.  1.603  Disqualification.

    (a) The Regional Office Director or the Regional Office Director's 
designee may revoke an individual's or an organization's access 
privileges to a particular claimant's records because the individual or 
organization no longer represents the claimant, and, therefore, the 
beneficiary's consent is no longer in effect. The individual or 
organization is no longer entitled to access as a matter of law under 
the Privacy Act, 5 U.S.C. 552a, and 38 U.S.C. 5701 and 7332. Under these 
circumstances, the individual or organization is not entitled to any 
hearing or to present any evidence in opposition to the revocation.
    (b) The Regional Office Director or the Regional Office Director's 
designee may revoke an individual's or an organization's access 
privileges either to an individual claimant's records or to all 
claimants' records in the VBA automated claims benefits systems if the 
individual or organization:
    (1) Violates any of the provisions of Sec. Sec.  1.600 through 
1.603;
    (2) Accesses or attempts to access data for a purpose other than 
representation of an individual veteran;
    (3) Accesses or attempts to access data other than the data 
specified in these regulations;
    (4) Accesses or attempts to access data on a VA beneficiary who is 
not represented either by the individual who obtains access or by the 
organization employing the individual who obtains access;
    (5) Utilizes unapproved computer hardware or software to obtain or 
attempt to obtain access to VBA computer systems;
    (6) Modifies or attempts to modify data in the VBA computer systems.
    (c) If VBA is considering revoking an individual's access under 
Sec.  1.603(b), and that individual works for an organization, the 
Regional Office of jurisdiction will notify the organization of the 
pendency of the action.
    (d) After an individual's access privileges are revoked, if the 
conduct which

[[Page 95]]

resulted in revocation was such that it merits reporting to an 
appropriate governmental licensing organization such as a State bar, the 
VBA Regional Office of jurisdiction will immediately inform the 
licensing organization in writing of the fact that the individual's 
access privileges were revoked and the reasons why.
    (e) The VBA Regional Office of jurisdiction may temporarily suspend 
access privileges prior to any determination on the merits of the 
proposed revocation where the Regional Office Director or the Director's 
designee determines that such immediate suspension is necessary in order 
to protect the integrity of the system or confidentiality of the data in 
the system from a reasonably foreseeable compromise. However, in such 
case, the Regional Office shall offer the individual or organization an 
opportunity to respond to the charges immediately after the temporary 
suspension.

[59 FR 47084, Sept. 14, 1994. Redesignated and amended at 73 FR 29870, 
29879, May 22, 2008]

        Inventions by Employees of Department of Veterans Affairs

    Authority: Sections 1.650 to 1.666 issued under sect. 1, 66 Stat. 
811, 72 Stat. 1114; 35 U.S.C. 266; 15 U.S.C. 3710a; 38 U.S.C. 501; E.O. 
10096, E.O. 10930, 15 FR 389; 3 CFR 1949-1953 Comp.



Sec.  1.650  Purpose.

    The purpose of these regulations is to prescribe the procedure to be 
followed in determining and protecting the respective rights of the 
United States Government and of Department of Veterans Affairs employees 
who make inventions.

[21 FR 10377, Dec. 28, 1956, as amended at 61 FR 29658, June 12, 1996]



Sec.  1.651  Definitions.

    The terms as used in the regulations concerning inventions by 
employees of the Department of Veterans Affairs are defined as follows:
    (a) The term invention includes any art, machine, manufacture, 
design, or composition of matter, or any new and useful improvement 
thereof, or any variety of plant, which is or may be patentable under 
the patent laws of the United States.
    (b) The term employee or Government employee means any officer or 
employee, civilian or military, of the Department of Veterans Affairs. 
Part-time, without compensation (WOC) employees and part-time 
consultants are included.
    (c) The term Secretary of Commerce means the Under Secretary of 
Commerce for Technology.

[21 FR 10377, Dec. 28, 1956, as amended at 31 FR 5291, Apr. 2, 1966; 61 
FR 29658, June 12, 1996]



Sec.  1.652  Criteria for determining rights to employee inventions.

    (a) The criteria to be applied in determining the respective rights 
of the Government and of the employee-inventor in and to any invention 
subject to these provisions shall be in accordance with the Uniform 
Patent Policy regulations found at 37 CFR 501.6 and 501.7.
    (b) Ownership in and to inventions arising under Cooperative 
Research and Development Agreements (CRADAs) pursuant to 15 USC 3710a 
shall be governed by the provisions of the pertinent CRADA, as 
authorized by the Federal Technology Transfer Act.

(Authority: 15 U.S.C. 3710a; 37 CFR part 501)

[61 FR 29658, June 12, 1996]



Sec.  1.653  Delegation of authority.

    The General Counsel, Deputy General Counsel or Assistant General 
Counsel for Professional Staff Group IV is authorized to act for the 
Secretary of Veterans Affairs in matters concerning patents and 
inventions, unless otherwise required by law. The determination of 
rights to an invention as between the Government and the employee where 
there is no cooperative research and development agreement shall be made 
by the General Counsel, Deputy General Counsel or the Assistant General 
Counsel for Professional Staff Group IV, in accordance with 37 CFR part 
500.

[62 FR 14822, Mar. 28, 1997]



Sec.  1.654  Patenting of inventions.

    Any invention owned by the Government under the criteria as set 
forth in

[[Page 96]]

37 CFR 501.6 should be protected by an application for a domestic patent 
and other necessary documents executed by the employee inventor prepared 
by or through the General Counsel, Deputy General Counsel or Assistant 
General Counsel for Professional Staff Group IV, unless some other 
agency has primary interest or it is decided to dedicate the invention 
to the public. Such dedication requires approval of the Secretary of 
Commerce. Applications on behalf of the Government for foreign patents 
may be made if determined to be in the public interest. The payment of 
necessary expenses in connection with any application filed or patent 
obtained under this section by the Department of Veterans Affairs is 
authorized.

[31 FR 5291, Apr. 2, 1966, as amended at 54 FR 26027, June 21, 1989; 61 
FR 29658, June 12, 1996; 62 FR 14822, Mar. 28, 1997]



Sec.  1.655  Government license in invention of employee.

    If an invention is made by an employee and it is determined that the 
employee inventor is entitled to full ownership under 37 CFR 501.6, 
subject to a nonexclusive, irrevocable, royalty-free license in the 
Government with power to grant sublicenses for all Governmental 
purposes, it shall be the duty of the employee inventor to notify the 
Office of General Counsel of the status of the patent application, 
including the patent application number, so that the Department may 
protect the interests reserved to the Government under 37 CFR 501.6.

[61 FR 29658, June 12, 1996]



Sec.  1.656  Information to be submitted by inventor.

    (a) In the case of an invention or believed invention, the inventor 
will prepare a statement for submission to his or her immediate 
superior. It will be submitted regardless of where the ownership is 
believed to exist. The statement will consist of two parts:
    (1) One part of the statement will be a disclosure of the invention 
sufficient to permit the preparation of a patent applicant. It shall 
consist of a description, including where applicable, of the parts or 
components of the invention as shown on the drawings or blueprints, 
accompanied further by a description of the construction and operation 
of the invention. Photographs of the invention may be included. The 
inventor should state pertinent prior art known to him or her, and set 
forth in detail as clearly as possible the respects which his or her 
invention differs.
    (2) The other part of the statement will set forth the circumstances 
attending the making of the invention. It will include the full name and 
address of the inventor; the grade and title of his or her position; 
whether full time or part time; his or her duties at the time the 
invention was made; the facts pertinent to a determination whether the 
invention bore a direct relation to or was made in consequence of such 
official duties; whether there was, and if so, the terms of any special 
agreement or understanding with respect to use or manufacture of his or 
her invention; date of the invention; when and where it was conceived, 
constructed and tested; whether it was made entirely during working 
hours; whether, and to what extent there was a contribution by the 
Government of any of the following: Facilities; equipment; materials or 
supplies; funds; information; time or services of other Government 
employees on duty. When the invention is disclosed through publication, 
or in consultation with a manufacturer or attorney, simultaneous 
notification of the publication shall be given to the Office of General 
Counsel. A copy of the article will accompany the notification.
    (b) The inventor's immediate superior shall promptly review the 
statement of the employee inventor for completeness and accuracy, and 
shall certify that the employee's statement of circumstances attending 
the invention is or is not correct, giving reasons if pertinent. The 
file should then be submitted through the facility head (or 
administration heads or top staff officials in the case of Central 
Office employees) to the General Counsel together with any comments or 
recommendations.

[61 FR 29658, June 12, 1996]



Sec.  1.657  Determination of rights.

    The General Counsel, Deputy General Counsel or Assistant General 
Counsel

[[Page 97]]

for Professional Staff Group IV will make a determination of rights 
subject to review where required by the Secretary of Commerce. The 
determination will be in accordance with 37 CFR 501.7.

[61 FR 29658, June 12, 1996, as amended at 62 FR 14822, Mar. 28, 1997]



Sec.  1.658  Right of appeal.

    In accordance with 37 CFR 501.8, the employee has a right of appeal 
to the Secretary of Commerce within 30 days of receipt of the 
Department's determination of ownership rights. The decision reached by 
the Secretary of Commerce will be communicated to the employee.

[61 FR 29658, June 12, 1996]



Sec.  1.659  Relationship to incentive awards program.

    Procedures set out in the regulations concerning inventions by 
employees of the Department of Veterans Affairs are not affected by the 
submission or proposed submission of an employee suggestion or idea on 
an item which may be patentable. Consideration of an item for a 
determination of ownership rights and also for an incentive award will 
proceed simultaneously, usually on separate correspondence. An employee 
suggestion or copies and extracts of the file may be forwarded to the 
General Counsel by the reviewing or awarding authority, or by the 
facility head, for an ownership determination where the employee idea or 
suggestion involves an invention. The employee shall be directed to 
submit a disclosure of invention in accordance with these regulations if 
such has not been previously submitted.

[31 FR 5291, Apr. 2, 1966, as amended at 61 FR 29659, June 12, 1996]



Sec.  1.660  Expeditious handling.

    No patent may be granted where the invention has been in public use 
or publicly disclosed for more than one year before filing of a patent 
application. Hence, submissions involving inventions should be made as 
promptly as possible in order to avoid delay which might jeopardize 
title to the invention or impair the rights of the inventor or the 
Government.

[61 FR 29659, June 12, 1996]



Sec.  1.661  Information to be kept confidential.

    All information pertaining to inventions and pending patent 
applications is confidential, and employees having access to such 
information are forbidden to disclose or reveal the same except as 
required in the performance of their official duties.

[21 FR 10378, Dec. 28, 1956. Redesignated at 61 FR 29659, June 12, 1996]



Sec.  1.662  Provisions of regulations made a condition of employment.

    The provisions of the regulations concerning inventions by employees 
of the Department of Veterans Affairs shall be a condition of employment 
of all employees.

[21 FR 10378, Dec. 28, 1956. Redesignated at 61 FR 29659, June 12, 1996]



Sec.  1.663  Licensing of Government-owned inventions.

    (a) The licensing of Government-owned inventions under VA control 
and custody will be conducted pursuant to the regulations on the 
licensing of Government-owned inventions contained in 37 CFR part 404, 
and 15 U.S.C. 3710a, as appropriate.
    (b) Any person whose application for a license in an invention under 
VA control and custody has been denied; whose license in such an 
invention has been modified or terminated, in whole or in part; or who 
timely filed a written objection in response to a proposal to grant an 
exclusive or partially exclusive license in an invention under VA 
control or custody, may, if damaged, appeal any decision or 
determination concerning the grant, denial, interpretation, 
modification, or termination of a license to the Secretary of Veterans 
Affairs. Such appeal shall be in writing; shall set forth with 
specificity the basis of the appeal; and shall be postmarked not later 
than 60 days after the action being appealed. Upon request of the 
appellant, such appeal may be considered by one to three persons 
appointed on a case-by-case basis by the Secretary of Veterans Affairs.

[[Page 98]]

Such a request will be granted only if it accompanies the written 
appeal. Appellant may appear and be represented by counsel before such a 
panel, which will sit in Washington, DC. If the appeal challenges a 
decision to grant an exclusive or partially exclusive license in an 
invention under VA control or custody, the licensee shall be furnished a 
copy of the appeal, shall be given the opportunity to respond in 
writing, may appear and be represented by counsel at any hearing 
requested by appellant, and may request a hearing if appellant has not, 
under the same terms and conditions, at which the appellant may also 
appear and be represented by counsel.

[61 FR 29659, June 12, 1996]



Sec. Sec.  1.664-1.666  [Reserved]

                     Administrative Control of Funds

    Source: 48 FR 30622, July 5, 1983, unless otherwise noted.



Sec.  1.670  Purpose.

    The following regulations establish a system of administrative 
controls for all appropriations and funds available to the Department of 
Veterans Affairs to accomplish the following purposes:
    (a) Establish an administrative subdivision of controls to restrict 
obligations and expenditures against each appropriation or fund to the 
amount of the apportionment or the reapportionment; and
    (b) Fix responsibility for the control of appropriations or funds to 
high level officials who bear the responsibility for apportionment or 
reapportionment control.

(Authority: 31 U.S.C. 1514)



Sec.  1.671  Definitions.

    For the purpose of Sec. Sec.  1.670 through 1.673, the following 
definitions apply:
    (a) Administrative subdivision of funds. An administrative 
subdivision of funds is any administrative subdivision of an 
appropriation or fund which makes funds available in a specified amount 
for the purpose of controlling apportionments or reapportionments.
    (b) Allotment. An allotment is an authorization by the Director, 
Office of Budget and Finance, to department and staff office heads 
(allottees) to incur obligations within specified amounts, during a 
specified period, pursuant to an Office of Management and Budget 
apportionment or reapportionment action. The creation of an obligation 
in excess of an allotment is a violation of the administrative 
subdivision of funds.
    (c) Allowance. An allowance is a subdivision below the allotment 
level, and is a guideline which may be issued by department or staff 
office heads (allottees) to facility directors and other officials, 
showing the expenditure pattern or operating budget they will be 
expected to follow in light of the program activities contemplated by 
the overall VA budget or plan of expenditure. The creation of an 
obligation in excess of an allowance is not a violation of the 
administrative subdivision of funds.

(Authority: 31 U.S.C. 1514)



Sec.  1.672  Responsibilities.

    (a) The issuance of an allotment to the administration and staff 
office heads (allottees) is required and is the responsibility of the 
Director, Office of Budget and Finance. The sum of such allotments shall 
not be in excess of the amount indicated in the apportionment or 
reapportionment document.
    (b) The issuance of an allowance is discretionary with department or 
staff office heads (allottees), as an allowance is merely a management 
device which allottees may utilize in carrying out their 
responsibilities. Allottees are responsible for keeping obligations 
within the amounts of their allotments, whether allowances are issued or 
not.
    (c) The Director, Office of Budget and Finance, is responsible for 
requesting apportionments and reapportionments from the Office of 
Management and Budget. Administration and staff heads shall promptly 
request that an appropriation or fund be reapportioned if feasible 
whenever it appears that obligations may exceed the level of the 
apportionment.

(Authority: 31 U.S.C. 1514)

[[Page 99]]



Sec.  1.673  Responsibility for violations of the administrative subdivision 
of funds.

    (a) In the event an allotment or an apportionment is exceeded except 
in the circumstances described in paragraph (b) of this section, the 
following factors will be considered in determining which official, or 
officials, are responsible for the violation.
    (1) Knowledge of circumstances which could lead to an allotment or 
apportionment being exceeded;
    (2) Whether the official had received explicit instructions to 
continue or cease incurring obligations;
    (3) Whether any action was taken in contravention of or with 
disregard for, instructions to monitor obligations incurred;
    (4) Whether the official had the authority to curtail obligations by 
directing a change in the manner of operations of the department or 
staff office; or
    (5) Any other facts which tend to fix the responsibility for the 
obligations which resulted in the allotment or apportionment being 
exceeded.
    (b) In the event that the sum of the allotments made in a particular 
fiscal year exceeds the amount apportioned by the Office of Management 
and Budget, and the apportionment is subsequently exceeded because of 
this action, the official who made the excess allotments will be the 
official responsible for the violation.

(Authority: 31 U.S.C. 1514)

  Use of Official Mail in the Location and Recovery of Missing Children

    Source: 52 FR 10889, Apr. 6, 1987, unless otherwise noted.



Sec.  1.700  Purpose.

    Sections 1.700 through 1.705 of this title provide a Missing 
Children Official Mail Program in the Department of Veterans Affairs.

(Authority: 39 U.S.C. 3220(a)(2), 5 U.S.C. 301)

[60 FR 48387, Sept. 19, 1995]



Sec.  1.701  Contact person for missing children official mail program.

    The Department of Veterans Affairs contact person for the Missing 
Children Official Mail Program is: Mrs. Roslynd R. Stewart, Information 
Management Service (045A4), Office of Policy and Program Assistance, 
Office of Information Resources Management, Office of Management, 
Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 
20420-0001. Telephone: (202) 565-8949.

(Authority: 39 U.S.C. 3220(a)(2), 5 U.S.C. 301)

[60 FR 48388, Sept. 19, 1995]



Sec.  1.702  Policy.

    (a) The Department of Veterans Affairs will supplement and expand 
the national effort to assist in the location and recovery of missing 
children by maximizing the economical use of missing children 
information in domestic official mail and publications directed to 
members of the public and Department of Veterans Affairs employees.
    (b) The Department of Veterans Affairs will insert pictures and 
biographical information related to missing children in a variety of 
official mail originating at the Department of Veterans Affairs 
automation centers. In addition, pictures and biographical information 
are printed in self-mailers and other Department of Veterans Affairs 
publications (newsletters, bulletins, etc.).
    (c) The National Center for Missing and Exploited Children (National 
Center) is the sole source from which the Department of Veterans Affairs 
will acquire the camera-ready and other photographic and biographical 
materials to be disseminated for use by Department of Veterans Affairs 
organizational units. The information is ordered and disseminated by 
Information Management Service.
    (d) The Department of Veterans Affairs will remove all printed 
inserts and other materials from circulation or other use within a 
three-month period from the date the National Center notifies the 
Department of Veterans Affairs that a child whose picture and 
biographical information have been made available to the Department of 
Veterans Affairs has been recovered or that permission of the parent(s) 
or guardian to use the child's photograph and biographical information 
has been

[[Page 100]]

withdrawn. The National Center is responsible for immediately notifying 
the Department of Veterans Affairs contact person, in writing, of the 
need to withdraw from circulation official mail and other materials 
related to a particular child. Photographs which were reasonably current 
as of the time of the child's disappearence shall be the only acceptable 
form of visual medium or pictorial likeness used in official mail.
    (e) The Department of Veterans Affairs will give priority to 
official mail that is addressed to:
    (1) Members of the public that will be received in the United 
States, its territories and possessions; and
    (2) Inter- and intra-agency publications and other media that will 
also be widely disseminated to Department of Veterans Affairs employees.
    (f) The Department of Veterans Affairs will avoid repetitive 
mailings of material to the same individuals.
    (g) All Department of Veterans Affairs employee suggestions and/or 
recommendations for additional cost-effective opportunities to use 
photographs and biographical data on missing children will be provided 
to the Department of Veterans Affairs contact person.
    (h) These shall be the sole regulations for the Department of 
Veterans Affairs and its component organizational units.

(Authority: 39 U.S.C. 3220(a)(2), 5 U.S.C. 301).

[52 FR 10889, Apr. 6, 1987, as amended at 60 FR 48388, Sept. 19, 1995]



Sec.  1.703  Percentage estimate.

    It is the Department of Veterans Affairs objective that 20 percent 
of its first class official mail addressed to the public contain missing 
children photographs and information.

(Authority: 39 U.S.C. 3220(a)(2), 5 U.S.C. 301)

[60 FR 48388, Sept. 19, 1995]



Sec.  1.704  [Reserved]



Sec.  1.705  Restrictions on use of missing children information.

    Missing children pictures and biographical data shall not be:
    (a) Printed on official envelopes and other materials ordered and 
stocked in quantities that represent more than a 90-day supply.
    (b) Printed on blank pages or covers of publications that may be 
included in the Superintendent of Documents Sales Program or be 
distributed to depository libraries.
    (c) Inserted in any envelope or publication the contents of which 
may be construed to be inappropriate for association with the missing 
children program.
    (d) Inserted in any envelope where the insertion would increase the 
postage cost for the item being mailed.
    (e) Placed on letter-size envelopes on the official indicia, the 
area designated for optical character readers (OCRs), bar code read 
area, and return address area in accordance with the Office of Juvenile 
Justice and Delinquency Prevention guidelines and U.S. Postal Service 
standards.

(Authority: 39 U.S.C. 3220(a)(2), 5 U.S.C. 301)

[52 FR 10889, Apr. 6, 1987, as amended at 60 FR 48388, Sept. 19, 1995]

                           Homeless Claimants



Sec.  1.710  Homeless claimants: Delivery of benefit payments and 
correspondence.

    (a) All correspondence and all checks for benefits payable to 
claimants under laws administered by the Department of Veterans Affairs 
shall be directed to the address specified by the claimant. The 
Department of Veterans Affairs will honor for this purpose any address 
of the claimant in care of another person or organization or in care of 
general delivery at a United States post office. In no event will a 
claim or payment of benefits be denied because the claimant provides no 
mailing address.


(Authority: 38 U.S.C. 5103; 5120)

    (b) To ensure prompt delivery of benefit payments and 
correspondence, claimants who seek personal assistance from Veterans 
Benefits Counselors when filing their claims shall be counseled as to 
the importance of providing his or her current mailing address and, if 
no address is provided, the procedures for delivery described in 
paragraph (d) of this section.


(Authority: 38 U.S.C. 5103; 5120)


[[Page 101]]


    (c) The Department of Veterans Affairs shall prepare and distribute 
to organizations specially serving the needs of veterans and the 
homeless, including but not limited to shelters, kitchens and private 
outreach facilities, information encouraging such organizations to 
counsel individuals on the importance of providing mailing addresses to 
the Department of Veterans Affairs and advising them of this regulation.


(Authority: 38 U.S.C. 5103; 5120)

    (d) If a claimant fails or refuses to provide a current mailing 
address to the Department of Veterans Affairs, all correspondence and 
any checks for benefits to which the claimant is entitled will be 
delivered to the Agent Cashier of the regional office which adjudicated 
or is adjudicating the claim in the case of compensation, pension or 
survivors' benefits, to the Agent Cashier of the Department of Veterans 
Affairs facility closest to the educational institution or training 
establishment attended by a claimant in the case of education benefits, 
or to the Agent Cashier of any other Department of Veterans Affairs 
facility deemed by the Agency to be appropriate under the circumstances 
of the particular case. The claimant, within 30 days after issuance, may 
obtain delivery of any check or correspondence held by an Agent Cashier 
upon presentation of proper identification. Checks unclaimed after 30 
days will be returned to the Department of the Treasury and the 
correspondence to the regional office or facility of jurisdiction. 
Thereafter, the claimant must request the reissuance of any such check 
or item of correspondence by written notice to the Department of 
Veterans Affairs.

(Authority: 38 U.S.C. 5103; 5120)

[53 FR 22654, June 17, 1988]



Sec. Sec.  1.780-1.783  [Reserved]

                   Part-Time Career Employment Program

    Source: 44 FR 55172, Sept. 25, 1979, unless otherwise noted.



Sec.  1.891  Purpose of program.

    Many individuals in society possess great productive potential which 
goes unrealized because they cannot meet the requirements of a standard 
workweek. Permanent part-time employment also provides benefits to other 
individuals in a variety of ways, such as providing older individuals 
with a gradual transition into retirement, providing employment 
opportunities to handicapped individuals or others who requires a 
reduced workweek, providing parents opportunities to balance family 
responsibilities with the need for additional income, and assisting 
students who must finance their own education or vocational training. In 
view of this, the Department of Veterans Affairs will operate a part-
time career employment program, consistent with the needs of its 
beneficiaries and its responsibilities.

(Authority: 5 U.S.C. 3401 note)



Sec.  1.892  Review of positions.

    Positions becoming vacant, unless excepted as provided by Sec.  
1.897, will be reviewed to determine the feasibility of converting them 
to part-time. Among the criteria which may be used when conducting this 
review are:
    (a) Mission requirements.
    (b) Workload.
    (c) Employment ceilings and budgetary considerations.
    (d) Availability of qualified applicants willing to work part time.
    (e) Other criteria based on local needs and circumstances.

(Authority: 5 U.S.C. 3402)



Sec.  1.893  Establishing and converting part-time positions.

    Position management and other internal reviews may indicate that 
positions may be either converted from full-time or initially 
established as part-time positions. Criteria listed in Sec.  1.892 may 
be used during these reviews. If a decision is made to convert to or to 
establish a part-time position, regular position management and 
classification procedures will be followed.

(Authority: 5 U.S.C. 3402)



Sec.  1.894  Annual goals and timetables.

    An departmentwide plan for promoting part-time employment 
opportunities will be developed annually. This plan will establish 
annual goals

[[Page 102]]

and set interim and final deadlines for achieving these goals. This plan 
will be applicable throughout the agency, but may be supplemented by 
field facilities.

(Authority: 5 U.S.C. 3402)



Sec.  1.895  Review and evaluation.

    The part-time career employment program will be reviewed through 
regular employment reports to determine levels of part-time employment. 
This program will also be designated an item of special interest to be 
reviewed during personnel management reviews.

(Authority: 5 U.S.C. 3402)

[61 FR 38571, July 25, 1996]



Sec.  1.896  Publicizing vacancies.

    When applicants from outside the Federal service are desired, part-
time vacancies may be publicized through various recruiting means, such 
as:
    (a) Federal Job Information Centers.
    (b) State Employment offices.
    (c) VA Recruiting Bulletins.

(Authority: 5 U.S.C. 3402)



Sec.  1.897  Exceptions.

    The Secretary of Veterans Affairs, or designees, may except 
positions from inclusion in this program as necessary to carry out the 
mission of the Department.

(Authority: 5 U.S.C. 3402)

   Standards for Collection, Compromise, Suspension or Termination of 
  Collection Effort, and Referral of Civil Claims for Money or Property

    Authority: Sections 1.900 through 1.953 are issued under the 
authority of 31 U.S.C. 3711 through 3720E; 38 U.S.C. 501, 5302, 5302A, 
5314, and as noted in specific sections.

    Source: 32 FR 2613, Feb. 8, 1967, unless otherwise noted.



Sec.  1.900  Prescription of standards.

    (a) The standards contained in Sec. Sec.  1.900 through 1.953 are 
issued pursuant to the Federal Claims Collection Standards, issued by 
the Department of the Treasury (Treasury) and the Department of Justice 
(DOJ) in parts 900 through 904 of 31 CFR, as well as other debt 
collection authority issued by Treasury in part 285 of 31 CFR, and apply 
to the collection, compromise, termination, and suspension of debts owed 
to VA, and the referral of such debts to Treasury (or other Federal 
agencies designated by Treasury) for offset and collection action and to 
DOJ for litigation, unless otherwise stated in this part or in other 
statutory or regulatory authority, or by contract.
    (b) Standards and policies regarding the classification of debt for 
accounting purposes (for example, write-off of uncollectible debt) are 
contained in the Office of Management and Budget's Circular A-129 
(Revised), ``Policies for Federal Credit Programs and Non-Tax 
Receivables.''

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62191, Oct. 25, 2004]



Sec.  1.901  No private rights created.

    Sections 1.900 through 1.953 do not create any right or benefit, 
substantive or procedural, enforceable at law or in equity by a party 
against the United States, its agencies, its officers, or any other 
person, nor shall the failure of VA to comply with any of the provisions 
of Sec. Sec.  1.900 through 1.953 be available to any debtor as a 
defense.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62191, Oct. 25, 2004]



Sec.  1.902  Antitrust, fraud, and tax and interagency claims.

    (a) The standards in Sec. Sec.  1.900 through 1.953 relating to 
compromise, suspension, and termination of collection activity do not 
apply to any debt based in whole or in part on conduct in violation of 
the antitrust laws or to any debt involving fraud, the presentation of a 
false claim, or misrepresentation on the part of the debtor or any party 
having an interest in the claim. Only the Department of Justice (DOJ) 
has the authority to compromise, suspend, or terminate collection 
activity on such claims. The standards in Sec. Sec.  1.900 through 1.953 
relating to the administrative collection of claims do apply, but only 
to the extent authorized by DOJ in a particular case. Upon 
identification of a claim based in whole or in part on conduct in 
violation of the antitrust laws or any claim involving

[[Page 103]]

fraud, the presentation of a false claim, or misrepresentation on the 
part of the debtor or any party having an interest in the claim, VA 
shall promptly refer the case to DOJ. At its discretion, DOJ may return 
the claim to VA for further handling in accordance with the standards in 
Sec. Sec.  1.900 through 1.953.
    (b) Sections 1.900 through 1.953 do not apply to tax debts.
    (c) Sections 1.900 through 1.953 do not apply to claims between 
Federal agencies.
    (d) Federal agencies should attempt to resolve interagency claims by 
negotiation in accordance with Executive Order 12146 (3 CFR, 1980 Comp., 
pp. 409-412).

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62192, Oct. 25, 2004]



Sec.  1.903  Settlement, waiver, or compromise under other statutory or
regulatory authority.

    Nothing in Sec. Sec.  1.900 through 1.953 precludes VA settlement, 
waiver, compromise, or other disposition of any claim under statutes and 
implementing regulations other than subchapter II of chapter 37 of Title 
31 of the United States Code (Claims of the United States Government) 
and the standards in Title 31 CFR parts 900 through 904. See, for 
example, the Federal Medical Care Recovery Act (42 U.S.C. 2651 et seq.) 
and applicable regulations, 28 CFR part 43. In such cases, the laws and 
regulations that are specifically applicable to claims collection 
activities of VA generally take precedence over 31 CFR parts 900 through 
904.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62192, Oct. 25, 2004]



Sec.  1.904  Form of payment.

    Claims may be paid in the form of money or, when a contractual basis 
exists, VA may demand the return of specific property or the performance 
of specific services.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62192, Oct. 25, 2004]



Sec.  1.905  Subdivision of claims not authorized.

    Debts may not be subdivided to avoid the monetary ceiling 
established by 31 U.S.C. 3711(a)(2). A debtor's liability arising from a 
particular transaction or contract shall be considered as a single debt 
in determining whether the debt is one of less than $100,000 (excluding 
interest, penalties, and administrative costs) or such higher amount as 
the Attorney General shall from time to time prescribe for purposes of 
compromise, suspension, or termination of collection activity.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62192, Oct. 25, 2004]



Sec.  1.906  Required administrative proceedings.

    (a) In applying Sec. Sec.  1.900 through 1.953, VA is not required 
to omit, foreclose, or duplicate administrative proceedings required by 
contract or other laws or regulations.
    (b) Nothing contained in Sec. Sec.  1.900 through 1.953 is intended 
to foreclose the right of any debtor to an administrative proceeding, 
including appeals, waivers, and hearings provided by statute, contract, 
or VA regulation (see 38 U.S.C. 3720(a)(4) and 5302 and 42 U.S.C. 2651-
2653).

(Authority: 38 U.S.C. 501, 3720(a)(4), 5302; 42 U.S.C. 2651 through 
2653)

[69 FR 62192, Oct. 25, 2004]



Sec.  1.907  Definitions.

    (a) The definitions and construction found in the Federal Claims 
Collection Standards in 31 CFR 900.2(a) through (d), and the definitions 
in the provisions on administrative wage garnishment in 31 CFR 285.11(c) 
shall apply to Sec. Sec.  1.900 through 1.953, except as otherwise 
stated.
    (b) As used in Sec. Sec.  1.900 through 1.953, referral for 
litigation means referral to the Department of Justice for appropriate 
legal actions, except in those specified instances where a case is 
referred to a VA Regional Counsel for legal action.
    (c) As used in Sec. Sec.  1.900 through 1.953, VA benefit program 
means medical care, home loan, and benefits payment programs 
administered by VA under Title 38 of the United States Code, except as 
otherwise stated.

[[Page 104]]

    (d) As used in Sec. Sec.  1.900 through 1.953, Treasury means the 
United States Department of the Treasury.

(Authority: 31 U.S.C. 3701, 3711; 38 U.S.C. 501, 5316)

[69 FR 62192, Oct. 25, 2004]

                   Standards for Collection of Claims

    Authority: Sections 1.900 through 1.953 are issued under the 
authority of 31 U.S.C. 3711 through 3720E; 38 U.S.C. 501, and as noted 
in specific sections.

    Source: 32 FR 2613, Feb. 8, 1967, unless otherwise noted.



Sec.  1.910  Aggressive collection action.

    (a) VA will take aggressive collection action on a timely basis, 
with effective follow-up, to collect all claims for money or property 
arising from its activities.
    (b) In accordance with 31 U.S.C. 3711(g) and the procedures set 
forth at 31 CFR 285.12, VA shall transfer to Treasury any non-tax debt 
or claim that has been delinquent for a period of 180 days or more so 
that Treasury may take appropriate action to collect the debt or 
terminate collection action. This requirement does not apply to any debt 
that:
    (1) Is in litigation or foreclosure;
    (2) Will be disposed of under an approved asset sale program;
    (3) Has been referred to a private collection contractor for a 
period of time acceptable to the Secretary of the Treasury;
    (4) Is at a debt collection center for a period of time acceptable 
to the Secretary of the Treasury;
    (5) Will be collected under internal offset procedures within 3 
years after the debt first became delinquent; or
    (6) Is exempt from this requirement based on a determination by the 
Secretary of the Treasury that exemption for a certain class of debt is 
in the best interest of the United States. VA may request that the 
Secretary of the Treasury exempt specific classes of debts.
    (c) In accordance with 31 U.S.C. 3716(c)(6) and the procedures set 
forth in 31 CFR part 285, VA shall notify Treasury of all past due, 
legally enforceable non-tax debt that is over 180 days delinquent for 
purposes of administrative offset, including tax refund offset and 
federal salary offset. (Procedures for referral to Treasury for tax 
refund offset are found at 31 CFR 285.2 and procedures for referral to 
Treasury for federal salary offset are found at 38 CFR 1.995 and 31 CFR 
285.7.)

(Authority: 31 U.S.C. 1311, 1316; 38 U.S.C. 501, 5314; 31 CFR part 285)

[69 FR 62192, Oct. 25, 2004]



Sec.  1.911  Collection of debts owed by reason of participation in a
benefits program.

    (a) Scope. This section applies to the collection of debts resulting 
from an individual's participation in a VA benefit or home loan program. 
It does not apply to VA's other debt collection activities. Standards 
for the demand for payment of all other debts owed to VA are set forth 
in Sec.  1.911a. School liability debts are governed by Sec.  21.4009 of 
this title.
    (b) Written demands. When VA has determined that a debt exists by 
reason of an administrative decision or by operation of law, VA shall 
promptly demand, in writing, payment of the debt. VA shall notify the 
debtor of his or her rights and remedies and the consequences of failure 
to cooperate with collection efforts. Generally, one demand letter is 
sufficient, but subsequent demand letters may be issued as needed.
    (c) Rights and remedies. Subject to limitations referred to in this 
paragraph, the debtor has the right to informally dispute the existence 
or amount of the debt, to request waiver of collection of the debt, to a 
hearing on the waiver request, and to appeal the Department of Veterans 
Affairs decision underlying the debt. These rights can be exercised 
separately or simultaneously. Except as provided in Sec.  1.912a 
(collection by offset), the exercise of any of these rights will not 
stay any collection proceeding.
    (1) Informal dispute. This means that the debtor writes to the 
Department of Veterans Affairs and questions whether he or she owes the 
debt or whether the amount is accurate. The Department of Veterans 
Affairs will, as expeditiously as possible, review the accuracy of the 
debt determination. If the resolution is adverse to the debtor, he or 
she may

[[Page 105]]

also request waiver of collection as indicated in paragraphs (c)(2) and 
(3) of this section.
    (2) Request for waiver; hearing on request. The debtor has the right 
to request waiver of collection, in accordance with Sec.  1.963 or Sec.  
1.964, and the right to a hearing on the request. Requests for waivers 
must be filed in writing. A waiver request must be filed within the time 
limit set forth in 38 U.S.C. 5302. If waiver is granted, in whole or in 
part, the debtor has a right to refund of amounts already collected up 
to the amount waived.
    (3) Appeal. In accordance with parts 19 and 20 of this title, the 
debtor may appeal the decision underlying the debt.
    (d) Notification. The Department of Veterans Affairs shall notify 
the debtor in writing of the following:
    (1) The exact amount of the debt;
    (2) The specific reasons for the debt, in simple and concise 
language;
    (3) The rights and remedies described in paragraph (c) of this 
section, including a brief explanation of the concept of, and 
requirements for, waiver;
    (4) That collection may be made by offset from current or future VA 
benefit payments (see Sec.  1.912a). In addition, the debtor shall be 
advised of any policies with respect to the use of credit bureaus, debt 
collection centers, and collection agencies; any other remedies to 
enforce payment of the debt, including administrative wage garnishment, 
Federal salary offset, tax refund offset, and litigation; and the 
requirement that any debt delinquent for more than 180 days be 
transferred to Treasury for administrative offset or collection.
    (5) That interest and administrative costs may be assessed in 
accordance with Sec.  1.915, as appropriate;
    (6) That the debtor shall have the opportunity to inspect and copy 
records; and
    (7) That the debtor shall have the opportunity to enter into a 
repayment agreement.
    (e) Sufficiency of notification. Notification is sufficient when 
sent by ordinary mail directed to the debtor's last known address and 
not returned as undeliverable by postal authorities.
    (f) Further explanation. Further explanation may be found for--
    (1) Appellate rights, in parts 19 and 20 of this title;
    (2) Notification of any decision affecting the payment of benefits 
or granting relief, in Sec.  3.103(e);
    (3) Right to appeal a waiver decision, in Sec.  1.958;
    (4) Refund to a successful waiver applicant of money already 
collected, in Sec.  1.967; and
    (5) The assessment of interest and administrative costs, in Sec.  
1.915.

(Authority: 38 U.S.C. 501, 5302, 5314)

[48 FR 1055, Jan. 10, 1983; 48 FR 6336, Feb. 11, 1983. Redesignated and 
amended at 52 FR 42105, Nov. 3, 1987; 54 FR 34980, Aug. 23, 1989; 69 FR 
62193, Oct. 25, 2004]



Sec.  1.911a  Collection of non-benefit debts.

    (a) This section is written in accordance with 31 CFR 901.2 and 
applies to the demand for payment of all debts, except those debts 
arising out of participation in a VA benefit or home loan program. 
Procedures for the demand for payment of VA benefit or home loan program 
debts are set forth in Sec.  1.911.
    (b) Written demand as described in paragraph (c) of this section 
shall be made promptly upon a debtor of VA in terms that inform the 
debtor of the consequences of failing to cooperate with VA to resolve 
the debt. Generally, one demand letter is sufficient, but subsequent 
letters may be issued. In determining the timing of the demand letter, 
VA should give due regard to the need to refer debts promptly to the 
Department of Justice for litigation, in accordance with Sec. Sec.  
1.950 through 1.953. When necessary to protect VA's interest (for 
example, to prevent the running of a statute of limitations), written 
demand may be preceded by other appropriate actions under 38 CFR 1.900 
through 1.953, including immediate referral for litigation.
    (c) The written demand letter shall inform the debtor of:
    (1) The basis for the indebtedness and any rights the debtor may 
have to seek review within VA, including the right to request waiver;
    (2) The applicable standards for imposing any interest or other late 
payment charges;

[[Page 106]]

    (3) The date by which payment should be made to avoid interest and 
other late payment charges and enforced collection, which generally 
should not be more than 30 days from the date that the demand letter is 
mailed;
    (4) The name, address, and phone number of a contact person or 
office within the agency;
    (5) The opportunity to inspect and copy VA records related to the 
debt; and
    (6) The opportunity to make a written agreement to repay the debt.
    (d) In addition to the items listed in paragraph (c) of this 
section, VA should include in the demand letter VA's willingness to 
discuss alternative methods of payment and its policies with respect to 
the use of credit bureaus, debt collection centers, and collection 
agencies. The letter should also indicate the agency's remedies to 
enforce payment of the debt (including assessment of interest, 
administrative costs and penalties, administrative garnishment, Federal 
salary offset, tax refund offset, administrative offset, and litigation) 
and the requirement that any debt delinquent for more than 180 days be 
transferred to Treasury for collection.
    (e) VA should respond promptly to communications from debtors and 
should advise debtors who dispute debts, or request waiver, to furnish 
available evidence to support their contentions.
    (f) Prior to referring a debt for litigation, VA should advise each 
debtor determined to be liable for the debt that, unless the debt can be 
collected administratively, litigation may be initiated. This 
notification may be given as part of a demand letter under paragraph (c) 
of this section or in a separate letter.
    (g) When VA learns that a bankruptcy petition has been filed with 
respect to a debtor, before proceeding with further collection action, 
VA should immediately seek legal advice from either VA's General Counsel 
or Regional Counsel concerning the impact of the Bankruptcy Code on any 
pending or contemplated collection activities. Unless VA determines that 
the automatic stay imposed at the time of filing pursuant to 11 U.S.C. 
362 has been lifted or is no longer in effect, in most cases collection 
activity against the debtor should stop immediately.
    (1) After VA seeks legal advice, a proof of claim should be filed in 
most cases with the bankruptcy court or the Trustee. VA should refer to 
the provisions of 11 U.S.C. 106 relating to the consequences on 
sovereign immunity of filing a proof of claim.
    (2) If VA is a secured creditor, it may seek relief from the 
automatic stay regarding its security, subject to the provisions and 
requirements of 11 U.S.C. 362.
    (3) Offset is prohibited in most cases by the automatic stay. 
However, VA should seek legal advice from VA's General Counsel or 
Regional Counsel to determine whether payments to the debtor and 
payments of other agencies available for offset may be frozen by VA 
until relief from the automatic stay can be obtained from the bankruptcy 
court. VA also should seek legal advice from VA's General Counsel or 
Regional Counsel to determine whether recoupment is available.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62193, Oct. 25, 2004]



Sec.  1.912  Collection by offset.

    (a) Authority and scope. In accordance with the procedures set forth 
in 31 CFR 901.3, as well as 31 CFR part 285, VA shall collect debts by 
administrative offset from payments made by VA to a debtor indebted to 
VA. Also in accordance with 31 CFR 901.3(b), as well as 31 CFR part 285, 
VA shall refer past due, legally enforceable non-tax debts which are 
over 180 days delinquent to Treasury for collection by centralized 
administrative offset (further procedures are set forth in paragraph (g) 
of this section). This section does not pertain to offset from either VA 
benefit payments made under the authority of 38 U.S.C. 5314 or from 
current salary, but does apply to offset from all other VA payments, 
including an employee's final salary check and lump-sum leave payment. 
Procedures for offset from benefit payments are found in Sec.  1.912a. 
Procedures for offset from current Federal salary are found in 
Sec. Sec.  1.980 through 1.995. NOTE: VA cannot offset, or refer for the 
purpose of offset, either under

[[Page 107]]

the authority of this section or under any other authority found in 
Sec. Sec.  1.900 through 1.953 and Sec. Sec.  1.980 through 1.995, any 
VA home loan program debt described in 38 U.S.C. 3726 unless the 
requirements set forth in that section have been met.
    (b) Notification. Prior to initiation of administrative offset, if 
not provided in the initial notice of indebtedness, VA is required to 
provide the debtor with written notice of:
    (1) The nature and amount of the debt;
    (2) VA's intention to pursue collection by offset procedures from 
the specified VA payment, the date of commencement of offset, and the 
exact amount to be offset;
    (3) The opportunity to inspect and copy VA records pertaining to the 
debt;
    (4) The right to contest either the existence or amount of the debt 
or the proposed offset schedule, or if applicable, to request a waiver 
of collection of the debt, or to request a hearing on any of these 
matters;
    (5) That commencement of offset will begin, unless the debtor makes 
a written request for the administrative relief discussed in paragraph 
(b)(4) of this section within 30 days of the date of this notice; and
    (6) The opportunity to enter into a written agreement with VA to 
repay the debt in lieu of offset.
    (c) Deferral of offset. (1) If the debtor, within 30 days of the 
date of the notification required by paragraph (b) of this section, 
disputes in writing the existence or amount of the debt or the amount of 
the scheduled offset, offset shall not commence until the dispute is 
reviewed and a decision is rendered by VA adverse to the debtor.
    (2) If the debtor, within 30 days of the date of the required 
notification by VA, requests in writing the waiver of collection of the 
debt in accordance with Sec.  1.963, Sec.  1.963a, or Sec.  1.964, 
offset shall not commence until VA has made an initial decision to deny 
the waiver request.
    (3) If the debtor, within 30 days of the required notification by 
VA, requests in writing a hearing on the issues found in paragraphs 
(c)(1) and (2) of this section, offset shall not commence until a 
decision is rendered by VA on the issue which is the basis of the 
hearing.
    (d) Exceptions. (1) Offset may commence prior to either resolution 
of a dispute or decision on a waiver request as discussed in paragraph 
(c) of this section, if collection of the debt would be jeopardized by 
deferral of offset (for example, if VA first learns of the debt when 
there is insufficient time before a final payment would be made to the 
debtor to allow for prior notice and opportunity for review or waiver 
consideration). In such a case, notification pursuant to paragraph (b) 
of this section shall be made at the time offset begins or as soon 
thereafter as possible. VA shall promptly refund any money that has been 
collected that is ultimately found not to have been owed to the 
Government.
    (2) If the United States has obtained a judgment against the debtor, 
offset may commence without the notification required by paragraph (b) 
of this section. However, a waiver request filed in accordance with the 
time limits and other requirements of Sec.  1.963, Sec.  1.963a, or 
Sec.  1.964 will be considered, even if filed after a judgment has been 
obtained against the debtor. If waiver is granted, in whole or in part, 
refund of amounts already collected will be made in accordance with 
Sec.  1.967.
    (3) The procedures set forth in paragraph (b) of this section may be 
omitted when the debt arises under a contract that provides for notice 
and other procedural protections.
    (4) Offset may commence without the notification required by 
paragraph (b) of this section when the offset is in the nature of a 
recoupment. As defined in 31 CFR 900.2(d), recoupment is a special 
method for adjusting debts arising under the same transaction or 
occurrence.
    (e) Hearing. (1) After a debtor requests a hearing, VA shall notify 
the debtor of the form of the hearing to be provided; i.e., whether the 
hearing will either be oral or paper. If an oral hearing is determined 
to be proper by the hearing official, the notice shall set forth the 
date, time, and location of the hearing. If the hearing is to be a paper 
review, the debtor shall be notified that he or she should submit his or 
her position and arguments in writing

[[Page 108]]

to the hearing official by a specified date, after which the record 
shall be closed. This date shall give the debtor reasonable time to 
submit this information.
    (2) Unless otherwise required by law, an oral hearing under this 
paragraph is not required to be a formal evidentiary type of hearing.
    (3) A debtor who requests a hearing shall be provided an oral 
hearing if VA determines that the matter cannot be resolved by review of 
documentary evidence. Whenever an issue of credibility or veracity is 
involved, an oral hearing will always be provided the debtor. For 
example, the credibility or veracity of a debtor is always an issue 
whenever the debtor requests a waiver of collection of the debt. Thus, a 
hearing held in conjunction with a waiver request will always be an oral 
hearing. If a determination is made to provide an oral hearing, the 
hearing official may offer the debtor the opportunity for a hearing by 
telephone conference call. If this offer is rejected or if the hearing 
official declines to offer a telephone conference call, the debtor shall 
be provided an oral hearing permitting the personal appearance of the 
debtor, his or her personal representative, and witnesses. Witnesses 
shall testify under oath or affirmation.
    (4) In all other cases where a debtor requests a hearing, a paper 
hearing shall be provided. The debtor shall be provided an opportunity 
to submit material for the record. A paper hearing shall consist of a 
review of the written evidence of record by the designated hearing 
official.
    (f) Statutes of limitation; multiple debts. When collecting multiple 
debts by administrative offset, VA shall apply the recovered amounts to 
those debts in accordance with the best interests of the United States, 
as determined by the facts and circumstances of the particular case, 
paying special attention to applicable statutes of limitation. In 
accordance with 31 CFR 901.3(a)(4), VA may not initiate offset to 
collect a debt more than 10 years after VA's right to collect the debt 
first accrued (with certain exceptions as specified in 31 CFR 
901.3(a)(4)).
    (g) Centralized administrative offset. (1) When VA refers delinquent 
debts to Treasury for centralized administrative offset in accordance 
with 31 CFR part 285, VA must certify that:
    (i) The debts are past due and legally enforceable; and
    (ii) VA has complied with all due process requirements under 31 
U.S.C. 3716(a) and paragraphs (b) and (c) of this section.
    (2) Payments that are prohibited by law from being offset are exempt 
from centralized administrative offset.
    (h) Computer Matching and Privacy Act waiver. In accordance with 31 
U.S.C. 3716(f), the Secretary of the Treasury may waive the provisions 
of the Computer Matching and Privacy Protection Act of 1988 concerning 
matching agreements and post-match notification and verification (5 
U.S.C. 552a(o) and (p)) for centralized administrative offset upon 
receipt of a certification from a creditor agency that the due process 
requirements enumerated in 31 U.S.C. 3716(a) and paragraphs (b) and (c) 
of this section have been met. The certification of a debt in accordance 
with paragraph (g) of this section will satisfy this requirement. If 
such a waiver is granted, only the Data Integrity Board of the 
Department of the Treasury is required to oversee any matching 
activities, in accordance with 31 U.S.C. 3716(g).
    (i) Requests by creditor agencies for offset. Unless the offset 
would not be in VA's best interest, or would otherwise be contrary to 
law, VA will comply with requests by creditor agencies to offset VA 
payments (except for current salary or benefit payments) made to a 
person indebted to the creditor agency. However, before VA may initiate 
offset, the creditor agency must certify in writing to VA that the 
debtor has been provided:
    (1) Written notice of the type and amount of the debt and the intent 
of the creditor agency to use administrative offset to collect the debt;
    (2) The opportunity to inspect and copy agency records related to 
the debt;
    (3) The opportunity for review within the agency of the 
determination of the indebtedness; and

[[Page 109]]

    (4) The opportunity to make a written agreement to repay the debt.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[52 FR 42105, Nov. 3, 1987, as amended at 54 FR 34980, Aug. 23, 1989; 69 
FR 62194, Oct. 25, 2004]



Sec.  1.912a  Collection by offset--from VA benefit payments.

    (a) Authority and scope. VA shall collect debts governed by Sec.  
1.911 of this part by offset against any current or future VA benefit 
payments to the debtor. Unless paragraphs (c) or (d) of this section 
apply, offset shall commence promptly after notification to the debtor 
as provided in paragraph (b) of this section. Certain military service 
debts shall be collected by offset against current or future 
compensation or pension benefit payments to the debtor under authority 
of 38 U.S.C. 5301(c), as provided in paragraph (e) of this section.
    (b) Notification. Unless paragraph (d) of this section applies, 
offset shall not commence until the debtor has been notified in writing 
of the matters described in Sec.  1.911(c) and (d) and paragraph (c) of 
this section.
    (c) Deferral of offset. (1) If the debtor, within thirty days of the 
date of the notification required by paragraph (b) of this section, 
disputes, in writing, the existence or amount of the debt in accordance 
with Sec.  1.911(c)(1), offset shall not commence until the dispute is 
reviewed as provided in Sec.  1.911(c)(1) and unless the resolution is 
adverse to the debtor.
    (2) If the debtor, within thirty days of the date of notification 
required by paragraph (b) of this section, requests, in writing, waiver 
of collection in accordance with Sec.  1.963 or Sec.  1.964, as 
applicable, offset shall not commence until the Department of Veterans 
Affairs has made an initial decision on waiver.
    (3) If the debtor, within thirty days of the notification required 
by paragraph (b) of this section, requests, in writing, a hearing on the 
waiver request, no decision shall be made on the waiver request until 
after the hearing has been held.
    (4) VA will pursue collection action once an adverse initial 
decision is reached on the debtor's request for waiver and/or the 
debtor's informal dispute (as described in Sec.  1.911(c)(1)) concerning 
the existence or amount of the debt, even if the debtor subsequently 
pursues appellate relief in accordance with parts 19 and 20 of this 
title.
    (d) Exceptions. Offset may commence prior to the resolution of a 
dispute or a decision on a waiver request if collection of the debt 
would be jeopardized by deferral of offset. In such case, notification 
pursuant to Sec.  1.911(d) shall be made at the time offset begins or as 
soon thereafter as possible.


(Authority: 38 U.S.C. 5314, Ch. 37)

    (e) Offset of military service debts. (1) In accordance with 38 
U.S.C. 5301(c), VA shall collect by offset from any current or future 
compensation or pension benefits payable to a veteran under laws 
administered by VA, the uncollected portion of the amount of any 
indebtedness associated with the veteran's participation in a plan 
prescribed in subchapter I or II of 10 U.S.C. chapter 73.
    (2) Offsets of a veteran's compensation or pension benefit payments 
to recoup indebtedness to the military services as described in 
paragraph (e)(1) of this section shall only be made by VA when the 
military service owed the debt has:
    (i) Determined the amount of the indebtedness of the veteran;
    (ii) Certified to VA that due process in accordance with the 
procedures prescribed in 31 U.S.C. 3716 have been provided to the 
veteran; and
    (iii) Requested collection of the total debt amount due.
    (3) Offset from any compensation or pension benefits under the 
authority of 38 U.S.C. 5301(c) shall not exceed 15% of the net monthly 
compensation or pension benefit payment. The net monthly compensation or 
pension benefit payment is defined as the authorized monthly 
compensation or pension benefit payment less all current deductions.

(Authority: 38 U.S.C. 5301(c) and 5314)

[48 FR 1055, Jan. 10, 1983, as amended at 52 FR 42106, Nov. 3, 1987; 57 
FR 47263, Oct. 15, 1992; 69 FR 62194, Oct. 25, 2004]

[[Page 110]]



Sec.  1.913  Liquidation of collateral.

    (a) VA should liquidate security or collateral through the exercise 
of a power of sale in the security instrument or a nonjudicial 
foreclosure, and apply the proceeds to the applicable debt, if the 
debtor fails to pay the debt within 180 days after demand and if such 
action is in the best interest of the United States. Collection from 
other sources, including liquidation of security or collateral, is not a 
prerequisite to requiring payment by a surety, insurer, or guarantor, 
unless such action is expressly required by statute or contract.
    (b) When VA learns that a bankruptcy petition has been filed with 
respect to a debtor, VA should seek legal advice from VA's General 
Counsel or Regional Counsel concerning the impact of the Bankruptcy 
Code, including, but not limited to, 11 U.S.C. 362, to determine the 
applicability of the automatic stay and the procedures for obtaining 
relief from such stay prior to proceeding under paragraph (a) of this 
section.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62195, Oct. 25, 2004]



Sec.  1.914  Collection in installments.

    (a) Whenever feasible, VA shall collect the total amount of a debt 
in one lump sum. If a debtor is financially unable to pay a debt in one 
lump sum, VA may accept payment in regular installments. VA should 
obtain financial statements from debtors who represent that they are 
unable to pay in one lump sum and independently verify such 
representations whenever possible. If VA agrees to accept payments in 
regular installments, VA should obtain a legally enforceable written 
agreement from the debtor that specifies all of the terms of the 
arrangement and contains a provision accelerating the debt in the event 
of default.
    (b) The size and frequency of installment payments should bear a 
reasonable relation to the size of the debt and the debtor's ability to 
pay. If possible, the installment payments should be sufficient in size 
and frequency to liquidate the debt in 3 years or less.
    (c) Security for deferred payments should be obtained in appropriate 
cases. However, VA may accept installment payments if the debtor refuses 
to execute a written agreement or to give security.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62195, Oct. 25, 2004]



Sec.  1.915  Interest, administrative costs, and penalties.

    (a) Except as otherwise provided by statute, contract, or other 
regulation to the contrary, and subject to 38 U.S.C. 3485(e) and 5302, 
VA shall assess:
    (1) Interest on all indebtedness to the United States arising out of 
participation in a VA benefit, medical care, or home loan program under 
authority of Title 38, U.S. Code.
    (2) Interest and administrative costs of collection on such debts 
described in paragraph (a)(1) of this section where repayment has become 
delinquent (as defined in 31 CFR 900.2(b)), and
    (3) Interest, administrative costs, and penalties in accordance with 
31 CFR 901.9 on all debts other than those described in paragraph (a)(1) 
of this section.
    (b) Every party entering into an agreement with the Department of 
Veterans Affairs for repayment of indebtedness in installments shall be 
advised of the interest charges to be added to the debt. All debtors 
being provided notice of indebtedness, including those entering into 
repayment agreements, shall be advised that upon the debt becoming 
delinquent, or in the case of repayment of already delinquent debts, 
interest and the administrative costs of collection will be added to the 
principal amount of the debt.
    (c) The rate of interest charged by VA shall be based on the rate 
established annually by the Secretary of the Treasury in accordance with 
31 U.S.C. 3717 and shall be adjusted annually by VA on the first day of 
the calendar year. Once the rate of interest has been determined for a 
particular debt, the rate shall remain in effect throughout the duration 
of repayment of that debt. When a debtor defaults on a repayment 
agreement and seeks to enter into a new agreement, VA may require 
payment of interest at a new rate that reflects the current value of 
funds to the

[[Page 111]]

Treasury at the time the new agreement is executed. Interest shall not 
be compounded, that is, interest shall not be charged on accrued 
interest and administrative costs required by this section. If, however, 
a debtor defaults on a previous repayment agreement, interest and 
administrative costs that accrued but were not collected under the 
defaulted agreement shall be added to the principal under the new 
agreement.
    (d) Interest on amounts covered by this section shall accrue from 
the date the initial notice of the debt is mailed to the debtor. 
Notification shall be considered sufficient when effected by ordinary 
mail, addressed to the last known address, and such notice is not 
returned as undeliverable by postal authorities.
    (e) Interest under this section shall not be charged if the debt is 
paid in full within 30 days of mailing of the initial notice described 
in paragraph (b) of this section. Once interest begins to accrue, and 
after expiration of the time period for payment of the debt in full to 
avoid assessment of interest and administrative costs, any amount 
received toward the payment of such debt shall be first applied to 
payment of outstanding administrative cost charges and then to accrued 
interest or costs, and then to principal, unless a different rule is 
prescribed by statute, contract, or other regulation.
    (f) All or any part of the interest and administrative costs 
assessed under this section are subject to consideration for waiver 
under section 5302 of title 38 U.S.C., and appropriate administrative 
procedures.
    (1) In general, interest and administrative costs may be waived only 
when the principal of the debt on which they are assessed is waived by a 
Committee on Waivers and Compromises. However, VA may forbear collection 
of interest and administrative costs, exclusive of collection of the 
principal of the debt on which they are assessed, as well as terminate 
further assessment of interest and administrative costs when the 
collection of such interest and costs are determined to be not in the 
government's best interest. Collection of interest and administrative 
costs shall not be considered to be in the best interest of the 
government when the amount of assessed interest and administrative cost 
is so large that there is a reasonable certainty that the original debt 
will never be repaid. The determination to forbear collection of 
interest and administrative cost, exclusive of collection of the 
principal of the debt, shall be made by the Chief of the Fiscal activity 
at the station responsible for the collection of the debt. Such a 
determination is not within the jurisdiction of a Committee on Waivers 
and Compromises.
    (2) [Reserved]
    (g) Administrative costs assessed under this section shall be the 
average costs of collection of similar debts, or actual collection costs 
as may be accurately determined in the particular case. No 
administrative costs of collection will be assessed under this section 
in any cases where the indebtedness is paid in full prior to the 30-day 
period specified in paragraph (e) of this section, or in any case where 
a repayment plan is proposed by the debtor and accepted by VA within 
that 30-day period, unless such repayment agreement becomes delinquent 
(as defined in 31 CFR 900.2(b)).

(Authority: 31 U.S.C. 3717; 38 U.S.C. 501, 5302, 5315)

[46 FR 62057, Dec. 22, 1981, as amended at 52 FR 42107, Nov. 3, 1987. 
Redesignated and amended at 69 FR 62195, Oct. 25, 2004]



Sec.  1.916  Disclosure of debt information to consumer reporting 
agencies (CRA).

    (a) The Department of Veterans Affairs may disclose all information 
determined to be necessary, including the name, address, Department of 
Veterans Affairs file number, Social Security number, and date of birth, 
to consumer reporting agencies for the purpose of--
    (1) Obtaining the location of an individual indebted to the United 
States as a result of participation in any benefits program administered 
by VA or indebted in any other manner to VA;
    (2) Obtaining a consumer report in order to assess an individuals 
ability to repay a debt when such individual has failed to respond to 
the Department's demand for repayment or when such individual has 
notified the Department that he/she will not repay the indebtedness; or

[[Page 112]]

    (3) Obtaining the location of an individual in order to conduct 
program evaluation studies as required by 38 U.S.C. 527 or any other 
law.
    (b) Information disclosed by the Department of Veterans Affairs 
under paragraph (a) of this section to consumer reporting agencies shall 
neither expressly nor implicitly indicate that an individual is indebted 
to the United States nor shall such information be recorded by consumer 
reporting agencies in a manner that reflects adversely upon the 
individual. Prior to disclosing this information, the Department of 
Veterans Affairs shall ascertain that consumer reporting agencies with 
which it contracts are able to comply with this requirement. The 
Department of Veterans Affairs shall also make reasonable efforts to 
insure compliance by its contractor with this requirement.
    (c) Subject to the conditions set forth in paragraph (d) of this 
section, information concerning individuals may be disclosed to consumer 
reporting agencies for inclusion in consumer reports pertaining to the 
individual, or for the purpose of locating the individual. Disclosure of 
the fact of indebtedness will be made if the individual fails to respond 
in accordance with written demands for repayment, or refuses to repay a 
debt to the United States. In making any disclosure under this section, 
VA will provide consumer reporting agencies with sufficient information 
to identify the individual, including the individual's name, address, if 
known, date of birth, VA file number, and Social Security number.
    (d)(1) Prior to releasing information under paragraph (c) of this 
section, the Department of Veterans Affairs will send a notice to the 
individual. This notice will inform the individual that--
    (i) The Department of Veterans Affairs has determined that he or she 
is indebted to the Department of Veterans Affairs;
    (ii) The debt is presently delinquent; and
    (iii) The fact of delinquency may be reported to consumer reporting 
agencies after 30 days have elapsed from the date of the notice.
    (2)(i) In accordance with Sec.  1.911 and Sec.  1.911a, VA shall 
notify each individual of the right to dispute the existence and amount 
of the debt and to request a waiver of the debt, if applicable.
    (ii) If the Department of Veterans Affairs has not previously 
notified the individual of the rights described in paragraph (d)(2)(i) 
of this section, the Department of Veterans Affairs will include this 
information in the notice described in paragraph (d)(1) of this section. 
The individual shall be afforded a minimum of 30 days from the date of 
the notice to respond to it before information is reported to consumer 
reporting agencies.
    (3) The Department of Veterans Affairs will defer reporting 
information to a consumer reporting agency if the individual disputes 
the existence or amount of any debt or requests waiver of the debt 
within the time limits set forth in paragraph (d)(2)(ii) of this 
section. The Department of Veterans Affairs will review any dispute and 
notify the individual of its findings. If the original decision is 
determined to be correct, or if the individual's request for waiver is 
denied, the Department of Veterans Affairs may report the fact of 
delinquency to a consumer reporting agency. However, the individual 
shall be afforded 30 days from date of the notice of the agency's 
determination to repay the debt.
    (4) Nothing in this section affects an individual's right to appeal 
an agency decision to the Board of Veterans Appeals. However, 
information concerning the debt may be disclosed while an appeal is 
pending before the Board of Veterans Appeals.
    (5) Upon request, the Department of Veterans Affairs will notify an 
individual--
    (i) Whether information concerning a debt has been reported to 
consumer reporting agencies;
    (ii) Of the name and address of each consumer reporting agency to 
which information has been released; and
    (iii) Of the specific information released.

A notice of the right to request this information will be sent with the 
notice described in paragraph (d)(1) of this section.
    (e) Subsequent to disclosure of information to consumer reporting 
agencies as described in paragraph (c) of this

[[Page 113]]

section, the Department of Veterans Affairs shall:
    (1) Notify on a monthly basis each consumer reporting agency 
concerned of any substantial change in the status or amount of 
indebtedness.
    (2) Promptly verify any and all information disclosed if so 
requested by the consumer reporting agency concerned.
    (f) In the absence of a different rule prescribed by statute, 
contract, or other regulation, an indebtedness is considered delinquent 
if not paid by the individual by the date due specified in the notice of 
indebtedness, unless satisfactory arrangements are made by such date.
    (g) Notification shall be considered sufficient when effected by 
ordinary mail, addressed to the last known address, and such notice is 
not returned as undeliverable by postal authorities.
    (h) The Privacy Act (5 U.S.C. 552a) does not apply to any contract 
between the Department of Veterans Affairs and a consumer reporting 
agency, nor does it apply to a consumer reporting agency and its 
employees. See 38 U.S.C. 5701(i). This paragraph does not relieve the 
Department of Veterans Affairs of its obligation to comply with the 
Privacy Act.
    (i) The term ``consumer reporting agency'' means any person or 
agency which, for monetary fees, dues, or on a cooperative nonprofit 
basis, regularly engages in whole or in part in the practice of 
assembling or evaluating consumer credit information or other 
information on consumers for the purpose of furnishing consumer reports 
to third parties or to other consumer reporting agencies. The term 
``consumer reporting agency'' shall also mean any person or agency which 
serves as a marketing agent under arrangements enabling third parties to 
obtain such information from consumer reporting agencies, or which 
obtain such information for the purpose of furnishing it to consumer 
reporting agencies.

(Authority: 31 U.S.C. 3711(e); 38 U.S.C. 501, 5701(g) and (i))

[46 FR 62058, Dec. 22, 1981, as amended at 52 FR 42107, Nov. 3, 1987. 
Redesignated and amended at 69 FR 62195, Oct. 25, 2004]



Sec.  1.917  Contracting for collection services.

    (a) VA has authority to contract for collection services to recover 
delinquent debts, provided that:
    (1) The authority to resolve disputes, compromise claims, suspend or 
terminate collection and refer the matter for litigation shall be 
retained by VA;
    (2) The contractor shall be subject to 38 U.S.C. 5701, and to the 
Privacy Act of 1974, as amended, to the extent specified in 5 U.S.C. 
552a(m), and to applicable Federal and State laws and regulations 
pertaining to debt collection practices, such as the Fair Debt 
Collection Practices Act, 15 U.S.C. 1692 et seq.
    (3) The contractor shall be required to strictly account for all 
amounts collected;
    (4) Upon returning an account to VA for subsequent referral to the 
Department of Justice for litigation, the contractor must agree to 
provide any data contained in its files relating to Sec.  1.951.
    (b) In accordance with 31 U.S.C. 3718(d), or as otherwise permitted 
by law, collection service contracts may be funded in the following 
manner:
    (1) VA may fund a collection service contract on a fixed-fee basis 
(i.e., payment of a fixed fee determined without regard to the amount 
actually collected under the contract). Payment of the fee under this 
type of contract must be charged to available appropriations;
    (2) VA may also fund a collection service contract on a contingent-
fee basis (i.e., by including a provision in the contract permitting the 
contractor to deduct its fee from amounts collected under the contract). 
The fee should be based upon a percentage of the amount collected, 
consistent with prevailing commercial practice;
    (3) VA may enter into a contract under paragraph (b)(1) of this 
section only if and to the extent that funding for the contract is 
provided for in advance by an appropriation act or other legislation, 
except that this requirement does not apply to the use of a revolving 
fund authorized by statute;
    (4) Except as authorized under paragraphs (b)(2) and (b)(5) of this 
section, or unless otherwise specifically provided by law, VA shall 
deposit all amounts recovered under collection

[[Page 114]]

service contracts for Loan Guaranty debts into the Loan Guaranty 
Revolving Fund, and for all other debts in the Treasury as miscellaneous 
receipts pursuant to 31 U.S.C. 3302.
    (5) For benefit overpayments recovered under collection service 
contract, VA, pursuant to 31 U.S.C. 3302, shall deposit:
    (i) Amounts equal to the original overpayments in the appropriations 
account from which the overpayments were made, and
    (ii) Amount of interest or administrative costs in the Treasury as 
miscellaneous receipts.
    (c) VA shall use government-wide debt collection contracts to obtain 
debt collection services provided by private collection contractors. 
However, VA may refer debts to private collection contractors pursuant 
to a contract between VA and a private collection contractor only if 
such debts are not subject to the requirement to transfer debts to 
Treasury for debt collection. See 31 U.S.C. 3711(g), 31 CFR 285.12(e), 
and 38 CFR 1.910.
    (d) VA may enter into contracts for locating and recovering assets 
of the United States, such as unclaimed assets.
    (e) VA may enter into contracts for debtor asset and income search 
reports. In accordance with 31 U.S.C. 3718(d), such contracts may 
provide that the fee a contractor charges the agency for such services 
may be payable from the amounts recovered, unless otherwise prohibited 
by statute.

(Authority: 31 U.S.C. 3718; 38 U.S.C. 501)

[52 FR 42107, Nov. 3, 1987. Redesignated and amended at 69 FR 62195, 
Oct. 25, 2004]



Sec.  1.918  Use and disclosure of mailing addresses.

    (a) When attempting to locate a debtor in order to compromise or 
collect a debt in accordance with Sec. Sec.  1.900 through 1.953, VA may 
send a request to the Secretary of the Treasury, or his/her designee, in 
order to obtain the debtor's most current mailing address from the 
records of the Internal Revenue Service.
    (b) VA is authorized to use mailing addresses obtained under 
paragraph (a) of this section to enforce collection of a delinquent debt 
and may disclose such mailing addresses to other agencies and to 
collection agencies for collection purposes.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[52 FR 42108, Nov. 3, 1987. Redesignated and amended at 69 FR 62196, 
Oct. 25, 2004]



Sec.  1.919  Administrative offset against amounts payable from Civil 
Service Retirement and Disability Fund, Federal Employees Retirement 
System (FERS), final salary check, and lump sum leave payments.

    (a) Unless otherwise prohibited by law or regulation, and in 
accordance with 31 CFR 901.3(d), VA may request that money which is due 
and payable to a debtor from either the Civil Service Retirement and 
Disability Fund or FERS be administratively offset in reasonable amounts 
in order to collect, in one full payment or a minimal number of 
payments, debts that are owed to VA by the debtor. Such requests shall 
be made to the appropriate officials at the Office of Personnel 
Management (OPM) in accordance with such regulations prescribed by the 
Director of OPM. (See 5 CFR 831.1801 through 831.1808). In addition, VA 
may also offset against a Federal employee's final salary check and lump 
sum leave payment. See Sec.  1.912 for procedures for offset against a 
final salary check and lump sum leave payment.
    (b) When making a request to the Office of Personnel Management for 
administrative offset under paragraph (a) of this section, VA shall 
include a written certification that:
    (1) The debtor owes VA a debt, including the amount of the debt;
    (2) VA has complied with the applicable statutes, regulations, and 
procedures of the Office of Personnel Management; and
    (3) VA has complied with Sec. Sec.  1.911, 1.911a, 1.912, 1.912a, 
and 31 CFR 901.3, to the extent applicable, including any required 
hearing or review.
    (c) Once VA decides to request administrative offset from the Civil 
Service Retirement and Disability Fund or Federal Employees Retirement 
System (FERS) under paragraph (a) of this section, it shall make the 
request as soon as possible after completion of the applicable 
procedures in order that the Office of Personnel Management may

[[Page 115]]

identify the debtor's account in anticipation of the time when the 
debtor requests or becomes eligible to receive payments from the Fund or 
FERS. This will satisfy any requirement that offset be initiated prior 
to expiration of the applicable statutes of limitations. At such time as 
the debtor makes a claim for payments from the Fund or FERS, if at least 
a year has elapsed since the offset request was originally made, the 
debtor should be permitted to offer a satisfactory repayment plan in 
lieu of offset upon establishing that such offset will create financial 
hardship.
    (d) If VA collects all or part of the debt by other means before 
deductions are made or completed in accordance with paragraph (a) of 
this section, VA shall promptly act to modify or terminate its request 
for offset under paragraph (a) of this section.
    (e) The Office of Personnel Management is neither required nor 
authorized by this section to review the merits of VA's determination 
with respect to the amount and validity of the debt waiver under 5 
U.S.C. 5584 or 38 U.S.C. 5302, or providing or not providing an oral 
hearing.

(Authority: 5 U.S.C. 8461; 31 U.S.C. 3711, 3716; 38 U.S.C. 501)

[52 FR 42108, Nov. 3, 1987. Redesignated and amended at 69 FR 62196, 
Oct. 25, 2004]



Sec.  1.920  Referral of VA debts.

    (a) When authorized, VA may refer an uncollectible debt to another 
Federal or State agency for the purpose of collection action. Collection 
action may include the offsetting of the debt from any current or future 
payment, except salary (see paragraph (e) of this section), made by such 
Federal or State agency to the person indebted to VA.
    (b) VA must certify in writing that the individual owes the debt, 
the amount and basis of the debt, the date on which payment became due, 
and the date VA's right to collect the debt first accrued.
    (c) This certification will also state that VA provided the debtor 
with written notice of:
    (1) The nature and amount of the debt;
    (2) VA's intention to pursue collection by offset procedures;
    (3) The opportunity to inspect and copy VA records pertaining to the 
debt;
    (4) The right to contest both the existence and amount of the debt 
and to request a waiver of collection of the debt (if applicable), as 
well as the right to a hearing on both matters;
    (5) The opportunity to enter into a written agreement with VA for 
the repayment of the debt; and
    (6) Other applicable notices required by Sec. Sec.  1.911, 1.911a, 
1.912, and 1.912a.
    (d) The written certification required by paragraphs (b) and (c) of 
this section will also contain (for all debts) a listing of all actions 
taken by both VA and the debtor subsequent to the notice, as well as the 
dates of such actions.
    (e) The referral by VA of a VA debt to another agency for the 
purpose of salary offset shall be done in accordance with 38 CFR 1.980 
through 1.995 and regulations prescribed by the Director of the Office 
of Personnel Management (OPM) in 5 CFR part 550, subpart K.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[52 FR 42108, Nov. 3, 1987. Redesignated and amended at 69 FR 62196, 
Oct. 25, 2004]



Sec.  1.921  Analysis of costs.

    VA collection procedures should provide for periodic comparison of 
costs incurred and amounts collected. Data on costs and corresponding 
recovery rates for debts of different types and in various dollar ranges 
should be used to compare the cost effectiveness of alternative 
collection techniques, establish guidelines with respect to points at 
which costs of further collection efforts are likely to exceed 
recoveries, assist in evaluating offers in compromise, and establish 
minimum debt amounts below which collection efforts need not be taken.

(Authority: 31 U.S.C. 3711-3719; 38 U.S.C. 501)

[69 FR 62196, Oct. 25, 2004]



Sec.  1.922  Exemptions.

    (a) Sections 1.900 through 1.953, to the extent they reflect 
remedies or procedures prescribed by the Debt Collection Act of 1982 and 
the Debt Collection Improvement Act of 1996, such as administrative 
offset, use of credit bureaus,

[[Page 116]]

contracting for collection agencies, and interest and related charges, 
do not apply to debts arising under, or payments made under, the 
Internal Revenue Code of 1986, as amended (26 U.S.C. 1 et seq.); the 
Social Security Act (42 U.S.C. 301 et seq.), except to the extent 
provided under 42 U.S.C. 404 and 31 U.S.C. 3716(c); or the tariff laws 
of the United States. These remedies and procedures, however, may be 
authorized with respect to debts that are exempt from the Debt 
Collection Act of 1982 and the DCIA of 1996, to the extent that they are 
authorized under some other statute or the common law.
    (b) This section should not be construed as prohibiting the use of 
Sec. Sec.  1.900 through 1.953 when collecting debts owed by persons 
employed by agencies administering the laws cited in paragraph (a) of 
this section unless the debt arose under those laws.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62196, Oct. 25, 2004]



Sec.  1.923  Administrative wage garnishment.

    (a) In accordance with the procedures set forth in 31 U.S.C. 3720D 
and 31 CFR 285.11, VA or Treasury may request that a non-Federal 
employer garnish the disposable pay of an individual to collect 
delinquent non-tax debt owed to VA. VA may pursue wage garnishment 
independently in accordance with this section or VA or Treasury may 
pursue garnishment after VA refers a debt to Treasury in accordance with 
Sec.  1.910 of this part and 31 CFR 285.12. For the purposes of this 
section, any reference to Treasury also includes any private collection 
agency under contract to Treasury.
    (b) At least 30 days prior to the initiation of garnishment 
proceedings, VA or Treasury shall send a written notice, as described in 
31 CFR 285.11(e), by first class mail to the debtor's last known 
address. This notice shall inform the debtor of:
    (1) The nature and amount of the debt;
    (2) The intention of VA or Treasury to initiate proceedings to 
collect the debt through deductions from the debtor's pay until the debt 
and all accumulated interest, and other late payment charges, are paid 
in full, and;
    (3) An explanation of the debtor's rights, including the 
opportunity:
    (i) To inspect and copy VA records pertaining to the debt;
    (ii) To enter into a written repayment agreement with VA or Treasury 
under terms agreeable to VA or Treasury, and;
    (iii) To a hearing in accordance with 31 CFR 285.11(f) and paragraph 
(c) of this section concerning the existence or amount of the debt or 
the terms of the proposed repayment schedule under the garnishment 
order. However, the debtor is not entitled to a hearing concerning the 
terms of the proposed repayment schedule if these terms have been 
established by written agreement under paragraph (b)(3)(ii) of this 
section.
    (c) Any hearing conducted as part of the administrative wage 
garnishment process shall be conducted by the designated hearing 
official in accordance with the procedures set forth in 31 CFR 
285.11(f). This hearing official may be any VA hearing official. This 
hearing official may also conduct administrative wage garnishment 
hearings for other Federal agencies.
    (1) The hearing may be oral or written as determined by the 
designated hearing official. The hearing official shall provide the 
debtor with a reasonable opportunity for an oral hearing when the 
hearing official determines that the issue in dispute cannot be resolved 
by review of documentary evidence, for example, when the validity of the 
claim turns on the issue of credibility or veracity. The hearing 
official shall establish the time and place of any oral hearing. At the 
debtor's option, an oral hearing may be conducted either in person or by 
telephone conference call. A hearing is not required to be a formal, 
evidentiary-type hearing, but witnesses who testify in oral hearings 
must do so under oath or affirmation. While it is not necessary to 
produce a transcript of the hearing, the hearing official must maintain 
a summary record of the proceedings. All travel expenses incurred by the 
debtor in connection with an in-person hearing shall be borne by the 
debtor. VA or Treasury shall be responsible for all

[[Page 117]]

telephone expenses. In the absence of good cause shown, a debtor who 
fails to appear at a hearing will be deemed as not having timely filed a 
request for a hearing.
    (2) If the hearing official determines that an oral hearing is not 
necessary, then he/she shall afford the debtor a ``paper hearing.'' In a 
``paper hearing,'' the hearing official will decide the issues in 
dispute based upon a review of the written record.
    (3) If the debtor's written request for a hearing is received by 
either VA or Treasury within 15 business days following the mailing of 
the notice described in paragraph (b) of this section, then VA or 
Treasury shall not issue a withholding order as described in paragraph 
(d) of this section until the debtor is afforded the requested hearing 
and a decision rendered. If the debtor's written request for a hearing 
is not received within 15 business days following the mailing of the 
notice described in paragraph (b) of this section, then the hearing 
official shall provide a hearing to the debtor, but will not delay 
issuance of a withholding order as described in paragraph (d) of this 
section, unless the hearing official determines that the delay in filing 
was caused by factors beyond the debtor's control.
    (4) The hearing official shall notify the debtor of:
    (i) The date and time of a telephone conference hearing;
    (ii) The date, time, and location of an in-person oral hearing, or;
    (iii) The deadline for the submission of evidence for a written 
hearing.
    (5) Except as provided in paragraph (c)(6)of this section, VA or 
Treasury shall have the burden of going forward to prove the existence 
or amount of the debt, after which the debtor must show, by a 
preponderance of the evidence, that no debt exists or that the amount of 
the debt is incorrect. In general, this means that the debtor must show 
that it is more likely than not that a debt does not exist or that the 
amount of the debt is incorrect. The debtor may also present evidence 
that terms of the repayment agreement are unlawful, would cause a 
financial hardship, or that collection of the debt may not be pursued 
due to operation of law.
    (6) If the debtor has previously contested the existence and/or 
amount of the debt in accordance with Sec.  1.911(c)(1) or Sec.  
1.911a(c)(1) and VA subsequently rendered a decision upholding the 
existence or amount of the debt, then such decision shall be 
incorporated by reference and become the basis of the hearing official's 
decision on such matters.
    (7) The hearing official shall issue a written decision as soon as 
practicable, but not later than 60 days after the date on which the 
request for such hearing was received by VA or Treasury. The decision 
will be the final action for the purposes of judicial review under the 
Administrative Procedure Act (5 U.S.C. 701 et seq.). The decision shall 
include:
    (i) A summary of the facts presented;
    (ii) The hearing official's findings, analysis, and conclusions, 
and;
    (iii) The terms of the repayment schedule, if applicable.
    (d) In accordance with 31 CFR 285.11(g) and (h), VA or Treasury 
shall send a Treasury-approved withholding order and certification form 
by first class mail to the debtor's employer within 30 days after the 
debtor fails to make a timely request for a hearing. If a timely request 
for a hearing has been filed by the debtor, then VA or Treasury shall 
send a withholding order and certification form by first class mail to 
the debtor's employer within 30 days after a final decision is made to 
proceed with the garnishment. The employer shall complete and return the 
certification form as described in 31 CFR 285.11(h).
    (e) After receipt of the garnishment order, the employer shall 
withhold the amount of garnishment as described in 31 CFR 285.11(i) from 
all disposable pay payable to the applicable debtor during each pay 
period.
    (f) A debtor whose wages are subject to a wage withholding order 
under 31 CFR 285.11 may request a review, under the procedures set forth 
in 31 CFR 285.11(k), of the amount garnished. A request for review shall 
only be considered after garnishment has been initiated. The request 
must be based on materially changed circumstances such as disability, 
divorce, or catastrophic illness which result in financial hardship

[[Page 118]]

that limit the debtor's ability to provide food, housing, clothing, 
transportation, and medical care for himself/herself and his/her 
dependents.

(Authority: 31 U.S.C. 3720D; 38 U.S.C. 501; 31 CFR 285.11)

[69 FR 62196, Oct. 25, 2004, as amended at 72 FR 65462, Nov. 21, 2007]



Sec.  1.924  Suspension or revocation of eligibility for federal loans, 
loan insurance, loan guarantees, licenses, permits, or privileges.

    (a) In accordance with 31 U.S.C. 3720B and the procedures set forth 
in 31 CFR 285.13 and Sec.  901.6, a person owing an outstanding non-tax 
debt that is in delinquent status shall not be eligible for Federal 
financial assistance unless exempted under paragraph (d) of this section 
or waived under paragraph (e) of this section.
    (b) Federal financial assistance or financial assistance means any 
Federal loan (other than a disaster loan), loan insurance, or loan 
guarantee.
    (c) For the purposes of this section only, a debt is in a delinquent 
status if the debt has not been paid within 90 days of the payment due 
date or by the end of any grace period provided by statute, regulation, 
contract, or agreement. The payment due date is the date specified in 
the initial written demand for payment. Further guidance concerning the 
delinquent status of a debt may be found at 31 CFR 285.13(d).
    (d) Upon the written request and recommendation of the Secretary of 
Veterans Affairs, the Secretary of the Treasury may grant exemptions 
from the provisions of this section. The standards for exemptions 
granted for classes of debts are set forth in 31 CFR 285.13(f).
    (e)(1) VA's Chief Financial Officer or Deputy Chief Financial 
Officer may waive the provisions of paragraph (a) of this section only 
on a person-by-person basis.
    (2) The Chief Financial Officer or Deputy Chief Financial Officer 
should balance the following factors when deciding whether to grant a 
waiver:
    (i) Whether the denial of the financial assistance to the person 
would tend to interfere substantially with or defeat the purposes of the 
financial assistance program or otherwise would not be in the best 
interests of the Federal government; and
    (ii) Whether the granting of the financial assistance to the person 
is contrary to the government's goal of reducing losses by requiring 
proper screening of potential borrowers.
    (3) When balancing the factors described in paragraph (e)(2)(i) and 
(e)(2)(ii) of this section, the Chief Financial Officer or Deputy Chief 
Financial Officer should consider:
    (i) The age, amount, and cause(s) of the delinquency and the 
likelihood that the person will resolve the delinquent debt; and
    (ii) The amount of the total debt, delinquent or otherwise, owed by 
the person and the person's credit history with respect to repayment of 
debt.
    (4) A centralized record shall be retained of the number and type of 
waivers granted under this section.
    (f) In non-bankruptcy cases, in seeking the collection of statutory 
penalties, forfeitures, or other similar types of claims, VA may suspend 
or revoke any license, permit, or other privilege granted a debtor when 
the debtor inexcusably or willfully fails to pay such a debt. The debtor 
should be advised in VA's written demand for payment of VA's ability to 
suspend or revoke licenses, permits, or privileges. VA may suspend or 
disqualify any lender, contractor, or broker who is engaged in making, 
guaranteeing, insuring, acquiring, or participating in loans from doing 
further business with VA or engaging in programs sponsored by VA if such 
lender, contractor, or broker fails to pay its debts to the Government 
within a reasonable time, or if such lender, contractor, or broker has 
been suspended, debarred, or disqualified from participation in a 
program or activity by another Federal agency. The failure of any surety 
to honor its obligations in accordance with 31 U.S.C. 9305 should be 
reported to Treasury.
    (g) In bankruptcy cases, before advising the debtor of the intention 
to suspend or revoke licenses, permits, or privileges, VA should seek 
legal advice from VA's General Counsel or Regional Counsel concerning 
the impact of the Bankruptcy Code, particularly 11

[[Page 119]]

U.S.C. 362 and 525, which may restrict such action.

(Authority: 31 U.S.C. 3720B; 38 U.S.C. 501)

[69 FR 62197, Oct. 25, 2004]



Sec.  1.929  Reduction of debt through performance of work-study services.

    (a) Scope. (1) Subject to the provisions of this section VA may 
allow an individual to reduce an indebtedness to the United States 
through offset of benefits to which the individual becomes entitled by 
performance of work-study services under 38 U.S.C. 3485 and 3537 when 
the debt arose by virtue of the individual's participation in a benefits 
program provided under any of the following:
    (i) 38 U.S.C. chapter 30;
    (ii) 38 U.S.C. chapter 31;
    (iii) 38 U.S.C. chapter 32;
    (iv) 38 U.S.C. chapter 34;
    (v) 38 U.S.C. chapter 35;
    (vi) 38 U.S.C. chapter 36 (other than an education loan provided 
under subpart F, part 21 of this title); or
    (vii) 10 U.S.C. chapter 1606 (other than an indebtedness arising 
from a refund penalty imposed under 10 U.S.C. 16135).
    (2) This section shall not apply in any case in which the individual 
has a pending request for waiver of the debt under Sec. Sec.  1.950 
through 1.970.


(Authority: 38 U.S.C. 3485(e)(1); Pub. L. 102-16)

    (b) Selection criteria. (1) If there are more candidates for a work-
study allowance than there are work-study positions available in the 
area in which the services are to be performed, VA will give priority to 
the candidates who are pursuing a program of education or 
rehabilitation.
    (2) Only after all candidates in the area described in paragraph 
(b)(1) of this section either have been given work-study contracts or 
have withdrawn their request for contracts will VA offer contracts to 
those who are not pursuing a program of education or rehabilitation and 
who wish to reduce their indebtedness through performance of work-study 
services.
    (3) VA shall not offer a contract to an individual who is receiving 
compensation from another source for the work-study services the 
individual wishes to perform.
    (4) VA shall not offer a contract to an individual if VA determines 
that the debt can be collected through other means such as collection in 
a lump sum, collection in installments as provided in Sec.  1.917 or 
compromise as provided in Sec.  1.918.


(Authority: 38 U.S.C. 3485(e); Pub. L. 102-16)

    (c) Utilization. The work-study services to be performed under a 
debt-liquidation contract will be limited as follows:
    (1) If the individual is concurrently receiving educational 
assistance in a program administered by VA, work-study services are 
limited to those allowed in the educational program under which the 
individual is receiving benefits.
    (2) If the individual is not concurrently receiving educational 
assistance in a program administered by VA, the individual may perform 
only those work-study services and activities which are or were open to 
those students receiving a work-study allowance while pursuing a program 
of education pursuant to the chapter under which the debt was incurred.


(Authority: 38 U.S.C. 3485(e); Pub. L. 102-16)

    (d) Contract to perform services. (1) The work-study services 
performed to reduce indebtedness shall be performed pursuant to a 
contract between the individual and VA.
    (2) The individual shall perform the work-study services required by 
the contract at the place or places designated by VA.
    (3) The number of hours of services to be performed under the 
contract must be sufficient to enable the individual to become entitled 
to a sum large enough to liquidate the debt by offset.
    (4) The number of weeks in the contract will not exceed the lesser 
of--
    (i) The number of weeks of services the individual needs to perform 
to liquidate his or her debt; or
    (ii) 52.
    (5) In determining the number of hours per week and the number of 
weeks under paragraphs (d)(3) and (d)(4) of this section necessary to 
liquidate the debt, VA will use the amount of the

[[Page 120]]

account receivable, including all accrued interest, administrative costs 
and marshall fees outstanding on the date the contract is offered to the 
individual and all accrued interest, administrative costs and marshall 
fees VA estimates will have become outstanding on the debt on the date 
the debt is to be liquidated.
    (6) The contract will automatically terminate after the total amount 
of the individual's indebtedness described in paragraph (d)(5) of this 
section has been recouped, waived, or otherwise liquidated. An 
individual performing work-study services under a contract to liquidate 
a debt is released from the contract if the debt is liquidated by other 
means.
    (7) The contract to perform work-study services for the purpose of 
liquidating indebtedness will be terminated if:
    (i) The individual is liquidating his or her debt under this section 
while receiving either an educational assistance allowance for further 
pursuit of a program of education or a subsistence allowance for further 
pursuit of a program of rehabilitation;
    (ii) The individual terminates or reduces the rate of pursuit of his 
or her program of education or rehabilitation; and
    (iii) The termination or reduction causes an account receivable as a 
debt owed by the individual.
    (8) VA may terminate the contract at any time the individual fails 
to perform the services required by the contract in a satisfactory 
manner.


(Authority: 38 U.S.C. 3485(e), 7104(a); Pub. L. 102-16)

    (e) Reduction of indebtedness. (1) In return for the individual's 
agreement to perform hours of services totaling not more than 40 times 
the number of weeks in the contract, VA will reduce the eligible 
person's outstanding indebtedness by an amount equal to the higher of--
    (i) The hourly minimum wage in effect under section 6(a) of the Fair 
Labor Standards Act of 1938 times the number of hours the individual 
works; or
    (ii) The hourly minimum wage under comparable law of the State in 
which the services are performed times the number of hours the 
individual works.
    (2) VA will reduce the individual's debt by the amount of the money 
earned for the performance of work-study services after the completion 
of each 50 hours of services (or in the case of any remaining hours 
required by the contract, the amount for those hours).


(Authority: 38 U.S.C. 3485(e); Pub. L. 102-16)

    (f) Suspension of collections by offset. Notwithstanding the 
provisions of Sec.  1.912a, during the period covered by the work-study 
debt-liquidation contract with the individual, VA will ordinarily 
suspend the collection by offset of a debt described in paragraph (a)(1) 
of this section. However, the individual may voluntarily permit VA to 
collect part of the debt through offset against other benefits payable 
while the individual is performing work-study services. If the contract 
is terminated before its scheduled completion date, and the debt has not 
been liquidated, collection through offset against other benefits 
payable will resume on the date the contract terminates.


(Authority: 38 U.S.C. 3485(e); Pub. L. 102-16)

    (g) Payment for additional hours. (1) If an individual, without 
fault on his or her part, performs work-study services for which payment 
may not be authorized, including services performed after termination of 
the contract, VA will pay the individual at the applicable hourly 
minimum wage for such services as the Director of the VA field station 
of jurisdiction determines were satisfactorily performed.
    (2) The Director of the VA field station of jurisdiction shall 
determine whether the individual was without fault. In making this 
decision he or she shall consider all evidence of record and any 
additional evidence which the individual wishes to submit.

(Authority: 38 U.S.C. 3485(e); Pub. L. 102-16)

[62 FR 15401, Apr. 1, 1997]

                   Standards for Compromise of Claims

    Authority: Sections 1.900 through 1.953 are issued under the 
authority of 31 U.S.C. 3711 through 3720E; 38 U.S.C. 501, and as noted 
in specific sections.

[[Page 121]]


    Source: 32 FR 2614, Feb. 8, 1967, unless otherwise noted.



Sec.  1.930  Scope and application.

    (a) The standards set forth in Sec. Sec.  1.930 through 1.936 of 
this part apply to the compromise of debts pursuant to 31 U.S.C. 3711. 
VA may exercise such compromise authority when the amount of the debt 
due, exclusive of interest, penalties, and administrative costs, does 
not exceed $100,000 or any higher amount authorized by the Attorney 
General.
    (b) Unless otherwise provided by law, when the principal balance of 
a debt, exclusive of interest, penalties, and administrative costs, 
exceeds $100,000 or any higher amount authorized by the Attorney 
General, the authority to accept the compromise rests with the 
Department of Justice (DOJ). If VA receives an offer to compromise any 
debt in excess of $100,000, VA should evaluate the compromise offer 
using the same factors as set forth in Sec.  1.931 of this part. If VA 
believes the offer has merit, it shall refer the debt to the Civil 
Division or other appropriate division in DOJ using a Claims Collection 
Litigation Report (CCLR). The referral shall include appropriate 
financial information and a recommendation for the acceptance of the 
compromise offer. DOJ approval is not required if VA decides to reject a 
compromise offer.
    (c) The $100,000 limit in paragraph (b) of this section does not 
apply to debts that arise out of participation in a VA loan program 
under Chapter 37 of Title 38 of the U.S. Code. VA has unlimited 
authority to compromise debts arising out of participation in a Chapter 
37 loan program, regardless of the amount of the debt.

(Authority: 31 U.S.C. 3711; 38 U.S.C 501, 3720)

[69 FR 62198, Oct. 25, 2004]



Sec.  1.931  Bases for compromise.

    (a) VA may compromise a debt if it cannot collect the full amount 
because:
    (1) The debtor is unable to pay the full amount in a reasonable 
time, as verified through credit reports or other financial information;
    (2) VA is unable to collect the debt in full within a reasonable 
time by enforced collection proceedings;
    (3) The cost of collecting the debt does not justify the enforced 
collection of the full amount; or
    (4) There is significant doubt concerning VA's ability to prove its 
case in court.
    (b) In determining the debtor's inability to pay, VA will consider 
relevant factors such as the following:
    (1) Age and health of the debtor;
    (2) Present and potential income;
    (3) Inheritance prospects;
    (4) The possibility that assets have been concealed or improperly 
transferred by the debtor; and
    (5) The availability of assets or income that may be realized by 
enforced collection proceedings.
    (c) VA will verify the debtor's claim of inability to pay by using a 
credit report and other financial information as provided in paragraph 
(g) of this section. VA should consider the applicable exemptions 
available to the debtor under State and Federal law in determining the 
ability to enforce collection. VA also may consider uncertainty as to 
the price that collateral or other property will bring at a forced sale 
in determining the ability to enforce collection. A compromise effected 
under this section should be for an amount that bears a reasonable 
relation to the amount that can be recovered by enforced collection 
procedures, with regard to the exemptions available to the debtor and 
the time that collection will take.
    (d) If there is significant doubt concerning VA's ability to prove 
its case in court for the full amount claimed, either because of the 
legal issues involved or because of a bona fide dispute as to the facts, 
then the amount accepted in compromise of such cases should fairly 
reflect the probabilities of successful prosecution to judgment, with 
due regard given to the availability of witnesses and other evidentiary 
support for VA's claim. In determining the risks involved in litigation, 
VA will consider the probable amount of court costs and attorney fees 
pursuant to the Equal Access to Justice Act, 28 U.S.C. 2412, that may be

[[Page 122]]

imposed against the Government if it is unsuccessful in litigation.
    (e) VA may compromise a debt if the cost of collecting the debt does 
not justify the enforced collection of the full amount. The amount 
accepted in compromise in such cases may reflect an appropriate discount 
for the administrative and litigative costs of collection, with 
consideration given to the time it will take to effect collection. 
Collection costs may be a substantial factor in the settlement of small 
debts. In determining whether the cost of collecting justifies enforced 
collection of the full amount, VA will consider whether continued 
collection of the debt, regardless of cost, is necessary to further an 
enforcement principle.
    (f) VA generally will not accept compromises payable in 
installments. If, however, payment of a compromise in installments is 
necessary, VA will obtain a legally enforceable written agreement 
providing that, in the event of default, the full original principal 
balance of the debt prior to compromise, less sums paid thereon, is 
reinstated. Whenever possible, VA will also obtain security for 
repayment.
    (g) To assess the merits of a compromise offer based in whole or in 
part on the debtor's inability to pay the full amount of a debt within a 
reasonable time, VA will obtain a current financial statement from the 
debtor showing the debtor's assets, liabilities, income, and expenses. 
Agencies also may obtain credit reports or other financial information 
to assess compromise offers.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[69 FR 62198, Oct. 25, 2004]



Sec.  1.932  Enforcement policy.

    VA may compromise statutory penalties, forfeitures, or claims 
established as an aid to enforcement and to compel compliance, if VA's 
enforcement policy in terms of deterrence and securing compliance, 
present and future, will be adequately served by VA's acceptance of the 
sum to be agreed upon.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[69 FR 62198, Oct. 25, 2004]



Sec.  1.933  Joint and several liability.

    (a) When two or more debtors are jointly and severally liable, VA 
will pursue collection activity against all debtors, as appropriate. VA 
will not attempt to allocate the burden of payment between the debtors 
but should proceed to liquidate the indebtedness as quickly as possible.
    (b) VA will ensure that a compromise agreement with one debtor does 
not release VA's claim against the remaining debtors. The amount of a 
compromise with one debtor shall not be considered a precedent or 
binding in determining the amount that will be required from other 
debtors jointly and severally liable on the claim.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[69 FR 62198, Oct. 25, 2004]



Sec.  1.934  Further review of compromise offers.

    If VA is uncertain whether to accept a firm, written, substantive 
compromise offer on a debt that is within its delegated compromise 
authority, it may refer the offer to VA General Counsel or Regional 
Counsel or to the Civil Division or other appropriate division in the 
Department of Justice (DOJ), using a Claims Collection Litigation Report 
(CCLR) accompanied by supporting data and particulars concerning the 
debt. DOJ may act upon such an offer or return it to the agency with 
instructions or advice.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[69 FR 62198, Oct. 25, 2004]



Sec.  1.935  Consideration of tax consequences to the Government.

    In negotiating a compromise, VA will consider the tax consequences 
to the Government. In particular, VA will consider requiring a waiver of 
tax-loss-carry-forward and tax-loss-carry-back rights of the debtor.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[69 FR 62198, Oct. 25, 2004]



Sec.  1.936  Mutual releases of the debtor and VA.

    In all appropriate instances, a compromise that is accepted by VA 
shall be

[[Page 123]]

implemented by means of a mutual release, in which the debtor is 
released from further non-tax liability on the compromised debt in 
consideration of payment in full of the compromise amount, and VA and 
its officials, past and present, are released and discharged from any 
and all claims and causes of action that the debtor may have arising 
from the same transaction. In the event a mutual release is not executed 
when a debt is compromised, unless prohibited by law, the debtor is 
still deemed to have waived any and all claims and causes of action 
against VA and its officials related to the transaction giving rise to 
the compromised debt.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[69 FR 62198, Oct. 25, 2004]

        Standards for Suspending or Terminating Collection Action

    Authority: Sections 1.900 through 1.953 are issued under the 
authority of 31 U.S.C. 3711 through 3720E; 38 U.S.C. 501, and as noted 
in specific sections.

    Source: 32 FR 2615, Feb. 8, 1967, unless otherwise noted.



Sec.  1.940  Scope and application.

    Except as otherwise provided in Sec.  1.945:
    (a) The standards set forth in Sec. Sec.  1.940 through 1.944 apply 
to the suspension or termination of collection activity pursuant to 31 
U.S.C. 3711 on debts that do not exceed $100,000, or such other amount 
as the Attorney General may direct, exclusive of interest, penalties, 
and administrative costs, after deducting the amount of partial payments 
or collections, if any. Prior to referring a debt to the Department of 
Justice (DOJ) for litigation, VA may suspend or terminate collection 
under this part with respect to the debt.
    (b) If, after deducting the amount of any partial payments or 
collections, the principal amount of a debt exceeds $100,000, or such 
other amount as the Attorney General may direct, exclusive of interest, 
penalties, and administrative costs, the authority to suspend or 
terminate rests solely with DOJ. If VA believes that suspension or 
termination of any debt in excess of $100,000 may be appropriate, it 
shall refer the debt to the Civil Division or other appropriate division 
in DOJ, using the Claims Collection Litigation Report (CCLR). The 
referral should specify the reasons for VA's recommendation. If, prior 
to referral to DOJ, VA determines that a debt is plainly erroneous or 
clearly without legal merit, VA may terminate collection activity 
regardless of the amount involved without obtaining DOJ concurrence.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62199, Oct. 25, 2004, as amended at 75 FR 53201, Aug. 31, 2010]



Sec.  1.941  Suspension of collection activity.

    (a) VA may suspend collection activity on a debt when:
    (1) It cannot locate the debtor;
    (2) The debtor's financial condition is expected to improve; or
    (3) The debtor has requested a waiver or review of the debt.
    (b) Based on the current financial condition of the debtor, VA may 
suspend collection activity on a debt when the debtor's future prospects 
justify retention of the debt for periodic review and collection 
activity and:
    (1) The applicable statute of limitations has not expired; or
    (2) Future collection can be effected by administrative offset, 
notwithstanding the expiration of the applicable statute of limitations 
for litigation of claims, and with due regard to the 10-year limitation 
for administrative offset prescribed by 31 U.S.C. 3716(e)(1); or
    (3) The debtor agrees to pay interest on the amount of the debt on 
which collection will be suspended, and such suspension is likely to 
enhance the debtor's ability to pay the full amount of the principal of 
the debt with interest at a later date.
    (c) Collection action may also be suspended, in accordance with 
Sec. Sec.  1.911, 1.911a, 1.912, and 1.912a, pending VA action on 
requests for administrative review of the existence or amount of the 
debt or a request for waiver of collection of the debt. However, 
collection action will be resumed once VA issues an initial decision on 
the administrative review or waiver request.

[[Page 124]]

    (d) When VA learns that a bankruptcy petition has been filed with 
respect to a debtor, in most cases the collection activity on a debt 
must be suspended, pursuant to the provisions of 11 U.S.C. 362, 1201, 
and 1301, unless VA can clearly establish that the automatic stay does 
not apply, has been lifted, or is no longer in effect. VA shall seek 
legal advice immediately from either the VA General Counsel or Regional 
Counsel and, if legally permitted, take the necessary steps to ensure 
that no funds or money are paid by VA to the debtor until relief from 
the automatic stay is obtained.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62199, Oct. 25, 2004]



Sec.  1.942  Termination of collection activity.

    Termination of collection activity involves a final determination. 
Collection activity may be terminated on cases previously suspended. The 
Department of Veterans Affairs may terminate collection activity and 
consider closing the agency file on a claim which meets any one of the 
following standards:
    (a) Inability to collect any substantial amount. Collection action 
may be terminated on a claim when it becomes clear that VA cannot 
collect or enforce collection of any significant amount from the debtor, 
having due regard for the judicial remedies available to the agency, the 
debtor's future financial prospects, and the exemptions available to the 
debtor under State and Federal law. In determining the debtor's 
inability to pay, the following factors, among others, shall be 
considered: Age and health of the debtor, present and potential income, 
inheritance prospects, the possibility that assets have been concealed 
or improperly transferred by the debtor, the availability of assets or 
income which may be realized by means of enforced collection 
proceedings.
    (b) Inability to locate debtor. The debtor cannot be located, no 
security remains to be liquidated, the applicable statute of limitations 
has run, and the prospects of collecting by offset are too remote.
    (c) Death of debtor. The debtor is determined to be deceased and the 
Government has no prospect of collection from his/her estate.
    (d) Cost will exceed recovery. The cost of further collection effort 
is likely to exceed the amount recoverable.
    (e) Claim legally without merit. Collection action should be 
terminated on a claim whenever it is determined that the claim is 
legally without merit.
    (f) Claim cannot be substantiated by evidence. VA will terminate 
collection action on once asserted claims because of lack of evidence or 
unavailability of witnesses only in cases where efforts to induce 
voluntary payment are unsuccessful.
    (g) Discharge in bankruptcy. Generally, VA shall terminate 
collection activity on a debt that has been discharged in bankruptcy, 
regardless of the amount. VA may continue collection activity, subject 
to the provisions of the Bankruptcy Code, for any payments provided 
under a plan of reorganization. Offset and recoupment rights may survive 
the discharge of the debtor in bankruptcy and, under some circumstances, 
claims also may survive the discharge.
    (h) Before terminating collection activity, VA should have pursued 
all appropriate means of collection and determined, based upon the 
results of the collection activity, that the debt is uncollectible. 
Termination of collection activity ceases active collection of the debt. 
The termination of collection activity does not preclude VA from 
retaining a record of the account for purposes of:
    (1) Selling the debt, if the Secretary of the Treasury determines 
that such sale is in the best interests of the United States;
    (2) Pursuing collection at a subsequent date in the event there is a 
change in the debtor's status or a new collection tool becomes 
available;
    (3) Offsetting against future income or assets not available at the 
time of termination of collection activity; or
    (4) Screening future applicants for prior indebtedness.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[32 FR 2615, Feb. 8, 1967, as amended at 52 FR 42111, Nov. 3, 1987; 69 
FR 62200, Oct. 25, 2004]

[[Page 125]]



Sec.  1.943  Exception to termination.

    When a significant enforcement policy is involved, or recovery of a 
judgment is a prerequisite to the imposition of administrative 
sanctions, VA may refer debts for litigation even though termination of 
collection activity may otherwise be appropriate.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62200, Oct. 25, 2004]



Sec.  1.944  Discharge of indebtedness; reporting requirements.

    (a) Before discharging a delinquent debt (also referred to as a 
close out of the debt), VA shall take all appropriate steps to collect 
the debt in accordance with 31 U.S.C. 3711(g), including, as applicable, 
administrative offset, tax refund offset, Federal salary offset, 
referral to Treasury or Treasury-designated debt collection centers or 
private collection contractors, credit bureau reporting, wage 
garnishment, litigation, and foreclosure. Discharge of indebtedness is 
distinct from termination or suspension of collection activity under 
Sec. Sec.  1.940 through 1.943 and is governed by the Internal Revenue 
Code (see 26 U.S.C. 6050P). When collection action on a debt is 
suspended or terminated, the debt remains delinquent and further 
collection action may be pursued at a later date in accordance with the 
standards set forth in Sec. Sec.  1.900 through 1.953. When VA 
discharges a debt in full or in part, further collection action is 
prohibited. Therefore, VA should make the determination that collection 
action is no longer warranted before discharging a debt. Before 
discharging a debt, VA must terminate debt collection action.
    (b) Upon discharge of an indebtedness, VA must report the discharge 
to the Internal Revenue Service (IRS) in accordance with the 
requirements of 26 U.S.C. 6050P and 26 CFR 1.6050P-1. VA may request 
Treasury or Treasury-designated debt collection centers to file such a 
discharge report to the IRS on VA's behalf.
    (c) When discharging a debt, VA must request that any liens of 
record securing the debt be released.
    (d) 31 U.S.C. 3711(i)(2) requires agencies to sell a delinquent 
nontax debt upon termination of collection action if the Secretary of 
the Treasury determines such a sale is in the best interests of the 
United States. Since the discharge of a debt precludes any further 
collection action (including the sale of a delinquent debt), VA may not 
discharge a debt until the requirements of Sec.  3711(i)(2) have been 
met.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62200, Oct. 25, 2004]



Sec.  1.945  Authority to suspend or terminate collection action on 
certain benefit indebtedness; authority for refunds.

    (a) The Secretary of Veterans Affairs (Secretary) may suspend or 
terminate collection action on all or any part of an indebtedness owed 
to VA by a member of the Armed Forces who dies while on active duty, if 
the Secretary determines that such suspension or termination of 
collection is appropriate and in the best interest of the United States.
    (b) The Secretary may terminate collection action on all or any part 
of an amount owed to the United States for an indebtedness resulting 
from an individual's participation in a benefits program administered by 
the Secretary, other than a program as described in paragraph (h) of 
this section, if the Secretary determines that such termination of 
collection is in the best interest of the United States. For purposes of 
this paragraph, an individual is any member of the Armed Forces or 
veteran who dies as a result of an injury incurred or aggravated in the 
line of duty while serving in a theater of combat operations in a war or 
in combat against a hostile force during a period of hostilities on or 
after September 11, 2001.
    (c) For purposes of this section:
    (1) Theater of combat operations means the geographic area of 
operations where the Secretary in consultation with the Secretary of 
Defense determines that combat occurred.
    (2) Period of hostilities means an armed conflict in which members 
of the United States Armed Forces are subjected to danger comparable to 
danger to which members of the Armed Forces have been subjected in 
combat

[[Page 126]]

with enemy armed forces during a period of war, as determined by the 
Secretary in consultation with the Secretary of Defense.
    (d) The Secretary may refund amounts collected after the death of a 
member of the Armed Forces or veteran in accordance with this paragraph 
and paragraph (e) of this section.
    (1) In any case where all or any part of a debt of a member of the 
Armed Forces, as described under paragraph (a) of this section, was 
collected, the Secretary may refund the amount collected if, in the 
Secretary's determination, the indebtedness would have been suspended or 
terminated under authority of 31 U.S.C. 3711(f). The member of the Armed 
Services must have been serving on active duty on or after September 11, 
2001. In any case where all or any part of a debt of a covered member of 
the Armed Forces was collected, the Secretary may refund the amount 
collected, but only if the Secretary determines that, under the 
circumstances applicable with respect to the deceased member of the 
Armed Forces, it is appropriate to do so.
    (2) In any case where all or any part of a debt of a covered member 
of the Armed Forces or veteran, as described under paragraph (b) of this 
section, was collected on or after September 11, 2001, the Secretary may 
refund the amount collected if, in the Secretary's determination, the 
indebtedness would have been terminated under authority of 38 U.S.C. 
5302A. In addition, the Secretary may refund the amount only if he or 
she determines that the deceased individual is equitably entitled to the 
refund.
    (e) Refunds under paragraph (d) of this section will be made to the 
estate of the decedent or, in its absence, to the decedent's next-of-kin 
in the order listed below.
    (1) The decedent's spouse.
    (2) The decedent's children (in equal shares).
    (3) The decedent's parents (in equal shares).
    (f) The authority exercised by the Secretary to suspend or terminate 
collection action and/or refund amounts collected on certain 
indebtedness is reserved to the Secretary and will not be delegated.
    (g) Requests for a determination to suspend or terminate collection 
action and/or refund amounts previously collected as described in this 
section will be submitted to the Office of the Secretary through the 
Office of the General Counsel. Such requests for suspension or 
termination and/or refund may be initiated by the head of the VA 
administration having responsibility for the program that gave rise to 
the indebtedness, or any concerned staff office, or by the Chairman of 
the Board of Veterans' Appeals. When a recommendation for refund under 
this section is initiated by the head of a staff office, or by the 
Chairman, Board of Veterans' Appeals, the views of the head of the 
administration that administers the program that gave rise to the 
indebtedness will be obtained and transmitted with the recommendation of 
the initiating office.
    (h) The provisions of this section concerning suspension or 
termination of collection actions and the refunding of moneys previously 
collected do not apply to any amounts owed the United States under any 
program carried out under 38 U.S.C. chapter 37.

(Authority: 38 U.S.C. 501, 5302A; 31 U.S.C. 3711(f)).

[75 FR 53201, Aug. 31, 2010]

             Referrals to GAO, Department of Justice, or IRS

    Authority: Sections 1.900 through 1.953 are issued under the 
authority of 31 U.S.C. 3711 through 3720E; 38 U.S.C. 501, and as noted 
in specific sections.

    Source: 52 FR 42111, 42112, Nov. 3, 1987, unless otherwise noted.



Sec.  1.950  Prompt referral.

    (a) VA shall promptly refer debts to Department of Justice (DOJ) for 
litigation where aggressive collection activity has been taken in 
accordance with Sec. Sec.  1.900 through 1.953, and such debts cannot be 
compromised, or on which collection activity cannot be suspended or 
terminated, in accordance with Sec. Sec.  1.930 through 1.936 and 
Sec. Sec.  1.940 through 1.944. Debts for which the principal amount is 
over $1,000,000, or such other amount as the Attorney General may 
direct, exclusive of interest and other late payment charges, shall be

[[Page 127]]

referred to the Civil Division or other division responsible for 
litigating such debts at DOJ. Debts for which the principal amount is 
$1,000,000, or less, or such other amount as the Attorney General may 
direct, exclusive of interest or penalties, shall be referred to DOJ's 
Nationwide Central Intake Facility as required by the Claims Collection 
Litigation Report (CCLR) instructions. Debts should be referred as early 
as possible, consistent with aggressive agency collection activity and 
the observance of the standards contained in Sec. Sec.  1.900 through 
1.953, and, in any event, well within the period for initiating timely 
lawsuits against the debtors. VA shall make every effort to refer 
delinquent debts to DOJ for litigation within 1 year of the date such 
debts last became delinquent. In the case of guaranteed or insured 
loans, VA should make every effort to refer these delinquent debts to 
DOJ for litigation within 1 year from the date the loan was presented to 
VA for payment or reinsurance.
    (b) DOJ has exclusive jurisdiction over the debts referred to it 
pursuant to this section. VA shall immediately terminate the use of any 
administrative collection activities to collect a debt at the time of 
the referral of that debt to DOJ. VA should advise DOJ of the collection 
activities that have been utilized to date, and their result. VA shall 
refrain from having any contact with the debtor and shall direct all 
debtor inquiries concerning the debt to DOJ. VA shall immediately notify 
DOJ of any payments credited to the debtor's account after referral of a 
debt under this section. DOJ shall notify VA, in a timely manner, of any 
payments it receives from the debtor.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62200, Oct. 25, 2004]



Sec.  1.951  Claims Collection Litigation Report (CCLR).

    (a) Unless excepted by the Department of Justice (DOJ), VA shall 
complete the CCLR, accompanied by a signed Certificate of Indebtedness, 
to refer all administratively uncollectible claims to DOJ for 
litigation. VA shall complete all of the sections of the CCLR 
appropriate to each claim as required by the CCLR instructions and 
furnish such other information as may be required in specific cases.
    (b) VA shall indicate clearly on the CCLR the actions it wishes DOJ 
to take with respect to the referred claim.
    (c) VA shall also use the CCLR to refer claims to DOJ to obtain 
approval of any proposals to compromise the claims or to suspend or 
terminate agency collection activity.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62200, Oct. 25, 2004]



Sec.  1.952  Preservation of evidence.

    VA must take care to preserve all files and records that may be 
needed by the Department of Justice (DOJ) to prove its claims in court. 
VA ordinarily should include certified copies of the documents that form 
the basis for the claim when referring such claims to DOJ for 
litigation. VA shall provide originals of such documents immediately 
upon request by DOJ.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62200, Oct. 25, 2004]



Sec.  1.953  Minimum amount of referrals to the Department of Justice.

    (a) Except as otherwise provided in paragraphs (b) and (c) of this 
section, VA shall not refer for litigation claims of less than $2,500, 
exclusive of interest, penalties, and administrative costs, or such 
other minimum amount as the Attorney General shall from time to time 
prescribe. The Department of Justice (DOJ) shall promptly notify 
referring agencies if the Attorney General changes this minimum amount.
    (b) VA shall not refer claims of less than the minimum amount 
prescribed by the Attorney General unless:
    (1) Litigation to collect such smaller claims is important to ensure 
compliance with VA's policies or programs;
    (2) The claim is being referred solely for the purpose of securing a 
judgment against the debtor, which will be filed as a lien against the 
debtor's property pursuant to 28 U.S.C. 3201 and returned to VA for 
enforcement; or
    (3) The debtor has the clear ability to pay the claim and the 
Government effectively can enforce payment, with

[[Page 128]]

due regard for the exemptions available to the debtor under State and 
Federal law and the judicial remedies available to the Government.
    (c) VA should consult with the Financial Litigation Staff of the 
Executive Office for United States Attorneys, in DOJ, prior to referring 
claims valued at less than the minimum amount.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501)

[69 FR 62200, Oct. 25, 2004]



Sec.  1.955  Regional office Committees on Waivers and Compromises.

    (a) Delegation of authority and establishment. (1) Sections 1.955 et 
seq. are issued to implement the authority for waiver consideration 
found in 38 U.S.C. 5302 and 5 U.S.C. 5584 and the compromise authority 
found 38 U.S.C. 3720(a) and 31 U.S.C. 3711. The duties, delegations of 
authority, and all actions required of the Committees on Waivers and 
Compromises are to be accomplished under the direction of, and authority 
vested in, the Director of the regional office. Delegations of authority 
and limitations for waiver actions under 5 U.S.C. 5584 are set forth in 
Sec.  1.963a of this part.
    (2) There is established in each regional office, a Committee on 
Waivers and Compromises to perform the duties and assume the 
responsibilities delegated by Sec. Sec.  1.956 and 1.957. The term 
regional office, as used in Sec.  1.955 et seq., includes VA Medical and 
Regional Office Centers and VA Centers where such are established.
    (b) Selection. The Director shall designate the employees to serve 
as Chairperson, members, and alternates. Except upon specific 
authorization of the Under Secretary for Benefits, when workload 
warrants a full-time committee, such designation will be part-time 
additional duty upon call of the Chairperson.
    (c) Control and staff. The administrative control of each Committee 
on Waivers and Compromises is the responsibility of the station's Fiscal 
Officer. However, the station Director has the authority to reassign the 
administrative control function to another station activity, rather than 
the Fiscal Officer, whenever the Director determines that such 
reassignment is appropriate. The quality control of the professional and 
clerical staff of the Committee is the responsibility of the 
Chairperson.
    (d) Overall control. The Assistant Secretary for Management is 
delegated complete management authority, including planning, policy 
formulation, control, coordination, supervision, and evaluation of 
Committee operations.
    (e) Committee composition. (1) The Committee shall consist of a 
Chairperson and Alternate Chairperson and as many Committee members and 
alternate members as the Director may appoint. Members and alternates 
shall be selected so that in each of the debt claim areas (i.e., 
compensation, pension, education, insurance, loan guaranty, etc.) there 
are members and alternates with special competence and familiarity with 
the program area.
    (2) When a claim is properly referred to the Committee for either 
waiver consideration or the consideration of a compromise offer, the 
Chairperson shall designate a panel from the available Committee members 
to consider the waiver request or compromise offer. If the debt for 
which the waiver request or compromise offer is made is $20,000 or less 
(exclusive or interest and administrative costs), the Chairperson will 
assign one Committee member as the panel. This one Committee member 
should have experience in the program area where the debt is located. 
The single panel member's decision shall stand as the decision of the 
Committee. If the debt for which the waiver request or compromise offer 
is made is more than $20,000 (exclusive of interest and administrative 
costs), the Chairperson shall assign two Committee members. One of the 
two members should be knowledgeable in the program area where the debt 
arose. If the two member panel cannot reach a unanimous decision, the 
Chairperson shall assign a third member of the Committee to the panel, 
or assign the case to three new members, and the majority vote shall 
determine the Committee decision.
    (3) The assignment of a one or two member panel as described in 
paragraph (e)(2) of this section is applicable if the debtor files a 
Notice of Disagreement with a Committee decision to deny waiver. That 
is, if the Notice of

[[Page 129]]

Disagreement is filed with a decision by a one member panel to deny 
waiver of collection of a debt of $20,000 or less, then the Notice of 
Disagreement should also be assigned to one panel member. Likewise, a 
Notice of Disagreement filed with a decision by a two or three member 
panel to deny waiver of collection of a debt of more than $20,000 should 
also be assigned to a Committee panel of two members (three if these two 
members cannot agree). However, a Chairperson must assign the Notice of 
Disagreement to a different one, two, or three member panel than the 
panel that made the original Committee decision that is now the subject 
of the Notice of Disagreement.

(Authority: 5 U.S.C. 5584, 31 U.S.C. 3711, 38 U.S.C. 3720(a), 5302)

[44 FR 59905, Oct. 17, 1979, as amended at 48 FR 1056, Jan. 10, 1983; 54 
FR 40871, Oct. 4, 1989; 57 FR 47264, Oct. 15, 1992; 60 FR 53276, Oct. 
13, 1995; 69 FR 62201, Oct. 25, 2004]



Sec.  1.956  Jurisdiction.

    (a) The regional office Committees are authorized, except as to 
determinations under Sec.  2.6(e)(4)(i) of this chapter where 
applicable, to consider and determine as limited in Sec. Sec.  1.955 et 
seq., settlement, compromise and/or waiver concerning the following 
debts and overpayments:
    (1) Arising out of operations of the Veterans Benefits 
Administration:
    (i) Overpayment or erroneous payments of pension, compensation, 
dependency and indemnity compensation, burial allowances, plot 
allowance, subsistence allowance, education (includes debts from work 
study and education loan defaults as well as from other overpayments of 
educational assistance benefits) or insurance benefits, clothing 
allowance and automobile or other conveyance and adaptive equipment 
allowances.
    (ii) Debts arising out of the loan program under 38 U.S.C. ch. 37 
after liquidation of security, if any.
    (iii) Such other debts as may be specifically designated by the 
Under Secretary for Benefits.
    (2) Arising out of operations of the Veterans Health Services and 
Research Administration:
    (i) Debts resulting from services furnished in error (Sec.  
17.101(a) of this chapter).
    (ii) Debts resulting from services furnished in a medical emergency 
(Sec.  17.101(b) of this chapter).
    (iii) Other claims arising in connection with transactions of the 
Veterans Health Administration (Sec.  17.103(c) of this chapter).
    (iv) The Chief Financial Officer of the Consolidated Patient Account 
Center is authorized to waive veterans' debts arising from medical care 
copayments (Sec.  17.105(c) of this chapter).
    (3) Claims for erroneous payments of pay and allowances, and 
erroneous payments of travel, transportation, and relocation expenses 
and allowances, made to or on behalf of employees (5 U.S.C. 5584).
    (b) The Under Secretary for Benefits may, at his or her discretion, 
assume original jurisdiction and establish an ad hoc Board to determine 
a particular issue arising within this section.

(Authority: 38 U.S.C. 501)

[39 FR 26400, July 19, 1974, as amended at 44 FR 59905, Oct. 17, 1979; 
60 FR 53276, Oct. 13, 1995; 69 FR 62201, Oct. 25, 2004; 80 FR 23241, 
Apr. 27, 2015]



Sec.  1.957  Committee authority.

    (a) Regional office committee. On matters covered in Sec.  1.956, 
the regional office Committee is authorized to determine the following 
issues:
    (1) Waivers. A decision may be rendered to grant or deny waiver of 
collection of a debt in the following debt categories:
    (i) Loan guaranty program (38 U.S.C. 5302(b)). Committees may 
consider waiver of the indebtedness of a veteran or spouse resulting 
from: (A) The payment of a claim under the guaranty or insurance of 
loans, (B) the liquidation of direct loans, (C) the liquidation of loans 
acquired under Sec.  36.4318, and (D) the liquidation of vendee 
accounts. The phrase veteran or spouse includes a veteran-borrower, 
veteran-transferee, a veteran-purchaser on a vendee account, a former 
spouse or surviving spouse of a veteran.
    (ii) Other than loan guaranty program. (38 U.S.C. 5302(a))
    (iii) Services erroneously furnished (Sec.  17.101(a)).

[[Page 130]]

    (2) Compromises--(i) Loan program debts (38 U.S.C. 3720(a)). Accept 
or reject a compromise offer irrespective of the amount of the debt 
(loan program matters under 38 U.S.C. chapter 37 are unlimited as to 
amount).
    (ii) Other than loan program debts (31 U.S.C. 3711).
    (A) Accept or reject a compromise offer on a debt which exceeds 
$1,000 but which is not over $100,000 (both amounts exclusive of 
interest and other late payment charges).
    (B) Accept or reject a compromise offer on a debt of a $1,000 or 
less, exclusive of interest and other late payment charges, which is not 
disposed of by the Chief, Fiscal activity, pursuant to paragraph (b) of 
this section.
    (C) Reject a compromise offer on a debt which exceeds $100,000, 
exclusive of interest and other late payment charges.
    (D) Recommend approval of a compromise offer on a debt which exceeds 
$100,000, exclusive of interest and other late payment charges. The 
authority to accept a compromise offer on such a debt rests solely 
within the jurisdiction of the Department of Justice. The Committee 
should evaluate a compromise offer on a debt in excess of $100,000, 
using the factors set forth in Sec. Sec.  1.930 through 1.938. If the 
Committee believes that the compromise offer is advantageous to the 
government, then the Committee members shall so state this conclusion in 
a written memorandum of recommendation of approval to the Chairperson. 
This recommendation, along with a Claims Collection Litigation Report 
(CCLR) completed in accordance with Sec.  1.951, will be referred to VA 
Central Office, Office of Financial Management (047G7), for submission 
to the Department of Justice for final approval.


(Authority: 31 U.S.C. 3711)

    (b) Chief of Fiscal activity. The Chief of the Fiscal activity at 
both VBA and VHA offices has the authority, as to debts within his/her 
jurisdiction, to:
    (1) On other than loan program debts under 38 U.S.C. chapter 37, 
accept compromise offers of 50% or more of a total debt not in excess of 
$1,000, exclusive of interest and other late payment charges, regardless 
of whether or not there has been a prior denial of waiver.
    (2) On other than loan program debts under 38 U.S.C. chapter 37, 
reject any offer of compromise of a total debt not in excess of $1,000, 
exclusive of interest and other late payment charges, regardless of 
whether or not there has been a prior denial of waiver.
    (3) On other than loan guaranty program debts under 38 U.S.C. 
chapter 37, reject any offer of compromise of a total debt not in excess 
of $1,000, exclusive of interest, regardless of whether or not there has 
been a prior denial of waiver.

(Authority: 31 U.S.C. 3711 and 38 U.S.C. 3720(a))

[44 FR 59906, Oct. 17, 1979, as amended at 51 FR 38803, Sept. 25, 1985; 
52 FR 42112, Nov. 3, 1987; 57 FR 47264, Oct. 15, 1992; 60 FR 53276, Oct. 
13, 1995; 69 FR 62201, Oct. 25, 2004]



Sec.  1.958  Finality of decisions.

    A decision by the regional office Committee, operating within the 
scope of its authority, denying waiver of all or part of a debt arising 
out of participation in a VA benefit or home loan program, is subject to 
appeal in accordance with 38 CFR parts 19 and 20. A denial of waiver of 
an erroneous payment of pay and allowances is subject to appeal in 
accordance with Sec.  1.963a(a). There is no right of appeal from a 
decision rejecting a compromise offer.

(Authority: 38 U.S.C. 501 and 7104).

[69 FR 62201, Oct. 25, 2004]



Sec.  1.959  Records and certificates.

    The Chairperson of the Committee shall execute or certify any 
documents pertaining to its proceedings. He/she will be responsible for 
maintaining needed records of the transactions of the Committee and 
preparation of any administrative or other reports which may be 
required.

(Authority: 38 U.S.C. 501)

[44 FR 59906, Oct. 17, 1979]



Sec.  1.960  Legal and technical assistance.

    Legal questions involving a determination under Sec.  2.6(e)(4) of 
this chapter will be referred to the Regional Counsel for action in 
accordance with

[[Page 131]]

delegations of the General Counsel, unless there is an existence a 
General Counsel's opinion or an approved Regional Counsel's opinion 
dispositive of the controlling legal principle. As to matters not 
controlled by Sec.  2.6(e)(4) of this chapter, the Chairperson of the 
regional office Committee or at his/her instance, a member, may seek and 
obtain advice from the Regional Counsel on legal matters within his/her 
jurisdiction and from other division chiefs in their areas of 
responsibility, on any matter properly before the Committee. Guidance 
may also be requested from the Central Office staff.

(Authority: 38 U.S.C. 501)

[44 FR 59906, Oct. 17, 1979]



Sec.  1.961  Releases.

    On matters within its jurisdiction, the Committee may authorize the 
release of any right, title, claim, lien or demand, however acquired, 
against any person obligated on a loan guaranteed, insured, or made by 
the Department of Veterans Affairs under the provisions of 38 U.S.C. ch. 
37, or on an acquired loan, or on a vendee account.

[39 FR 26400, July 19, 1974]



Sec.  1.962  Waiver of overpayments.

    There shall be no collection of an overpayment, or any interest 
thereon, which results from participation in a benefit program 
administered under any law by VA when it is determined by a regional 
office Committee on Waivers and Compromises that collection would be 
against equity and good conscience. For the purpose of this regulation, 
the term overpayment refers only to those benefit payments made to a 
designated living payee or beneficiary in excess of the amount due or to 
which such payee or beneficiary is entitled. The death of an indebted 
payee, either prior to a request for waiver of the indebtedness or 
during Committee consideration of the waiver request, shall not preclude 
waiver consideration. There shall be no waiver consideration of an 
indebtedness that results from the receipt of a benefit payment by a 
non-payee who has no claim or entitlement to such payment.
    (a) Waiver consideration is applicable in an indebtedness resulting 
from work study and education loan default, as well as indebtedness of a 
veteran-borrower, veteran transferee, or indebted spouse of either, 
arising out of participation in the loan program administered under 38 
U.S.C. ch. 37. Also subject to waiver consideration is an indebtedness 
which is the result of VA hospitalization, domiciliary care, or 
treatment of a veteran, either furnished in error or on the basis of 
tentative eligibility.
    (b) In any case where there is an indication of fraud or 
misrepresentation of a material fact on the part of the debtor or any 
other party having an interest in the claim, action on a request for 
waiver will be deferred pending appropriate disposition of the matter. 
However, the existence of a prima facie case of fraud shall, 
nevertheless, entitle a claimant to an opportunity to make a rebuttal 
with countervailing evidence; similiarly, the misrepresentation must be 
more than non-willful or mere inadvertence. The Committee may act on a 
request for waiver concerning such debts, after the Inspector General or 
the Regional Counsel has determined that prosecution is not indicated, 
or the Department of Justice has notified VA that the alleged fraud or 
misrepresentation does not warrant action by that department, or the 
Department of Justice or the appropriate United States Attorney, 
specifically authorized action on the request for waiver.

(Authority: 38 U.S.C. 501)

[39 FR 26400, July 19, 1974, as amended at 44 FR 59906, Oct. 17, 1979; 
50 FR 38803, Sept. 25, 1985; 52 FR 42112, Nov. 3, 1987]



Sec.  1.963  Waiver; other than loan guaranty.

    (a) General. Recovery of overpayments of any benefits made under 
laws administered by the VA shall be waived if there is no indication of 
fraud, misrepresentation, or bad faith on the part of the person or 
persons having an interest in obtaining the waiver and recovery of the 
indebtedness from the payee who received such benefits would be against 
equity and good conscience.
    (b) Application. A request for waiver of an indebtedness under this 
section shall only be considered:

[[Page 132]]

    (1) If made within 2 years following the date of a notice of 
indebtedness issued on or before March 31, 1983, by the Department of 
Veterans Affairs to the debtor, or
    (2) Except as otherwise provided herein, if made within 180 days 
following the date of a notice of indebtedness issued on or after April 
1, 1983, by the Department of Veterans Affairs to the debtor. The 180 
day period may be extended if the individual requesting waiver 
demonstrated to the Chairperson of the Committee on Waivers and 
Compromises that, as a result of an error by either the Department of 
Veterans Affairs or the postal authorities, or due to other 
circumstances beyond the debtor's control, there was a delay in such 
individual's receipt of the notification of indebtedness beyond the time 
customarily required for mailing (including forwarding). If the 
requester does substantiate that there was such a delay in the receipt 
of the notice of indebtedness, the Chairperson shall direct that the 180 
day period be computed from the date of the requester's actual receipt 
of the notice of indebtedness.

(Authority: 38 U.S.C. 5302 (a) & (c))

[39 FR 26400, July 19, 1974, as amended at 44 FR 59906, Oct. 17, 1979; 
48 FR 27400, June 15, 1983; 50 FR 38803, Sept. 25, 1985; 58 FR 3840, 
Jan. 12, 1993]



Sec.  1.963a  Waiver; erroneous payments of pay and allowances.

    (a) The provisions applicable to VA (including refunds) concerning 
waiver actions relating to erroneous payments to VA employees of pay and 
allowances, and travel, transportation, and relocation expenses and 
allowances, are set forth in 5 U.S.C. 5584. The members of Committees on 
Waivers and Compromises assigned to waiver actions under Sec.  1.955 of 
this part are delegated all authority granted the Secretary under 5 
U.S.C. 5584 to deny waiver or to grant waiver in whole or in part of any 
debt regardless of the amount of the indebtedness. Committee members 
also have exclusive authority to consider and render a decision on the 
appeal of a waiver denial or the granting of a partial waiver. However, 
the Chairperson of the Committee must assign the appeal to a different 
Committee member or members than the member or members who made the 
original decision that is now the subject of the appeal. The following 
are the only provisions of Sec. Sec.  1.955 through 1.970 of this part 
applicable to waiver actions concerning erroneous payments of pay and 
allowances, and travel, transportation, and relocation expenses and 
allowances, under 5 U.S.C. 5584: Sec. Sec.  1.955(a) through (e)(2), 
1.956(a)(introductory text) and (a)(3), 1.959, 1.960, 1.963a, and 
1.967(c).
    (b) Waiver may be granted under this section and 5 U.S.C. 5584 when 
collection would be against equity and good conscience and not in the 
best interest of the United States. Generally, these criteria will be 
met by a finding that the erroneous payment occurred through 
administrative error and that there is no indication of fraud, 
misrepresentation, fault, or lack of good faith on the part of the 
employee or other person having an interest in obtaining a waiver of the 
claim, and waiver would not otherwise be inequitable. Generally, waiver 
is precluded when an employee receives a significant unexplained 
increase in pay or allowances, or otherwise knows, or reasonably should 
know, that an erroneous payment has occurred, and fails to make 
inquiries or bring the matter to the attention of the appropriate 
officials. Waiver under this standard will depend upon the facts 
existing in each case.
    (c) An application for waiver must be received within 3 years 
immediately following the date on which the erroneous payment was 
discovered.

(Authority: 5 U.S.C. 5584; 38 U.S.C. 501).

[69 FR 62202, Oct. 25, 2004]



Sec.  1.964  Waiver; loan guaranty.

    (a) General. Any indebtedness of a veteran or the indebtedness of 
the spouse shall be waived only when the following factors are 
determined to exist:
    (1) Following default there was a loss of the property which 
constituted security for the loan guaranteed, insured or made under 
chapter 37 of title 38 United States Code;
    (2) There is no indication of fraud, misrepresentation, or bad faith 
on the

[[Page 133]]

part of the person or persons having an interest in obtaining the 
waiver; and
    (3) Collection of such indebtedness would be against equity and good 
conscience.
    (b) Spouse. The waiver of a veteran's indebtedness shall inure to 
the spouse of such veteran insofar as concerns said indebtedness, unless 
the obligation of the spouse is specifically excepted. However, the 
waiver of the indebtedness of the veteran's spouse shall not inure to 
the benefit of the veteran unless specifically provided for in the 
waiver decision.
    (c) Surviving spouse or former spouse. A surviving spouse of a 
veteran or the former spouse of a veteran may be granted a waiver of the 
indebtedness provided the requirements of paragraph (a) of this section 
are met.
    (d) Preservation of Government rights. In cases in which it is 
determined that waiver may be granted, the action will take such form 
(covenant not to sue, or otherwise) as will preserve the rights of the 
Government against obligors other than the veteran or the spouse.
    (e) Application. A request for waiver of an indebtedness under this 
section shall be made within one year after the date on which the debtor 
receives, by Certified Mail-Return Receipt Requested, written notice 
from VA of the indebtedness. If written notice of indebtedness is sent 
by means other than Certified Mail-Return Receipt Requested, then there 
is no time limit for filing a request for waiver of indebtedness under 
this section.


(Authority: 38 U.S.C. 5302(b))

    (f) Exclusion. Except as otherwise provided in this section, the 
indebtedness of a nonveteran obligor under the loan program is excluded 
from waiver.

(Authority: 38 U.S.C. 5302 (b) and (c))

[39 FR 26400, July 19, 1974, as amended at 44 FR 59907, Oct. 17, 1979; 
57 FR 33875, July 31, 1992; 58 FR 3840, Jan. 12, 1993]



Sec.  1.965  Application of standard.

    (a) The standard ``Equity and Good Conscience'', will be applied 
when the facts and circumstances in a particular case indicate a need 
for reasonableness and moderation in the exercise of the Government's 
rights. The decision reached should not be unduly favorable or adverse 
to either side. The phrase equity and good conscience means arriving at 
a fair decision between the obligor and the Government. In making this 
determination, consideration will be given to the following elements, 
which are not intended to be all inclusive:
    (1) Fault of debtor. Where actions of the debtor contribute to 
creation of the debt.
    (2) Balancing of faults. Weighing fault of debtor against Department 
of Veterans Affairs fault.
    (3) Undue hardship. Whether collection would deprive debtor or 
family of basic necessities.
    (4) Defeat the purpose. Whether withholding of benefits or recovery 
would nullify the objective for which benefits were intended.
    (5) Unjust enrichment. Failure to make restitution would result in 
unfair gain to the debtor.
    (6) Changing position to one's detriment. Reliance on Department of 
Veterans Affairs benefits results in relinquishment of a valuable right 
or incurrence of a legal obligation.
    (b) In applying this single standard for all areas of indebtedness, 
the following elements will be considered, any indication of which, if 
found, will preclude the granting of waiver:
    (1) Fraud or misrepresentation of a material fact (see Sec.  
1.962(b)).
    (2) Bad faith. This term generally describes unfair or deceptive 
dealing by one who seeks to gain thereby at another's expense. Thus, a 
debtor's conduct in connection with a debt arising from participation in 
a VA benefits/services program exhibits bad faith if such conduct, 
although not undertaken with actual fraudulent intent, is undertaken 
with intent to seek an unfair advantage, with knowledge of the likely 
consequences, and results in a loss to the government.

(Authority: 38 U.S.C. 5302(c))

[39 FR 26400, July 19, 1974, as amended at 58 FR 3841, Jan. 12, 1993; 58 
FR 7296, Feb. 5, 1993; 69 FR 62202, Oct. 25, 2004]



Sec.  1.966  Scope of waiver decisions.

    (a) Decisions will be based on the evidence of record. A hearing may 
be held at the request of the claimant or his/

[[Page 134]]

her representative. No expenses incurred by a claimant, his 
representative, or any witness incident to a hearing will be paid by the 
Department of Veterans Affairs.
    (b) A regional office Committee may:
    (1) Waive recovery as to certain persons and decline to waive as to 
other persons whose claims are based on the same veteran's service.
    (2) Waive or decline to waive recovery from specific benefits or 
sources, except that:
    (i) There shall be no waiver of recovery out of insurance of an 
indebtedness secured thereby; i.e., an insurance overpayment to an 
insured. However, recovery may be waived of any or all of such 
indebtedness out of benefits other than insurance then or thereafter 
payable to the insured.

(Authority: 38 U.S.C. 501, 5302)

[39 FR 26400, July 19, 1974, as amended at 44 FR 59907, Oct. 17, 1979; 
48 FR 1056, Jan. 10, 1983; 69 FR 62202, Oct. 25, 2004]



Sec.  1.967  Refunds.

    (a) Except as provided in paragraph (c) of this section, any portion 
of an indebtedness resulting from participation in benefits programs 
administered by the Department of Veterans Affairs which has been 
recovered by the U.S. Government from the debtor may be considered for 
waiver, provided the debtor requests waiver in accordance with the time 
limits of Sec.  1.963(b). If collection of an indebtness is waived as to 
the debtor, such portions of the indebtedness previously collected by 
the Department of Veterans Affairs will be refunded. In the event that 
waiver of collection is granted for either an education, loan guaranty, 
or direct loan debt, there will be a reduction in the debtor's 
entitlement to future benefits in the program in which the debt 
originated.
    (b) The Department of Veterans Affairs may not waive collection of 
the indebtedness of an educational institution found liable under 38 
U.S.C. 3685. Waiver of collection of educational benefit overpayments 
from all or a portion of the eligible persons attending an educational 
institution which has been found liable under 38 U.S.C. 3685 shall not 
relieve the institution of its assessed liability. (See 38 CFR 
21.4009(f)).
    (c) The regulatory provisions concerning refunds of indebtedness 
collected by the Department of Veterans Affairs arising from erroneous 
payments of pay and allowances and travel, transportation, and 
relocation expenses and allowances are set forth in 4 CFR Parts 91 and 
92.
    (d) Refund of the entire amount collected may not be made when only 
a part of the debt is waived or when collection of the balance of a loan 
guaranty indebtedness by the Department of Veterans Affairs from 
obligors, other than a husband or wife of the person requesting waiver, 
will be adversely affected. Only where the amount collected exceeds the 
balance of the indebtedness still in existence will a refund be made in 
the amount of the difference between the two. Otherwise, refunds will be 
made in accordance with paragraph (a) of this section.

(Authority: 38 U.S.C. 3685, 5302; 5 U.S.C. 5584)

[48 FR 1056, Jan. 10, 1983, as amended at 60 FR 53276, Oct. 13, 1995]



Sec.  1.968  [Reserved]



Sec.  1.969  Revision of waiver decisions.

    (a) Jurisdiction. A decision involving waiver may be reversed or 
modified on the basis of new and material evidence, fraud, a change in 
law or interpretation of law specifically stated in a Department of 
Veterans Affairs issue, or clear and unmistakable error shown by the 
evidence in file at the time the prior decision was rendered by the same 
or any other regional office Committee.
    (b) Finality of decisions. Except as provided in paragraph (a) of 
this section, a decision involving waiver rendered by the Committee 
having jurisdiction is final, subject to the provisions of:
    (1) Sections 3.104(a), 19.153 and 19.154 of this chapter as to 
finality of decisions;
    (2) Section 3.105 (a) and (b) of this chapter as to revision of 
decisions, except that the Central Office staff may postaudit or make an 
administrative review of any decision of a regional office Committee;

[[Page 135]]

    (3) Sections 3.103, 19.113 and 19.114 of this chapter as to notice 
of disagreement and the right of appeal;
    (4) Section 19.124 of this chapter as to the filing of 
administrative appeals and the time limits for filing such appeals.
    (c) Difference of opinion. Where reversal or amendment of a decision 
involving waiver is authorized under Sec.  3.105(b) of this chapter 
because of a difference of opinion, the effective date of waiver will be 
governed by the principle contained in Sec.  3.400(h) of this chapter.

(Authority: 38 U.S.C. 501)

[44 FR 59907, Oct. 17, 1979]



Sec.  1.970  Standards for compromise.

    Decisions of the Committee respecting acceptance or rejection of a 
compromise offer shall be in conformity with the standards in Sec. Sec.  
1.930 through 1.936. In loan guaranty cases the offer of a veteran or 
other obligor to effect a compromise must relate to an indebtedness 
established after the liquidation of the security, if any, and shall be 
reviewed by the Committee. An offer to effect a compromise may be 
accepted if it is deemed advantageous to the Government. A decision on 
an offer of compromise may be revised or modified on the basis of any 
information which would warrant a change in the original decision.

(Authority: 31 U.S.C. 3711; 38 U.S.C. 501, 3720)

[44 FR 59907, Oct. 17, 1979, as amended at 69 FR 62202, Oct. 25, 2004]

                        Salary Offset Provisions

    Source: 52 FR 1905, Jan. 16, 1987, unless otherwise noted.



Sec.  1.980  Scope.

    (a) In accordance with 5 CFR part 550, subpart K, the provisions set 
forth in Sec. Sec.  1.980 through 1.995 implement VA's authority for the 
use of salary offset to satisfy certain debts owed to VA.
    (b) These regulations apply to offsets from the salaries of current 
employees of VA, or any other agency, who owe debts to VA. Offsets by VA 
from salaries of current VA employees who owe debts to other agencies 
shall be processed in accordance with procedures set forth in 5 CFR part 
550, subpart K.
    (c) These regulations do not apply to debts or claims arising under 
the Internal Revenue Code of 1954, as amended, the Social Security Act, 
the tariff laws of the United States, or to any case where collection of 
a debt by salary offset is explicitly provided for (e.g., travel 
advances in 5 U.S.C. 5705 and employee training expenses in 5 U.S.C. 
4108) or prohibited by another statute.
    (d) These regulations do not preclude an employee from requesting 
waiver of an overpayment under 38 U.S.C. 5302, 5 U.S.C. 5584, or any 
other similar provision of law, or in any way questioning the amount or 
validity of a debt not involving benefits under the laws administered by 
VA by submitting a subsequent claim to the General Accounting Office in 
accordance with procedures prescribed by that office.
    (e) These regulations do not apply to any adjustment to pay arising 
out of an employee's election of coverage or a change in coverage under 
a Federal benefits program requiring periodic deductions from pay if the 
amount to be recovered was accumulated over four pay periods or less.
    (f) These regulations do not apply to a routine intra-agency 
adjustment of pay that is made to correct an overpayment of pay 
attributable to clerical or administrative errors or delays in 
processing pay documents, if the overpayment occurred within the four 
pay periods preceding the adjustment and, at the time of such 
adjustment, or as soon thereafter as practicable, the individual is 
provided written notice of the nature and amount of the adjustment and a 
point of contact for contesting such adjustment.
    (g) These regulations do not apply to any adjustment to collect a 
debt amounting to $50 or less, if at the time of such adjustment, or as 
soon thereafter as practicable, the individual is provided with written 
notice of the nature and amount of the adjustment and a point of contact 
for contesting such adjustment.
    (h) These regulations do not preclude the compromise, suspension, or 
termination of collection action under the Federal Claims Collection 
Standards (FCCS) (31 CFR parts 900-904) and VA regulations 38 CFR 1.930 
through 1.944.

[[Page 136]]

    (i) The procedures and requirements of these regulations do not 
apply to salary offset used to recoup a Federal employee's debt where a 
judgment has been obtained against the employee for the debt.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987; 52 FR 23824, June 25, 1987, as amended at 54 
FR 34980, Aug. 23, 1989; 69 FR 62202, Oct. 25, 2004]



Sec.  1.981  Definitions.

    (a) Agency means:
    (1) An executive agency as defined in 5 U.S.C. 105, including the 
U.S. Postal Service, and the U.S. Postal Rate Commission, and
    (2) A military department as defined in 5 U.S.C. 102.
    (3) An agency or court of the judicial branch, including a court as 
defined in 28 U.S.C. 610, the District Court for the Northern Mariana 
Islands, and the Judicial Panel on Multidistrict Litigation;
    (4) An agency of the legislative branch, including the U.S. Senate 
and the U.S. House of Representatives; and
    (5) Other independent establishments that are entities of the 
Federal Government.
    (b) Debt means an amount owed to the United States from sources 
which include loans insured or guaranteed by the United States and all 
other amounts due the United States from fees, leases, rents, royalties, 
services, sales of real or personal property, overpayments, penalties, 
damages, interest, fines and forfeitures (except those arising under the 
Uniform Code of Military Justice), and all other similar sources.
    (c) Disposable pay means that part of current basic pay, special 
pay, incentive pay, retired pay, retainer pay, or in the case of an 
employee not entitled to basic pay, other authorized pay remaining after 
the deduction of any amount required by law to be withheld. Excluded 
from this definition are deductions described in 5 CFR 581.105(b) 
through (f).
    (d) Employee means a current employee of VA or other Federal agency 
including a current member of the Armed Forces or a Reserve of the Armed 
Forces (Reserves).
    (e) Salary offset means an attempt to collect a debt under 5 U.S.C. 
5514 by deduction(s) at one or more officially estabilished pay 
intervals from the current pay account of an employee without his or her 
consent.
    (f) Waiver means the cancellation, remission, forgiveness, or non-
recovery of a debt owed by an employee to VA or another Federal agency 
as permitted or required by 5 U.S.C. 5584 or 38 U.S.C. 5302, or other 
similar statutes.
    (g) Extreme hardship to an employee means an employee's inability to 
provide himself or herself and his or her dependents with the 
necessities of life such as food, housing, clothing, transportation, and 
medical care.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987; 52 FR 23824, June 25, 1987]



Sec.  1.982  Salary offsets of debts involving benefits under the laws
administered by VA.

    (a) VA will not collect a debt involving benefits under the laws 
administered by VA by salary offset unless the Secretary or appropriate 
designee first provides the employee with a minimum of 30 calendar days 
written notice.
    (b) If the employee has not previously appealed the amount or 
existence of the debt under 38 CFR parts 19 and 20 and the time for 
pursuing such an appeal has not expired (Sec.  20.302), the Secretary or 
appropriate designee will provide the employee with written notice of 
the debt. The written notice will state that the employee may appeal the 
amount and existence of the debt in accordance with the procedures set 
forth in 38 CFR parts 19 and 20 and will contain the determination and 
information required by Sec.  1.983(b)(1) through (5), (7), (9), (10), 
and (12) though (14). The notice will also state that the employee may 
request a hearing on the offset schedule under the procedures set forth 
in Sec.  1.984 and such a request will stay the commencement of salary 
offset.
    (c) If the employee previously appealed the amount or existence of 
the debt and the Board of Veterans Appeals decided the appeal on the 
merits or if the employee failed to pursue an appeal within the time 
provided by regulations, the Secretary or designee shall

[[Page 137]]

provide the employee with written notice prior to collecting the debt by 
salary offset. The notice will state:
    (1) The determinations and information required by Sec.  
1.983(b)(1)-(5), (7), and (12)-(14);
    (2) That the employee's appeal of the existence or amount of the 
debt was determined on the merits or that the employee failed to pursue 
an appeal within the time provided, and VA's decision is final except as 
otherwise provided in agency regulations;
    (3) That the employee may request a waiver of the debt pursuant to 
38 CFR 1.911(c)(2) subject to the time limits of 38 U.S.C. 5302.
    (4) That the employee may request an oral or paper hearing on the 
offset schedule and receive a decision within 60 days of such request 
under the procedures and time limit set forth in Sec.  1.984 and that 
such a request will stay the commencement of salary offset.
    (d) If the employee has appealed the existence or amount of the debt 
and the Board of Veterans Appeals has not decided the appeal on the 
merits, collection of the debt by salary offset will be suspended until 
the appeal is decided or the employee ceases to pursue the appeal.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987, as amended at 69 FR 62202, Oct. 25, 2004]



Sec.  1.983  Notice requirements before salary offsets of debts not 
involving benefits under the laws administered by VA.

    (a) For a debt not involving benefits under the laws administered by 
VA, the Secretary or designee will review the records relating to the 
debt to assure that it is owed prior to providing the employee with a 
notice of the debt.
    (b) Except as provided in Sec.  1.980(e), salary offset of debts not 
involving benefits under the laws administered by VA will not be made 
unless the Secretary or designee first provides the employee with a 
minimum of 30 calendar days written notice. This notice will state:
    (1) The Secretary or designee's determination that a debt is owed;
    (2) The amount of the debt owed and the facts giving rise to the 
debt;
    (3) The Secretary or designee's intention to collect the debt by 
means of deduction from the employee's current disposable pay account 
until the debt and all accumulated interest and associated costs are 
paid in full;
    (4) The amount, frequency, approximate beginning date, and duration 
of the intended deductions;
    (5) An explanation of VA's requirements concerning interest, 
administrative costs, and penalties;
    (6) The employee's right to inspect and copy VA records relating to 
the debt or, if the employee or his or her representative cannot 
personally inspect the records, to request and receive a copy of such 
records;
    (7) The employee's right to enter into a written agreement with the 
Secretary or designee for a repayment schedule differing from that 
proposed by the Secretary or designee, so long as the terms of the 
repayment schedule proposed by the employee are agreeable to the 
Secretary or designee;
    (8) The VA employee's right to request an oral or paper hearing on 
the Secretary or appropriate designee's determination of the existence 
or amount of the debt, or the percentage of disposable pay to be 
deducted each pay period, so long as a request is filed by the employee 
as prescribed by the Secretary. The hearing official for the hearing 
requested by a VA employee must be either a VA administrative law judge 
or a hearing official from an agency other than VA. Any VA hearing 
official may conduct an oral or paper hearing at the request of a non-VA 
employee on the determination by an appropriately designated official of 
the employing agency of the existence or amount of the debt, or the 
percentage of disposable pay to be deducted each pay period, so long as 
a hearing request is filed by the non-VA employee as prescribed by the 
employing agency.
    (9) The method and time period for requesting a hearing;
    (10) That the timely filing of a request for a hearing (oral or 
paper) will stay the commencement of salary offset;
    (11) That a final decision after the hearing will be issued at the 
earliest

[[Page 138]]

practical date, but no later than 60 calendar days after the filing of 
the request for the hearing, unless the employee requests and the 
hearing officer grants a delay in the proceedings;
    (12) That any knowingly false or frivolous statements, 
representations, or evidence may subject the employee to:
    (i) Disciplinary procedures appropriate under 5 U.S.C. ch. 75, 5 CFR 
part 752, or any other applicable statutes or regulations;
    (ii) Penalties under the False Claims Act, 31 U.S.C. 3729-3731, or 
any other applicable statutory authority; or
    (iii) Criminal penalties under 18 U.S.C. 286, 287, 1001, and 1002 or 
any other applicable statutory authority.
    (13) The employee's right, if applicable, to request waiver under 5 
U.S.C. 5584 and 38 CFR 1.963a and any other rights and remedies 
available to the employee under statutes or regulations governing the 
program for which the collection is being made; and
    (14) Unless there are applicable contractual or statutory provisions 
to the contrary, that amounts paid on or deducted for the debt which are 
later waived or found not owed to the United States will be promptly 
refunded to the employee.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987, as amended at 69 FR 62202, Oct. 25, 2004; 72 
FR 65462, Nov. 21, 2007]



Sec.  1.984  Request for a hearing.

    (a) Except as provided in paragraph (b) of this section and in Sec.  
1.982, an employee wishing a hearing on the existence or amount of the 
debt or on the proposed offset schedule must send such a request to the 
office which sent the notice of the debt. The employee must also specify 
whether an oral or paper hearing is requested. If an oral hearing is 
requested, the request should explain why the matter cannot be resolved 
by review of the documentary evidence. The request must be received by 
the office which sent the notice of the debt not later than 30 calendar 
days from the date of the notice.
    (b) If the employee files a request for a hearing after the 
expiration of the 30 day period provided for in paragraph (a) of this 
section, VA may accept the request if the employee shows that the delay 
was because of circumstances beyond his or her control or because of 
failure to receive the written notice of the filing deadline (unless the 
employee has actual notice of the filing deadline).

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987, as amended at 69 FR 62203, Oct. 25, 2004]



Sec.  1.985  Form, notice of, and conduct of hearing.

    (a) After an employee requests a hearing, the hearing official or 
administrative law judge shall notify the employee of the form of the 
hearing to be provided. If the hearing will be oral, the notice shall 
set forth the date, time, and location for the hearing. If the hearing 
will be paper, the employee shall be notified that he or she should 
submit his or her position and arguments in writing to the hearing 
official or administrative law judge by a specified date after which the 
record shall be closed. This date shall give the employee reasonable 
time to submit this information.
    (b) An employee who requests an oral hearing shall be provided an 
oral hearing if the hearing official or administrative law judge 
determines that the matter cannot be resolved by review of documentary 
evidence, for example, when an issue of credibility or veracity is 
involved. If a determination is made to provide an oral hearing, the 
hearing official or administrative law judge may offer the employee the 
opportunity for a hearing by telephone conference call. If this offer is 
rejected or if the hearing official or administrative law judge declines 
to offer a telephone conference call hearing, the employee shall be 
provided an oral hearing permitting the personal appearance of the 
employee, his or her personal representative, and witnesses. A record or 
transcript of every oral hearing shall be made. Witnesses shall testify 
under oath or affirmation. VA shall not be responsible for the payment 
of any expenses incident to attendance at the hearing which are incurred 
by either the employee, his or her representative or Counsel, or 
witnesses.
    (c) In all other cases where an employee requests a hearing, a paper 
hearing shall be provided. A paper

[[Page 139]]

hearing shall consist of a review of the written evidence of record by 
the administrative law judge or hearing official.
    (d) In any hearing under this section, the administrative law judge 
or hearing official may exclude from consideration evidence or testimony 
which is irrelevant, immaterial, or unduly repetitious.

(Authority: 5 U.S.C. 5514)



Sec.  1.986  Result if employee fails to meet deadlines.

    An employee waives the right to a hearing, and will have his or her 
disposable pay offset in accordance with the offset schedule, if the 
employee:
    (a) Fails to file a request for a hearing as prescribed in Sec.  
1.982, Sec.  1.984, or Sec. Sec.  19.1 through 19.200, whichever is 
applicable, unless such failure is excused as provided in Sec.  
1.984(b); or
    (b) Fails to appear at an oral hearing of which he or she had been 
notified unless the administrative law judge or hearing official 
determines that failure to appear was due to circumstances beyond the 
employee's control.

(Authority: 5 U.S.C. 5514)



Sec.  1.987  Review by the hearing official or administrative law judge.

    (a) The hearing official or administrative law judge shall uphold 
VA's determination of the existence and amount of the debt unless 
determined to be erroneous by a preponderance of the evidence.
    (b) The hearing official or administrative law judge shall uphold 
VA's offset schedule unless the schedule would result in extreme 
hardship to the employee.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987; 52 FR 23824, June 25, 1987]



Sec.  1.988  Written decision following a hearing requested under 
Sec.  1.984.

    (a) The hearing official or administrative law judge must issue a 
written decision not later than 60 days after the employee files a 
request for the hearing.
    (b) Written decisions provided after a hearing requested under Sec.  
1.984 will include:
    (1) A statement of the facts presented to support the nature and 
origin of the alleged debt;
    (2) The hearing official or administrative law judge's analysis, 
findings and conclusions concerning as applicable:
    (i) The employee's or VA's grounds;
    (ii) The amount and validity of the alleged debt; and
    (iii) The repayment schedule.
    (c) The decision in a case where a paper hearing was provided shall 
be based upon a review of the written record. The decision in a case 
where an oral hearing was provided shall be based upon the hearing and 
the written record.

(Authority: 5 U.S.C. 5514)



Sec.  1.989  Review of VA records related to the debt.

    (a) Notification by employee. An employee who intends to inspect or 
copy VA records related to the debt as permitted by a notice provided 
under Sec.  1.983 must send a letter to the office which sent the notice 
of the debt stating his or her intention. The letter must be received by 
that office within 30 calendar days of the date of the notice.
    (b) VA response. In response to timely notice submitted by the 
debtor as described in paragraph (a) of this section, VA will notify the 
employee of the location and time when the employee may inspect and copy 
records related to the debt.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987, as amended at 69 FR 62203, Oct. 25, 2004]



Sec.  1.990  Written agreement to repay debt as alternative to salary
offset.

    (a) Notification by employee. The employee may propose, in response 
to a notice under Sec.  1.983, a written agreement to repay the debt as 
an alternative to salary offset. Any employee who wishes to do this must 
submit a proposed written agreement to repay the debt which is received 
by the office which sent the notice of the debt within 30 calendar days 
of the date of the notice.
    (b) VA response. In response to timely notice by the debtor as 
described in

[[Page 140]]

paragraph (a) of this section, VA will notify the employee whether the 
employee's proposed written agreement for repayment is acceptable. It is 
within VA's discretion to accept a repayment agreement instead of 
proceeding by offset. In making this determination, VA will balance its 
interest in collecting the debt against the hardship to the employee. VA 
will accept a repayment agreement instead of offset only if the employee 
is able to establish that offset would result in extreme hardship.

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987, as amended at 69 FR 62203, Oct. 25, 2004]



Sec.  1.991  Procedures for salary offset: when deductions may begin.

    (a) Deductions to liquidate an employee's debt will be by the method 
and in the amount stated in the notice to collect from the employee's 
current pay as modified by a written decision issued under Sec.  1.982 
or Sec.  1.988, or parts 19 and 20 or by written agreement between the 
employee and the VA under Sec.  1.990.
    (b) If the employee filed a request for a hearing as provided by 
Sec.  1.984 before the expiration of the period provided for in that 
section, deductions will not begin until after the hearing official or 
administrative law judge has provided the employee with a hearing, and 
has rendered a final written decision.
    (c) If the employee failed to file a timely request for a hearing, 
deductions will begin on the date specified in the notice of intention 
to offset, unless a hearing is granted pursuant to Sec.  1.984(b).
    (d) If an employee retires, resigns, or his or her employment ends 
before collection of the amount of the indebtedness is completed, the 
remaining indebtedness will be collected according to procedures for 
administrative offset (see 5 CFR 831.1801 through 831.1808, 31 CFR 
901.3, and 38 CFR 1.912).

(Authority: 5 U.S.C. 5514)

[52 FR 1905, Jan. 16, 1987, as amended at 69 FR 62203, Oct. 25, 2004]



Sec.  1.992  Procedures for salary offset.

    (a) Types of collection. A debt will be collected in a lump-sum or 
in installments. Collection will be in a lump-sum unless the employee is 
financially unable to pay in one lump-sum, or if the amount of the debt 
exceeds 15 percent of the employee's disposable pay. In these cases, 
deduction will be by installments.
    (b) Installment deductions. (1) A debt to be collected in 
installments will be deducted at officially established pay intervals 
from an employee's current pay account unless the employee and the 
Secretary agree to alternative arrangements for repayment. The 
alternative arrangement must be in writing and signed by both the 
employee and Secretary or designee.
    (2) Installment deductions will be made over a period not greater 
than the anticipated period of employment. The size and frequency of 
installment deductions will bear a reasonable relation to the size of 
the debt and the employee's ability to pay. However, the amount deducted 
for any period will not exceed 15 percent of the disposable pay from 
which the deduction is made, unless the employee has agreed in writing 
to the deduction of a greater amount. If possible, the installment 
payment will be sufficient in size and frequency to liquidate the debt 
in three years. Installment payments of less than $25 per pay period or 
$50 a month will be acceptable only in the most unusual circumstances.
    (c) Imposition of interest, penalties, and administrative costs. 
Interest, penalties, and administrative costs shall be charged in 
accordance with 31 CFR 901.9 and 38 CFR 1.915.

(Authority: 5 U.S.C. 5514; 38 U.S.C. 501)

[52 FR 1905, Jan. 16, 1987, as amended at 54 FR 34980, Aug. 23, 1989; 69 
FR 62203, Oct. 25, 2004]



Sec.  1.993  Non-waiver of rights.

    So long as there are not statutory or contractual provisions to the 
contrary, an employee's involuntary payment (of all or a portion of a 
debt) under these regulations will not be interpreted as a waiver of any 
rights that the employee may have under 5 U.S.C. 5514.

(Authority: 5 U.S.C. 5514)
    VA will refund promptly to the appropriate individual amounts offset 
under these regulations when:

[[Page 141]]

    (a) A debt is waived or otherwise found not owed the United States 
(unless expressly prohibited by statute or regulation); or
    (b) VA is directed by an administrative or judicial order to refund 
amounts deducted from the employee's current pay.

(Authority: 5 U.S.C. 5514)



Sec.  1.995  Requesting recovery through centralized administrative offset.

    (a) Under 31 U.S.C. 3716, VA and other creditor agencies must notify 
Treasury of all debts over 180 days delinquent so that recovery of such 
debts may be made by centralized administrative offset. This includes 
those debts that VA and other agencies seek from the pay account of an 
employee of another Federal agency via salary offset. Treasury and other 
disbursing officials will match payments, including Federal salary 
payments, against these debts. Where a match occurs, and all the 
requirements for offset have been met, the payment will be offset to 
satisfy the debt in whole or part.
    (b) Prior to submitting a debt to Treasury for the purpose of 
collection by offset, including salary offset, VA shall provide written 
certification to Treasury that:
    (1) The debt is past due and legally enforceable in the amount 
submitted to Treasury and that VA will ensure that any subsequent 
collections are credited to the debt and that Treasury shall be notified 
of such;
    (2) Except in the case of a judgment debt or as otherwise allowed by 
law, the debt is referred to Treasury for offset within 10 years after 
VA's right of action accrues;
    (3) VA has complied with the provisions of 31 U.S.C. 3716 and 38 CFR 
1.912 and 1.912a including, but not limited to, those provisions 
requiring that VA provide the debtor with applicable notices and 
opportunities for a review of the debt; and
    (4) VA has complied with the provisions of 5 U.S.C. 5514 (salary 
offset) and 38 CFR 1.980 through 1.994 including, but not limited to, 
those provisions requiring that VA provide the debtor with applicable 
notices and opportunities for a hearing.
    (c) Specific procedures for notifying Treasury of debts for purposes 
of collection by centralized administrative offset are contained in the 
31 CFR 285.7. VA and other creditor agencies may notify Treasury of 
debts that have been delinquent for 180 days or less, including debts 
that VA and other creditor agencies seek to recover from the pay of an 
employee via salary offset.

(Authority: 31 U.S.C. 3716; 38 U.S.C. 501)

[69 FR 62203, Oct. 25, 2004]

 Procedures for Financial Institutions Regarding Garnishment of Benefit 
                       Payments After Disbursement



Sec.  1.1000  Garnishment of payments after disbursement.

    (a) Payments of benefits due under any law administered by the 
Secretary that are protected by 38 U.S.C. 5301(a) and made by direct 
deposit to a financial institution are subject to 31 CFR part 212, 
Garnishment of Accounts Containing Federal Benefit Payments.
    (b) This section may be amended only by a rulemaking issued jointly 
by the Department of the Treasury and the agencies defined as a 
``benefit agency'' in 31 CFR 212.3.

[76 FR 9961, Feb. 23, 2011]



PART 2_DELEGATIONS OF AUTHORITY--Table of Contents



Sec.
2.1 General provisions.
2.2 Delegation of authority to employees to issue subpoenas, etc.
2.3 Delegation of authority to employees to take affidavits, to 
          administer oaths, etc.
2.4 Delegation of authority to order paid advertising for use in 
          recruitment.
2.5 Delegation of authority to certify copies of documents, records, or 
          papers in Department of Veterans Affairs files.
2.6 Secretary's delegations of authority to certain officials (38 U.S.C. 
          512).
2.7 Delegation of authority to provide relief on account of 
          administrative error.
2.8 Delegation of authority to authorize allowances for Department of 
          Veterans Affairs employees who are notaries public.

    Authority: 5 U.S.C. 302, 552a; 38 U.S.C. 501, 512, 515, 1729, 1729A, 
5711; 44 U.S.C. 3702, and as noted in specific sections.

[[Page 142]]



Sec.  2.1  General provisions.

    In addition to the delegations of authority in this part, numerous 
delegations of authority are set forth throughout this title.

(Authority: 38 U.S.C. 512)

[64 FR 47111, Aug. 30, 1999]



Sec.  2.2  Delegation of authority to employees to issue subpoenas, etc.

    (a) Authority to issue subpoenas. Employees occupying or acting in 
the positions designated in paragraph (b) of this section shall have the 
power to issue subpoenas for (by countersigning VA Form 2-4003) and 
compel the attendance of witnesses within a radius of 100 miles from the 
place of hearing and to require the production of books, papers, 
documents, and other evidence. Issuing officials shall use discretion 
when exercising this power.
    (b) Designated positions. The positions designated pursuant to 
paragraph (a) of this section are: General Counsel, Deputy General 
Counsel, Chairman, Board of Veterans' Appeals, Heads of Regional Offices 
and Centers having insurance or regional office activities, Under 
Secretary for Health (for income matching programs), Director, Income 
Verification Match Center (for income matching programs), and the 
Associate Director for Operations, Income Verification Match Center (for 
income matching programs).
    (c) Means of service. Subpoenas issued pursuant to this section may 
be served by registered or certified mail, return receipt requested, 
addressed to the witness only. Personal service by any VA employee or 
other authorized person may be made where authorized in writing by the 
issuing official.
    (d) Fees and mileage; district courts of the United States. Any 
person required by such subpoena to attend as a witness shall be allowed 
and paid the same fees and mileage as are paid witnesses in the district 
courts of the United States. In case of disobedience to any such 
subpoena, the aid of any district court of the United States may be 
invoked in requiring attendance and testimony of witnesses and the 
production of documentary evidence, and such court within the 
jurisdiction in which the inquiry is carried on may, in the case of 
contumacy or refusal to obey a subpoena issued to any officer, agent, or 
employee of any corporation or to any other person, issue an order 
requiring such corporation or other person to appear or to give evidence 
touching the matter in question, and any failure to obey such order of 
the court may be punished by such court as a contempt thereof.

(Authority: 38 U.S.C.A. 501, 5711)

[60 FR 40757, Aug. 10, 1995. Redesignated at 64 FR 47111, Aug. 30, 1999]



Sec.  2.3  Delegation of authority to employees to take affidavits, to
administer oaths, etc.

    (a) An employee to whom authority is delegated by the Secretary in 
accordance with 38 U.S.C. 5711, or to whom authority was delegated by 
the Secretary in accordance with title III, Pub. L. 844, 74th Congress, 
section 616, Pub. L. 801, 76th Congress, and section 1211, Pub. L. 85-
56, is by virtue of such delegated authority, until such authority is 
revoked or otherwise terminated, empowered to take affidavits, to 
administer oaths and affirmations, to aid claimants in the preparation 
and presentation of claims, and to make investigations, examine 
witnesses, and certify to the correctness of papers and documents upon 
any matter within the jurisdiction of the Department of Veterans 
Affairs. Such employee is not authorized to administer oaths in 
connection with the execution of affidavits relative to fiscal vouchers 
and is not authorized to take acknowledgments to policy loan agreements 
and applications for cash surrender value to United States Government 
life insurance and National Service life insurance.
    (b) Any such oath, affirmation, affidavit, or examination, when 
certified under the hand of any such employee by whom it was 
administered or taken and authenticated by the seal of the Department of 
Veterans Affairs, may be offered or used in any court of the United 
States and, without further proof of the identity or authority of such 
employee, shall have like force and effect as if administered or taken 
before a clerk of such court.

[[Page 143]]

    (c) The delegated authority from the Secretary to employees to take 
affidavits, to administer oaths, etc., will be evidenced by VA Form 4505 
series.

[24 FR 10018, Dec. 11, 1959. Redesignated at 64 FR 47111, Aug. 30, 1999]



Sec.  2.4  Delegation of authority to order paid advertising for use in
recruitment.

    Paid advertisements may be used in recruitment for VA competitive 
and excepted service positions. Authority to order such advertisements 
is hereby delegated to Administration Heads, Assistant Secretaries, 
Other Key Officials (the General Counsel; the Inspector General; the 
Chairman, Board of Veterans' Appeals; and the Director, Office of Small 
and Disadvantaged Business Utilization), Deputy Assistant Secretaries, 
to the deputies of such officials, to the Deputy Assistant Secretary and 
Associate Deputy Assistant Secretary for Human Resources Management, and 
to field facility Directors.

(Authority: 5 U.S.C. 302(b)(2); 44 U.S.C. 3702)

[61 FR 20134, May 6, 1996, as amended at 72 FR 65462, Nov. 21, 2007]



Sec.  2.5  Delegation of authority to certify copies of documents, records,
or papers in Department of Veterans Affairs files.

    (a) Persons occupying or acting for the following positions in the 
Office of the General Counsel are authorized to certify copies of public 
documents, records, or papers belonging to or in the files of the 
Department of Veterans Affairs for the purposes of 38 U.S.C. 302: 
General Counsel, Deputy General Counsel, Assistant General Counsel, 
Deputy Assistant General Counsel, and the Regional Counsel for Puerto 
Rico.
    (b) The person occupying or acting in the position of Chairman, 
Board of Veterans Apeals, is authorized to certify copies of decisions, 
orders, subpoenas, and other documents, records, or papers issued by, 
belonging to, or in the files of the Board for the purposes of 38 U.S.C. 
302.

(Authority: 38 U.S.C. 302, 501, 512)

[46 FR 18978, Mar. 27, 1981, as amended at 49 FR 30692, Aug. 1, 1984; 60 
FR 48029, Sept. 18, 1995; 72 FR 65462, Nov. 21, 2007]



Sec.  2.6  Secretary's delegations of authority to certain officials
(38 U.S.C. 512).

    Employees occupying or acting in the positions designated below are 
delegated authority as indicated:
    (a) Veterans Health Administration. The Under Secretary for Health 
is delegated authority:
    (1) To act on all matters assigned to the Veterans Health 
Administration by statute (38 U.S.C. Ch. 73) and by regulation, except 
such matters as require the personal attention or action of the 
Secretary.
    (2) To revise, exceed, delete, increase, or decrease fees contained 
in Department of Veterans Affairs Veterans Health Services and Research 
Administration Manual M-1, part I, appendix A (following agreement 
therefor as provided in the contract with the intermediary involved), in 
an approved State fee schedule, and to add additional fees when found to 
be necessary, provided such fees are not in excess of those customarily 
charged the general public, in the community concerned, for the same 
service.
    (3) To designate the Deputy Under Secretary for Health, or other 
physician of the Veterans Health Administration, and authority is hereby 
delegated such designee to perform the functions prescribed in paragraph 
(a)(2) of this section.
    (4) To revise, exceed, delete, increase or decrease dental fees 
established in Department of Veterans Affairs Veterans Health Services 
and Research Administration Manual M-4, chapter 6, and any amendments 
thereto, and to add additional fees when found to be necessary, 
provided: such fees are not in excess of those customarily charged the 
general public, in the community concerned, for the same service.
    (5) To designate the Assistant Chief Medical Director for Dentistry, 
and authority is hereby delegated such designee, to perform the 
functions prescribed in paragraph (a)(4) of this section.
    (6) To supervise programs for grants to the Republic of the 
Philippines and medical care for Commonwealth Army

[[Page 144]]

veterans and Philippine Scouts in Veterans Memorial Medical Center, 
Manila, pursuant to the provisions of 38 U.S.C. ch. 17, subch. IV.
    (7) To designate the Deputy Under Secretary for Health of the 
Veterans Health Administration and authority is hereby delegated such 
designee to designate a Department of Veterans Affairs full-time 
physician or nonmedical Director to serve as an ex officio member on 
advisory bodies to State Comprehensive Health Planning agencies and to 
individual Regional Medical Programs in those areas in which there is 
located one or more Department of Veterans Affairs hospitals or other 
health facilities, who shall serve on such advisory group as the 
representative of the Department of Veterans Affairs health facilities 
located in that area.
    (8) To authorize Directors of Department of Veterans Affairs 
property and facilities under the charge and control of the Department 
of Veterans Affairs to appoint police officers with the power to enforce 
Federal laws and Department of Veterans Affairs regulations, to 
investigate violations of those laws and to arrest for crimes committed 
on Department of Veterans Affairs property to the full extent provided 
by Department policies and procedures.


(Authority: 38 U.S.C. 501 and 512)

    (9) To develop and establish minimum safety and quality standards 
for adaptive equipment provided under chapter 39 of title 38, United 
States Code, or to appoint a designee to perform these functions.
    (b) Veterans Benefits Administration--(1) General. The Under 
Secretary for Benefits is delegated authority to act on all matters 
assigned to the Veterans Benefits Administration except as provided in 
Sec.  1.771 of this chapter and to authorize supervisory or adjudicative 
personnel within his/her jurisdiction to perform such functions as may 
be assigned.
    (2) Philippines. The Director, Department of Veterans Affairs 
Regional Office, Manila, Philippines, is delegated authority to exercise 
such authorities as are delegated to directors of regional offices in 
the United States, which are appropriate to the administration in the 
Republic of the Philippines of the laws administered by the Department 
of Veterans Affairs.
    (c) Office of Management. (1) The Assistant Secretary for Management 
(Chief Financial Officer) is delegated authority to act on all matters 
assigned to his/her office, and to authorize supervisory personnel 
within his/her jurisdiction to perform such functions as may be 
assigned. Appropriate written notification will be furnished other 
Federal agencies concerning such authorizations.
    (2) The Assistant Secretary for Management (Chief Financial Officer) 
is delegated authority under 31 U.S.C. 1553(c)(1), to approve, in a 
fixed appropriation account to which the period of availability for 
obligation has expired, obligational increases related to contract 
changes when such transaction will cause cumulative obligational 
increase for contract changes during a fiscal year to exceed $4 million 
but not more than $25 million; for this responsibility the Assistant 
Secretary for Management (Chief Financial Officer) shall act as a member 
of the Office of the Secretary and shall report to and consult with the 
Secretary on these matters.
    (d) Assistant Secretary for Management (Chief Financial Officer); 
administration heads and staff office directors. The Assistant Secretary 
for Management (Chief Financial Officer) is delegated authority to take 
appropriate action (other than provided for in paragraphs (e)(3) and 
(e)(4) of this section) in connection with the collection of civil 
claims by VA for money or property, as authorized in Sec.  1.900, et 
seq. The Assistant Secretary for Management (Chief Financial Officer) 
may redelegate such authority as he/she deems appropriate to 
administration heads and staff office directors.


(Authority: 38 U.S.C. 501, 512)

    (e) General Counsel. (1) The General Counsel is delegated authority 
to serve as the Regulatory Policy Officer for the Department in 
accordance with Executive Order 12866. The General Counsel, the 
Principal Deputy General Counsel, the Deputy General Counsel, Central 
Office, and the Director of the

[[Page 145]]

Office of Regulation Policy and Management are delegated authority to 
manage, direct, and coordinate the Department's rulemaking activities, 
including the revision and reorganization of regulations, and to perform 
all functions necessary or appropriate under Executive Order 12866 and 
other rulemaking requirements.


(Authority: 38 U.S.C. 501, 512)

    (2) Under the provisions of 38 U.S.C. 515(b), the General Counsel, 
Deputy General Counsel, Assistant General Counsel and Regional Counsel, 
or those authorized to act for them, are authorized to consider, 
ascertain, adjust, determine, and settle tort claims cognizable 
thereunder and to execute an appropriate voucher and other necessary 
instruments in connection with the final disposition of such claims.
    (3) Under the provisions of ``The Federal Medical Care Recovery 
Act,'' 42 U.S.C. 2651, et seq. (as implemented by part 43, title 28, 
Code of Federal Regulations), authority is delegated to the General 
Counsel, Deputy General Counsel, Assistant General Counsel (Professional 
Staff Group I), Deputy Assistant General Counsel of said staff group, 
and Regional Counsels or those authorized to act for them, to collect in 
full, compromise, settle, or waive any claim and execute the release 
thereof; however, claims in excess of $100,000 may be compromised, 
settled, or waived only with the prior approval of the Department of 
Justice.
    (4) Under the Federal Claims Collection Act of 1966, 31 U.S.C. 3711, 
et seq., authority is delegated to the General Counsel, Deputy General 
Counsel, Assistant General Counsel, Deputy Assistant General Counsel and 
Regional Counsel, or those authorized to act for them, to:
    (i) Make appropriate determinations with respect to the litigative 
probabilities of a claim (Sec.  1.932 of this chapter), the legal merits 
of a claim (Sec.  1.942(e) of this chapter), and any other legal 
considerations of a claim.
    (ii) Collect in full a claim involving damage to or loss of 
government property under the jurisdiction of the Department of Veterans 
Affairs resulting from negligence or other legal wrong of a person 
(other than an employee of the Government while acting within the scope 
of his or her employment) and to compromise, suspend, or terminate any 
such claim not exceeding $100,000.
    (iii) Collect a claim in full from an individual or legal entity who 
is liable for the cost of hospital, medical, surgical, or dental care 
and treatment of a person, and to compromise, suspend, or terminate any 
such claim not exceeding $100,000.


(Authority: 31 U.S.C. 3711(a)(2); 38 U.S.C. 501, 512)

    (iv) The delegations of authority set forth in paragraphs (e)(4)(ii) 
and (iii) of this section do not apply to the handling of any claim as 
to which there is an indication of fraud, the presentation of a false 
claim or misrepresentation on the part of the debtor or any other party 
having an interest in the claim, or to any claim based in whole or in 
part on conduct in violation of the antitrust laws. Such cases will be 
considered by the General Counsel, who will make the determination in 
all instances as to whether the case warrants referral to the Department 
of Justice. The delegations of authority are applicable to those claims 
where the Department of Justice determines that action based upon the 
alleged fraud, false claim, or misrepresentation is not warranted.
    (5) Pursuant to the provisions of the Military Personnel and 
Civilian Employees' Claim Act of 1964, 31 U.S.C. 3721, as amended, the 
General Counsel, Deputy General Counsel, Assistant General Counsel 
(Professional Staff Group III), Deputy Assistant General Counsel of said 
staff group, and Regional Counsel or those authorized to act for them, 
are authorized to settle and pay a claim for not more than $40,000 made 
by a civilian officer or employee of the Department of Veterans Affairs 
for damage to, or loss of, personal property incident to his or her 
service. (Pub. L. 97-226)
    (6) Under the provisions of 38 U.S.C. 7316(e), authority is 
delegated to the General Counsel, Deputy General Counsel, and the 
Assistant General Counsel (Professional Staff Group I) to hold harmless 
or provide liability insurance for any person to whom the immunity

[[Page 146]]

provisions of section 7316 apply, for damage for personal injury or 
death, or for property damage, negligently caused by such person while 
furnishing medical care or treatment in the exercise of his or her 
duties in or for the Veterans Health Administration, if such person is 
assigned to a foreign country, detailed to State or political division 
thereof, or is acting under any other circumstances which would preclude 
the remedies of an injured third person against the United States, 
provided by sections 1346(b) and 2672 of title 28, United States Code, 
for such damage or injury.
    (7) The General Counsel, Deputy General Counsel, and those 
authorized to act for them, are authorized to conduct investigations, 
examine witnesses, take affidavits, administer oaths and affirmations, 
and certify copies of public or private documents on all matters within 
the jurisdiction of the General Counsel. Pursuant to the provisions of 
Sec.  2.2(c), the General Counsel, Deputy General Counsel, and those 
authorized to act for them, are authorized to countersign VA Form 4505.
    (8) The General Counsel, or the Deputy General Counsel acting as or 
for the General Counsel, is authorized to designate, in accordance with 
established standards, those legal opinions of the General Counsel which 
will be considered precedent opinions involving veterans' benefits under 
laws administered by the Department of Veterans Affairs.


(Authority: 38 U.S.C. 501, 512)

    (9) Under the provisions of 38 U.S.C. 1729(c)(1), authority is 
delegated to the General Counsel, Deputy General Counsel, Assistant 
General Counsel (Professional Staff Group I), Deputy Assistant General 
Counsel of said staff group, and Regional Counsel, or those authorized 
to act for them, to collect in full, compromise, settle, or waive any 
claim and execute the release thereof; however, claims in excess of 
$100,000 may only be compromised, settled, or waived with the prior 
approval of the General Counsel, Deputy General Counsel, Assistant 
General Counsel (Professional Staff Group I), or Deputy Assistant 
General Counsel of said staff group, or those authorized to act for 
them.


(Authority: 31 U.S.C. 3711(a)(2); 38 U.S.C. 501, 512).

    (10) Except as prescribed in paragraph (g)(3) of this section, the 
General Counsel, Deputy General Counsel, and the Assistant General 
Counsel for Professional Staff Group IV are authorized to make final 
Departmental decisions on appeals under the Freedom of Information Act, 
the Privacy Act, and 38 U.S.C. 5701, 5705 and 7332.


(Authority: 38 U.S.C. 512)

    (11) All authority delegated in this paragraph to Regional Counsels 
will be exercised by them under the supervision of and in accordance 
with instructions issued by the General Counsel.
    (f) National Cemetery Administration. Under Secretary for Memorial 
Affairs is delegated authority:
    (1) To act on all matters assigned to the National Cemetery 
Administration by statute (38 U.S.C. chapter 24) and by regulation 
except where specifically requiring the personal attention or action of 
the Secretary and to authorize supervisory personnel within the 
jurisdiction of the Under Secretary for Memorial Affairs, to perform 
such functions as may be assigned.
    (2) To designate, as deemed necessary, Superintendents of National 
Cemeteries as special investigators under 38 U.S.C. 901, however, such 
law enforcement authority is limited to enforcement of rules and 
regulations governing conduct on property under the charge and control 
of the Department of Veterans Affairs, as those rules and regulations 
apply to the cemetery over which the individual Superintendent exercises 
control and jurisdiction. Such designation will not authorize the 
carrying of firearms by any Superintendent.
    (3) To accept donations, except offers of land, made in any manner, 
for the beautification or benefit of national cemeteries.
    (4) To name features in national cemeteries, such as, roads, walks, 
and special structures.

[[Page 147]]

    (5) To establish policies and specifications for inscriptions on 
Government headstones, markers, and private monuments.


(Authority: 38 U.S.C. 501, 512, 2404)

    (g) Inspector General. (1) The Secretary delegates to the Inspector 
General, the authority, as head of the Department of Veterans Affairs, 
to make written requests under the Privacy Act of 1974, 5 U.S.C. 
552a(b)(7), for the transfer of records or copies of records maintained 
by other agencies which are necessary to carry out an authorized law 
enforcement activity of the Office of Inspector General. This delegation 
is made pursuant to 38 U.S.C. 512. The Inspector General may redelegate 
the foregoing authority within the Office of Inspector General, but the 
delegation may only be to an official of sufficient rank to ensure that 
the request for the records has been the subject of a high level 
evaluation of the need for the information.
    (2) The Inspector General delegates the authority under the 
Inspector General Act of 1978, and redelegates the authority under 
paragraph (a) of this section, to request Privacy Act-protected records 
from Federal agencies pursuant to subsection (b)(7) of the Privacy Act 
to each of the following Office of Inspector General officials: (i) 
Deputy Inspector General, (ii) Assistant Inspector General for 
Investigations, (iii) Deputy Assistant Inspector General for 
Investigations, (iv) Chief of Operations, and (v) Special Agents in 
Charge of Field Offices of Investigations. These officials may not 
redelegate this authority.
    (3) The Office of Inspector General is authorized to make final 
decisions on appeals submitted pursuant to the Freedom of Information 
Act concerning any Office of Inspector General records.


(Authority: 38 U.S.C. 512)

    (h) Delegations to Office Resolution Management Officials (ORM). (1) 
The Deputy Assistant Secretary for Resolution Management is delegated 
authority to supervise and control the operation of the administrative 
EEO Discrimination Complaint Processing System within the Department.
    (2) The Deputy Assistant Secretary for Resolution Management, the 
Chief Operating Officer, and all Regional EEO Officers/Field Managers 
are delegated authority to make procedural agency decisions to either 
accept or dismiss, in whole or in part, EEO discrimination complaints 
based upon race, color, national origin, sex, religion, age, disability, 
or reprisal filed by employees, former employees, or applicants for 
employment.
    (3) The Deputy Assistant Secretary for Resolution Management, the 
Chief Operating Officer, and the Chief, Policy and Compliance are 
delegated authority to make agency decisions on all breach of settlement 
claims raised by employees, former employees, and applicants for 
employment.
    (4) The Deputy Assistant Secretary for Resolution Management, the 
Chief Operating Officer, and the Chief, Policy and Compliance are 
delegated authority to consider and resolve all claims raised by 
employees, former employees, and applicants for employment that allege 
dissatisfaction with the processing of a previously filed EEO 
discrimination complaint.
    (5) The Deputy Assistant Secretary for Resolution Management, the 
Chief Operating Officer, and the Chief, Policy and Compliance are 
delegated authority to monitor compliance by Department organizational 
components with orders and decisions of the OEDCA and the EEOC.
    (i) Delegations to officials of the Office of Employment 
Discrimination Complaint Adjudication (OEDCA). (1) The Director and 
Associate Director, OEDCA, are delegated authority to make procedural 
decisions to dismiss, in whole or in part, any EEO discrimination 
complaint filed by any employee, former employee, or applicant for 
employment that may be pending before OEDCA, where administrative 
complaint processing efficiency may be best served by doing so.
    (2) The Director and Associate Director, OEDCA, are delegated 
authority to dismiss, in whole or in part any EEO discrimination 
complaint based upon race, color, religion, sex, national origin, age, 
disability, or reprisal filed by any ORM employee, former employee, or 
applicant for employment.

[[Page 148]]

    (3) The Director and Associate Director, OEDCA, are delegated 
authority to make the agency decision on all breach of settlement claims 
raised by ORM employees, former employees, and applicants for 
employment.
    (4) The Director and Associate Director, OEDCA, are delegated 
authority to consider and resolve all claims raised by ORM employees, 
former employees, and applicants for employment that allege 
dissatisfaction with the processing of a previously filed EEO 
discrimination complaint.
    (5) The Director and Associate Director, OEDCA, are delegated 
authority to make procedural agency decisions to either accept or 
dismiss, in whole or in part, EEO discrimination complaints filed by 
employees, former employees, or applicants for employment where the ORM 
must recuse itself from a case due to an actual, apparent, or potential 
conflict of interest.
    (j) Delegation to the Chairman, Board of Veterans' Appeals. In cases 
where OEDCA has recused itself from a case due to an actual, apparent, 
or potential conflict of interest, the Chairman, Board of Veterans' 
Appeals, is delegated authority to make procedural agency decisions to 
dismiss, in whole or in part, EEO discrimination complaints filed by 
agency employees, former employees, and applicants for employment; to 
make substantive final agency decisions where complainants do not 
request an EEOC hearing; to take final agency action following a 
decision by an EEOC Administrative Judge; and to make final agency 
decisions ordering appropriate remedies and relief where there is a 
finding of discrimination.
    (k) Processing complaints involving certain officials. A complaint 
alleging that the Secretary or the Deputy Secretary personally made a 
decision directly related to matters in dispute, or are otherwise 
personally involved in such matters, will be referred for procedural 
acceptability review, investigation, and substantive decisionmaking to 
another Federal agency (e.g., The Department of Justice) pursuant to a 
cost reimbursement agreement. Referral will not be made when the action 
complained of relates merely to ministerial involvement in such matters 
(e.g., ministerial approval of selection recommendations submitted to 
the Secretary by the Under Secretary for Health, the Under Secretary for 
Benefits, the Under Secretary for Memorial Affairs, assistant 
secretaries, or staff office heads).

(Authority: 38 U.S.C. 501, 512)

[25 FR 11095, Nov. 23, 1960]

    Editorial Note: For Federal Register citations affecting Sec.  2.6, 
see the List of CFR Sections Affected, which appears in the Finding Aids 
section of the printed volume and at www.govinfo.gov.



Sec.  2.7  Delegation of authority to provide relief on account of 
administrative error.

    (a) Section 503(a) of title 38 U.S.C., provides that if the 
Secretary determines that benefits administered by the Department of 
Veterans Affairs have not been provided by reason of administrative 
error on the part of the Federal Government or any of its employees, the 
Secretary is authorized to provide such relief on account of such error 
as the Secretary determines equitable, including the payment of moneys 
to any person whom he determines equitably entitled thereto.
    (b) Section 503(b) of title 38 U.S.C., provides that if the 
Secretary determines that any veteran, surviving spouse, child of a 
veteran, or other person, has suffered loss, as a consequence of 
reliance upon a determination by the Department of Veterans Affairs of 
eligibility or entitlement to benefits, without knowledge that it was 
erroneously made, the Secretary is authorized to provide such relief as 
the Secretary determines equitable, including the payment of moneys to 
any person equitably entitled thereto. The Secretary is also required to 
submit an annual report to the Congress, containing a brief summary of 
each recommendation for relief and its disposition. Preparation of the 
report shall be the responsibility of the General Counsel.
    (c) The authority to grant the equitable relief, referred to in 
paragraphs (a) and (b) of this section, has not been delegated and is 
reserved to the Secretary. Recommendation for the correction of 
administrative error and for appropriate equitable relief therefrom will 
be submitted to the Secretary,

[[Page 149]]

through the General Counsel. Such recommendation may be initiated by the 
head of the administration having responsibility for the benefit, or of 
any concerned staff office, or by the Chairman, Board of Veterans 
Appeals. When a recommendation for relief under paragraph (a) or (b) of 
this section is initiated by the head of a staff office, or the 
Chairman, Board of Veterans Appeals, the views of the head of the 
administration having responsibility for the benefit will be obtained 
and transmitted with the recommendation of the initiating office.

(Authority: 38 U.S.C. 503, 512)

[37 FR 22864, Oct. 26, 1972, as amended at 49 FR 30693, Aug. 1, 1984; 54 
FR 34981, Aug. 23, 1989; 68 FR 25504, May 13, 2003]



Sec.  2.8  Delegation of authority to authorize allowances for Department 
of Veterans Affairs employees who are notaries public.

    (a) Employees occupying or acting in the positions designated in 
paragraph (b) of this section are authorized to designate those 
employees who are required to serve as notaries public in connection 
with the performance of official business and to pay an allowance for 
the costs therefor not to exceed the expense required to be incurred by 
them in order to obtain their commission.


(Authority: 5 U.S.C. 5945)

    (b) Designated positions: Deputy Secretary, Under Secretary for 
Benefits, Director, Office of Data Management and Telecommunications, 
Chief Medical Director, General Counsel, Directors of regional offices, 
hospitals, domiciliaries, and centers.

[35 FR 13771, Aug. 29, 1970, as amended at 49 FR 30693, Aug. 1, 1984]



PART 3_ADJUDICATION--Table of Contents



     Subpart A_Pension, Compensation, and Dependency and Indemnity 
                              Compensation

                                 General

Sec.
3.1 Definitions.
3.2 Periods of war.
3.3 Pension.
3.4 Compensation.
3.5 Dependency and indemnity compensation.
3.6 Duty periods.
3.7 Individuals and groups considered to have performed active military, 
          naval, or air service.
3.10 Dependency and indemnity compensation rate for a surviving spouse.
3.11 Homicide.
3.12 Character of discharge.
3.12a Minimum active-duty service requirement.
3.13 Discharge to change status.
3.14 Validity of enlistments.
3.15 Computation of service.
3.16 Service pension.
3.17 Disability and death pension; Mexican border period and later war 
          periods.
3.18-3.19 [Reserved]
3.20 Surviving spouse's benefit for month of veteran's death.
3.21 Monetary rates.
3.22 DIC benefits for survivors of certain veterans rated totally 
          disabled at time of death.
3.23 Improved pension rates--Veterans and surviving spouses.
3.24 Improved pension rates--Surviving children.
3.25 Parents' dependency and indemnity compensation (DIC)--Method of 
          payment computation.
3.26 Section 306 and old-law pension annual income limitations.
3.27 Automatic adjustment of benefit rates.
3.28 Automatic adjustment of section 306 and old-law pension income 
          limitations.
3.29 Rounding.
3.30 Frequency of payment of improved pension and parents' dependency 
          and indemnity compensation (DIC).
3.31 Commencement of the period of payment.
3.32 Exchange rates for foreign currencies.

                                 General

3.40 Philippine and Insular Forces.
3.41 Philippine service.
3.42 Compensation at the full-dollar rate for certain Filipino veterans 
          residing in the United States.
3.43 Burial benefits at the full-dollar rate for certain Filipino 
          veterans residing in the United States on the date of death.

                              Relationship

3.50 Spouse and surviving spouse.
3.52 Marriages deemed valid.
3.53 Continuous cohabitation.
3.54 Marriage dates.
3.55 Reinstatement of benefits eligibility based upon terminated marital 
          relationships.
3.56 [Reserved]
3.57 Child.
3.58 Child adopted out of family.

[[Page 150]]

3.59 Parent.
3.60 Definition of ``living with''.

                             Administrative

3.100 Delegations of authority.
3.102 Reasonable doubt.
3.103 Procedural due process and other rights.
3.104 Binding nature of decisions.
3.105 Revision of decisions.
3.106 Renouncement.
3.107 Awards where not all dependents apply.
3.108 State Department as agent of Department of Veterans Affairs.
3.109 Time limit.
3.110 Computation of time limit.
3.111 [Reserved]
3.112 Fractions of one cent.
3.114 Change of law or Department of Veterans Affairs issue.
3.115 Access to financial records.

                                 Claims

3.150 Forms to be furnished.
3.151 Claims for disability benefits.
3.152 Claims for death benefits.
3.153 Claims filed with Social Security.
3.154 Injury due to hospital treatment, etc.
3.155 How to file a claim.
3.156 New evidence.
3.158 Abandoned claims.
3.159 Department of Veterans Affairs assistance in developing claims.
3.160 Status of claims.
3.161 [Reserved]

                          Evidence Requirements

3.200 Testimony certified or under oath.
3.201 Exchange of evidence; Social Security and Department of Veterans 
          Affairs.
3.202 Evidence from foreign countries.
3.203 Service records as evidence of service and character of discharge.
3.204 Evidence of dependents and age.
3.205 Marriage.
3.206 Divorce.
3.207 Void or annulled marriage.
3.208 Claims based on attained age.
3.209 Birth.
3.210 Child's relationship.
3.211 Death.
3.212 Unexplained absence for 7 years.
3.213 Change of status affecting entitlement.
3.214 Court decisions; unremarried surviving spouses.
3.215 Termination of marital relationship or conduct.
3.216 Mandatory disclosure of social security numbers.
3.217 Submission of statements or information affecting entitlement to 
          benefits.

                      Dependency, Income and Estate

  Regulations Applicable to Programs in Effect Prior to January 1, 1979

3.250 Dependency of parents; compensation.
3.251 Income of parents; dependency and indemnity compensation.
3.252 Annual income; pension; Mexican border period and later war 
          periods.
3.253-3.255 [Reserved]
3.256 Eligibility reporting requirements.
3.257 Children; no surviving spouse entitled.
3.258-3.259 [Reserved]
3.260 Computation of income.
3.261 Character of income; exclusions and estates.
3.262 Evaluation of income.
3.263 Corpus of estate; net worth.
3.270 Applicability of various dependency, income and estate 
          regulations.

  Regulations Applicable to the Improved Pension Program Which Became 
                        Effective January 1, 1979

3.271 Computation of income.
3.272 Exclusions from income.
3.273 Rate computation.
3.274 Net worth and VA pension.
3.275 How VA determines the asset amount for pension net worth 
          determinations.
3.276 Asset transfers and penalty periods.
3.277 Eligibility reporting requirements.
3.278 Deductible medical expenses.
3.279 Statutory exclusions from income or assets (net worth or corpus of 
          the estate).

        Ratings and Evaluations; Basic Entitlement Considerations

3.300 Claims based on the effects of tobacco products.
3.301 Line of duty and misconduct.
3.302 Service connection for mental unsoundness in suicide.

               Ratings and Evaluations; Service Connection

3.303 Principles relating to service connection.
3.304 Direct service connection; wartime and peacetime.
3.305 Direct service connection; peacetime service before January 1, 
          1947.
3.306 Aggravation of preservice disability.
3.307 Presumptive service connection for chronic, tropical, or prisoner-
          of-war related disease, disease associated with exposure to 
          certain herbicide agents, or disease associated with exposure 
          to contaminants in the water supply at Camp Lejeune; wartime 
          and service on or after January 1, 1947.
3.308 Presumptive service connection; peacetime service before January 
          1, 1947.
3.309 Disease subject to presumptive service connection.

[[Page 151]]

3.310 Disabilities that are proximately due to, or aggravated by, 
          service-connected disease or injury.
3.311 Claims based on exposure to ionizing radiation.
3.312 Cause of death.
3.313 Claims based on service in Vietnam.
3.314 Basic pension determinations.
3.315 Basic eligibility determinations; dependents, loans, education.
3.316 Claims based on chronic effects of exposure to mustard gas and 
          Lewisite.
3.317 Compensation for certain disabilities occurring in Persian Gulf 
          veterans.
3.318 Presumptive service connection for amyotrophic lateral sclerosis.
3.319-3.320 [Reserved]
3.321 General rating considerations.
3.322 Rating of disabilities aggravated by service.
3.323 Combined ratings.
3.324 Multiple noncompensable service-connected disabilities.
3.325 [Reserved]
3.326 Examinations.
3.327 Reexaminations.
3.328 Independent medical opinions.
3.329 [Reserved]
3.330 Resumption of rating when veteran subsequently reports for 
          Department of Veterans Affairs examination.
3.331-3.339 [Reserved]
3.340 Total and permanent total ratings and unemployability.
3.341 Total disability ratings for compensation purposes.
3.342 Permanent and total disability ratings for pension purposes.
3.343 Continuance of total disability ratings.
3.344 Stabilization of disability evaluations.

                      Ratings for Special Purposes

3.350 Special monthly compensation ratings.
3.351 Special monthly dependency and indemnity compensation, death 
          compensation, pension and spouse's compensation ratings.
3.352 Criteria for determining need for aid and attendance and 
          ``permanently bedridden.''
3.353 Determinations of incompetency and competency.
3.354 Determinations of insanity.
3.355 Testamentary capacity for insurance purposes.
3.356 Conditions which determine permanent incapacity for self-support.
3.357 Civil service preference ratings.
3.358 Compensation for disability or death from hospitalization, medical 
          or surgical treatment, examinations or vocational 
          rehabilitation training (Sec.  3.800).
3.359 Determination of service connection for former members of the 
          Armed Forces of Czechoslovakia or Poland.
3.360 Service-connected health-care eligibility of certain persons 
          administratively discharged under other than honorable 
          condition.
3.361 Benefits under 38 U.S.C. 1151(a) for additional disability or 
          death due to hospital care, medical or surgical treatment, 
          examination, training and rehabilitation services, or 
          compensated work therapy program.
3.362 Offsets under 38 U.S.C. 1151(b) of benefits awarded under 38 
          U.S.C. 1151(a).
3.363 Bar to benefits under 38 U.S.C. 1151.

           Rating Considerations Relative to Specific Diseases

3.370 Pulmonary tuberculosis shown by X-ray in active service.
3.371 Presumptive service connection for tuberculous disease; wartime 
          and service on or after January 1, 1947.
3.372 Initial grant following inactivity of tuberculosis.
3.373 [Reserved]
3.374 Effect of diagnosis of active tuberculosis.
3.375 Determination of inactivity (complete arrest) in tuberculosis.
3.376-3.377 [Reserved]
3.378 Changes from activity in pulmonary tuberculosis pension cases.
3.379 Anterior poliomyelitis.
3.380 Diseases of allergic etiology.
3.381 Service connection of dental conditions for treatment purposes.
3.382 [Reserved]
3.383 Special consideration for paired organs and extremities.
3.384 Psychosis.
3.385 Disability due to impaired hearing.

                             Effective Dates

3.400 General.
3.401 Veterans.
3.402 Surviving spouse.
3.403 Children.
3.404 Parents.
3.405 Filipino veterans and their survivors; benefits at the full-dollar 
          rate.

                             Apportionments

3.450 General.
3.451 Special apportionments.
3.452 Situations when benefits may be apportioned.
3.453 Veterans compensation or service pension or retirement pay.
3.454 Veterans disability pension.
3.458 Veteran's benefits not apportionable.
3.459 Death compensation.
3.460 Death pension.
3.461 Dependency and indemnity compensation.

                     Reductions and Discontinuances

3.500 General.

[[Page 152]]

3.501 Veterans.
3.502 Surviving spouses.
3.503 Children.
3.504 Parents; aid and attendance.
3.505 Filipino veterans and their survivors; benefits at the full-dollar 
          rate.

                       Hospitalization Adjustments

3.551 Reduction because of hospitalization.
3.552 Adjustment of allowance for aid and attendance.
3.553-3.555 [Reserved]
3.556 Adjustment on discharge or release.
3.557 [Reserved]
3.558 Resumption and payment of withheld benefits; incompetents with 
          estates that equaled or exceeded statutory limit.
3.559 [Reserved]

                       Adjustments and Resumptions

3.650 Rate for additional dependent.
3.651 Change in status of dependents.
3.652 Periodic certification of continued eligibility.
3.653 Foreign residence.
3.654 Active service pay.
3.655 Failure to report for Department of Veterans Affairs examination.
3.656 Disappearance of veteran.
3.657 Surviving spouse becomes entitled, or entitlement terminates.
3.658 Offsets; dependency and indemnity compensation.
3.659 Two parents in same parental line.
3.660 Dependency, income and estate.
3.661 Eligibility Verification Reports.
3.662-3.664 [Reserved]
3.665 Incarcerated beneficiaries and fugitive felons--compensation.
3.666 Incarcerated beneficiaries and fugitive felons--pension.
3.667 School attendance.
3.668 [Reserved]
3.669 Forfeiture.

                    Concurrent Benefits and Elections

3.700 General.
3.701 Elections of pension or compensation.
3.702 Dependency and indemnity compensation.
3.703 Two parents in same parental line.
3.704 Elections within class of dependents.
3.705-3.706 [Reserved]
3.707 Dependents' educational assistance.
3.708 Federal Employees' Compensation.
3.710 Civil service annuitants.
3.711 Improved pension elections.
3.712 Improved pension elections; surviving spouses of Spanish-American 
          War veterans.
3.713 Effective dates of improved pension elections.
3.714 Improved pension elections--public assistance beneficiaries.
3.715 Radiation Exposure Compensation Act of 1990.

                               Retirement

3.750 Entitlement to concurrent receipt of military retired pay and 
          disability compensation.
3.751 Statutory awards; retired service personnel.
3.752 [Reserved]
3.753 Public Health Service.
3.754 Emergency officers' retirement pay.

                            Special Benefits

3.800 Disability or death due to hospitalization, etc.
3.801 Special acts.
3.802 Medal of Honor.
3.803 Naval pension.
3.804 Special allowance under 38 U.S.C. 1312.
3.805 Loan guaranty for surviving spouses; certification.
3.806 Death gratuity; certification.
3.807 Dependents' educational assistance; certification.
3.808 Automobiles or other conveyances and adaptive equipment; 
          certification.
3.809 Specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i).
3.809a Special home adaptation grants under 38 U.S.C. 2101(b).
3.810 Clothing allowance.
3.811 Minimum income annuity and gratuitous annuity.
3.812 Special allowance payable under section 156 of Pub. L. 97-377.
3.813 Interim benefits for disability or death due to chloracne or 
          porphyria cutanea tarda.
3.814 Monetary allowance under 38 U.S.C. chapter 18 for an individual 
          suffering from spina bifida whose biological father or mother 
          is or was a Vietnam veteran or a veteran with covered service 
          in Korea.
3.815 Monetary allowance under 38 U.S.C. chapter 18 for an individual 
          with disability from covered birth defects whose biological 
          mother is or was a Vietnam veteran; identification of covered 
          birth defects.
3.816 Awards under the Nehmer Court Orders for disability or death 
          caused by a condition presumptively associated with herbicide 
          exposure.

                               Forfeiture

3.900 General.
3.901 Fraud.
3.902 Treasonable acts.
3.903 Subversive activities.
3.904 Effect of forfeiture after veteran's death.
3.905 Declaration of forfeiture or remission of forfeiture.

                               Protection

3.950 Helpless children; Spanish-American and prior wars.
3.951 Preservation of disability ratings.

[[Page 153]]

3.952 Protected ratings.
3.953 Pub. L. 85-56 and Pub. L. 85-857.
3.955-3.956 [Reserved]
3.957 Service connection.
3.958 Federal employees' compensation cases.
3.959 Tuberculosis.
3.960 Section 306 and old-law pension protection.

                                 Accrued

3.1000 Entitlement under 38 U.S.C. 5121 to benefits due and unpaid upon 
          death of a beneficiary.
3.1001 Hospitalized competent veterans.
3.1002 Political subdivisions of United States.
3.1003 Returned and canceled checks.
3.1004-3.1006 [Reserved]
3.1007 Hospitalized incompetent veterans.
3.1008 Accrued benefits payable to foreign beneficiaries.
3.1009 Personal funds of patients.
3.1010 Substitution under 38 U.S.C. 5121A following death of a claimant.

                        Subpart B_Burial Benefits

                        Burial Benefits: General

3.1700 Types of VA burial benefits.
3.1701 Deceased veterans for whom VA may provide burial benefits.
3.1702 Persons who may receive burial benefits; priority of payments.
3.1703 Claims for burial benefits.

            Burial Benefits: Allowances & Expenses Paid by VA

3.1704 Burial allowance based on service-connected death.
3.1705 Burial allowance based on non-service-connected death.
3.1706 Burial allowance for a veteran who died while hospitalized by VA.
3.1707 Plot or interment allowances for burial in a State veterans 
          cemetery or other cemetery.
3.1708 Burial of a veteran whose remains are unclaimed.
3.1709 Transportation expenses for burial in a national cemetery.

                         Burial Benefits: Other

3.1710 Escheat (payment of burial benefits to an estate with no heirs).
3.1711 Effect of contributions by government, public, or private 
          organizations.
3.1712 Effect of forfeiture on payment of burial benefits.
3.1713 Eligibility based on status before 1958.

Subpart C [Reserved]

  Subpart D_Universal Adjudication Rules That Apply to Benefit Claims 
                    Governed by Part 3 of This Title

                                 General

3.2100 Scope of Applicability.
3.2130 Will VA accept a signature by mark or thumbprint?
3.2400 Applicability of modernized review system.
3.2500 Review of decisions.
3.2501 Supplemental claims.
3.2502 Return by higher-level adjudicator or remand by the Board of 
          Veterans' Appeals.

                                Revisions

3.2600 Legacy review of benefit claims decisions.
3.2601 Higher-level review.

    Editorial Note: Nomenclature changes to part 3 appear at 61 FR 7216, 
Feb. 27, 1996; 62 FR 35970, July 3, 1997; 62 FR 47532, Sept. 9, 1997; 
and 67 FR 46868, July 17, 2002.



     Subpart A_Pension, Compensation, and Dependency and Indemnity 
                              Compensation

    Authority: 38 U.S.C. 501(a), unless otherwise noted.

                                 General



Sec.  3.1  Definitions.

    (a) Armed Forces means the United States Army, Navy, Marine Corps, 
Air Force, and Coast Guard, including their Reserve components.
    (b) Reserve component means the Army, Naval, Marine Corps, Air 
Force, and Coast Guard Reserves and the National and Air National Guard 
of the United States.
    (c) Reserves means members of a Reserve component of one of the 
Armed Forces.
    (d) Veteran means a person who served in the active military, naval, 
or air service and who was discharged or released under conditions other 
than dishonorable.
    (1) For compensation and dependency and indemnity compensation the 
term veteran includes a person who died in active service and whose 
death was not due to willful misconduct.

[[Page 154]]

    (2) For death pension the term veteran includes a person who died in 
active service under conditions which preclude payment of service-
connected death benefits, provided such person had completed at least 2 
years honorable military, naval or air service, as certified by the 
Secretary concerned. (See Sec. Sec.  3.3(b)(3)(i) and 3.3(b)(4)(i))


(Authority: 38 U.S.C. 501)

    (e) Veteran of any war means any veteran who served in the active 
military, naval or air service during a period of war as set forth in 
Sec.  3.2.
    (f) Period of war means the periods described in Sec.  3.2.
    (g) Secretary concerned means:
    (1) The Secretary of the Army, with respect to matters concerning 
the Army;
    (2) The Secretary of the Navy, with respect to matters concerning 
the Navy or the Marine Corps;
    (3) The Secretary of the Air Force, with respect to matters 
concerning the Air Force;
    (4) The Secretary of Homeland Security, with respect to matters 
concerning the Coast Guard;
    (5) The Secretary of Health and Human Services, with respect to 
matters concerning the Public Health Service; and
    (6) The Secretary of Commerce, with respect to matters concerning 
the Coast and Geodetic Survey, the Environmental Science Services 
Administration, and the National Oceanic and Atmospheric Administration.
    (h) Discharge or release includes retirement from the active 
military, naval, or air service.
    (i) State means each of the several States, Territories and 
possessions of the United States, the District of Columbia, and 
Commonwealth of Puerto Rico.
    (j) Marriage means a marriage valid under the law of the place where 
the parties resided at the time of marriage, or the law of the place 
where the parties resided when the right to benefits accrued.


(Authority: 38 U.S.C. 103(c))

    (k) Service-connected means, with respect to disability or death, 
that such disability was incurred or aggravated, or that the death 
resulted from a disability incurred or aggravated, in line of duty in 
the active military, naval, or air service.
    (l) Nonservice-connected means, with respect to disability or death, 
that such disability was not incurred or aggravated, or that the death 
did not result from a disability incurred or aggravated, in line of duty 
in the active military, naval, or air service.
    (m) In line of duty means an injury or disease incurred or 
aggravated during a period of active military, naval, or air service 
unless such injury or disease was the result of the veteran's own 
willful misconduct or, for claims filed after October 31, 1990, was a 
result of his or her abuse of alcohol or drugs. A service department 
finding that injury, disease or death occurred in line of duty will be 
binding on the Department of Veterans Affairs unless it is patently 
inconsistent with the requirements of laws administered by the 
Department of Veterans Affairs. Requirements as to line of duty are not 
met if at the time the injury was suffered or disease contracted the 
veteran was:
    (1) Avoiding duty by desertion, or was absent without leave which 
materially interfered with the performance of military duty.
    (2) Confined under a sentence of court-martial involving an 
unremitted dishonorable discharge.
    (3) Confined under sentence of a civil court for a felony as 
determined under the laws of the jurisdiction where the person was 
convicted by such court.


(Authority: 38 U.S.C. 105)

    Note: See Sec.  3.1(y)(2)(iii) for applicability of in line of duty 
in determining former prisoner of war status.

    (n) Willful misconduct means an act involving conscious wrongdoing 
or known prohibited action. A service department finding that injury, 
disease or death was not due to misconduct will be binding on the 
Department of Veterans Affairs unless it is patently inconsistent with 
the facts and the requirements of laws administered by the Department of 
Veterans Affairs.
    (1) It involves deliberate or intentional wrongdoing with knowledge 
of or wanton and reckless disregard of its probable consequences.

[[Page 155]]

    (2) Mere technical violation of police regulations or ordinances 
will not per se constitute willful misconduct.
    (3) Willful misconduct will not be determinative unless it is the 
proximate cause of injury, disease or death. (See Sec. Sec.  3.301, 
3.302.)
    (o) Political subdivision of the United States includes the 
jurisdiction defined as a State in paragraph (i) of this section, and 
the counties, cities or municipalities of each.
    (p) Claim means a written or electronic communication requesting a 
determination of entitlement or evidencing a belief in entitlement, to a 
specific benefit under the laws administered by the Department of 
Veterans Affairs submitted on an application form prescribed by the 
Secretary. (See scope of claim, Sec.  3.155(d)(2); complete claim, Sec.  
3.160(a); issues within a claim, Sec.  3.151(c)).
    (1) Initial claim. An initial claim is any complete claim, other 
than a supplemental claim, for a benefit on a form prescribed by the 
Secretary. The first initial claim for one or more benefits received by 
VA is further defined as an original claim. (See original claim, Sec.  
3.160(b)). Initial claims include:
    (i) A new claim requesting service connection for a disability or 
grant of a new benefit, and
    (ii) A claim for increase in a disability evaluation rating or rate 
of a benefit paid based on a change or worsening in condition or 
circumstance since the last decision issued by VA for the benefit.
    (2) Supplemental claim. A supplemental claim is any complete claim 
for a VA benefit on an application form prescribed by the Secretary 
where an initial or supplemental claim for the same or similar benefit 
on the same or similar basis was previously decided. (See supplemental 
claim; Sec.  3.2501.)
    (q) Notice means written notice sent to a claimant or payee at his 
or her latest address of record.
    (r) Date of receipt means the date on which a claim, information or 
evidence was received in the Department of Veterans Affairs, except as 
to specific provisions for claims or evidence received in the State 
Department (Sec.  3.108), or in the Social Security Administration 
(Sec. Sec.  3.153, 3.201), or Department of Defense as to initial claims 
filed at or prior to separation. However, the Under Secretary for 
Benefits may establish, by notice published in the Federal Register, 
exceptions to this rule, using factors such as postmark or the date the 
claimant signed the correspondence, when he or she determines that a 
natural or man-made interference with the normal channels through which 
the Veterans Benefits Administration ordinarily receives correspondence 
has resulted in one or more Veterans Benefits Administration offices 
experiencing extended delays in receipt of claims, information, or 
evidence from claimants served by the affected office or offices to an 
extent that, if not addressed, would adversely affect such claimants 
through no fault of their own.


(Authority: 38 U.S.C. 501(a), 512(a), 5110)

    (s) On the borders thereof means, with regard to service during the 
Mexican border period, the States of Arizona, California, New Mexico, 
and Texas, and the nations of Guatemala and British Honduras.


(Authority: 38 U.S.C. 101(30))

    (t) In the waters adjacent thereto means, with regard to service 
during the Mexican border period, the waters (including the islands 
therein) which are within 750 nautical miles (863 statute miles) of the 
coast of the mainland of Mexico.


(Authority: 38 U.S.C. 101(30)

    (u) Section 306 pension means those disability and death pension 
programs in effect on December 31, 1978, which arose out of Pub. L. 86-
211; 73 Stat. 432.
    (v) Old-Law pension means the disability and death pension programs 
that were in effect on June 30, 1960. Also known as protected pension, 
i.e., protected under section 9(b) of the Veteran's Pension Act of 1959 
(Pub. L. 86-211; 73 Stat. 432).
    (w) Improved pension means the disability and death pension programs 
becoming effective January 1, 1979, under authority of Pub. L. 95-588; 
92 Stat. 2497.
    (x) Service pension is the name given to Spanish-American War 
pension. It is

[[Page 156]]

referred to as a service pension because entitlement is based solely on 
service without regard to nonservice-connected disability, income and 
net worth.


(Authority: 38 U.S.C. 1512, 1536)

    (y) Former prisoner of war. The term former prisoner of war means a 
person who, while serving in the active military, naval or air service, 
was forcibly detained or interned in the line of duty by an enemy or 
foreign government, the agents of either, or a hostile force.
    (1) Decisions based on service department findings. The Department 
of Veterans Affairs shall accept the findings of the appropriate service 
department that a person was a prisoner of war during a period of war 
unless a reasonable basis exists for questioning it. Such findings shall 
be accepted only when detention or internment is by an enemy government 
or its agents.
    (2) Other decisions. In all other situations, including those in 
which the Department of Veterans Affairs cannot accept the service 
department findings, the following factors shall be used to determine 
prisoner of war status:
    (i) Circumstances of detention or internment. To be considered a 
former prisoner of war, a serviceperson must have been forcibly detained 
or interned under circumstances comparable to those under which persons 
generally have been forcibly detained or interned by enemy governments 
during periods of war. Such circumstances include, but are not limited 
to, physical hardships or abuse, psychological hardships or abuse, 
malnutrition, and unsanitary conditions. Each individual member of a 
particular group of detainees or internees shall, in the absence of 
evidence to the contrary, be considered to have experienced the same 
circumstances as those experienced by the group.
    (ii) Reason for detainment or internment. The reason for which a 
serviceperson was detained or interned is immaterial in determining POW 
status, except that a serviceperson who is detained or interned by a 
foreign government for an alleged violation of its laws is not entitled 
to be considered a former POW on the basis of that period of detention 
or internment, unless the charges are a sham intended to legitimize the 
period of detention or internment.
    (3) Central Office approval. The Director of the Compensation 
Service, VA Central Office, shall approve all VA regional office 
determinations establishing or denying POW status, with the exception of 
those service department determinations accepted under paragraph (y)(1) 
of this section.
    (4) In line of duty. The Department of Veterans Affairs shall 
consider that a serviceperson was forcibly detained or interned in line 
of duty unless the evidence of record discloses that forcible detainment 
or internment was the proximate result of the serviceperson's own 
willful misconduct.
    (5) Hostile force. The term hostile force means any entity other 
than an enemy or foreign government or the agents of either whose 
actions are taken to further or enhance anti-American military, 
political or economic objectives or views, or to attempt to embarrass 
the United States.


(Authority: 38 U.S.C. 101(32))

    (z) Nursing home means
    (1) Any extended care facility which is licensed by a State to 
provide skilled or intermediate-level nursing care,
    (2) A nursing home care unit in a State veterans' home which is 
approved for payment under 38 U.S.C. 1742, or
    (3) A Department of Veterans Affairs Nursing Home Care Unit.
    (aa) Fraud:
    (1) As used in 38 U.S.C. 103 and implementing regulations, fraud 
means an intentional misrepresentation of fact, or the intentional 
failure to disclose pertinent facts, for the purpose of obtaining, or 
assisting an individual to obtain an annulment or divorce, with 
knowledge that the misrepresentation or failure to disclose may result 
in the erroneous granting of an annulment or divorce; and


(Authority: 38 U.S.C. 501)

    (2) As used in 38 U.S.C. 110 and 1159 and implementing regulations, 
fraud means an intentional misrepresentation of fact, or the intentional 
failure

[[Page 157]]

to disclose pertinent facts, for the purpose of obtaining or retaining, 
or assisting an individual to obtain or retain, eligibility for 
Department of Veterans Affairs benefits, with knowledge that the 
misrepresentation or failure to disclose may result in the erroneous 
award or retention of such benefits.

(Authority: 38 U.S.C. 501)

    Cross References: Pension. See Sec.  3.3. Compensation. See Sec.  
3.4. Dependency and indemnity compensation. See Sec.  3.5. Preservation 
of disability ratings. See Sec.  3.951. Service-connection. See Sec.  
3.957.

[26 FR 1563, Feb. 24, 1961]

    Editorial Note: For Federal Register citations affecting Sec.  3.1, 
see the List of CFR Sections Affected, which appears in the Finding Aids 
section of the printed volume and at www.govinfo.gov.



Sec.  3.2  Periods of war.

    This section sets forth the beginning and ending dates of each war 
period beginning with the Indian wars. Note that the term period of war 
in reference to pension entitlement under 38 U.S.C. 1521, 1541 and 1542 
means all of the war periods listed in this section except the Indian 
wars and the Spanish-American War. See Sec.  3.3(a)(3) and (b)(4)(i).
    (a) Indian wars. January 1, 1817, through December 31, 1898, 
inclusive. Service must have been rendered with the United States 
military forces against Indian tribes or nations.
    (b) Spanish-American War. April 21, 1898, through July 4, 1902, 
inclusive. If the veteran served with the United States military forces 
engaged in hostilities in the Moro Province, the ending date is July 15, 
1903. The Philippine Insurrection and the Boxer Rebellion are included.
    (c) World War I. April 6, 1917, through November 11, 1918, 
inclusive. If the veteran served with the United States military forces 
in Russia, the ending date is April 1, 1920. Service after November 11, 
1918 and before July 2, 1921 is considered World War I service if the 
veteran served in the active military, naval, or air service after April 
5, 1917 and before November 12, 1918.
    (d) World War II. December 7, 1941, through December 31, 1946, 
inclusive. If the veteran was in service on December 31, 1946, 
continuous service before July 26, 1947, is considered World War II 
service.
    (e) Korean conflict. June 27, 1950, through January 31, 1955, 
inclusive.
    (f) Vietnam era. The period beginning on February 28, 1961, and 
ending on May 7, 1975, inclusive, in the case of a veteran who served in 
the Republic of Vietnam during that period. The period beginning on 
August 5, 1964, and ending on May 7, 1975, inclusive, in all other 
cases.


(Authority: 38 U.S.C. 101(29))

    (g) Future dates. The period beginning on the date of any future 
declaration of war by the Congress and ending on a date prescribed by 
Presidential proclamation or concurrent resolution of the Congress.


(Authority: 38 U.S.C. 101)

    (h) Mexican border period. May 9, 1916, through April 5, 1917, in 
the case of a veteran who during such period served in Mexico, on the 
borders thereof, or in the waters adjacent thereto.


(Authority: 38 U.S.C. 101(30))

    (i) Persian Gulf War. August 2, 1990, through date to be prescribed 
by Presidential proclamation or law.

(Authority: 38 U.S.C. 101(33))

[26 FR 1563, Feb. 24, 1961, as amended at 32 FR 13223, Sept. 19, 1967; 
36 FR 8445, May 6, 1971; 37 FR 6676, Apr. 1, 1972; 40 FR 27030, June 26, 
1975; 44 FR 45931, Aug. 6, 1979; 56 FR 57986, Nov. 15, 1991; 62 FR 
35422, July 1, 1997]



Sec.  3.3  Pension.

    (a) Pension for veterans--(1) Service pension; Spanish-American War. 
A benefit payable monthly by the Department of Veterans Affairs because 
of service in the Spanish-American War. Basic entitlement exists if a 
veteran:
    (i) Had 70 (or 90) days or more active service during the Spanish-
American War; or
    (ii) Was discharged or released from such service for a disability 
adjudged service connected without benefit of presumptive provisions of 
law, or at the time of discharge had such a service-connected 
disability, shown by official service records, which in medical

[[Page 158]]

judgment would have justified a discharge for disability.


(Authority: 38 U.S.C. 1512)

    (2) Section 306 pension. A benefit payable monthly by the Department 
of Veterans Affairs because of nonservice-connected disability or age. 
Basic entitlement exists if a veteran:
    (i) Served 90 days or more in either the Mexican border period, 
World War I, World War II, the Korean conflict, or the Vietnam era, or 
served an aggregate of 90 days or more in separate periods of service 
during the same or during different war periods, including service 
during the Spanish-American War (Pub. L. 87-101, 75 Stat. 218; Pub. L. 
90-77, 81 Stat. 178; Pub. L. 92-198, 85 Stat. 663); or
    (ii) Served continuously for a period of 90 consecutive days or more 
and such period ended during the Mexican border period or World War I, 
or began or ended during World War II, the Korean conflict or the 
Vietnam era (Pub. L. 87-101, 75 Stat. 218; Pub. L. 88-664, 78 Stat. 
1094; Pub. L. 90-77, 81 Stat. 178; Pub. L. 91-588, 84 Stat. 1580; Pub. 
L. 92-198, 85 Stat. 663; Pub. L. 94-169, 89 Stat. 1013; Pub. L. 95-204, 
91 Stat. 1455); or
    (iii) Was discharged or released from such wartime service, before 
having served 90 days, for a disability adjudged service connected 
without the benefit of presumptive provisions of law, or at the time of 
discharge had such a service-connected disability, shown by official 
service records, which in medical judgment would have justified a 
discharge for disability; and
    (iv) Is permanently and totally disabled (a) from nonservice-
connected disability not due to the veteran's own willful misconduct or 
vicious habits, or (b) by reason of having attained the age of 65 years 
or by reason of having become unemployable after age 65; and
    (v)(a) Is in receipt of section 306 pension or (b) has an 
application for pension pending on December 31, 1978, or (c) meets the 
age or disability requirements for such pension on December 31, 1978, 
and files a claim within 1 year of that date and also within 1 year 
after meeting the age or disability requirements.
    (vi) Meets the income and net worth requirements of 38 U.S.C. 1521 
and 1522 as in effect on December 31, 1978, and all other provisions of 
title 38, United States Code, in effect on December 31, 1978, applicable 
to section 306 pension.

    Note: The pension provisions of title 38 U.S.C., as in effect on 
December 31, 1978, are available in any VA regional office.

    (3) Improved pension; Pub. L. 95-588 (92 Stat. 2497). A benefit 
payable by the Department of Veterans Affairs to veterans of a period or 
periods of war because of nonservice-connected disability or age. The 
qualifying periods of war for this benefit are the Mexican border 
period, World War I, World War II, the Korean conflict, the Vietnam era 
and the Persian Gulf War. Payments are made monthly unless the amount of 
the annual benefit is less than 4 percent of the maximum annual rate 
payable to a veteran under 38 U.S.C. 1521(b), in which case payments may 
be made less frequently than monthly. Basic entitlement exists if a 
veteran:
    (i) Served in the active military, naval or air service for 90 days 
or more during a period of war (38 U.S.C. 1521(j)); or
    (ii) Served in the active military, naval or air service during a 
period of war and was discharged or released from such service for a 
disability adjudged service-connected without presumptive provisions of 
law, or at time of discharge had such a service-connected disability, 
shown by official service records, which in medical judgment would have 
justified a discharge for disability (38 U.S.C. 1521(j)); or
    (iii) Served in the active military, naval or air service for a 
period of 90 consecutive days or more and such period began or ended 
during a period of war (38 U.S.C. 1521(j)); or
    (iv) Served in the active military, naval or air service for an 
aggregate of 90 days or more in two or more separate periods of service 
during more than one period of war (38 U.S.C. 1521(j)); and
    (v) Meets the net worth requirements under Sec.  3.274 and does not 
have an annual income in excess of the applicable maximum annual pension 
rate specified in Sec.  3.23; and
    (vi)(A) Is age 65 or older; or

[[Page 159]]

    (B) Is permanently and totally disabled from nonservice-connected 
disability not due to the veteran's own willfull misconduct. For 
purposes of this paragraph, a veteran is considered permanently and 
totally disabled if the veteran is any of the following:
    (1) A patient in a nursing home for long-term care because of 
disability; or
    (2) Disabled, as determined by the Commissioner of Social Security 
for purposes of any benefits administered by the Commissioner; or
    (3) Unemployable as a result of disability reasonably certain to 
continue throughout the life of the person; or
    (4) Suffering from:
    (i) Any disability which is sufficient to render it impossible for 
the average person to follow a substantially gainful occupation, but 
only if it is reasonably certain that such disability will continue 
throughout the life of the person; or
    (ii) Any disease or disorder determined by VA to be of such a nature 
or extent as to justify a determination that persons suffering from that 
disease or disorder are permanently and totally disabled.


(Authority: 38 U.S.C. 1502(a), 1513, 1521, 1522)

    (b) Pension for survivors--(1) Indian war death pension. A monthly 
benefit payable by the Department of Veterans Affairs to the surviving 
spouse or child of a deceased veteran of an Indian war. Basic 
entitlement exists if a veteran had qualifying service as specified in 
38 U.S.C. 1511. Indian war death pension rates are set forth in 38 
U.S.C. 1534 and 1535.
    (2) Spanish-American War death pension. A monthly benefit payable by 
the Department of Veterans Affairs to the surviving spouse or child of a 
deceased veteran of the Spanish-American War, if the veteran:
    (i) Had 90 days or more active service during the Spanish-American 
War; or
    (ii) Was discharged or released from such service for a disability 
service-connected without benefit of presumptive provisions of law, or 
at time of discharge had such a service-connected disability, as shown 
by official service records, which in medical judgment would have 
justified a discharge for disability.


(Authority: 38 U.S.C. 1536, 1537)

    (3) Section 306 death pension. A monthly benefit payable by the 
Department of Veterans Affairs to a surviving spouse or child because of 
a veteran's nonservice-connected death. Basic entitlement exists if:
    (i) The veteran (as defined in Sec.  3.1(d) and (d)(2)) had 
qualifying service as specified in paragraph (a)(2)(i), (ii), or (iii) 
of this section; or
    (ii) The veteran was, at time of death, receiving or entitled to 
receive compensation or retired pay for service-connected disability 
based on wartime service; and
    (iii) The surviving spouse or child (A) was in receipt of section 
306 pension on December 31, 1978, or (B) had a claim for pension pending 
on that date, or (C) filed a claim for pension after that date but 
within 1 year after the veteran's death, if the veteran died before 
January 1, 1979; and
    (iv) The surviving spouse or child meets the income and net worth 
requirements of 38 U.S.C. 1541, 1542 or 1543 as in effect on December 
31, 1978, and all other provisions of title 38, United States Code in 
effect on December 31, 1978, applicable to section 306 pension.

    Note: The pension provisions of title 38, United States Code, as in 
effect on December 31, 1978, are available in any VA regional office.)

    (4) Improved death pension, Public Law 95-588. A benefit payable by 
the Department of Veterans Affairs to a veteran's surviving spouse or 
child because of the veteran's nonservice-connected death. Payments are 
made monthly unless the amount of the annual benefit is less than 4 
percent of the maximum annual rate payable to a veteran under 38 U.S.C. 
1521(b), in which case payments may be made less frequently than 
monthly. Basic entitlement exists if:
    (i) The veteran (as defined in Sec.  3.1(d) and (d)(2)) had 
qualifying service as specified in paragraph (a)(3)(i), (ii), (iii), or 
(iv) of this section (38 U.S.C. 1541(a)); or
    (ii) The veteran was, at time of death, receiving or entitled to 
receive

[[Page 160]]

compensation or retired pay for a service-connected disability based on 
service during a period of war. (The qualifying periods of war are 
specified in paragraph (a)(3) of this section.) (38 U.S.C. 1541(a)); and
    (iii) The surviving spouse or child meets the net worth requirements 
of Sec.  3.274 and has an annual income not in excess of the applicable 
maximum annual pension rate specified in Sec. Sec.  3.23 and 3.24.

(Authority: 38 U.S.C. 1541 and 1542)

    Cross References: Section 306 pension. See Sec.  3.1(u). Improved 
pension. See Sec.  3.1(w). Improved pension rates. See Sec.  3.23. 
Improved pension rates; surviving children. See Sec.  3.24. Frequency of 
payment of improved pension. See Sec.  3.30. Relationship of net worth 
to pension entitlement. See Sec.  3.274.

[44 FR 45931, Aug. 6, 1979, as amended at 56 FR 19579, Apr. 29, 1991; 56 
FR 22910, May 17, 1991; 56 FR 25044, June 3, 1991; 56 FR 57986, Nov. 15, 
1991; 68 FR 34541, June 10, 2003]



Sec.  3.4  Compensation.

    (a) Compensation. This term means a monthly payment made by the 
Department of Veterans Affairs to a veteran because of service-connected 
disability, or to a surviving spouse, child, or parent of a veteran 
because of the service-connected death of the veteran occurring before 
January 1, 1957, or under the circumstances outlined in paragraph (c)(2) 
of this section. If the veteran was discharged or released from service, 
the discharge or release must have been under conditions other than 
dishonorable.


(Authority: 38 U.S.C. 101(2), (13))

    (b) Disability compensation. (1) Basic entitlement for a veteran 
exists if the veteran is disabled as the result of a personal injury or 
disease (including aggravation of a condition existing prior to service) 
while in active service if the injury or the disease was incurred or 
aggravated in line of duty.


(Authority: 38 U.S.C. 1110, 1131)

    (2) An additional amount of compensation may be payable for a 
spouse, child, and/or dependent parent where a veteran is entitled to 
compensation based on disability evaluated as 30 per centum or more 
disabling.


(Authority: 38 U.S.C. 1115)

    (c) Death compensation. Basic entitlement exists for a surviving 
spouse, child or children, and dependent parent or parents if:
    (1) The veteran died before January 1, 1957; or
    (2) The veteran died on or after May 1, 1957, and before January 1, 
1972, if at the time of death a policy of United States Government Life 
Insurance or National Service Life Insurance was in effect under waiver 
of premiums under 38 U.S.C. 1924 unless the waiver was granted under the 
first proviso of section 622(a) of the National Service Life Insurance 
Act of 1940, and the veteran died before return to military jurisdiction 
or within 120 days thereafter. (See Sec.  3.5(d) as to Public Health 
Service.)

(Authority: 38 U.S.C. 1121, 1141)

[26 FR 1564, Feb. 24, 1961, as amended at 38 FR 21923, Aug. 14, 1973; 39 
FR 34529, Sept. 26, 1974; 44 FR 22717, Apr. 17, 1979]



Sec.  3.5  Dependency and indemnity compensation.

    (a) Dependency and indemnity compensation. This term means a monthly 
payment made by the Department of Veterans Affairs to a surviving 
spouse, child, or parent:
    (1) Because of a service-connected death occurring after December 
31, 1956, or
    (2) Pursuant to the election of a surviving spouse, child, or 
parent, in the case of such a death occurring before January 1, 1957.


(Authority: 38 U.S.C. 101 (14))

    (b) Entitlement. Basic entitlement for a surviving spouse, child or 
children, and parent or parents of a veteran exists, if:
    (1) Death occurred on or after January 1, 1957, except in the 
situation specified in Sec.  3.4(c)(2); or
    (2) Death occurred prior to January 1, 1957, and the claimant was 
receiving or eligible to receive death compensation on December 31, 1956 
(or, as to a parent, would have been eligible except for income), under 
laws in effect on that date or who subsequently becomes

[[Page 161]]

eligible by reason of a death which occurred prior to January 1, 1957; 
or
    (3) Death occurred on or after May 1, 1957, and before January 1, 
1972, and the claimant had been ineligible to receive dependency and 
indemnity compensation because of the exception in subparagraph (1) of 
this paragraph. In such case dependency and indemnity compensation is 
payable upon election.


(38 U.S.C. 1310, 1316, 1317, Public Law 92-197, 85 Stat. 660)

    (c) Exclusiveness of remedy. No person eligible for dependency and 
indemnity compensation by reason of a death occurring on or after 
January 1, 1957, shall be eligible by reason of such death for death 
pension or compensation under any other law administered by the 
Department of Veterans Affairs, except that, effective November 2, 1994, 
a surviving spouse who is receiving dependency and indemnity 
compensation may elect to receive death pension instead of such 
compensation.


(Authority: 38 U.S.C. 1317)

    (d) Group life insurance. No dependency and indemnity compensation 
or death compensation shall be paid to any surviving spouse, child or 
parent based on the death of a commissioned officer of the Public Health 
Service, the Coast and Geodetic Survey, the Environmental Science 
Services Administration, or the National Oceanic and Atmospheric 
Administration occuring on or after May 1, 1957, if any amounts are 
payable under the Federal Employees' Group Life Insurance Act of 1954 
(Pub. L. 598, 83d Cong., as amended) based on the same death.


(Authority: Sec. 501(c)(2), Pub. L. 881, 84th Cong. (70 Stat. 857), as 
amended by Sec. 13(u), Pub. L. 85-857; (72 Stat. 1266); Sec. 5, Pub. L. 
91-621 (84 Stat. 1863))

[29 FR 10396, July 25, 1964, as amended at 35 FR 18661, Dec. 9, 1970; 37 
FR 6676, Apr. 1, 1972; 39 FR 34529, Sept. 26, 1974; 44 FR 22717, Apr. 
17, 1979; 58 FR 25561, Apr. 27, 1993; 58 FR 27622, May 10, 1993; 60 FR 
18355, Apr. 11, 1995; 70 FR 72220, Dec. 2, 2005; 73 FR 23356, Apr. 30, 
2008]



Sec.  3.6  Duty periods.

    (a) Active military, naval, and air service. This includes active 
duty, any period of active duty for training during which the individual 
concerned was disabled or died from a disease or injury incurred or 
aggravated in line of duty, and any period of inactive duty training 
during which the individual concerned was disabled or died from an 
injury incurred or aggravated in line of duty or from an acute 
myocardial infarction, a cardiac arrest, or a cerebrovascular accident 
which occurred during such training.


(Authority: 38 U.S.C. 101(24))

    (b) Active duty. This means:
    (1) Full-time duty in the Armed Forces, other than active duty for 
training;
    (2) Full-time duty (other than for training purposes) as a 
commissioned officer of the Regular or Reserve Corps of the Public 
Health Service:
    (i) On or after July 29, 1945, or
    (ii) Before that date under circumstances affording entitlement to 
full military benefits, or
    (iii) At any time, for the purposes of dependency and indemnity 
compensation.
    (3) Full-time duty as a commissioned officer of the Coast and 
Geodetic Survey or of its successor agencies, the Environmental Science 
Services Administration and the National Oceanic and Atmospheric 
Administration:
    (i) On or after July 29, 1945, or
    (ii) Before that date:
    (a) While on transfer to one of the Armed Forces, or
    (b) While, in time of war or national emergency declared by the 
President, assigned to duty on a project for one of the Armed Forces in 
an area determined by the Secretary of Defense to be of immediate 
military hazard, or
    (c) In the Philippine Islands on December 7, 1941, and continuously 
in such islands thereafter, or
    (iii) At any time, for the purposes of dependency and indemnity 
compensation.
    (4) Service at any time as a cadet at the United States Military, 
Air Force, or Coast Guard Academy, or as a midshipman at the United 
States Naval Academy;
    (5) Attendance at the preparatory schools of the United States Air 
Force Academy, the United States Military Academy, or the United States 
Naval

[[Page 162]]

Academy for enlisted active-duty members who are reassigned to a 
preparatory school without a release from active duty, and for other 
individuals who have a commitment to active duty in the Armed Forces 
that would be binding upon disenrollment from the preparatory school;
    (6) Authorized travel to or from such duty or service; and
    (7) A person discharged or released from a period of active duty, 
shall be deemed to have continued on active duty during the period of 
time immediately following the date of such discharge or release from 
such duty determined by the Secretary concerned to have been required 
for him or her to proceed to his or her home by the most direct route, 
and, in all instances, until midnight of the date of such discharge or 
release.


(Authority: 38 U.S.C. 106(c))

    (c) Active duty for training. (1) Full-time duty in the Armed Forces 
performed by Reserves for training purposes;
    (2) Full-time duty for training purposes performed as a commissioned 
officer of the Reserve Corps of the Public Health Service:
    (i) On or after July 29, 1945, or
    (ii) Before that date under circumstances affording entitlement to 
full military benefits, or
    (iii) At any time, for the purposes of dependency and indemnity 
compensation:
    (3) Full-time duty performed by members of the National Guard of any 
State, under 32 U.S.C. 316, 502, 503, 504, or 505, or the prior 
corresponding provisions of law or full-time duty by such members while 
participating in the reenactment of the Battle of First Manassas in July 
1961;
    (4) Duty performed by a member of a Senior Reserve Officers' 
Training Corps program when ordered to such duty for the purpose of 
training or a practice cruise under chapter 103 of title 10 U.S.C.
    (i) The requirements of this paragraph are effective--
    (A) On or after October 1, 1982, with respect to deaths and 
disabilities resulting from diseases or injuries incurred or aggravated 
after September 30, 1982, and
    (B) October 1, 1983, with respect to deaths and disabilities 
resulting from diseases or injuries incurred or aggravated before 
October 1, 1982.
    (ii) Effective on or after October 1, 1988, such duty must be 
prerequisite to the member being commissioned and must be for a period 
of at least four continuous weeks.


(Authority: 38 U.S.C. 101(22)(D) as amended by Pub. L. 100-456)

    (5) Attendance at the preparatory schools of the United States Air 
Force Academy, the United States Military Academy, or the United States 
Naval Academy by an individual who enters the preparatory school 
directly from the Reserves, National Guard or civilian life, unless the 
individual has a commitment to service on active duty which would be 
binding upon disenrollment from the preparatory school.
    (6) Authorized travel to or from such duty.


(Authority: 38 U.S.C. 101(22))


The term does not include duty performed as a temporary member of the 
Coast Guard Reserve.
    (d) Inactive duty training. This means: (1) Duty (other than full-
time duty) prescribed for Reserves (including commissioned officers of 
the Reserve Corps of the Public Health Service) by the Secretary 
concerned under 37 U.S.C. 206 or any other provision of law;
    (2) Special additional duties authorized for Reserves (including 
commissioned officers of the Reserve Corps of the Public Health Service) 
by an authority designated by the Secretary concerned and performed by 
them on a voluntary basis in connection with the prescribed training or 
maintenance activities of the units to which they are assigned; and
    (3) Training (other than active duty for training) by a member of, 
or applicant for membership (as defined in 5 U.S.C. 8140(g)) in, the 
Senior Reserve Officers' Training Corps prescribed under chapter 103 of 
title 10 U.S.C.
    (4) Duty (other than full-time duty) performed by a member of the 
National

[[Page 163]]

Guard of any State, under 32 U.S.C. 316, 502, 503, 504, or 505, or the 
prior corresponding provisions of law. The term inactive duty training 
does not include:
    (i) Work or study performed in connection with correspondence 
courses,
    (ii) Attendance at an educational institution in an inactive status, 
or
    (iii) Duty performed as a temporary member of the Coast Guard 
Reserve.


(Authority: 38 U.S.C. 101(23))

    (e) Travel status--training duty (disability or death from injury or 
covered disease). Any individual:
    (1) Who, when authorized or required by competent authority, assumes 
an obligation to perform active duty for training or inactive duty 
training; and
    (2) Who is disabled or dies from an injury or covered disease 
incurred while proceeding directly to or returning directly from such 
active duty for training or inactive duty training shall be deemed to 
have been on active duty for training or inactive duty training, as the 
case may be. The Department of Veterans Affairs will determine whether 
such individual was so authorized or required to perform such duty, and 
whether the individual was disabled or died from an injury or covered 
disease so incurred. In making such determinations, there shall be taken 
into consideration the hour on which the individual began to proceed or 
return; the hour on which the individual was scheduled to arrive for, or 
on which the individual ceased to perform, such duty; the method of 
travel performed; the itinerary; the manner in which the travel was 
performed; and the immediate cause of disability or death. Whenever any 
claim is filed alleging that the claimant is entitled to benefits by 
reason of this paragraph, the burden of proof shall be on the claimant.
    (3) For purposes of this section, the term covered disease means any 
of the following:
    (i) An acute myocardial infarction.
    (ii) A cardiac arrest.
    (iii) A cerebrovascular accident.

(Authority: 38 U.S.C. 106(d))

[26 FR 1564, Feb. 24, 1961, as amended at 26 FR 6767, July 28, 1961; 27 
FR 4023, Apr. 27, 1962; 29 FR 14171, Oct. 15, 1964; 36 FR 5341, Mar. 20, 
1971; 41 FR 26881, June 29, 1976; 49 FR 47003, Nov. 30, 1984; 54 FR 
51200, Dec. 13, 1989; 55 FR 23931, June 13, 1990; 60 FR 57179, Nov. 14, 
1995; 61 FR 11731, Mar. 22, 1996; 66 FR 48560, Sept. 21, 2001; 67 FR 
49585, July 31, 2002]



Sec.  3.7  Individuals and groups considered to have performed active
military, naval, or air service.

    The following individuals and groups are considered to have 
performed active military, naval, or air service:
    (a) Aerial transportation of mail (Pub. L. 140, 73d Congress). 
Persons who were injured or died while serving under conditions set 
forth in Pub. L. 140, 73d Congress.
    (b) Aliens. Effective July 28, 1959, a veteran discharged for 
alienage during a period of hostilities unless evidence affirmatively 
shows he or she was discharged at his or her own request. A veteran who 
was discharged for alienage after a period of hostilities and whose 
service was honest and faithful is not barred from benefits if he or she 
is otherwise entitled. A discharge changed prior to January 7, 1957, to 
honorable by a board established under authority of section 301, Pub. L. 
346, 78th Congress, as amended, or section 207, Pub. L. 601, 79th 
Congress, as amended (now 10 U.S.C. 1552 and 1553), will be considered 
as evidence that the discharge was not at the alien's request. (See 
Sec.  3.12.)


(Authority: 38 U.S.C. 5303(c))

    (c) Army field clerks. Included as enlisted men.
    (d) Army Nurse Corps, Navy Nurse Corps, and female dietetic and 
physical therapy personnel. (1) Army and Navy nurses (female) on active 
service under order of the service department.
    (2) Dietetic and physical therapy (female) personnel, excluding 
students and apprentices, appointed with relative rank on or after 
December 22, 1942, or commissioned on or after June 22, 1944.
    (e) Aviation camps. Students who were enlisted men during World War 
I.

[[Page 164]]

    (f) Cadets and midshipmen. See Sec.  3.6(b)(4).
    (g) Coast and Geodetic Survey, and its successor agencies, the 
Environmental Science Services Administration and the National Oceanic 
and Atmospheric Administration. See Sec.  3.6(b)(3).
    (h) Coast Guard. Active service in Coast Guard on or after January 
29, 1915, while under jurisdiction of the Treasury Department, Navy 
Department, or the Department of Transportation. (See Sec.  3.6 (c) and 
(d) as to temporary members of the Coast Guard Reserves.)
    (i) Contract surgeons. For compensation and dependency and indemnity 
compensation, if the disability or death was the result of disease or 
injury contracted in line of duty during a war period while actually 
performing the duties of assistant surgeon or acting assistant surgeon 
with any military force in the field, or in transit or in hospital.
    (j) Field clerks, Quartermaster Corps. Included as enlisted men.
    (k) Lighthouse service personnel. Transferred to the service and 
jurisdiction of War or Navy Departments by Executive order under the Act 
of August 29, 1916. Effective July 1, 1939, service was consolidated 
with the Coast Guard.
    (l) Male nurses. Persons who were enlisted men of Medical Corps.
    (m) National Guard. Members of the National Guard of the United 
States and Air National Guard of the United States are included as 
Reserves. See Sec.  3.6 (c) and (d) as to training duty performed by 
members of a State National Guard and paragraph (o) of this section as 
to disability suffered after being called into Federal service and 
before enrollment.
    (n) Persons heretofore having a pensionable or compensable status.


(Authority: 38 U.S.C. 1152, 1504)

    (o) Persons ordered to service. (1) Any person who has:
    (i) Applied for enlistment or enrollment in the active military, 
naval, or air service and who is provisionally accepted and directed, or 
ordered, to report to a place for final acceptance into the service, or
    (ii) Been selected or drafted for such service, and has reported 
according to a call from the person's local draft board and before final 
rejection, or
    (iii) Been called into Federal service as a member of the National 
Guard, but has not been enrolled for Federal service, and
    (iv) Suffered injury or disease in line of duty while going to, or 
coming from, or at such place for final acceptance or entry upon active 
duty,

is considered to have been on active duty and therefore to have incurred 
such disability in active service.
    (2) The injury or disease must be due to some factor relating to 
compliance with proper orders. Draftees and selectees are included when 
reporting for preinduction examination or for final induction on active 
duty. Such persons are not included for injury or disease suffered 
during the period of inactive duty, or period of waiting, after a final 
physical examination and prior to beginning the trip to report for 
induction. Members of the National Guard are included when reporting to 
a designated rendezvous.
    (p) Philippine Scouts and others. See Sec.  3.40.
    (q) Public Health Service. See Sec.  3.6 (a) and (b).
    (r) Reserves. See Sec.  3.6 (a), (b), and (c).
    (s) Revenue Cutter Service. While serving under direction of 
Secretary of the Navy in cooperation with the Navy.
    (t) Training camps. Members of training camps authorized by section 
54 of the National Defense Act, except members of Student Army Training 
Corps Camps at the Presidio of San Francisco, Plattsburg, New York, Fort 
Sheridan, Illinois, Howard University, Washington, D.C., Camp Perry, 
Ohio, and Camp Hancock, Georgia, from July 18, 1918, to September 16, 
1918.
    (u) Women's Army Corps (WAC). Service on or after July 1, 1943.
    (v) Women's Reserve of Navy, Marine Corps, and Coast Guard. Same 
benefits as members of the Officers Reserve Corps or enlisted men of the 
United States Navy, Marine Corps or Coast Guard.
    (w) Russian Railway Service Corps. Service during World War I as 
certified by the Secretary of the Army.
    (x) Active military service certified as such under section 401 of 
Pub. L. 95-202.

[[Page 165]]

Such service if certified by the Secretary of Defense as active military 
service and if a discharge under honorable conditions is issued by the 
Secretary. The effective dates for an award based upon such service 
shall be as provided by Sec.  3.400(z) and 38 U.S.C. 5110, except that 
in no event shall such an award be made effective earlier than November 
23, 1977. Service in the following groups has been certified as active 
military service.
    (1) Women's Air Forces Service Pilots (WASP).
    (2) Signal Corps Female Telephone Operators Unit of World War I.
    (3) Engineer Field Clerks (WWI).
    (4) Women's Army Auxiliary Corps (WAAC).
    (5) Quartermaster Corps Female Clerical Employees serving with the 
AEF (American Expeditionary Forces) in World War I.
    (6) Civilian Employees of Pacific Naval Air Bases Who Actively 
Participated in Defense of Wake Island During World War II.
    (7) Reconstruction Aides and Dietitians in World War I.
    (8) Male Civilian Ferry Pilots.
    (9) Wake Island Defenders from Guam.
    (10) Civilian Personnel Assigned to the Secret Intelligence Element 
of the OSS.
    (11) Guam Combat Patrol.
    (12) Quartermaster Corps Keswick Crew on Corregidor (WWII).
    (13) U.S. Civilian Volunteers Who Actively Participated in the 
Defense of Bataan.
    (14) United States Merchant Seamen Who Served on Blockships in 
Support of Operation Mulberry.
    (15) American Merchant Marine in Oceangoing Service during the 
Period of Armed Conflict, December 7, 1941, to August 15, 1945.
    (16) Civilian Navy IFF Technicians Who Served in the Combat Areas of 
the Pacific during World War II (December 7, 1941 to August 15, 1945). 
As used in the official name of this group, the acronym IFF stands for 
Identification Friend or Foe.
    (17) U.S. Civilians of the American Field Service (AFS) Who Served 
Overseas Operationally in World War I during the Period August 31, 1917 
to January 1, 1918.
    (18) U.S. Civilians of the American Field Service (AFS) Who Served 
Overseas Under U.S. Armies and U.S. Army Groups in World War II during 
the Period December 7, 1941 through May 8, 1945.
    (19) U.S. Civilian Employees of American Airlines Who Served 
Overseas as a Result of American Airlines' Contract with the Air 
Transport Command During the Period December 14, 1941 through August 14, 
1945.
    (20) Civilian Crewmen of United States Coast and Geodetic Survey 
(USCGS) Vessels Who Performed Their Service in Areas of Immediate 
Military Hazard While Conducting Cooperative Operations with and for the 
United States Armed Forces Within a Time Frame of December 7, 1941, to 
August 15, 1945 on a qualifying USCGS vessel. Qualifying USCGS vessels 
are the Derickson, Explorer, Gilbert, Hilgard, E. Lester Jones, Lydonia, 
Patton, Surveyor, Wainwright, Westdahl, Oceanographer, Hydrographer, and 
Pathfinder.
    (21) Honorably Discharged Members of the American Volunteer Group 
(Flying Tigers) Who Served During the Period December 7, 1941 to July 
18, 1942.
    (22) U.S. Civilian Flight Crew and Aviation Ground Support Employees 
of United Air Lines (UAL), Who Served Overseas as a Result of UAL's 
Contract With the Air Transport Command During the Period December 14, 
1941, through August 14, 1945.
    (23) U.S. Civilian Flight Crew and Aviation Ground Support Employees 
of Transcontinental and Western Air (TWA), Inc., Who Served Overseas as 
a Result of TWA's Contract with the Air Transport Command During the 
Period December 14, 1941, through August 14, 1945. The ``Flight Crew'' 
includes pursers.
    (24) U.S. Civilian Flight Crew and Aviation Ground Support Employees 
of Consolidated Vultree Aircraft Corporation (Consairway Division) Who 
Served Overseas as a Result of a Contract With the Air Transport Command 
During the Period December 14, 1941, through August 14, 1945.
    (25) U.S. Civilian Flight Crew and Aviation Ground Support Employees 
of Pan American World Airways and Its

[[Page 166]]

Subsidiaries and Affiliates, Who Served Overseas as a Result of Pan 
American's Contract With the Air Transport Command and Naval Air 
Transport Service During the Period December 14, 1941 through August 14, 
1945.
    (26) Honorably Discharged Members of the American Volunteer Guard, 
Eritrea Service Command During the Period June 21, 1942 to March 31, 
1943.
    (27) U.S. Civilian Flight Crew and Aviation Ground Support Employees 
of Northwest Airlines, Who Served Overseas as a Result of Northwest 
Airline's Contract with the Air Transport Command during the Period 
December 14, 1941 through August 14, 1945.
    (28) U.S. Civilian Female Employees of the U.S. Army Nurse Corps 
While Serving in the Defense of Bataan and Corregidor During the Period 
January 2, 1942 to February 3, 1945.
    (29) U.S. Flight Crew and Aviation Ground Support Employees of 
Northeast Airlines Atlantic Division, Who Served Overseas as a Result of 
Northeast Airlines' Contract With the Air Transport Command During the 
Period December 7, 1941, Through August 14, 1945.
    (30) U.S. Civilian Flight Crew and Aviation Ground Support Employees 
of Braniff Airways, Who Served Overseas in the North Atlantic or Under 
the Jurisdiction of the North Atlantic Wing, Air Transport Command 
(ATC), as a Result of a Contract With the ATC During the Period February 
26, 1942, Through August 14, 1945.
    (31) The approximately 50 Chamorro and Carolinian former native 
policemen who received military training in the Donnal area of central 
Saipan and were placed under the command of Lt. Casino of the 6th 
Provisional Military Police Battalion to accompany United States Marines 
on active, combat-patrol activity from August 19, 1945, to September 2, 
1945.
    (32) Three scouts/guides, Miguel Tenorio, Penedicto Taisacan, and 
Cristino Dela Cruz, who assisted the United States Marines in the 
offensive operations against the Japanese on the Northern Mariana 
Islands from June 19, 1944, through September 2, 1945.
    (33) The Operational Analysis Group of the Office of Scientific 
Research and Development, Office of Emergency Management, which served 
overseas with the U.S. Army Air Corps from December 7, 1941, through 
August 15, 1945.


(Authority: Sec. 401, Pub. L. 95-202, 91 Stat. 1449)

    (y) Alaska Territorial Guard: Members of the Alaska Territorial 
Guard during World War II who were honorably discharged from such 
service as determined by the Secretary of Defense.

(Authority: 38 U.S.C. 106(f))

    Cross Reference: Office of Workers' Compensation Programs. See Sec.  
3.708.

[26 FR 1565, Feb. 24, 1961]

    Editorial Note: For Federal Register citations affecting Sec.  3.7, 
see the List of CFR Sections Affected, which appears in the Finding Aids 
section of the printed volume and at www.govinfo.gov.



Sec.  3.10  Dependency and indemnity compensation rate for a surviving
spouse.

    (a) General determination of rate. When VA grants a surviving spouse 
entitlement to DIC, VA will determine the rate of the benefit it will 
award. The rate of the benefit will be the total of the basic monthly 
rate specified in paragraph (b) or (d) of this section and any 
applicable increases specified in paragraph (c) or (e) of this section.
    (b) Basic monthly rate. Except as provided in paragraph (d) of this 
section, the basic monthly rate of DIC for a surviving spouse will be 
the amount set forth in 38 U.S.C. 1311(a)(1).
    (c) Section 1311(a)(2) increase. The basic monthly rate under 
paragraph (b) of this section shall be increased by the amount specified 
in 38 U.S.C. 1311(a)(2) if the veteran, at the time of death, was 
receiving, or was entitled to receive, compensation for service-
connected disability that was rated by VA as totally disabling for a 
continuous period of at least eight years immediately preceding death. 
Determinations of entitlement to this increase shall be made in 
accordance with paragraph (f) of this section.
    (d) Alternative basic monthly rate for death occurring prior to 
January 1, 1993. The basic monthly rate of DIC for a surviving spouse 
when the death of the veteran occurred prior to January 1, 1993, will be 
the amount specified in 38

[[Page 167]]

U.S.C. 1311(a)(3) corresponding to the veteran's pay grade in service, 
but only if such rate is greater than the total of the basic monthly 
rate and the section 1311(a)(2) increase (if applicable) the surviving 
spouse is entitled to receive under paragraphs (b) and (c) of this 
section. The Secretary of the concerned service department will certify 
the veteran's pay grade and the certification will be binding on VA. DIC 
paid pursuant to this paragraph may not be increased by the section 
1311(a)(2) increase under paragraph (c) of this section.
    (e) Additional increases. One or more of the following increases may 
be paid in addition to the basic monthly rate and the section 1311(a)(2) 
increase.
    (1) Increase for children. If the surviving spouse has one or more 
children under the age of 18 of the deceased veteran (including a child 
not in the surviving spouse's actual or constructive custody, or a child 
who is in active military service), the monthly DIC rate will be 
increased by the amount set forth in 38 U.S.C. 1311(b) for each child.
    (2) Increase for regular aid and attendance. If the surviving spouse 
is determined to be in need of regular aid and attendance under the 
criteria in Sec.  3.352 or is a patient in a nursing home, the monthly 
DIC rate will be increased by the amount set forth in 38 U.S.C. 1311(c).
    (3) Increase for housebound status. If the surviving spouse does not 
qualify for the regular aid and attendance allowance but is housebound 
under the criteria in Sec.  3.351(e), the monthly DIC rate will be 
increased by the amount set forth in 38 U.S.C. 1311(d).
    (4) For a two-year period beginning on the date entitlement to 
dependency and indemnity compensation commenced, the dependency and 
indemnity compensation paid monthly to a surviving spouse with one or 
more children below the age of 18 shall be increased by the amount set 
forth in 38 U.S.C. 1311(f), regardless of the number of such children. 
The dependency and indemnity compensation payable under this paragraph 
is in addition to any other dependency and indemnity compensation 
payable. The increase in dependency and indemnity compensation of a 
surviving spouse under this paragraph shall cease beginning with the 
first month commencing after the month in which all children of the 
surviving spouse have attained the age of 18.
    (f) Criteria governing section 1311(a)(2) increase. In determining 
whether a surviving spouse qualifies for the section 1311(a)(2) increase 
under paragraph (c) of this section, the following standards shall 
apply.
    (1) Marriage requirement. The surviving spouse must have been 
married to the veteran for the entire eight-year period referenced in 
paragraph (c) of this section in order to qualify for the section 
1311(a)(2) increase.
    (2) Determination of total disability. As used in paragraph (c) of 
this section, the phrase ``rated by VA as totally disabling'' includes 
total disability ratings based on unemployability (Sec.  4.16 of this 
chapter).
    (3) Definition of ``entitled to receive''. As used in paragraph (c) 
of this section, the phrase ``entitled to receive'' means that the 
veteran filed a claim for disability compensation during his or her 
lifetime and one of the following circumstances is satisfied:
    (i) The veteran would have received total disability compensation 
for the period specified in paragraph (c) of this section but for clear 
and unmistakable error committed by VA in a decision on a claim filed 
during the veteran's lifetime; or
    (ii) Additional evidence submitted to VA before or after the 
veteran's death, consisting solely of service department records that 
existed at the time of a prior VA decision but were not previously 
considered by VA, provides a basis for reopening a claim finally decided 
during the veteran's lifetime and for awarding a total service-connected 
disability rating retroactively in accordance with Sec. Sec.  3.156(c) 
and 3.400(q)(2) of this part for the period specified in paragraph (c) 
of this section; or
    (iii) At the time of death, the veteran had a service-connected 
disability that was continuously rated totally disabling by VA for the 
period specified in paragraph (c) of this section, but was not receiving 
compensation because:
    (A) VA was paying the compensation to the veteran's dependents;

[[Page 168]]

    (B) VA was withholding the compensation under the authority of 38 
U.S.C. 5314 to offset an indebtedness of the veteran;
    (C) The veteran had not waived retired or retirement pay in order to 
receive compensation;
    (D) VA was withholding payments under the provisions of 10 U.S.C. 
1174(h)(2);
    (E) VA was withholding payments because the veteran's whereabouts 
were unknown, but the veteran was otherwise entitled to continued 
payments based on a total service-connected disability rating; or
    (F) VA was withholding payments under 38 U.S.C. 5308 but determines 
that benefits were payable under 38 U.S.C. 5309.

(Authority: 38 U.S.C. 501(a), 1311, 1314, and 1321)

[70 FR 72220, Dec. 2, 2005, as amended at 71 FR 44918, Aug. 8, 2006; 77 
FR 40525, July 10, 2012; 80 FR 18117, Apr. 3, 2015]



Sec.  3.11  Homicide.

    Any person who has intentionally and wrongfully caused the death of 
another person is not entitled to pension, compensation, or dependency 
and indemnity compensation or increased pension, compensation, or 
dependency and indemnity compensation by reason of such death. For the 
purpose of this section the term dependency and indemnity compensation 
includes benefits at dependency and indemnity compensation rates paid 
under 38 U.S.C. 1318.

[44 FR 22718, Apr. 17, 1979, as amended at 54 FR 31829, Aug. 2, 1989]



Sec.  3.12  Character of discharge.

    (a) If the former service member did not die in service, pension, 
compensation, or dependency and indemnity compensation is not payable 
unless the period of service on which the claim is based was terminated 
by discharge or release under conditions other than dishonorable. (38 
U.S.C. 101(2)). A discharge under honorable conditions is binding on the 
Department of Veterans Affairs as to character of discharge.
    (b) A discharge or release from service under one of the conditions 
specified in this section is a bar to the payment of benefits unless it 
is found that the person was insane at the time of committing the 
offense causing such discharge or release or unless otherwise 
specifically provided (38 U.S.C. 5303(b)).
    (c) Benefits are not payable where the former service member was 
discharged or released under one of the following conditions:
    (1) As a conscientious objector who refused to perform military 
duty, wear the uniform, or comply with lawful order of competent 
military authorities.
    (2) By reason of the sentence of a general court-martial.
    (3) Resignation by an officer for the good of the service.
    (4) As a deserter.
    (5) As an alien during a period of hostilities, where it is 
affirmatively shown that the former service member requested his or her 
release. See Sec.  3.7(b).
    (6) By reason of a discharge under other than honorable conditions 
issued as a result of an absence without official leave (AWOL) for a 
continuous period of at least 180 days. This bar to benefit entitlement 
does not apply if there are compelling circumstances to warrant the 
prolonged unauthorized absence. This bar applies to any person awarded 
an honorable or general discharge prior to October 8, 1977, under one of 
the programs listed in paragraph (h) of this section, and to any person 
who prior to October 8, 1977, had not otherwise established basic 
eligibility to receive Department of Veterans Affairs benefits. The term 
established basic eligibility to receive Department of Veterans Affairs 
benefits means either a Department of Veterans Affairs determination 
that an other than honorable discharge was issued under conditions other 
than dishonorable, or an upgraded honorable or general discharge issued 
prior to October 8, 1977, under criteria other than those prescribed by 
one of the programs listed in paragraph (h) of this section. However, if 
a person was discharged or released by reason of the sentence of a 
general court-martial, only a finding of insanity (paragraph (b) of this 
section) or a decision of a board of correction of records established 
under 10 U.S.C. 1552 can estalish basic eligibility to receive 
Department of Veterans Affairs benefits.

[[Page 169]]

The following factors will be considered in determining whether there 
are compelling circumstances to warrant the prolonged unauthorized 
absence.
    (i) Length and character of service exclusive of the period of 
prolonged AWOL. Service exclusive of the period of prolonged AWOL should 
generally be of such quality and length that it can be characterized as 
honest, faithful and meritorious and of benefit to the Nation.
    (ii) Reasons for going AWOL. Reasons which are entitled to be given 
consideration when offered by the claimant include family emergencies or 
obligations, or similar types of obligations or duties owed to third 
parties. The reasons for going AWOL should be evaluated in terms of the 
person's age, cultural background, educational level and judgmental 
maturity. Consideration should be given to how the situation appeared to 
the person himself or herself, and not how the adjudicator might have 
reacted. Hardship or suffering incurred during overseas service, or as a 
result of combat wounds of other service-incurred or aggravated 
disability, is to be carefully and sympathetically considered in 
evaluating the person's state of mind at the time the prolonged AWOL 
period began.
    (iii) A valid legal defense exists for the absence which would have 
precluded a conviction for AWOL. Compelling circumstances could occur as 
a matter of law if the absence could not validly be charged as, or lead 
to a conviction of, an offense under the Uniform Code of Military 
Justice. For purposes of this paragraph the defense must go directly to 
the substantive issue of absence rather than to procedures, 
technicalities or formalities.
    (d) A discharge or release because of one of the offenses specified 
in this paragraph is considered to have been issued under dishonorable 
conditions.
    (1) Acceptance of an undesirable discharge to escape trial by 
general court-martial.
    (2) Mutiny or spying.
    (3) An offense involving moral turpitude. This includes, generally, 
conviction of a felony.
    (4) Willful and persistent misconduct. This includes a discharge 
under other than honorable conditions, if it is determined that it was 
issued because of willful and persistent misconduct. A discharge because 
of a minor offense will not, however, be considered willful and 
persistent misconduct if service was otherwise honest, faithful and 
meritorious.
    (5) Homosexual acts involving aggravating circumstances or other 
factors affecting the performance of duty. Examples of homosexual acts 
involving aggravating circumstances or other factors affecting the 
performance of duty include child molestation, homosexual prostitution, 
homosexual acts or conduct accompanied by assault or coercion, and 
homosexual acts or conduct taking place between service members of 
disparate rank, grade, or status when a service member has taken 
advantage of his or her superior rank, grade, or status.
    (e) An honorable discharge or discharge under honorable conditions 
issued through a board for correction of records established under 
authority of 10 U.S.C. 1552 is final and conclusive on the Department of 
Veterans Affairs. The action of the board sets aside any prior bar to 
benefits imposed under paragraph (c) or (d) of this section.
    (f) An honorable or general discharge issued prior to October 8, 
1977, under authority other than that listed in paragraphs (h) (1), (2) 
and (3) of this section by a discharge review board established under 10 
U.S.C. 1553 set aside any bar to benefits imposed under paragraph (c) or 
(d) of this section except the bar contained in paragraph (c)(2) of this 
section.
    (g) An honorable or general discharge issued on or after October 8, 
1977, by a discharge review board established under 10 U.S.C. 1553, sets 
aside a bar to benefits imposed under paragraph (d), but not paragraph 
(c), of this section provided that:
    (1) The discharge is upgraded as a result of an individual case 
review;
    (2) The discharge is upgraded under uniform published standards and 
procedures that generally apply to all persons administratively 
discharged or released from active military, naval or air service under 
conditions other than honorable; and

[[Page 170]]

    (3) Such standards are consistent with historical standards for 
determining honorable service and do not contain any provision for 
automatically granting or denying an upgraded discharge.
    (h) Unless a discharge review board established under 10 U.S.C. 1553 
determines on an individual case basis that the discharge would be 
upgraded under uniform standards meeting the requirements set forth in 
paragraph (g) of this section, an honorable or general discharge awarded 
under one of the following programs does not remove any bar to benefits 
imposed under this section:
    (1) The President's directive of January 19, 1977, implementing 
Presidential Proclamation 4313 of September 16, 1974; or
    (2) The Department of Defense's special discharge review program 
effective April 5, 1977; or
    (3) Any discharge review program implemented after April 5, 1977, 
that does not apply to all persons administratively discharged or 
released from active military service under other than honorable 
conditions.


(Authority: 38 U.S.C. 5303 (e))

    (i) No overpayments shall be created as a result of payments made 
after October 8, 1977, based on an upgraded honorable or general 
discharge issued under one of the programs listed in paragraph (h) of 
this section which would not be awarded under the standards set forth in 
paragraph (g) of this section. Accounts in payment status on or after 
October 8, 1977, shall be terminated the end of the month in which it is 
determined that the original other than honorable discharge was not 
issued under conditions other than dishonorable following notice from 
the appropriate discharge review board that the discharge would not have 
been upgraded under the standards set forth in paragraph (g) of this 
section, or April 7, 1978, whichever is the earliest. Accounts in 
suspense (either before or after October 8, 1977) shall be terminated on 
the date of last payment or April 7, 1978, whichever is the earliest.
    (j) No overpayment shall be created as a result of payments made 
after October 8, 1977, in cases in which the bar contained in paragraph 
(c)(6) of this section is for application. Accounts in payment status on 
or after October 8, 1977, shall be terminated at the end of the month in 
which it is determined that compelling circumstances do not exist, or 
April 7, 1978, whichever is the earliest. Accounts in suspense (either 
before or after October 8, 1977) shall be terminated on the date of last 
payment, or April 7, 1978, whichever is the earliest.
    (k) Uncharacterized separations. Where enlisted personnel are 
administratively separated from service on the basis of proceedings 
initiated on or after October 1, 1982, the separation may be classified 
as one of the three categories of administrative separation that do not 
require characterization of service by the military department 
concerned. In such cases conditions of discharge will be determined by 
the VA as follows:
    (1) Entry level separation. Uncharacterized administrative 
separations of this type shall be considered under conditions other than 
dishonorable.
    (2) Void enlistment or induction. Uncharacterized administrative 
separations of this type shall be reviewed based on facts and 
circumstances surrounding separation, with reference to the provisions 
of Sec.  3.14 of this part, to determine whether separation was under 
conditions other than dishonorable.
    (3) Dropped from the rolls. Uncharacterized administrative 
separations of this type shall be reviewed based on facts and 
circumstances surrounding separation to determine whether separation was 
under conditions other than dishonorable.

(Authority: 38 U.S.C. 501)

    Cross References: Validity of enlistments. See Sec.  3.14. Revision 
of decisions. See Sec.  3.105. Effective dates. See Sec.  3.400(g). 
Minimum active-duty service requirement. See Sec.  3.12a.

[28 FR 123, Jan. 4, 1963, as amended at 41 FR 12656, Mar. 26, 1976; 43 
FR 15153, Apr. 11, 1978; 45 FR 2318, Jan. 11, 1980; 49 FR 44099, Nov. 2, 
1984; 62 FR 14823, Mar. 28, 1997]

[[Page 171]]



Sec.  3.12a  Minimum active-duty service requirement.

    (a) Definitions. (1) The term minimum period of active duty means, 
for the purposes of this section, the shorter of the following periods.
    (i) Twenty-four months of continuous active duty. Non-duty periods 
that are excludable in determining the Department of Veterans Affairs 
benefit entitlement (e.g., see Sec.  3.15) are not considered as a break 
in service for continuity purposes but are to be subtracted from total 
time served.
    (ii) The full period for which a person was called or ordered to 
active duty.
    (2) The term benefit includes a right or privilege but does not 
include a refund of a participant's contributions under 38 U.S.C. Ch. 
32.
    (b) Effect on Department of Veterans Affairs benefits. Except as 
provided in paragraph (d) of this section, a person listed in paragraph 
(c) of this section who does not complete a minimum period of active 
duty is not eligible for any benefit under title 38, United States Code 
or under any law administered by the Department of Veterans Affairs 
based on that period of active service.
    (c) Persons included. Except as provided in paragraph (d) of this 
section, the provisions of paragraph (b) of this section apply to the 
following persons:
    (1) A person who originally enlists (enlisted person only) in a 
regular component of the Armed Forces after September 7, 1980 (a person 
who signed a delayed-entry contract with one of the service branches 
prior to September 8, 1980, and under that contract was assigned to a 
reserve component until entering on active duty after September 7, 1980, 
shall be considered to have enlisted on the date the person entered on 
active duty); and
    (2) Any other person (officer as well as enlisted) who enters on 
active duty after October 16, 1981 and who has not previously completed 
a continuous period of active duty of at least 24 months or been 
discharged or released from active duty under 10 U.S.C. 1171 (early 
out).
    (d) Exclusions. The provisions of paragraph (b) of this section are 
not applicable to the following cases:
    (1) To a person who is discharged or released under 10 U.S.C. 1171 
or 1173 (early out or hardship discharge).
    (2) To a person who is discharged or released from active duty for a 
disability adjudged service connected without presumptive provisions of 
law, or who at time of discharge had such a service-connected 
disability, shown by official service records, which in medical judgment 
would have justified a discharge for disability.
    (3) To a person with a compensable service-connected disability.
    (4) To the provision of a benefit for or in connection with a 
service-connected disability, condition, or death.
    (5) To benefits under chapter 19 of title 38, United States Code.
    (e) Dependent or survivor benefits--(1) General. If a person is, by 
reason of this section, barred from receiving any benefits under title 
38, United States Code (or under any other law administered by the 
Department of Veterans Affairs based on a period of active duty, the 
person's dependents or survivors are also barred from receiving benefits 
based on the same period of active duty.
    (2) Exceptions. Paragraph (e)(1) of this section does not apply to 
benefits under chapters 19 and 37 of title 38, United States Code. (38 
U.S.C. 5303A)

[47 FR 24549, June 7, 1982]



Sec.  3.13  Discharge to change status.

    (a) A discharge to accept appointment as a commissioned or warrant 
officer, or to change from a Reserve or Regular commission to accept a 
commission in the other component, or to reenlist is a conditional 
discharge if it was issued during one of the following periods:
    (1) World War I; prior to November 11, 1918. As to reenlistments, 
this subparagraph applies only to Army and National Guard. No 
involuntary extension or other restrictions existed on Navy enlistments.
    (2) World War II, the Korean conflict or the Vietnam era; prior to 
the date the person was eligible for discharge under the point or length 
of service system, or under any other criteria in effect.

[[Page 172]]

    (3) Peacetime service; prior to the date the person was eligible for 
an unconditional discharge.
    (b) Except as provided in paragraph (c) of this section, the entire 
period of service under the circumstances stated in paragraph (a) of 
this section constitutes one period of service and entitlement will be 
determined by the character of the final termination of such period of 
active service except that, for death pension purposes, Sec.  3.3(b)(3) 
and (4) is controlling as to basic entitlement when the conditions 
prescribed therein are met.
    (c) Despite the fact that no unconditional discharge may have been 
issued, a person shall be considered to have been unconditionally 
discharged or released from active military, naval or air service when 
the following conditions are met:
    (1) The person served in the active military, naval or air service 
for the period of time the person was obligated to serve at the time of 
entry into service;
    (2) The person was not discharged or released from such service at 
the time of completing that period of obligation due to an intervening 
enlistment or reenlistment; and
    (3) The person would have been eligible for a discharge or release 
under conditions other than dishonorable at that time except for the 
intervening enlistment or reenlistment.

[26 FR 1566, Feb. 24, 1961, as amended at 27 FR 4024, Apr. 27, 1962; 32 
FR 13224, Sept. 19, 1967; 43 FR 15154, Apr. 11, 1978; 46 FR 23926, Apr. 
29, 1981]



Sec.  3.14  Validity of enlistments.

    Service is valid unless the enlistment is voided by the service 
department.
    (a) Enlistment not prohibited by statute. Where an enlistment is 
voided by the service department for reasons other than those stated in 
paragraph (b) of this section, service is valid from the date of entry 
upon active duty to the date of voidance by the service department. 
Benefits may not be paid, however, unless the discharge is held to have 
been under conditions other than dishonorable. Generally discharge for 
concealment of a physical or mental defect except incompetency or 
insanity which would have prevented enlistment will be held to be under 
dishonorable conditions.
    (b) Statutory prohibition. Where an enlistment is voided by the 
service department because the person did not have legal capacity to 
contract for a reason other than minority (as in the case of an insane 
person) or because the enlistment was prohibited by statute (a deserter 
or person convicted of a felony), benefits may not be paid based on that 
service even though a disability was incurred during such service. An 
undesirable discharge by reason of the fraudulent enlistment voids the 
enlistment from the beginning.
    (c) Misrepresentation of age. Active service which was terminated 
because of concealment of minority or misrepresentation of age is 
honorable if the veteran was released from service under conditions 
other than dishonorable. Service is valid from the date of entry upon 
active duty to the date of discharge.
    (d) Honorable discharges. Determinations as to honorable service 
will be made by the service departments and the finding shall be binding 
on the Department of Veterans Affairs, but, in the case of an alien, the 
effect of the discharge will be governed by Sec.  3.7(b).

[26 FR 1567, Feb. 24, 1961, as amended at 27 FR 4024, Apr. 27, 1962]



Sec.  3.15  Computation of service.

    For nonservice-connected or service-connected benefits, active 
service is countable exclusive of time spent on an industrial, 
agricultural, or indefinite furlough, time lost on absence without leave 
(without pay), under arrest (without acquittal), in desertion, while 
undergoing sentence of court-martial or a period following release from 
active duty under the circumstances outlined in Sec.  3.41. In claims 
based on Spanish-American War service, leave authorized under General 
Order No. 130, War Department, is included.

    Cross Reference: Duty periods. See Sec.  3.6(b)(6).

[40 FR 16064, Apr. 9, 1975]



Sec.  3.16  Service pension.

    In computing the 70 or 90 days required under Sec.  3.3(a) active 
service which began before or extended beyond

[[Page 173]]

the war period will be included if such service was continuous. Broken 
periods of service during a war period may be added together to meet the 
requirement for length of service.

[41 FR 18299, May 3, 1976, as amended at 44 FR 45932, Aug. 6, 1979]



Sec.  3.17  Disability and death pension; Mexican border period and 
later war periods.

    In computing the 90 days' service required for pension entitlement 
(see Sec.  3.3), there will be included active service which began 
before and extended into the Mexican border period or ended during World 
War I, or began or ended during World War II, the Korean conflict, the 
Vietnam era or the Persian Gulf War, if such service was continuous. 
Service during different war periods may be combined with service during 
any other war period to meet the 90 days' service requirement.

(Authority: 38 U.S.C. 1521)

[37 FR 6676, Apr. 1, 1972, as amended at 44 FR 45932, Aug. 6, 1979; 56 
FR 57986, Nov. 15, 1991]



Sec. Sec.  3.18-3.19  [Reserved]



Sec.  3.20  Surviving spouse's benefit for month of veteran's death.

    (a) Where the veteran died on or after December 1, 1962, and before 
October 1, 1982, the rate of death pension or dependency and indemnity 
compensation otherwise payable for the surviving spouse for the month in 
which the death occurred shall be not less than the amount of pension or 
compensation which would have been payable to or for the veteran for 
that month but for his or her death.


(Authority: 38 U.S.C. 5310)

    (b) Where the veteran dies on or after October 1, 1982, the 
surviving spouse may be paid death pension or dependency and indemnity 
compensation for the month in which the veteran died at a rate equal to 
the amount of compensation or pension which would have been payable to 
the veteran for that month had death not occurred, but only if such rate 
is equal to or greater than the monthly rate of death pension or 
dependency and indemnity compensation to which the surviving spouse is 
entitled. Otherwise, no payment of death pension or dependency and 
indemnity compensation may be made for the month in which the veteran 
died.


(Authority: 38 U.S.C. 5111(c))

    (c)(1) Where a veteran receiving compensation or pension dies after 
December 31, 1996, the surviving spouse, if not entitled to death 
compensation, dependency and indemnity compensation, or death pension 
for the month of death, shall be entitled to a benefit for that month in 
an amount equal to the amount of compensation or pension the veteran 
would have received for that month but for his or her death.
    (2) A payment issued to a deceased veteran as compensation or 
pension for the month in which death occurred shall be treated as 
payable to that veteran's surviving spouse, if the surviving spouse is 
not entitled to death compensation, dependency and indemnity 
compensation or death pension for that month and, if negotiated or 
deposited, shall be considered to be the benefit to which the surviving 
spouse is entitled under paragraph (c)(1) of this section. However, if 
such payment is in an amount less than the amount of the benefit under 
paragraph (c)(1) of this section, the unpaid difference shall be treated 
in the same manner as an accrued benefit under Sec.  3.1000 of this 
part.

(Authority: 38 U.S.C. 5310(b))

[48 FR 34471, July 29, 1983, as amended at 62 FR 35422, July 1, 1997; 64 
FR 30392, June 8, 1999]



Sec.  3.21  Monetary rates.

    The rates of compensation, dependency and indemnity compensation for 
surviving spouses and children, and section 306 and old-law disability 
and death pension, are published in tabular form in appendix B of the 
Veterans Benefits Administration Manual M21-1 and are to be given the 
same force and effect as if published in the regulations (title 38, Code 
of Federal Regulations). The maximum annual rates of improved pension 
payable under Pub. L. 95-588 (92 Stat. 2497) are set forth in Sec. Sec.  
3.23 and 3.24. The monthly rates and annual income limitations 
applicable

[[Page 174]]

to parents' dependency and indemnity compensation are set forth in Sec.  
3.25.

    Cross References: Section 306 pension. See Sec.  3.1(u). Old-law 
pension. See Sec.  3.1(v). Improved pension. See Sec.  3.1(w).

[44 FR 45932, Aug. 6, 1979]



Sec.  3.22  DIC benefits for survivors of certain veterans rated totally
disabled at time of death.

    (a) Even though a veteran died of non-service-connected causes, VA 
will pay death benefits to the surviving spouse or children in the same 
manner as if the veteran's death were service-connected, if:
    (1) The veteran's death was not the result of his or her own willful 
misconduct, and
    (2) At the time of death, the veteran was receiving, or was entitled 
to receive, compensation for service-connected disability that was:
    (i) Rated by VA as totally disabling for a continuous period of at 
least 10 years immediately preceding death;
    (ii) Rated by VA as totally disabling continuously since the 
veteran's release from active duty and for at least 5 years immediately 
preceding death; or
    (iii) Rated by VA as totally disabling for a continuous period of 
not less than one year immediately preceding death, if the veteran was a 
former prisoner of war.


(Authority: 38 U.S.C. 1318(b))

    (b) For purposes of this section, ``entitled to receive'' means that 
the veteran filed a claim for disability compensation during his or her 
lifetime and one of the following circumstances is satisfied:
    (1) The veteran would have received total disability compensation at 
the time of death for a service-connected disability rated totally 
disabling for the period specified in paragraph (a)(2) of this section 
but for clear and unmistakable error committed by VA in a decision on a 
claim filed during the veteran's lifetime; or
    (2) Additional evidence submitted to VA before or after the 
veteran's death, consisting solely of service department records that 
existed at the time of a prior VA decision but were not previously 
considered by VA, provides a basis for reopening a claim finally decided 
during the veteran's lifetime and for awarding a total service-connected 
disability rating retroactively in accordance with Sec. Sec.  3.156(c) 
and 3.400(q)(2) of this part for the relevant period specified in 
paragraph (a)(2) of this section; or
    (3) At the time of death, the veteran had a service-connected 
disability that was continuously rated totally disabling by VA for the 
period specified in paragraph (a)(2), but was not receiving compensation 
because:
    (i) VA was paying the compensation to the veteran's dependents;
    (ii) VA was withholding the compensation under authority of 38 
U.S.C. 5314 to offset an indebtedness of the veteran;
    (iii) The veteran had not waived retired or retirement pay in order 
to receive compensation;
    (iv) VA was withholding payments under the provisions of 10 U.S.C. 
1174(h)(2);
    (v) VA was withholding payments because the veteran's whereabouts 
were unknown, but the veteran was otherwise entitled to continued 
payments based on a total service-connected disability rating; or
    (vi) VA was withholding payments under 38 U.S.C. 5308 but determines 
that benefits were payable under 38 U.S.C. 5309.
    (c) For purposes of this section, ``rated by VA as totally 
disabling'' includes total disability ratings based on unemployability 
(Sec.  4.16 of this chapter).
    (d) To be entitled to benefits under this section, a surviving 
spouse must have been married to the veteran--
    (1) For at least 1 year immediately preceding the date of the 
veteran's death; or
    (2) For any period of time if a child was born of the marriage, or 
was born to them before the marriage.


(Authority: 38 U.S.C. 1318)

    (e) Effect of judgment or settlement. If a surviving spouse or child 
eligible for benefits under paragraph (a) of this section receives any 
money or property pursuant to a judicial proceeding based upon, or a 
settlement or compromise of, any cause of action or other right of

[[Page 175]]

recovery for damages for the death of the veteran, benefits payable 
under paragraph (a) of this section shall not be paid for any month 
following the month in which such money or property is received until 
the amount of benefits that would otherwise have been payable under 
paragraph (a) of this section equals the total of the amount of money 
received and the fair market value of the property received. The 
provisions of this paragraph do not apply, however, to any portion of 
such benefits payable for any period preceding the end of the month in 
which such money or property of value is received.


(Authority: 38 U.S.C. 501)

    (f) Social security and worker's compensation. Benefits received 
under social security or worker's compensation are not subject to 
recoupment under paragraph (e) of this section even though such benefits 
may have been awarded pursuant to a judicial proceeding.
    (g) Beneficiary's duty to report. Any person entitled to benefits 
under paragraph (a) of this section shall promptly report to the 
Department of Veterans Affairs the receipt of any money or property 
received pursuant to a judicial proceeding based upon, or a settlement 
or compromise of, any cause of action or other right of recovery for 
damages for the death of the veteran. The amount to be reported is the 
total of the amount of money received and the fair market value of 
property received. Expenses incident to recovery, such as attorney's 
fees, may not be deducted from the amount to be reported.
    (h) Relationship to survivor benefit plan. For the purpose of 10 
U.S.C. 1448(d) and 1450(c) eligibility for benefits under paragraph (a) 
of this section shall be deemed eligibility for dependency and indemnity 
compensation under 38 U.S.C. 1311(a).

(Authority: 38 U.S.C. 1318)

    Cross References: Marriage dates. See Sec.  3.54. Homicide. See 
Sec.  3.11.

[44 FR 22718, Apr. 17, 1979, as amended at 48 FR 41161, Sept. 14, 1983; 
53 FR 23235, June 21, 1988; 54 FR 31829, Aug. 2, 1989; 65 FR 3391, Jan. 
21, 2000; 65 FR 43699, July 14, 2000; 70 FR 72220, Dec. 2, 2005; 77 FR 
40526, July 10, 2012]



Sec.  3.23  Improved pension rates--Veterans and surviving spouses.

    (a) Maximum annual rates of improved pension. The maximum annual 
rates of improved pension for the following categories of beneficiaries 
shall be the amounts specified in 38 U.S.C. 1521 and 1542, as increased 
from time to time under 38 U.S.C. 5312. Each time there is an increase 
under 38 U.S.C. 5312, the actual rates will be published in the 
``Notices'' section of the Federal Register. (1) Veterans who are 
permanently and totally disabled.


(Authority: 38 U.S.C. 1521(b) or (c))

    (2) Veterans in need of aid and attendance.


(Authority: 38 U.S.C. 1521(d))

    (3) Veterans who are housebound.


(Authority: 38 U.S.C. 1521(e))

    (4) Two veterans married to one another; combined rates.


(Authority: 38 U.S.C. 1521(f))

    (5) Surviving spouse alone or with a child or children of the 
deceased veteran in custody of the surviving spouse.


(Authority: 38 U.S.C. 1541(b) or (c))

    (6) Surviving spouses in need of aid and attendance.


(Authority: 38 U.S.C. 1541(d))

    (7) Surviving spouses who are housebound.


(Authority: 38 U.S.C. 1541(e))

    (b) Reduction for income. The maximum rates of improved pension in 
paragraph (a) of this section shall be reduced by the amount of the 
countable annual income of the veteran or surviving spouse.


(Authority: 38 U.S.C. 1521, 1541)

    (c) Mexican border period and World War I veterans. The applicable 
maximum annual rate payable to a Mexican border period or World War I 
veteran under this section shall be increased by the amount specified in 
38 U.S.C. 1521(g), as increased from time

[[Page 176]]

to time under 38 U.S.C 5312. Each time there is an increase under 38 
U.S.C. 5312, the actual rate will be published in the ``Notices'' 
section of the Federal Register.


(Authority: 38 U.S.C. 1521(g))

    (d) Definitions of terms used in this section--(1) Dependent. A 
veteran's spouse or child. A veteran's spouse who resides apart from the 
veteran and is estranged from the veteran may not be considered the 
veteran's dependent unless the spouse receives reasonable support 
contributions from the veteran. (Note that under Sec.  3.60 a veteran 
and spouse who reside apart are considered to be living together unless 
they are estranged.) A child of a veteran not in custody of the veteran 
and to whose support the veteran is not reasonably contributing, may not 
be considered the veteran's dependent.


(Authority: 38 U.S.C. 1521(b))

    (2) In need of aid and attendance. As defined in Sec.  3.351(b).
    (3) Housebound. As defined in Sec.  3.351(d)(2), (f). This term also 
includes a veteran who has a disability or disabilities evaluated as 60 
percent or more disabling in addition to a permanent and totally 
disabling condition. See Sec.  3.351(d)(1).
    (4) Veteran's annual income. This term includes the veteran's annual 
income, the annual income of the veteran's dependent spouse, and the 
annual income of each child of the veteran (other than a child for whom 
increased pension is not payable under 38 U.S.C. 1522(b)) in the 
veteran's custody or to whose support the veteran is reasonably 
contributing (to the extent such child's income is reasonably available 
to or for the veteran, unless in the judgment of the Department of 
Veterans Affairs to do so would work a hardship on the veteran.) There 
is a rebuttable presumption that all of such a child's income is 
reasonably available to or for the veteran.


(Authority: 38 U.S.C. 1521 (c), (h))

    (5) Surviving spouse's annual income. This term includes the 
surviving spouse's annual income and the annual income of each child of 
the veteran (other than a child for whom increased pension is not 
payable under 38 U.S.C. 1543(a)(2)) in the custody of the surviving 
spouse to the extent that such child's income is reasonably available to 
or for the surviving spouse, unless in the judgment of the Department of 
Veterans Affairs to do so would work a hardship on the surviving spouse. 
There is a rebuttable presumption that all of such a child's income is 
available to or for the surviving spouse.


(Authority: 38 U.S.C. 1541(c), (g))

    (6) Reasonable availability and hardship. For the purposes of 
paragraphs (d)(4) and (d)(5) of this section, a child's income shall be 
considered ``reasonably available'' when it can be readily applied to 
meet the veteran's or surviving spouse's expenses necessary for 
reasonable family maintenance, and ``hardship'' shall be held to exist 
when annual expenses necessary for reasonable family maintenance exceed 
the sum of countable annual income plus VA pension entitlement. Expenses 
necessary for reasonable family maintenance include expenses for basic 
necessities (such as food, clothing, shelter, etc.) and other expenses, 
determined on a case-by-case basis, which are necessary to support a 
reasonable quality of life.

(Authority: 38 U.S.C. 501)

    Cross References: Improved pension. See Sec.  3.1(w). Child. See 
Sec.  3.57(d). Definition of living with. See Sec.  3.60. Exclusions 
from income. See Sec.  3.272.

[44 FR 45933, Aug. 6, 1979, as amended at 52 FR 34907, Sept. 14, 1987; 
53 FR 23235, June 21, 1988]



Sec.  3.24  Improved pension rates--Surviving children.

    (a) General. The provisions of this section apply to children of a 
deceased veteran not in the custody of a surviving spouse who has basic 
eligibility to receive improved pension. Children in custody of a 
surviving spouse who has basic eligibility to receive improved pension 
do not have separate entitlement. Basic eligibility to receive improved 
pension means that the surviving spouse is in receipt of improved 
pension or could become entitled to receive improved pension except for 
the amount of the surviving

[[Page 177]]

spouse's countable annual income or the size of the surviving spouse's 
estate (See Sec.  3.274(c)). Under Sec.  3.23(d)(5) the countable annual 
income of a surviving spouse includes the countable annual income of 
each child of the veteran in custody of the surviving spouse to the 
extent the child's income is reasonably available to or for the 
surviving spouse, unless in the judgment of the Department of Veterans 
Affairs to do so would work a hardship on the surviving spouse.
    (b) Child with no personal custodian or in the custody of an 
institution. In cases in which there is no personal custodian, i.e., 
there is no person who has the legal right to exercise parental control 
and responsibility for the child's welfare (See Sec.  3.57(d)), or the 
child is in the custody of an institution, pension shall be paid to the 
child at the annual rate specified in 38 U.S.C. 1542, as increased from 
time to time under 38 U.S.C. 5312, reduced by the amount of the child's 
countable annual income. Each time there is an increase under 38 U.S.C. 
5312, the actual rate will be published in the ``Notices'' section of 
the Federal Register.
    (c) Child in the custody of person legally responsible for support--
(1) Single child. Pension shall be paid to a child in the custody of a 
person legally responsible for the child's support at an annual rate 
equal to the difference between the rate for a surviving spouse and one 
child under Sec.  3.23(a)(5), and the sum of the annual income of such 
child and the annual income of such person or, the maximum annual 
pension rate under paragraph (b) of this section, whichever is less.
    (2) More than one child. Pension shall be paid to children in 
custody of a person legally responsible for the children's support at an 
annual rate equal to the difference between the rate for a surviving 
spouse and an equivalent number of children (but not including any child 
who has countable annual income equal to or greater than the maximum 
annual pension rate under paragraph (b) of this section) and the sum of 
the countable annual income of the person legally responsible for 
support and the combined countable annual income of the children (but 
not including the income of any child whose countable annual income is 
equal to or greater than the maximum annual pension rate under paragraph 
(b) of this section, or the maximum annual pension rate under paragraph 
(b) of this section times the number of eligible children, whichever is 
less).

(Authority: 38 U.S.C. 1542)

    Cross References: Child. See Sec.  3.57(d). Exclusions from income. 
See Sec.  3.272.

[44 FR 45933, Aug. 6, 1979, as amended at 52 FR 34907, Sept. 14, 1987; 
61 FR 20727, May 8, 1996]



Sec.  3.25  Parent's dependency and indemnity compensation (DIC)-
-Method of payment computation.

    Monthly payments of parents' DIC shall be computed in accordance 
with the following formulas:
    (a) One parent. Except as provided in paragraph (b) of this section, 
if there is only one parent, the monthly rate specified in 38 U.S.C 
1315(b)(1), as increased from time to time under 38 U.S.C. 5312, reduced 
by $.08 for each dollar of such parent's countable annual income in 
excess of $800. No payments of DIC may be made under this paragraph, 
however, if such parent's countable annual income exceeds the amount 
specified in 38 U.S.C. 1315(b)(3), as increased from time to time under 
38 U.S.C. 5312, and no payment of DIC to a parent under this paragraph 
may be less than $5 a month.
    (b) One parent who has remarried. If there is only one parent and 
the parent has remarried and is living with the parent's spouse, DIC 
shall be paid under paragraph (a) or paragraph (d) of this section, 
whichever shall result in the greater benefit being paid to the 
veteran's parent. In the case of remarriage, the total combined annual 
income of the parent and the parent's spouse shall be counted in 
determining the monthly rate of DIC.
    (c) Two parents not living together. The rate computation method in 
this paragraph applies to:
    (1) Two parents who are not living together, or
    (2) An unremarried parent when both parents are living and the other 
parent has remarried.

The monthly rate of DIC paid to such parent shall be the rate sepcified 
in 38

[[Page 178]]

U.S.C. 1315(c)(1), as increased from time to time under 38 U.S.C. 5312, 
reduced by an amount no greater than $.08 for each dollar of such 
parent's countable annual income in excess of $800, except that no 
payments of DIC may be made under this paragraph if such parent's 
countable annual income exceeds the amount specified in 38 U.S.C. 
1315(c)(3), as increased from time to time under 38 U.S.C. 5312, and no 
payment of DIC to a parent under this paragraph may be less than $5 
monthly. Each time there is a rate increase under 38 U.S.C. 5312, the 
amount of the reduction under this paragraph shall be recomputed to 
provide, as nearly as possible, for an equitable distribution of the 
rate increase. The results of this computation method shall be published 
in schedular format in the ``Notices'' section of the Federal Register 
as provided in paragraph (f) of this section.
    (d) Two parents living together or remarried parents living with 
spouse. The rate computation method in this paragraph applies to each 
parent living with another parent and to each remarried parent when both 
parents are alive. The monthly rate of DIC paid to such parents shall be 
the rate specified in 38 U.S.C. 1315(d)(1), as increased from time to 
time under 38 U.S.C. 5312, reduced to an amount no greater than $.08 for 
each dollar of such parent's and spouse's combined countable annual 
income in excess of $1,000 except that no payments of DIC to a parent 
under this paragraph may be less than $5 monthly. Each time there is a 
rate increase under 38 U.S.C. 5312, the amount of the reduction under 
this paragraph shall be recomputed to provide, as nearly as possible, 
for an equitable distribution of the rate increase. The results of this 
computation method shall be published in schedular format in the 
``Notices'' section of the Federal Register as provided in paragraph (f) 
of this section.
    (e) Aid and attendance. The monthly rate of DIC payable to a parent 
under this section shall be increased by the amount specified in 38 
U.S.C. 1315(g), as increased from time to time under 38 U.S.C. 5312, if 
such parent is:
    (1) A patient in a nursing home, or
    (2) Helpless or blind, or so nearly helpless or blind as to need or 
require the regular aid and attendance of another person.
    (f) Rate publication. Each time there is an increase under 38 U.S.C. 
5312, the actual rates will be published in the ``Notices'' section of 
the Federal Register.

(Authority: 38 U.S.C. 501)

[52 FR 34907, Sept. 14, 1987, as amended at 61 FR 20727, May 8, 1996]



Sec.  3.26  Section 306 and old-law pension annual income limitations.

    (a) The annual income limitations for section 306 pension shall be 
the amounts specified in section 306(a)(2)(A) of Pub. L. 95-588, as 
increased from time to time under section 306(a)(3) of Pub. L. 95-588.
    (b) If a beneficiary under section 306 pension is in need of aid and 
attendance, the annual income limitation under paragraph (a) of this 
section shall be increased in accordance with 38 U.S.C. 1521(d), as in 
effect on December 31, 1978.
    (c) The annual income limitations for old-law pension shall be the 
amounts specified in section 306(b)(3) of Pub. L. 95-588, as increased 
from time to time under section 306(b)(4) of Pub. L. 95-588.
    (d) Each time there is an increase under section 306 (a)(3) or 
(b)(4) of Pub. L. 95-588, the actual income limitations will be 
published in the ``Notices'' section of the Federal Register.

(Authority: 38 U.S.C. 501)

[52 FR 34908, Sept. 14, 1987]



Sec.  3.27  Automatic adjustment of benefit rates.

    (a) Improved pension. Whenever there is a cost-of-living increase in 
benefit amounts payable under section 215(i) of title II of the Social 
Security Act, VA shall, effective on the dates such increases become 
effective, increase by the same percentage each maximum annual rate of 
pension.


(Authority: 38 U.S.C. 5312(a))

    (b) Parents' dependency and indemnity compensation--maximum annual 
income limitation and maximum monthly rates.

[[Page 179]]

Whenever there is a cost-of-living increase in benefit amounts payable 
under section 215(i) of title II of the Social Security Act, VA shall, 
effective on the dates such increases become effective, increase by the 
same percentage the annual income limitations and the maximum monthly 
rates of dependency indemnity compensation for parents.


(Authority: 38 U.S.C. 5312(b)(1))

    (c) Monetary allowance under 38 U.S.C. chapter 18 for certain 
individuals who are children of Vietnam veterans or children of veterans 
with covered service in Korea. Whenever there is a cost-of-living 
increase in benefit amounts payable under section 215(i) of Title II of 
the Social Security Act, VA shall, effective on the dates such increases 
become effective, increase by the same percentage the monthly allowance 
rates under 38 U.S.C. chapter 18.


(Authority: 38 U.S.C. 1805(b)(3), 1815(d), 1821, 5312)

    (d) Medal of Honor pension. Beginning in the year 2004, VA shall, 
effective December 1 of each year, increase the monthly Medal of Honor 
pension by the same percentage as the percentage by which benefit 
amounts payable under section 215(i) of Title II of the Social Security 
Act are increased effective December 1 of such year.


(Authority: 38 U.S.C. 1562(e))

    (e) Publishing requirements. Increases in pension rates, parents' 
dependency and indemnity compensation rates and income limitation, the 
monthly allowance rates under 38 U.S.C. chapter 18 and the Medal of 
Honor pension made under this section shall be published in the Federal 
Register.


(Authority: 38 U.S.C. 1805(b)(3), 1815(d), 5312(c)(1))

[44 FR 45934, Aug. 6, 1979, as amended at 52 FR 34908, Sept. 14, 1987; 
62 FR 51278, Sept. 30, 1997; 67 FR 49586, July 31, 2002; 68 FR 55467, 
Sept. 26, 2003; 76 FR 4247, Jan. 25, 2011]



Sec.  3.28  Automatic adjustment of section 306 and old-law pension income
limitations.

    Whenever the maximum annual rates of improved pension are increased 
by reason of the provisions of 38 U.S.C. 5312, the following will be 
increased by the same percentage effective the same date:
    (a) The maximum annual income limitations applicable to continued 
receipt of section 306 and old-law pension; and
    (b) The dollar amount of a veteran's spouse's income that is 
excludable in determining the income of a veteran for section 306 
pension purposes. (See Sec.  3.262(b)(2))

These increases shall be published in the Federal Register at the same 
time that increases under Sec.  3.27 are published.

(Authority: Sec. 306, Pub. L. 95-588).

[52 FR 34908, Sept. 14, 1987]

    Cross References: Section 306 and old-law pension annual income 
limitations. See Sec.  3.26.



Sec.  3.29  Rounding.

    (a) Annual rates. Where the computation of an increase in improved 
pension rates under Sec. Sec.  3.23 and 3.24 would otherwise result in a 
figure which includes a fraction of a dollar, the benefit rate will be 
adjusted to the next higher dollar amount. This method of computation 
will also apply to increases in old-law and section 306 pension annual 
income limitations under Sec.  3.26, including the income of a spouse 
which is excluded from a veteran's countable income, and parents' 
dependency and indemnity compensation benefit rates and annual income 
limitations under Sec.  3.25.


(Authority: 38 U.S.C. 5312(c)(2))

    (b) Monthly or other periodic pension rates. After determining the 
monthly or other periodic rate of improved pension under Sec. Sec.  
3.273 and 3.30 or the rate payable under section 306(a) of Pub. L. 95-
588 (92 Stat. 2508), the resulting rate, if not a multiple of one 
dollar, will be rounded down to the nearest whole dollar amount. The 
provisions of this paragraph apply with respect to amounts of pension 
payable for periods beginning on or after June 1, 1983, under the 
provisions of 38 U.S.C. 1521,

[[Page 180]]

1541 or 1542, or under section 306(a) of Pub. L. 95-588.


(Authority: 38 U.S.C. 5123)

    (c) Monthly rates under 38 U.S.C. chapter 18. When increasing the 
monthly monetary allowance rates under 38 U.S.C. chapter 18 for certain 
individuals who are children of Vietnam veterans or children of veterans 
with covered service in Korea, VA will round any resulting rate that is 
not an even dollar amount to the next higher dollar.

(Authority: 38 U.S.C. 1805(b)(3), 1815(d), 1821, 5312)

[48 FR 34471, July 29, 1983, as amended at 65 FR 35282, June 2, 2000; 67 
FR 49586, July 31, 2002; 75 FR 4247, Jan. 25, 2011]



Sec.  3.30  Frequency of payment of improved pension and parents' 
dependency and indemnity compensation (DIC).

    Payment shall be made as shown in paragraphs (a), (b), (c), (d), 
(e), and (f) of this section; however, beneficiaries receiving payment 
less frequently than monthly may elect to receive payment monthly in 
cases in which other Federal benefits would otherwise be denied.


(Authority: 38 U.S.C. 501)

    (a) Improved pension--Monthly. Payment shall be made monthly if the 
annual rate payable is $228 or more.
    (b) Improved pension--Quarterly. Payment shall be made every 3 
months on or about March 1, June 1, September l, and December 1, if the 
annual rate payable is at least $144 but less than $228.
    (c) Improved pension--Semiannually. Payment shall be made every 6 
months on or about June 1, and December 1, if the annual rate payable is 
at least $72 but less than $144.
    (d) Improved pension--Annually. Payment shall be made annually on or 
about June 1, if the annual rate payable is less than $72.


(Authority: 38 U.S.C. 1508)

    (e) Parents' DIC--Semiannually. Benefits shall be paid every 6 
months on or about June 1, and December 1, if the amount of the annual 
benefit is less than 4 percent of the maximum annual rate payable under 
38 U.S.C. 1315.
    (f) Payment of less than one dollar. Payments of less than $1 shall 
not be made.

    Cross Reference: Pension. See Sec.  3.3(a)(3), (b)(4).

[44 FR 45935, Aug. 6, 1979, as amended at 51 FR 1790, Jan. 15, 1986; 53 
FR 7903, Mar. 11, 1988; 57 FR 10425, Mar. 26, 1992; 71 FR 52290, Sept. 
5, 2006]



Sec.  3.31  Commencement of the period of payment.

    Regardless of VA regulations concerning effective dates of awards, 
and except as provided in paragraph (c) of this section, payment of 
monetary benefits based on original, supplemental, or increased awards 
of compensation, pension, dependency and indemnity compensation, or a 
monetary allowance under 38 U.S.C. chapter 18 for an individual who is a 
child of a Vietnam veteran or a child of a veteran with covered service 
in Korea may not be made for any period prior to the first day of the 
calendar month following the month in which the award became effective. 
However, beneficiaries will be deemed to be in receipt of monetary 
benefits during the period between the effective date of the award and 
the date payment commences for the purpose of all laws administered by 
the Department of Veterans Affairs except that nothing in this section 
will be construed as preventing the receipt of retired or retirement pay 
prior to the effective date of waiver of such pay in accordance with 38 
U.S.C. 5305.
    (a) Increased award defined. For the purposes of this section the 
term increased award means an award which is increased because of an 
added dependent, increase in disability or disability rating, or 
reduction in income. The term also includes elections of improved 
pension under section 306 of Pub. L. 95-588 and awards pursuant to 
paragraphs 29 and 30 of the Schedule for Rating Disabilities except as 
provided in paragraph (c) of this section.
    (b) General rule of applicability. The provisions of this section 
apply to all original, supplemental, or increased awards unless such 
awards provide only

[[Page 181]]

for continuity of entitlement with no increase in rate of payment.
    (c) Specific exclusions. The provisions of this section do not apply 
to the following types of awards.
    (1) Surviving spouse's rate for the month of a veteran's death (for 
exception see Sec.  3.20(b))
    (2) In cases where military retired or retirement pay is greater 
than the amount of compensation payable, compensation will be paid as of 
the effective date of waiver of such pay. However, in cases where the 
amount of compensation payable is greater than military retired or 
retirement pay, payment of the available difference for any period prior 
to the effective date of total waiver of such pay is subject to the 
general provisions of this section.
    (3) Adjustments of awards--such as in the case of original or 
increased apportionments or the termination of any withholding, 
reduction, or suspension by reason of:
    (i) Recoupment,
    (ii) An offset to collect indebtedness,
    (iii) Institutionalization (hospitalization),
    (iv) Incompetency,
    (v) Incarceration,
    (vi) An estate that exceeds the limitation for certain hospitalized 
incompetent veterans, or
    (vii) Discontinuance of apportionments.
    (4) Increases resulting solely from the enactment of legislation--
such as
    (i) Cost-of-living increases in compensation or dependency and 
indemnity compensation,
    (ii) Increases in Improved Pension, parents' dependency and 
indemnity compensation, or a monetary allowance under 38 U.S.C. chapter 
18 pursuant to Sec.  3.27, or
    (iii) Changes in the criteria for statutory award designations.
    (5) Temporary total ratings pursuant to paragraph 29 of the Schedule 
for Rating Disabilities when the entire period of hospitalization or 
treatment, including any period of post-hospitalization convalescence, 
commences and terminates within the same calendar month. In such cases 
the period of payment shall commence on the first day of the month in 
which the hospitalization or treatment began.

(Authority: 38 U.S.C. 1805, 1815, 1821, 1832, 5111)

[48 FR 34472, July 29, 1983; 48 FR 37031, Aug. 16, 1983, as amended at 
49 FR 47003, Nov. 30, 1984; 65 FR 35282, June 2, 2000; 67 FR 49586, July 
31, 2002; 76 FR 4247, Jan. 25, 2011; 84 FR 166, Jan. 18, 2019]



Sec.  3.32  Exchange rates for foreign currencies.

    When determining the rates of pension or parents' DIC or the amounts 
of burial, plot or headstone allowances or accrued benefits to which a 
claimant or beneficiary may be entitled, income received or expenses 
paid in a foreign currency shall be converted into U.S. dollar 
equivalents employing quarterly exchange rates established by the 
Department of the Treasury.
    (a) Pension and parents' DIC. (1) Because exchange rates for foreign 
currencies cannot be determined in advance, rates of pension and 
parents' DIC shall be projected using the most recent quarterly exchange 
rate and shall be adjusted retroactively based upon actual exchange 
rates when an annual eligibility verification report is filed.
    (2) Retroactive adjustments due to fluctuations in exchange rates 
shall be calculated using the average of the four most recent quarterly 
exchange rates. If the claimant reports income and expenses for a prior 
reporting period, the retroactive adjustment shall be calculated using 
the average of the four quarterly rates which were the most recent 
available on the closing date of the twelve-month period for which 
income and expenses are reported.
    (b) Burial, plot or headstone allowances and accrued benefits. 
Payment amounts for burial, plot or headstone allowances and claims for 
accrued benefits as reimbursement from the person who bore the expenses 
of a deceased beneficiary's last illness or burial shall be determined 
using the quarterly exchange rate for the quarter in which the expenses 
forming the basis of the claim were paid. If the claim is filed by an 
unpaid creditor, however, the quarterly

[[Page 182]]

rate for the quarter in which the veteran died shall apply. When 
entitlement originates during a quarter for which the Department of the 
Treasury has not yet published a quarterly rate, amounts due shall be 
calculated using the most recent quarterly exchange rate.

    Cross References: Accrued benefits. See Sec.  3.1000. Accrued 
benefits payable to foreign beneficiaries. See Sec.  3.1008.

(Authority: 38 U.S.C. 501)

[55 FR 8140, Mar. 7, 1990; 55 FR 10867, Mar. 23, 1990]

                                 General



Sec.  3.40  Philippine and Insular Forces.

    (a) Regular Philippine Scouts. Service in the Philippine Scouts 
(except that described in paragraph (b) of this section), the Insular 
Force of the Navy, Samoan Native Guard, and Samoan Native Band of the 
Navy is included for pension, compensation, dependency and indemnity 
compensation, and burial allowance. Benefits are payable in dollars at 
the full-dollar rate.
    (b) Other Philippine Scouts. Service of persons enlisted under 
section 14, Pub. L. 190, 79th Congress (Act of October 6, 1945), is 
included for compensation and dependency and indemnity compensation. 
Except as provided in Sec. Sec.  3.42 and 3.43, benefits based on 
service described in this paragraph are payable at a rate of $0.50 for 
each dollar authorized under the law. All enlistments and reenlistments 
of Philippine Scouts in the Regular Army between October 6, 1945, and 
June 30, 1947, inclusive, were made under the provisions of Pub. L. 190 
as it constituted the sole authority for such enlistments during that 
period. This paragraph does not apply to officers who were commissioned 
in connection with the administration of Pub. L. 190.


(Authority: 38 U.S.C. 107)

    (c) Commonwealth Army of the Philippines. (1) Service is included, 
for compensation, dependency and indemnity compensation, and burial 
allowance, from and after the dates and hours, respectively, when they 
were called into service of the Armed Forces of the United States by 
orders issued from time to time by the General Officer, U.S. Army, 
pursuant to the Military Order of the President of the United States 
dated July 26, 1941. Service as a guerrilla under the circumstances 
outlined in paragraph (d) of this section is also included. Except as 
provided in Sec. Sec.  3.42 and 3.43, benefits based on service 
described in this paragraph are payable at a rate of $0.50 for each 
dollar authorized under the law.


(Authority: 38 U.S.C. 107)

    (2) Unless the record shows examination at time of entrance into the 
Armed Forces of the United States, such persons are not entitled to the 
presumption of soundness. This also applies upon reentering the Armed 
Forces after a period of inactive service.
    (d) Guerrilla service. (1) Persons who served as guerrillas under a 
commissioned officer of the United States Army, Navy or Marine Corps, or 
under a commissioned officer of the Commonwealth Army recognized by and 
cooperating with the United States Forces are included. (See paragraph 
(c) of this section.) Service as a guerrilla by a member of the 
Philippine Scouts or the Armed Forces of the United States is considered 
as service in his or her regular status. (See paragraph (a) of this 
section.)
    (2) The following certifications by the service departments will be 
accepted as establishing guerrilla service:
    (i) Recognized guerrilla service;
    (ii) Unrecognized guerrilla service under a recognized commissioned 
officer only if the person was a former member of the United States 
Armed Forces (including the Philippine Scouts), or the Commonwealth 
Army. This excludes civilians.


A certification of Anti-Japanese Activity will not be accepted as 
establishing guerrilla service.
    (e) Combined service. Where a veteran who had Commonwealth Army or 
guerrilla service and also had other service, wartime or peacetime, in 
the Armed Forces of the United States, has disabilities which are 
compensable separately on a dollar and a $0.50 for each dollar 
authorized basis, and the disabilities are combined under the authority

[[Page 183]]

contained in 38 U.S.C. 1157, the evaluation for which dollars are 
payable will be first considered and the difference between this 
evaluation and the combined evaluation will be the basis for computing 
the amount payable at the rate of $0.50 for each dollar authorized.

    Cross Reference: Computation of service. See Sec.  3.15.

[26 FR 1565, Feb. 24, 1961, as amended at 31 FR 14454, Nov. 10, 1966; 60 
FR 18355, Apr. 11, 1995. Redesignated and amended at 66 FR 66767, Dec. 
27, 2001; 71 FR 8220, Feb. 16, 2006]



Sec.  3.41  Philippine service.

    (a) For a Regular Philippine Scout or a member of one of the regular 
components of the Philippine Commonwealth Army while serving with Armed 
Forces of United States, the period of active service will be from the 
date certified by the Armed Forces as the date of enlistment or date of 
report for active duty whichever is later to date of release from active 
duty, discharge, death, or in the case of a member of the Philippine 
Commonwealth Army June 30, 1946, whichever was earlier. Release from 
active duty includes:
    (1) Leaving one's organization in anticipation of or due to the 
capitulation.
    (2) Escape from prisoner-of-war status.
    (3) Parole by the Japanese.
    (4) Beginning of missing-in-action status, except where factually 
shown at that time he was with his or her unit or death is presumed to 
have occurred while carried in such status: Provided, however, That 
where there is credible evidence that he was alive after commencement of 
his or her missing-in-action status, the presumption of death will not 
apply for Department of Veterans Affairs purposes.
    (5) Capitulation on May 6, 1942, except that periods of recognized 
guerrilla service or unrecognized guerrilla service under a recognized 
commissioned officer or periods of service in units which continued 
organized resistance against Japanese prior to formal capitulation will 
be considered return to active duty for period of such service.
    (b) Active service of a Regular Philippine Scout or a member of the 
Philippine Commonwealth Army serving with the Armed Forces of the United 
States will include a prisoner-of-war status immediately following a 
period of active duty, or a period of recognized guerrilla service or 
unrecognized guerrilla service under a recognized commissioned officer. 
In those cases where following release from active duty as set forth in 
paragraph (a) of this section, the veteran is factually found by the 
Department of Veterans Affairs to have been injured or killed by the 
Japanese because of anti-Japanese activities or his or her former 
service in the Armed Forces of the United States, such injury or death 
may be held to have been incurred in active service for Department of 
Veterans Affairs purposes. Determination shall be based on all available 
evidence, including service department reports, and consideration shall 
be given to the character and length of the veteran's former active 
service in the Armed Forces of the United States.
    (c) A prisoner-of-war status based upon arrest during general 
zonification will not be sufficient of itself to bring a case within the 
definition of return to military control.
    (d) The active service of members of the irregular forces guerrilla 
will be the period certified by the service department.

[26 FR 1566, Feb. 24, 1961, as amended at 26 FR 4612, May 26, 
1961Redesignated at 66 FR 66767, Dec. 27, 2001]



Sec.  3.42  Compensation at the full-dollar rate for certain Filipino
veterans residing in the United States.

    (a) Definitions. For purposes of this section:
    (1) United States (U.S.) means the states, territories and 
possessions of the United States; the District of Columbia, and the 
Commonwealth of Puerto Rico.
    (2) Residing in the U.S. means that an individual's principal, 
actual dwelling place is in the U.S. and that the individual meets the 
residency requirements of paragraph (c)(4) of this section.
    (3) Citizen of the U.S. means any individual who acquires U.S. 
citizenship through birth in the territorial U.S., birth abroad as 
provided under title 8, United States Code, or through naturalization, 
and has not renounced his

[[Page 184]]

or her U.S. citizenship, or had such citizenship cancelled, revoked, or 
otherwise terminated.
    (4) Lawfully admitted for permanent residence means that an 
individual has been lawfully accorded the privilege of residing 
permanently in the U.S. as an immigrant by the U.S. Citizenship and 
Immigration Services under title 8, United States Code, and still has 
this status.
    (b) Eligibility requirements. Compensation and dependency and 
indemnity compensation is payable at the full-dollar rate, based on 
service described in Sec.  3.40(b), (c), or (d), to a veteran or a 
veteran's survivor who is residing in the U.S. and is either:
    (1) A citizen of the U.S., or
    (2) An alien lawfully admitted for permanent residence in the U.S.
    (c) Evidence of eligibility. (1) A valid original or copy of one of 
the following documents is required to prove that the veteran or the 
veteran's survivor is a natural born citizen of the U.S.:
    (i) A valid U.S. passport;
    (ii) A birth certificate showing that he or she was born in the 
U.S.; or
    (iii) A Report of Birth Abroad of a Citizen of the U.S. issued by a 
U.S. consulate abroad.
    (2) Only verification by the U.S. Citizenship and Immigration 
Services to VA that a veteran or a veteran's survivor is a naturalized 
citizen of the U.S., or a valid U.S. passport, will be sufficient proof 
of such status.
    (3) Only verification by the U.S. Citizenship and Immigration 
Services to VA that a veteran or a veteran's survivor is an alien 
lawfully admitted for permanent residence in the U.S. will be sufficient 
proof of such status.
    (4) VA will not pay benefits at the full-dollar rate under this 
section unless the evidence establishes that the veteran or survivor is 
lawfully residing in the U.S.
    (i) Such evidence should identify the veteran's or survivor's name 
and relevant dates, and may include:
    (A) A valid driver's license issued by the state of residence;
    (B) Employment records, which may consist of pay stubs, W-2 forms, 
and certification of the filing of Federal, State, or local income tax 
returns;
    (C) Residential leases, rent receipts, utility bills and receipts, 
or other relevant documents showing dates of utility service at a leased 
residence;
    (D) Hospital or medical records showing medical treatment or 
hospitalization, and showing the name of the medical facility or 
treating physician;
    (E) Property tax bills and receipts; and
    (F) School records.
    (ii) A Post Office box mailing address in the veteran's name or the 
name of the veteran's survivor does not constitute evidence showing that 
the veteran or veteran's survivor is lawfully residing in the United 
States.
    (d) Continued eligibility. (1) In order to continue receiving 
benefits at the full-dollar rate under this section, a veteran or a 
veteran's survivor must be physically present in the U.S. for at least 
183 days of each calendar year in which he or she receives payments at 
the full-dollar rate, and may not be absent from the U.S. for more than 
60 consecutive days at a time unless good cause is shown. However, if a 
veteran or a veteran's survivor becomes eligible for full-dollar rate 
benefits for the first time on or after July 1 of any calendar year, the 
183-day rule will not apply during that calendar year. VA will not 
consider a veteran or a veteran's survivor to have been absent from the 
U.S. if he or she left and returned to the U.S. on the same date.
    (2) A veteran or a veteran's survivor receiving benefits at the 
full-dollar rate under this section must notify VA within 30 days of 
leaving the U.S., or within 30 days of losing either his or her U.S. 
citizenship or lawful permanent resident alien status. When a veteran or 
a veteran's survivor no longer meets the eligibility requirements of 
paragraph (b) of this section, VA will reduce his or her payment to the 
rate of $0.50 for each dollar authorized under the law, effective on the 
date determined under Sec.  3.505. If such veteran or survivor regains 
his or her U.S. citizenship or lawful permanent resident alien status, 
VA will restore full-dollar rate benefits, effective the date the 
veteran or survivor meets the eligibility requirements in paragraph (b) 
of this section.

[[Page 185]]

    (3) When requested to do so by VA, a veteran or survivor receiving 
benefits at the full-dollar rate under this section must verify that he 
or she continues to meet the residency and citizenship or permanent 
resident alien status requirements of paragraph (b) of this section. VA 
will advise the veteran or survivor at the time of the request that the 
verification must be furnished within 60 days and that failure to do so 
will result in the reduction of benefits. If the veteran or survivor 
fails to furnish the evidence within 60 days, VA will reduce his or her 
payment to the rate of $0.50 for each dollar authorized, as provided in 
Sec.  3.652.
    (4) A veteran or survivor receiving benefits at the full-dollar rate 
under this section must promptly notify VA of any change in his or her 
address. If mail from VA to the veteran or survivor is returned to VA by 
the U.S. Postal Service, VA will make reasonable efforts to determine 
the correct mailing address. If VA is unable to determine the correct 
mailing address through reasonable efforts, VA will reduce benefit 
payments to the rate of $0.50 for each dollar authorized under law, 
effective on the date determined under Sec.  3.505.
    (e) Effective date for restored eligibility. In the case of a 
veteran or survivor receiving benefits at the full-dollar rate, if VA 
reduces his or her payment to the rate of $0.50 for each dollar 
authorized under the law, VA will resume payments at the full-dollar 
rate, if otherwise in order, effective the first day of the month 
following the date on which he or she again meets the requirements. 
However, such increased payments will be retroactive no more than one 
year prior to the date on which VA receives evidence that he or she 
again meets the requirements.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0655)

[66 FR 66767, Dec. 27, 2001, as amended at 71 FR 8220, Feb. 16, 2006; 72 
FR 9, Jan. 3, 2007]



Sec.  3.43  Burial benefits at the full-dollar rate for certain Filipino
veterans residing in the United States on the date of death.

    (a) Definitions. For purposes of this section:
    (1) United States (U.S.) means the states, territories and 
possessions of the United States, the District of Columbia, and the 
Commonwealth of Puerto Rico.
    (2) Residing in the U.S. means an individual's principal, actual 
dwelling place was in the U.S. When death occurs outside the U.S., VA 
will consider the deceased individual to have been residing in the U.S. 
on the date of death if the individual maintained his or her principal 
actual dwelling place in the U.S. until his or her most recent departure 
from the U.S., and he or she had been physically absent from the U.S. 
less than 61 consecutive days when he or she died.
    (3) Citizen of the U.S. means any individual who acquires U.S. 
citizenship through birth in the territorial U.S., birth abroad as 
provided under title 8, United States Code, or through naturalization, 
and has not renounced his or her U.S. citizenship, or had such 
citizenship cancelled, revoked, or otherwise terminated.
    (4) Lawfully admitted for permanent residence means that the 
individual was lawfully accorded the privilege of residing permanently 
in the U.S. as an immigrant by the U.S. Citizenship and Immigration 
Services under title 8, United States Code, and on the date of death, 
still had this status.
    (b) Eligibility requirements. VA will pay burial benefits under 
chapter 23 of title 38, United States Code, at the full-dollar rate, 
based on service described in Sec.  3.40(c) or (d), when an individual 
who performed such service dies after November 1, 2000, or based on 
service described in Sec.  3.40(b) when an individual who performed such 
service dies after December 15, 2003, and was on the date of death:
    (1) Residing in the U.S.; and
    (2) Either--
    (i) A citizen of the U.S., or
    (ii) An alien lawfully admitted for permanent residence in the U.S.; 
and
    (3) Either--

[[Page 186]]

    (i) Receiving compensation under chapter 11 of title 38, United 
States Code; or
    (ii) Would have satisfied the disability, income and net worth 
requirements of Sec.  3.3(a)(3) of this part and would have been 
eligible for pension if the veteran's service had been deemed to be 
active military, naval, or air service.
    (c) Evidence of eligibility. (1) In a claim for full-dollar rate 
burial payments based on the deceased veteran having been a natural born 
citizen of the U.S., a valid original or copy of one of the following 
documents is required:
    (i) A valid U.S. passport;
    (ii) A birth certificate showing that he or she was born in the 
U.S.; or
    (iii) A Report of Birth Abroad of a Citizen of the U.S. issued by a 
U.S. consulate abroad.
    (2) In a claim based on the deceased veteran having been a 
naturalized citizen of the U.S., only verification of that status by the 
U.S. Citizenship and Immigration Services to VA, or a valid U.S. 
passport, will be sufficient proof for purposes of eligibility for full-
dollar rate benefits.
    (3) In a claim based on the deceased veteran having been an alien 
lawfully admitted for permanent residence in the U.S., only verification 
of that status by the U.S. Citizenship and Immigration Services to VA 
will be sufficient proof for purposes of eligibility for full-dollar 
rate benefits.
    (4) VA will not pay benefits at the full-dollar rate under this 
section unless the evidence establishes that the veteran was lawfully 
residing in the U.S. on the date of death.
    (i) Such evidence should identify the veteran's name and relevant 
dates, and may include:
    (A) A valid driver's license issued by the state of residence;
    (B) Employment records, which may consist of pay stubs, W-2 forms, 
and certification of the filing of Federal, State, or local income tax 
returns;
    (C) Residential leases, rent receipts, utility bills and receipts, 
or other relevant documents showing dates of utility service at a leased 
residence;
    (D) Hospital or medical records showing medical treatment or 
hospitalization of the veteran or survivor, and showing the name of the 
medical facility or treating physician;
    (E) Property tax bills and receipts; and
    (F) School records.
    (ii) A Post Office box mailing address in the veteran's name does 
not constitute evidence showing that the veteran was lawfully residing 
in the United States on the date of death.

(Authority: 38 U.S.C. 107, 501(a))

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0655)

[66 FR 66767, Dec. 27, 2001, as amended at 71 FR 8221, Feb. 16, 2006; 72 
FR 9, Jan. 3, 2007]

                              Relationship



Sec.  3.50  Spouse and surviving spouse.

    (a) Spouse. ``Spouse'' means a person of the opposite sex whose 
marriage to the veteran meets the requirements of Sec.  3.1(j).
    (b) Surviving spouse. Except as provided in Sec.  3.52, ``surviving 
spouse'' means a person of the opposite sex whose marriage to the 
veteran meets the requirements of Sec.  3.1(j) and who was the spouse of 
the veteran at the time of the veteran's death and:
    (1) Who lived with the veteran continuously from the date of 
marriage to the date of the veteran's death except where there was a 
separation which was due to the misconduct of, or procured by, the 
veteran without the fault of the spouse; and
    (2) Except as provided in Sec.  3.55, has not remarried or has not 
since the death of the veteran and after September 19, 1962, lived with 
another person of the opposite sex and held himself or herself out 
openly to the public to be the spouse of such other person.

[62 FR 5529, Feb. 6, 1997]



Sec.  3.52  Marriages deemed valid.

    Where an attempted marriage of a claimant to the veteran was invalid 
by reason of a legal impediment, the marriage will nevertheless be 
deemed valid if:
    (a) The marriage occurred 1 year or more before the veteran died or 
existed for any period of time if a child was born of the purported 
marriage or was

[[Page 187]]

born to them before such marriage (see Sec.  3.54(d)), and
    (b) The claimant entered into the marriage without knowledge of the 
impediment, and
    (c) The claimant cohabited with the veteran continuously from the 
date of marriage to the date of his or her death as outlined in Sec.  
3.53, and
    (d) No claim has been filed by a legal surviving spouse who has been 
found entitled to gratuitous death benefits other than accrued monthly 
benefits covering a period prior to the veteran's death.

(Authority: 38 U.S.C. 103(a))

    Cross Reference: Definition, marriage. See Sec.  3.205(c).

[26 FR 1567, Feb. 24, 1961, as amended at 27 FR 1215, Feb. 9, 1962; 32 
FR 13224, Sept. 19, 1967; 41 FR 18299, May 3, 1976]



Sec.  3.53  Continuous cohabitation.

    (a) General. The requirement that there must be continuous 
cohabitation from the date of marriage to the date of death of the 
veteran will be considered as having been met when the evidence shows 
that any separation was due to the misconduct of, or procured by, the 
veteran without the fault of the surviving spouse. Temporary separations 
which ordinarily occur, including those caused for the time being 
through fault of either party, will not break the continuity of the 
cohabitation.
    (b) Findings of fact. The statement of the surviving spouse as to 
the reason for the separation will be accepted in the absence of 
contradictory information. If the evidence establishes that the 
separation was by mutual consent and that the parties lived apart for 
purposes of convenience, health, business, or any other reason which did 
not show an intent on the part of the surviving spouse to desert the 
veteran, the continuity of the cohabitation will not be considered as 
having been broken. State laws will not control in determining questions 
of desertion; however, due weight will be given to findings of fact in 
court decisions made during the life of the veteran on issues 
subsequently involved in the application of this section.

[41 FR 18300, May 3, 1976, as amended at 59 FR 32659, June 24, 1994]



Sec.  3.54  Marriage dates.

    A surviving spouse may qualify for pension, compensation, or 
dependency and indemnity compensation if the marriage to the veteran 
occurred before or during his or her service or, if married to him or 
her after his or her separation from service, before the applicable date 
stated in his section.
    (a) Pension. Death pension may be paid to a surviving spouse who was 
married to the veteran:
    (1) One year or more prior to the veteran's death, or
    (2) For any period of time if a child was born of the marriage, or 
was born to them before the marriage, or
    (3) Prior to the applicable delimiting dates, as follows:
    (i) Civil War--June 27, 1905.
    (ii) Indian wars--March 4, 1917.
    (iii) Spanish-American War--January 1, 1938.
    (iv) Mexican border period and World War I--December 14, 1944.
    (v) World War II--January 1, 1957.
    (vi) Korean conflict--February 1, 1965.
    (vii) Vietnam era--May 8, 1985.
    (viii) Persian Gulf War--January 1, 2001.


(Authority: 38 U.S.C. 532(d), 534(c), 536(c), 541(e), 541(f))

    (b) Compensation. Death compensation may be paid to a surviving 
spouse who, with respect to date of marriage, could have qualified as a 
surviving spouse for death compensation under any law administered by 
the Department of Veterans Affairs in effect on December 31, 1957, or 
who was married to the veteran:
    (1) Before the expiration of 15 years after termination of the 
period of service in which the injury or disease which caused the 
veteran's death was incurred or aggravated, or
    (2) One year or more, or
    (3) For any period of time if a child was born of the marriage, or 
was born to them before the marriage.


(Authority: 38 U.S.C. 1102)


[[Page 188]]


    (c) Dependency and indemnity compensation. Dependency and indemnity 
compensation payable under 38 U.S.C. 1310(a) may be paid to the 
surviving spouse of a veteran who died on or after January 1, 1957, who 
was married to the veteran:
    (1) Before the expiration of 15 years after the termination of the 
period of service in which the injury or disease causing the death of 
the veteran was incurred or aggravated, or
    (2) For 1 year or more, or
    (3) For any period of time if a child was born of the marriage, or 
was born to them before the marriage.


(Authority: 38 U.S.C. 1304)

    (d) Child born. The term child born of the marriage means a birth on 
or after the date of the marriage on which the surviving spouse's 
entitlement is predicated. The term born to them before the marriage 
means a birth prior to the date of such marriage. Either term includes a 
fetus advanced to the point of gestation required to constitute a birth 
under the law of the jurisdiction in which the fetus was delivered.
    (e) More than one marriage to veteran. For periods commencing on or 
after January 1, 1958, where a surviving spouse has been married legally 
to a veteran more than once, the date of the original marriage will be 
used in determining whether the statutory requirement as to date of 
marriage has been met.

(Authority: 38 U.S.C. 103(b))

[26 FR 1567, Feb. 24, 1961, as amended at 27 FR 6498, July 10, 1962; 32 
FR 13224, Sept. 19, 1967; 40 FR 16064, Apr. 9, 1975; 40 FR 48680, Oct. 
17, 1975; 41 FR 18300, May 3, 1976; 44 FR 22718, Apr. 17, 1979; 54 FR 
31829, Aug. 2, 1989; 56 FR 5756, Feb. 13, 1991; 56 FR 57986, Nov. 15, 
1991; 65 FR 3392, Jan. 21, 2000]



Sec.  3.55  Reinstatement of benefits eligibility based upon terminated 
marital relationships.

    (a) Surviving spouse. (1) Remarriage of a surviving spouse shall not 
bar the furnishing of benefits to such surviving spouse if the marriage:
    (i) Was void, or
    (ii) Has been annulled by a court having basic authority to render 
annulment decrees, unless it is determined by the Department of Veterans 
Affairs that the annulment was obtained through fraud by either party or 
by collusion.
    (2) On or after January 1, 1971, remarriage of a surviving spouse 
terminated prior to November 1, 1990, or terminated by legal proceedings 
commenced prior to November 1, 1990, by an individual who, but for the 
remarriage, would be considered the surviving spouse, shall not bar the 
furnishing of benefits to such surviving spouse provided that the 
marriage:
    (i) Has been terminated by death, or
    (ii) Has been dissolved by a court with basic authority to render 
divorce decrees unless the Department of Veterans Affairs determines 
that the divorce was secured through fraud by the surviving spouse or by 
collusion.
    (3) On or after October 1, 1998, remarriage of a surviving spouse 
terminated by death, divorce, or annulment, will not bar the furnishing 
of dependency and indemnity compensation, unless the Secretary 
determines that the divorce or annulment was secured through fraud or 
collusion.


(Authority: 38 U.S.C. 1311(e))

    (4) On or after December 1, 1999, remarriage of a surviving spouse 
terminated by death, divorce, or annulment, will not bar the furnishing 
of benefits relating to medical care for survivors and dependents under 
38 U.S.C. 1781, educational assistance under 38 U.S.C. chapter 35, or 
housing loans under 38 U.S.C. chapter 37, unless the Secretary 
determines that the divorce or annulment was secured through fraud or 
collusion.


(Authority: 38 U.S.C. 103(d))

    (5) On or after January 1, 1971, the fact that a surviving spouse 
has lived with another person and has held himself or herself out openly 
to the public as the spouse of such other person shall not bar the 
furnishing of benefits to him or her after he or she terminates the 
relationship, if the relationship terminated prior to November 1, 1990.
    (6) On or after October 1, 1998, the fact that a surviving spouse 
has lived with another person and has held himself or herself out openly 
to the public as the spouse of such other person will not bar the 
furnishing of dependency

[[Page 189]]

and indemnity compensation to the surviving spouse if he or she ceases 
living with such other person and holding himself or herself out openly 
to the public as such other person's spouse.


(Authority: 38 U.S.C. 1311(e))

    (7) On or after December 1, 1999, the fact that a surviving spouse 
has lived with another person and has held himself or herself out openly 
to the public as the spouse of such other person will not bar the 
furnishing of benefits relating to medical care for survivors and 
dependents under 38 U.S.C. 1781, educational assistance under 38 U.S.C. 
chapter 35, or housing loans under 38 U.S.C. chapter 37 to the surviving 
spouse if he or she ceases living with such other person and holding 
himself or herself out openly to the public as such other person's 
spouse.


(Authority: 38 U.S.C. 103(d))

    (8) On or after January 1, 1971, the fact that benefits to a 
surviving spouse may previously have been barred because his or her 
conduct or a relationship into which he or she had entered had raised an 
inference or presumption that he or she had remarried or had been 
determined to be open and notorious adulterous cohabitation, or similar 
conduct, shall not bar the furnishing of benefits to such surviving 
spouse after he or she terminates the conduct or relationship, if the 
relationship terminated prior to November 1, 1990.
    (9) Benefits under 38 U.S.C. 1781 for a surviving spouse who 
remarries after age 55. (i) On or after February 4, 2003, the remarriage 
of a surviving spouse after age 55 shall not bar the furnishing of 
benefits relating to medical care for survivors and dependents under 38 
U.S.C. 1781, subject to the limitation in paragraph (a)(9)(ii) of this 
section.
    (ii) A surviving spouse who remarried after the age of 55, but 
before December 6, 2002, may be eligible for benefits relating to 
medical care for survivors and dependents under 38 U.S.C. 1781 pursuant 
to paragraph (a)(9)(i) only if the application for such benefits was 
received by VA before December 16, 2004.

(Authority: 38 U.S.C. 103).

    (10) Benefits for a surviving spouse who remarries after age 57. (i) 
On or after January 1, 2004, the remarriage of a surviving spouse after 
the age of 57 shall not bar the furnishing of benefits relating to 
dependency and indemnity compensation under 38 U.S.C. 1311, medical care 
for survivors and dependents under 38 U.S.C. 1781, educational 
assistance under 38 U.S.C. chapter 35, or housing loans under 38 U.S.C. 
chapter 37, subject to the limitation in paragraph (a)(10)(ii) of this 
section.
    (ii) A surviving spouse who remarried after the age of 57, but 
before December 16, 2003, may be eligible for dependency and indemnity 
compensation under 38 U.S.C. 1311, medical care for survivors and 
dependents under 38 U.S.C. 1781, educational assistance under 38 U.S.C. 
chapter 35, or housing loans under 38 U.S.C. chapter 37 pursuant to 
paragraph (a)(10)(i) only if the application for such benefits was 
received by VA before December 16, 2004.

(Authority: 38 U.S.C. 103).

    (b) Child. (1) Marriage of a child shall not bar the furnishing of 
benefits to or on account of such child, if the marriage:
    (i) Was void, or
    (ii) Has been annulled by a court having basic authority to render 
annulment decrees, unless it is determined by the Department of Veterans 
Affairs that the annulment was obtained through fraud by either party or 
by collusion.
    (2) On or after January 1, 1975, marriage of a child terminated 
prior to November 1, 1990, shall not bar the furnishing of benefits to 
or for such child provided that the marriage:
    (i) Has been terminated by death, or
    (ii) Has been dissolved by a court with basic authority to render 
divorce decrees unless the Department of Veterans Affairs determines 
that the divorce was secured through fraud by either party or by 
collusion.

(Authority: 38 U.S.C. 103; 105 Stat. 424, 106 Stat. 4322)

[[Page 190]]


    Cross References: Evidence. See Sec. Sec.  3.206 and 3.207. 
Termination of marital relationship or conduct. See Sec.  3.215.

[58 FR 32444, June 10, 1993, as amended at 60 FR 52863, Oct. 11, 1995; 
64 FR 30245, June 7, 1999; 65 FR 43700, July 14, 2000; 71 FR 29084, May 
19, 2006]



Sec.  3.56  [Reserved]



Sec.  3.57  Child.

    (a) General. (1) Except as provided in paragraphs (a)(2) through (4) 
of this section, the term child of the veteran means an unmarried person 
who is a legitimate child, a child legally adopted before the age of 18 
years, a stepchild who acquired that status before the age of 18 years 
and who is a member of the veteran's household or was a member of the 
veteran's household at the time of the veteran's death, or an 
illegitimate child; and
    (i) Who is under the age of 18 years; or
    (ii) Who, before reaching the age of 18 years, became permanently 
incapable of self-support; or
    (iii) Who, after reaching the age of 18 years and until completion 
of education or training (but not after reaching the age of 23 years) is 
pursuing a course of instruction at an educational institution approved 
by the Department of Veterans Affairs. For the purposes of this section 
and Sec.  3.667, the term ``educational institution'' means a permanent 
organization that offers courses of instruction to a group of students 
who meet its enrollment criteria, including schools, colleges, 
academies, seminaries, technical institutes, and universities. The term 
also includes home schools that operate in compliance with the 
compulsory attendance laws of the States in which they are located, 
whether treated as private schools or home schools under State law. The 
term ``home schools'' is limited to courses of instruction for grades 
kindergarten through 12.


(Authority: 38 U.S.C. 101(4)(A), 104(a))

    (2) For the purposes of determining entitlement of benefits based on 
a child's school attendance, the term child of the veteran also includes 
the following unmarried persons:
    (i) A person who was adopted by the veteran between the ages of 18 
and 23 years.
    (ii) A person who became a stepchild of the veteran between the ages 
of 18 and 23 years and who is a member of the veteran's household or was 
a member of the veteran's household at the time of the veteran's death.
    (3) Subject to the provisions of paragraphs (c) and (e) of this 
section, the term child also includes a person who became permanently 
incapable of self-support before reaching the age of 18 years, who was a 
member of the veteran's household at the time he or she became 18 years 
of age, and who was adopted by the veteran, regardless of the age of 
such person at the time of adoption.


(Authority: 38 U.S.C. 101(4)(A))

    (4) For purposes of any benefits provided under 38 U.S.C. 1115, 
Additional compensation for dependents, the term child does not include 
a child of a veteran who is adopted out of the family of the veteran. 
This limitation does not apply to any benefit administered by the 
Secretary that is payable directly to a child in the child's own right, 
such as dependency and indemnity compensation under 38 CFR 3.5.


(Authority: 38 U.S.C. 101(4), 501, 1115).

    (b) Stepchild. The term means a legitimate or an illegitimate child 
of the veteran's spouse. A child of a surviving spouse whose marriage to 
the veteran is deemed valid under the provisions of Sec.  3.52, and who 
otherwise meets the requirements of this section is included.
    (c) Adopted child. Except as provided in paragraph (e) of this 
section, the term means a child adopted pursuant to a final decree of 
adoption, a child adopted pursuant to an unrescinded interlocutory 
decree of adoption while remaining in the custody of the adopting parent 
(or parents) during the interlocutory period, and a child who has been 
placed for adoption under an agreement entered into by the adopting 
parent (or parents) with any agency authorized under law to so act, 
unless and until such agreement is terminated, while the child remains 
in the custody of the adopting parent (or parents) during the period of 
placement

[[Page 191]]

for adoption under such agreement. The term includes, as of the date of 
death of a veteran, such a child who:
    (1) Was living in the veteran's household at the time of the 
veteran's death, and
    (2) Was adopted by the veteran's spouse under a decree issued within 
2 years after August 25, 1959, or the veteran's death whichever is 
later, and
    (3) Was not receiving from an individual other than the veteran or 
the veteran's spouse, or from a welfare organization which furnishes 
services or assistance for children, recurring contributions of 
sufficient size to constitute the major portion of the child's support.


(Authority: 38 U.S.C. 101(4))

    (d) Definition of child custody. The provisions of this paragraph 
are for the purpose of determining entitlement to improved pension under 
Sec. Sec.  3.23 and 3.24.
    (1) Custody of a child shall be considered to rest with a veteran, 
surviving spouse of a veteran or person legally responsible for the 
child's support if that person has the legal right to exercise parental 
control and responsibility for the welfare and care of the child. A 
child of the veteran residing with the veteran, surviving spouse of the 
veteran who is the child's natural or adoptive parent, or person legally 
responsible for the child's support shall be presumed to be in the 
custody of that individual. Where the veteran, surviving spouse, or 
person legally responsible for the child's support has not been divested 
of legal custody, but the child is not residing with that individual, 
the child shall be considered in the custody of the individual for 
purposes of Department of Veterans Affairs benefits.
    (2) The term person legally responsible for the child's support 
means a person who is under a legally imposed obligation (e.g., by 
statute or court order) to provide for the child's support, as well as a 
natural or adoptive parent who has not been divested of legal custody. 
If the child's natural or adoptive parent has remarried, the stepparent 
may also be considered a person legally responsible for the child's 
support. A child shall be considered in the joint custody of his or her 
stepparent and natural or adoptive parent so long as the natural or 
adoptive parent and the stepparent are not estranged and residing apart, 
and the natural or adoptive parent has not been divested of legal 
custody. When a child is in such joint custody the combined income of 
the natural or adoptive parent and the stepparent shall be included as 
income of the person legally responsible for support under Sec.  
3.24(c).
    (3) A person having custody of a child prior to the time the child 
attains age 18 shall be considered to retain custody of the child for 
periods on and after the child's 18th birthday, unless the person is 
divested of legal custody. This applies without regard to when a child 
reaches the age of majority under applicable State law. This also 
applies without regard to whether the child was entitled to pension 
prior to age 18, or whether increased pension was payable to a veteran 
or surviving spouse on behalf of the child prior to the child's 18th 
birthday. If the child's custodian dies after the child has attained age 
18, the child shall be considered to be in custody of a successor 
custodian provided the successor custodian has the right to exercise 
parental control and responsibility for the welfare and care of the 
child.


(Authority: 38 U.S.C. 501, 1521(c), 1541(c))

    (e) Child adopted under foreign law--(1) General. The provisions of 
this paragraph are applicable to a person adopted under the laws of any 
jurisdiction other than a State. The term State is defined in 38 U.S.C. 
101(20) and also includes the Commonwealth of the Northern Mariana 
Islands. The term veteran includes, for the purposes of this paragraph, 
a Commonwealth Army veteran or new Philippine Scout as defined in 38 
U.S.C. 3566.
    (2) Adopted child of living veteran. A person residing outside any 
of the States shall not be considered to be a legally adopted child of a 
veteran during the lifetime of the veteran unless all of the following 
conditions are met.
    (i) The person was less than 18 years of age at the time of 
adoption.
    (ii) The person is receiving one-half or more of the person's 
support from the veteran.

[[Page 192]]

    (iii) The person is not in the custody of the person's natural 
parent unless the natural parent is the veteran's spouse.
    (iv) The person is residing with the veteran (or in the case of 
divorce following adoption, with the divorced spouse who is also a 
natural or adoptive parent) except for periods during which the person 
is residing apart from the veteran for purposes of full-time attendance 
at an educational institution or during which the person or the veteran 
is confined in a hospital, nursing home, other health-care facility, or 
other institution.
    (3) Adopted child of deceased veteran. A person shall not be 
considered to have been a legally adopted child of a veteran as of the 
date of the veteran's death and thereafter unless one of the following 
conditions is met.
    (i) The veteran was entitled to and was receiving for the person a 
dependent's allowance or similar monetary benefit payable under title 
38, United States Code at any time within the 1-year period immediately 
preceding the veteran's death; or
    (ii) The person met the requirements of paragraph (e)(2) of this 
section for a period of at least 1 year prior to the veteran's death.
    (4) Verification. In the case of an adopted child of a living 
veteran, the requirements of paragraphs (e)(2)(ii), (iii) and (iv) of 
this section are for prospective application. That is, in addition to 
meeting all of the requirements of paragraph (e)(2) of this section at 
the time of initial adjudication, benefits are not payable thereafter 
for or to a child adopted under the laws of any jurisdiction other than 
a State unless the requirements of paragraphs (e)(2)(ii), (iii) and (iv) 
of this section continue to be met. Consequently, whenever Department of 
Veterans Affairs benefits are payable to or for a child adopted under 
the laws of any jurisdiction other than a State, and the veteran who 
adopted the child is living, the beneficiary shall submit, upon 
Department of Veterans Affairs request, a report, or other evidence, to 
determine if the requirements of paragraph (e)(2)(ii), (iii), and (iv) 
of this section were met for any period for which payment was made for 
or to the child and whether such requirements will continue to be met 
for future entitlement periods. Failure to submit the requested report 
or evidence within a reasonable time from date of request may result in 
termination of benefits payable for or to the child.

(Authority: 38 U.S.C. 101(4), 501)

    Cross References: Improved pension rates. See Sec.  3.23. Improved 
pension rates; surviving children. See Sec.  3.24. Child adopted out of 
family. See Sec.  3.58. Child's relationship. See Sec.  3.210. 
Helplessness. See Sec.  3.403(a)(1). Helplessness. See Sec.  
3.503(a)(3). Veteran's benefits not apportionable. See Sec.  3.458. 
School attendance. See Sec.  3.667. Helpless children--Spanish-American 
and prior wars. See Sec.  3.950.

[44 FR 45935, Aug. 6, 1979 and 45 FR 1878, Jan. 9, 1980, as amended at 
45 FR 25391, Apr. 15, 1980; 49 FR 47003, Nov. 30, 1984; 65 FR 12116, 
Mar. 8, 2000; 72 FR 6959, Feb. 14, 2007; 80 FR 48451, Aug. 13, 2015]



Sec.  3.58  Child adopted out of family.

    (a) Except as provided in paragraph (b) of this section, a child of 
a veteran adopted out of the family of the veteran either prior or 
subsequent to the veteran's death is nevertheless a child within the 
meaning of that term as defined by Sec.  3.57 and is eligible for 
benefits payable under all laws administered by the Department of 
Veterans Affairs.
    (b) A child of a veteran adopted out of the family of the veteran is 
not a child within the meaning of Sec.  3.57 for purposes of any 
benefits provided under 38 U.S.C. 1115, Additional compensation for 
dependents.

(Authority: 38 U.S.C. 101(4)(A), 1115).


    Cross References: Child. See Sec.  3.57. Veteran's benefits not 
apportionable. See Sec.  3.458.

[80 FR 48451, Aug. 13, 2015]



Sec.  3.59  Parent.

    (a) The term parent means a natural mother or father (including the 
mother of an illegitimate child or the father of an illegitimate child 
if the usual family relationship existed), mother or father through 
adoption, or a person who for a period of not less than 1 year stood in 
the relationship of a parent to a veteran at any time before his or her 
entry into active service.

[[Page 193]]

    (b) Foster relationship must have begun prior to the veteran's 21st 
birthday. Not more than one father and one mother, as defined, will be 
recognized in any case. If two persons stood in the relationship of 
father or mother for 1 year or more, the person who last stood in such 
relationship before the veteran's last entry into active service will be 
recognized as the parent.

(Authority: 38 U.S.C. 101(5))

[26 FR 1568, Feb. 24, 1961, as amended at 44 FR 45935, Aug. 6, 1979]



Sec.  3.60  Definition of ``living with''.

    For the purposes of determining entitlement to pension under 38 
U.S.C. 1521, a person shall be considered as living with his or her 
spouse even though they reside apart unless they are estranged.

(Authority: 38 U.S.C. 1521(h)(2))

[44 FR 45935, Aug. 6, 1979]

                             Administrative



Sec.  3.100  Delegations of authority.

    (a) Authority is delegated to the Under Secretary for Benefits and 
to supervisory or adjudicative personnel within the jurisdiction of the 
Veterans Benefits Administration designated by the Under Secretary to 
make findings and decisions under the applicable laws, regulations, 
precedents, and instructions, as to entitlement of claimants to benefits 
under all laws administered by the Department of Veterans Affairs 
governing the payment of monetary benefits to veterans and their 
dependents, within the jurisdiction of the Compensation Service or the 
Pension and Fiduciary Service.
    (b) Authority is delegated to the Director, Compensation Service, 
and the Director, Pension and Fiduciary Service, and to personnel of 
each service designated by its Director to determine whether a claimant 
or payee has forfeited the right to gratuitious benefits or to remit a 
prior forfeiture pursuant to the provisions of 38 U.S.C. 6103 or 6104. 
See Sec.  3.905.

(Authority: 38 U.S.C. 512(a))

[29 FR 7547, June 12, 1964, as amended at 31 FR 14455, Nov. 10, 1966; 37 
FR 10442, May 23, 1972; 53 FR 3207, Feb. 4, 1988; 60 FR 18355, Apr. 11, 
1995; 61 FR 20727, May 8, 1996; 78 FR 2100, Jan. 13, 2014]



Sec.  3.102  Reasonable doubt.

    It is the defined and consistently applied policy of the Department 
of Veterans Affairs to administer the law under a broad interpretation, 
consistent, however, with the facts shown in every case. When, after 
careful consideration of all procurable and assembled data, a reasonable 
doubt arises regarding service origin, the degree of disability, or any 
other point, such doubt will be resolved in favor of the claimant. By 
reasonable doubt is meant one which exists because of an approximate 
balance of positive and negative evidence which does not satisfactorily 
prove or disprove the claim. It is a substantial doubt and one within 
the range of probability as distinguished from pure speculation or 
remote possibility. It is not a means of reconciling actual conflict or 
a contradiction in the evidence. Mere suspicion or doubt as to the truth 
of any statements submitted, as distinguished from impeachment or 
contradiction by evidence or known facts, is not justifiable basis for 
denying the application of the reasonable doubt doctrine if the entire, 
complete record otherwise warrants invoking this doctrine. The 
reasonable doubt doctrine is also applicable even in the absence of 
official records, particularly if the basic incident allegedly arose 
under combat, or similarly strenuous conditions, and is consistent with 
the probable results of such known hardships.

(Authority: 38 U.S.C. 501)

[50 FR 34458, Aug. 26, 1985, as amended at 66 FR 45630, Aug. 29, 2001]



Sec.  3.103  Procedural due process and other rights.

    (a) Statement of policy. Every claimant has the right to written 
notice of the decision made on his or her claim, the right to a hearing, 
and the right of representation. Proceedings before VA

[[Page 194]]

are ex parte in nature, and it is the obligation of VA to assist a 
claimant in developing the facts pertinent to the claim and to render a 
decision which grants every benefit that can be supported in law while 
protecting the interests of the Government. The provisions of this 
section apply to all claims for benefits and relief, and decisions 
thereon, within the purview of this part 3.
    (b) The right to notice--
    (1) General. Claimants and their representatives are entitled to 
notice of any decision made by VA affecting the payment of benefits or 
the granting of relief. Such notice will clearly set forth the elements 
described under paragraph (f) of this section, the right to a hearing on 
any issue involved in the claim as provided in paragraph (d) of this 
section, the right of representation, and the right, as well as the 
necessary procedures and time limits to initiate a higher-level review, 
supplemental claim, or appeal to the Board of Veterans' Appeals.
    (2) Advance notice and opportunity for hearing. Except as otherwise 
provided in paragraph (b)(3) of this section, no award of compensation, 
pension or dependency and indemnity compensation shall be terminated, 
reduced or otherwise adversely affected unless the beneficiary has been 
notified of such adverse action and has been provided a period of 60 
days in which to submit evidence for the purpose of showing that the 
adverse action should not be taken.
    (3) Exceptions. In lieu of advance notice and opportunity for a 
hearing, VA will send a written notice to the beneficiary or his or her 
fiduciary at the same time it takes an adverse action under the 
following circumstances:
    (i) An adverse action based solely on factual and unambiguous 
information or statements as to income, net worth, or dependency or 
marital status that the beneficiary or his or her fiduciary provided to 
VA in writing or orally (under the procedures set forth in Sec.  
3.217(b)), with knowledge or notice that such information would be used 
to calculate benefit amounts.
    (ii) An adverse action based upon the beneficiary's or fiduciary's 
failure to return a required eligibility verification report.
    (iii) Evidence reasonably indicates that a beneficiary is deceased. 
However, in the event that VA has received a death certificate, a 
terminal hospital report verifying the death of a beneficiary or a claim 
for VA burial benefits, no notice of termination (contemporaneous or 
otherwise) will be required.
    (iv) An adverse action based upon a written and signed statement 
provided by the beneficiary to VA renouncing VA benefits (see Sec.  
3.106 on renouncement).
    (v) An adverse action based upon a written statement provided to VA 
by a veteran indicating that he or she has returned to active service, 
the nature of that service, and the date of reentry into service, with 
the knowledge or notice that receipt of active service pay precludes 
concurrent receipt of VA compensation or pension (see Sec.  3.654 
regarding active service pay).
    (vi) An adverse action based upon a garnishment order issued under 
42 U.S.C. 659(a).


(Authority: 38 U.S.C. 501(a))

    (4) Restoration of benefits. VA will restore retroactively benefits 
that were reduced, terminated, or otherwise adversely affected based on 
oral information or statements if within 30 days of the date on which VA 
issues the notification of adverse action the beneficiary or his or her 
fiduciary asserts that the adverse action was based upon information or 
statements that were inaccurate or upon information that was not 
provided by the beneficiary or his or her fiduciary. This will not 
preclude VA from taking subsequent action that adversely affects 
benefits.
    (c) Submission of evidence--(1) General rule. VA will include in the 
record, any evidence whether documentary, testimonial, or in other form, 
submitted by the claimant in support of a pending claim and any issue, 
contention, or argument a claimant may offer with respect to a claim, 
except as prescribed in paragraph (c)(2) of this section and Sec.  
3.2601(f).
    (2) Treatment of evidence received after notice of a decision. The 
evidentiary record for a claim before the agency of

[[Page 195]]

original jurisdiction closes when VA issues notice of a decision on the 
claim. The agency of original jurisdiction will not consider, or take 
any other action on evidence that is submitted by a claimant, associated 
with the claims file, or constructively received by VA as described in 
paragraph (c)(2)(iii) of this section, after notice of decision on a 
claim, and such evidence will not be considered part of the record at 
the time of any decision by the agency of original jurisdiction, except 
as described in Sec.  3.156(c) and under the following circumstances:
    (i) Receipt of a complete claim. The agency of original jurisdiction 
subsequently receives a complete application for a supplemental claim or 
initial claim; or
    (ii) Board and higher-level review returns. A claim is pending 
readjudication after identification of a duty to assist error (which 
includes an error resulting from constructive receipt of evidence prior 
to the notice of decision), during a higher-level review or appeal to 
the Board of Veterans' Appeals. Those events reopen the record and any 
evidence previously submitted to the agency of original jurisdiction or 
associated with the claims file while the record was closed will become 
part of the evidentiary record to be considered upon readjudication.
    (iii) Constructive receipt of VA treatment records. Records within 
the actual custody of the Veterans Health Administration are deemed 
constructively received by the Veterans Benefits Administration at the 
time when the Veterans Benefits Administration had knowledge of the 
existence of said records through information furnished by the claimant 
sufficient to locate those records (see 38 U.S.C. 5103A(c)).
    (d) The right to a hearing. (1) Upon request, a claimant is entitled 
to a hearing on any issue involved in a claim within the purview of part 
3 of this chapter before VA issues notice of a decision on an initial or 
supplemental claim. A hearing is not available in connection with a 
request for higher-level review under Sec.  3.2601. VA will provide the 
place of hearing in the VA field office having original jurisdiction 
over the claim, or at the VA office nearest the claimant's home having 
adjudicative functions, or videoconference capabilities, or, subject to 
available resources and solely at the option of VA, at any other VA 
facility or federal building at which suitable hearing facilities are 
available. VA will provide one or more employees who have original 
determinative authority of such issues to conduct the hearing and be 
responsible for establishment and preservation of the hearing record. 
Upon request, a claimant is entitled to a hearing in connection with 
proposed adverse actions before one or more VA employees having original 
determinative authority who did not participate in the proposed action. 
All expenses incurred by the claimant in connection with the hearing are 
the responsibility of the claimant.
    (2) The purpose of a hearing is to permit the claimant to introduce 
into the record, in person, any available evidence which he or she 
considers relevant and any arguments or contentions with respect to the 
facts and applicable law which he or she may consider pertinent. All 
testimony will be under oath or affirmation. The claimant is entitled to 
produce witnesses, but the claimant and witnesses must be present. The 
agency of original jurisdiction will not normally schedule a hearing for 
the sole purpose of receiving argument from a representative. It is the 
responsibility of the VA employees conducting the hearings to explain 
fully the issues and suggest the submission of evidence which the 
claimant may have overlooked and which would be of advantage to the 
claimant's position. To assure clarity and completeness of the hearing 
record, questions which are directed to the claimant and to witnesses 
are to be framed to explore fully the basis for claimed entitlement 
rather than with an intent to refute evidence or to discredit testimony.
    (e) The right to representation. Subject to the provisions of 
Sec. Sec.  14.626 through 14.637 of this title, claimants are entitled 
to representation of their choice at every stage in the prosecution of a 
claim.
    (f) Notification of decisions. The claimant or beneficiary and his 
or her representative will be notified in writing of decisions affecting 
the payment of

[[Page 196]]

benefits or granting of relief. Written notification must include in the 
notice letter or enclosures or a combination thereof, all of the 
following elements:
    (1) Identification of the issues adjudicated;
    (2) A summary of the evidence considered;
    (3) A summary of the laws and regulations applicable to the claim;
    (4) A listing of any findings made by the adjudicator that are 
favorable to the claimant under Sec.  3.104(c);
    (5) For denied claims, identification of the element(s) required to 
grant the claim(s) that were not met;
    (6) If applicable, identification of the criteria required to grant 
service connection or the next higher-level of compensation;
    (7) An explanation of how to obtain or access evidence used in 
making the decision; and
    (8) A summary of the applicable review options under Sec.  3.2500 
available for the claimant to seek further review of the decision.

(Authority:38 U.S.C. 501, 1115, 1506, 5104)

[55 FR 13527, Apr. 11, 1990; 55 FR 17530, Apr. 25, 1990, as amended at 
55 FR 20148, May 15, 1990; 55 FR 25308, June 21, 1990; 57 FR 56993, Dec. 
2, 1992; 58 FR 16360, Mar. 26, 1993; 58 FR 59366, Nov. 9, 1993; 59 FR 
6218, Feb. 10, 1994; 59 FR 6901, Feb. 14, 1994; 66 FR 56613, Nov. 9, 
2001; 76 FR 52574, Aug. 23, 2011; 77 FR 23129, Apr. 18, 2012; 84 FR 166, 
Jan. 18, 2019]



Sec.  3.104  Binding nature of decisions.

    (a) Binding decisions. A decision of a VA rating agency is binding 
on all VA field offices as to conclusions based on the evidence on file 
at the time VA issues written notification in accordance with 38 U.S.C. 
5104. A binding agency decision is not subject to revision except by the 
Board of Veterans' Appeals, by Federal court order, or as provided in 
Sec. Sec.  3.105, 3.2500, and 3.2600.
    (b) Binding administrative determinations. Current determinations of 
line of duty, character of discharge, relationship, dependency, domestic 
relations questions, homicide, and findings of fact of death or 
presumptions of death made in accordance with existing instructions, and 
by application of the same criteria and based on the same facts, by 
either an Adjudication activity or an Insurance activity are binding one 
upon the other in the absence of clear and unmistakable error.
    (c) Favorable findings. Any finding favorable to the claimant made 
by either a VA adjudicator, as described in Sec.  3.103(f)(4), or by the 
Board of Veterans' Appeals, as described in Sec.  20.801(a) of this 
chapter, is binding on all subsequent agency of original jurisdiction 
and Board of Veterans' Appeals adjudicators, unless rebutted by evidence 
that identifies a clear and unmistakable error in the favorable finding. 
For purposes of this section, a finding means a conclusion either on a 
question of fact or on an application of law to facts made by an 
adjudicator concerning the issue(s) under review.

[29 FR 1462, Jan. 29, 1964, as amended at 29 FR 7547, June 12, 1964; 56 
FR 65846, Dec. 19, 1991; 66 FR 21874, May 2, 2001; 84 FR 167, Jan. 18, 
2019]



Sec.  3.105  Revision of decisions.

    The provisions of this section apply except where an award was based 
on an act of commission or omission by the payee, or with his or her 
knowledge (Sec.  3.500(b)); there is a change in law or a Department of 
Veterans Affairs issue, or a change in interpretation of law or a 
Department of Veterans Affairs issue (Sec.  3.114); or the evidence 
establishes that service connection was clearly illegal. The provisions 
with respect to the date of discontinuance of benefits are applicable to 
running awards. Where the award has been suspended, and it is determined 
that no additional payments are in order, the award will be discontinued 
effective date of last payment.
    (a)(1) Error in final decisions. Decisions are final when the 
underlying claim is finally adjudicated as provided in Sec.  3.160(d). 
Final decisions will be accepted by VA as correct with respect to the 
evidentiary record and the law that existed at the time of the decision, 
in the absence of clear and unmistakable error. At any time after a 
decision is final, the claimant may request, or VA may initiate, review 
of the decision to determine if there was a clear and unmistakable error 
in the decision. Where evidence establishes such error, the prior 
decision will be reversed or amended.

[[Page 197]]

    (i) Definition of clear and unmistakable error. A clear and 
unmistakable error is a very specific and rare kind of error. It is the 
kind of error, of fact or of law, that when called to the attention of 
later reviewers compels the conclusion, to which reasonable minds could 
not differ, that the result would have been manifestly different but for 
the error. If it is not absolutely clear that a different result would 
have ensued, the error complained of cannot be clear and unmistakable. 
Generally, either the correct facts, as they were known at the time, 
were not before VA, or the statutory and regulatory provisions extant at 
the time were incorrectly applied.
    (ii) Effective date of reversed or revised decisions. For the 
purpose of authorizing benefits, the rating or other adjudicative 
decision which constitutes a reversal or revision of a prior decision on 
the grounds of clear and unmistakable error has the same effect as if 
the corrected decision had been made on the date of the reversed 
decision. Except as provided in paragraphs (d) and (e) of this section, 
where an award is reduced or discontinued because of administrative 
error or error in judgment, the provisions of Sec.  3.500(b)(2) will 
apply.
    (iii) Record to be reviewed. Review for clear and unmistakable error 
in a prior final decision of an agency of original jurisdiction must be 
based on the evidentiary record and the law that existed when that 
decision was made. The duty to assist in Sec.  3.159 does not apply to 
requests for revision based on clear and unmistakable error.
    (iv) Change in interpretation. Clear and unmistakable error does not 
include the otherwise correct application of a statute or regulation 
where, subsequent to the decision being challenged, there has been a 
change in the interpretation of the statute or regulation.
    (v) Limitation on Applicability. Decisions of an agency of original 
jurisdiction on issues that have been decided on appeal by the Board or 
a court of competent jurisdiction are not subject to revision under this 
subsection.
    (vi) Duty to assist not applicable. For examples of situations that 
are not clear and unmistakable error see 38 CFR 20.1403(d).
    (vii) Filing Requirements--(A) General. A request for revision of a 
decision based on clear and unmistakable error must be in writing, and 
must be signed by the requesting party or that party's authorized 
representative. The request must include the name of the claimant; the 
name of the requesting party if other than the claimant; the applicable 
Department of Veterans Affairs file number; and the date of the decision 
to which the request relates. If the applicable decision involved more 
than one issue, the request must identify the specific issue, or issues, 
to which the request pertains.
    (B) Specific allegations required. The request must set forth 
clearly and specifically the alleged clear and unmistakable error, or 
errors, of fact or law in the prior decision, the legal or factual basis 
for such allegations, and why the result would have been manifestly 
different but for the alleged error. Non-specific allegations of failure 
to follow regulations or failure to give due process, or any other 
general, non-specific allegations of error, are insufficient to satisfy 
the requirement of the previous sentence.
    (2) Error in binding decisions prior to final adjudication. Prior to 
the time that a claim is finally adjudicated, previous decisions which 
are binding will be accepted as correct by the agency of original 
jurisdiction, with respect to the evidentiary record and law existing at 
the time of the decision, unless the decision is clearly erroneous, 
after considering whether any favorable findings may be reversed as 
provided in Sec.  3.104(c).
    (b) Difference of opinion. Whenever an adjudicative agency is of the 
opinion that a revision or an amendment of a previous decision is 
warranted on the basis of the evidentiary record and law that existed at 
the time of the decision, a difference of opinion being involved rather 
than a clear and unmistakable error, the proposed revision will be 
recommended to Central Office. However, a decision may be revised under 
Sec.  3.2600 or Sec.  3.2601 without being recommended to Central 
Office.
    (c) Character of discharge. A determination as to character of 
discharge or line of duty which would result in discontinued entitlement 
is subject to

[[Page 198]]

the provisions of paragraph (d) of this section.
    (d) Severance of service connection. Subject to the limitations 
contained in Sec. Sec.  3.114 and 3.957, service connection will be 
severed only where evidence establishes that it is clearly and 
unmistakably erroneous (the burden of proof being upon the Government). 
(Where service connection is severed because of a change in or 
interpretation of a law or Department of Veterans Affairs issue, the 
provisions of Sec.  3.114 are for application.) A change in diagnosis 
may be accepted as a basis for severance action if the examining 
physician or physicians or other proper medical authority certifies 
that, in the light of all accumulated evidence, the diagnosis on which 
service connection was predicated is clearly erroneous. This 
certification must be accompanied by a summary of the facts, findings, 
and reasons supporting the conclusion. When severance of service 
connection is considered warranted, a rating proposing severance will be 
prepared setting forth all material facts and reasons. The claimant will 
be notified at his or her latest address of record of the contemplated 
action and furnished detailed reasons therefor and will be given 60 days 
for the presentation of additional evidence to show that service 
connection should be maintained. Unless otherwise provided in paragraph 
(i) of this section, if additional evidence is not received within that 
period, final rating action will be taken and the award will be reduced 
or discontinued, if in order, effective the last day of the month in 
which a 60-day period from the date of notice to the beneficiary of the 
final rating action expires.


(Authority: 38 U.S.C. 5112(b)(6))

    (e) Reduction in evaluation--compensation. Where the reduction in 
evaluation of a service-connected disability or employability status is 
considered warranted and the lower evaluation would result in a 
reduction or discontinuance of compensation payments currently being 
made, a rating proposing the reduction or discontinuance will be 
prepared setting forth all material facts and reasons. The beneficiary 
will be notified at his or her latest address of record of the 
contemplated action and furnished detailed reasons therefor, and will be 
given 60 days for the presentation of additional evidence to show that 
compensation payments should be continued at their present level. Unless 
otherwise provided in paragraph (i) of this section, if additional 
evidence is not received within that period, final rating action will be 
taken and the award will be reduced or discontinued effective the last 
day of the month in which a 60-day period from the date of notice to the 
beneficiary of the final rating action expires.


(Authority: 38 U.S.C. 5112(b)(6))

    (f) Reduction in evaluation--pension. Where a change in disability 
or employability warrants a reduction or discontinuance of pension 
payments currently being made, a rating proposing the reduction or 
discontinuance will be prepared setting forth all material facts and 
reasons. The beneficiary will be notified at his or her latest address 
of record of the contemplated action and furnished detailed reasons 
therefor, and will be given 60 days for the presentation of additional 
evidence to show that pension benefits should be continued at their 
present level. Unless otherwise provided in paragraph (i) of this 
section, if additional evidence is not received within that period, 
final rating action will be taken and the award will be reduced or 
discontinued effective the last day of the month in which the final 
rating action is approved.


(Authority: 38 U.S.C. 5112(b)(5))

    (g) Reduction in evaluation--monetary allowance under 38 U.S.C. 
chapter 18 for certain individuals who are children of Vietnam veterans 
or children of veterans with covered service in Korea. Where a reduction 
or discontinuance of a monetary allowance currently being paid under 38 
U.S.C. chapter 18 is considered warranted, VA will notify the 
beneficiary at his or her latest address of record of the proposed 
reduction, furnish detailed reasons therefor, and allow the beneficiary 
60 days to present additional evidence to show that the monetary 
allowance should be continued at the present level. Unless otherwise 
provided in paragraph (i) of this

[[Page 199]]

section, if VA does not receive additional evidence within that period, 
it will take final rating action and reduce the award effective the last 
day of the month following 60 days from the date of notice to the 
beneficiary of the proposed reduction.


(Authority: 38 U.S.C. 1805, 1815, 1821, 1832, 5112(b)(6))

    (h) Other reductions/discontinuances. Except as otherwise specified 
at Sec.  3.103(b)(3) of this part, where a reduction or discontinuance 
of benefits is warranted by reason of information received concerning 
income, net worth, dependency, or marital or other status, a proposal 
for the reduction or discontinuance will be prepared setting forth all 
material facts and reasons. The beneficiary will be notified at his or 
her latest address of record of the contemplated action and furnished 
detailed reasons therefor, and will be given 60 days for the 
presentation of additional evidence to show that the benefits should be 
continued at their present level. Unless otherwise provided in paragraph 
(i) of this section, if additional evidence is not received within that 
period, final adverse action will be taken and the award will be reduced 
or discontinued effective as specified under the provisions of 
Sec. Sec.  3.500 through 3.503 of this part.


(Authority: 38 U.S.C. 5112)

    (i) Predetermination hearings. (1) In the advance written notice 
concerning proposed actions under paragraphs (d) through (h) of this 
section, the beneficiary will be informed that he or she will have an 
opportunity for a predetermination hearing, provided that a request for 
such a hearing is received by VA within 30 days from the date of the 
notice. If a timely request is received, VA will notify the beneficiary 
in writing of the time and place of the hearing at least 10 days in 
advance of the scheduled hearing date. The 10 day advance notice may be 
waived by agreement between VA and the beneficiary or representative. 
The hearing will be conducted by VA personnel who did not participate in 
the proposed adverse action and who will bear the decision-making 
responsibility. If a predetermination hearing is timely requested, 
benefit payments shall be continued at the previously established level 
pending a final determination concerning the proposed action.
    (2) Following the predetermination procedures specified in this 
paragraph and paragraph (d), (e), (f), (g) or (h) of this section, 
whichever is applicable, final action will be taken. If a 
predetermination hearing was not requested or if the beneficiary failed 
without good cause to report for a scheduled predetermination hearing, 
the final action will be based solely upon the evidence of record. 
Examples of good cause include, but are not limited to, the illness or 
hospitalization of the claimant or beneficiary, death of an immediate 
family member, etc. If a predetermination hearing was conducted, the 
final action will be based on evidence and testimony adduced at the 
hearing as well as the other evidence of record including any additional 
evidence obtained following the hearing pursuant to necessary 
development. Whether or not a predetermination hearing was conducted, a 
written notice of the final action shall be issued to the beneficiary 
and his or her representative, setting forth the reasons therefor and 
the evidence upon which it is based. Where a reduction or discontinuance 
of benefits is found warranted following consideration of any additional 
evidence submitted, the effective date of such reduction or 
discontinuance shall be as follows:
    (i) Where reduction or discontinuance was proposed under the 
provisions of paragraph (d) or (e) of this section, the effective date 
of final action shall be the last day of the month in which a 60-day 
period from the date of notice to the beneficiary of the final action 
expires.
    (ii) Where reduction or discontinuance was proposed under the 
provisions of paragraphs (f) and (g) of this section, the effective date 
of final action shall be the last day of the month in which such action 
is approved.
    (iii) Where reduction or discontinuance was proposed under the 
provisions of paragraph (h) of this section, the effective date of final 
action shall be as specified under the provisions of Sec. Sec.  3.500 
through 3.503 of this part.

[[Page 200]]

    (j) Supplemental claims and higher-level review. VA may revise an 
earlier decision denying benefits, if warranted, upon resolution of a 
supplemental claim under Sec.  3.160(c) or higher-level review under 
Sec.  3.2601.

(Authority: 38 U.S.C. 5112)

    Cross References: Effective dates. See Sec.  3.400. Reductions and 
discontinuances. See Sec.  3.500. Protection; service connection. See 
Sec.  3.957.

[26 FR 1569, Feb. 24, 1961, as amended at 27 FR 11886, Dec. 1, 1962; 39 
FR 17222, May 14, 1974; 55 FR 13528, Apr. 11, 1990; 56 FR 65846, Dec. 
19, 1991; 57 FR 56993, Dec. 2, 1992; 62 FR 51278, Sept. 30, 1997; 66 FR 
21874, May 2, 2001; 67 FR 49586, July 31, 2002; 76 FR 4247, Jan. 25, 
2011; 84 FR 167, Jan. 18, 2019]



Sec.  3.106  Renouncement.

    (a) Any person entitled to pension, compensation, or dependency and 
indemnity compensation under any of the laws administered by the 
Department of Veterans Affairs may renounce his or her right to that 
benefit but may not renounce less than all of the component items which 
together comprise the total amount of the benefit to which the person is 
entitled nor any fixed monetary amounts less than the full amount of 
entitlement. The renouncement will be in writing over the person's 
signature. Upon receipt of such renouncement in the Department of 
Veterans Affairs, payment of such benefits and the right thereto will be 
terminated, and such person will be denied any and all rights thereto 
from such filing.


(Authority: 38 U.S.C. 5306(a))

    (b) The renouncement will not preclude the person from filing a new 
application for pension, compensation, or dependency and indemnity 
compensation at any future date. Such new application will be treated as 
an original application, and no payments will be made thereon for any 
period before the date such new application is received in the 
Department of Veterans Affairs.


(Authority: 38 U.S.C. 5306(b))

    (c) Notwithstanding the provisions of paragraph (b) of this section, 
if a new application for pension or parents' dependency and indemnity 
compensation is filed within one year after the date that the Department 
of Veterans Affairs receives a renouncement of that benefit, such 
application shall not be treated as an original application and benefits 
will be payable as if the renouncement had not occurred.


(Authority: 38 U.S.C. 5306(c))

    (d) The renouncement of dependency and indemnity compensation by one 
beneficiary will not serve to increase the rate payable to any other 
beneficiary in the same class.
    (e) The renouncement of dependency and indemnity compensation by a 
surviving spouse will not serve to vest title to this benefit in 
children under the age of 18 years or to increase the rate payable to a 
child or children over the age of 18 years.

[26 FR 1569, Feb. 24, 1961, as amended at 37 FR 5384, Mar. 15, 1972; 39 
FR 17222, May 14, 1974; 60 FR 18355, Apr. 11, 1995; 62 FR 5529, Feb. 6, 
1997]



Sec.  3.107  Awards where not all dependents apply.

    Except as provided in Sec.  3.251(a)(4), in any case where claim has 
not been filed by or on behalf of all dependents who may be entitled, 
the awards (original or amended) for those dependents who have filed 
claim will be made for all periods at the rates and in the same manner 
as though there were no other dependents. However, if the file reflects 
the existence of other dependents who have not filed claim and there is 
potential entitlement to benefits for a period prior to the date of 
filing claim, the award to a person who has filed claim will be made at 
the rate which would be payable if all dependents were receiving 
benefits. If at the expiration of the period allowed, claims have not 
been filed for such dependents, the full rate will be authorized for the 
first payee.

[29 FR 9564, July 15, 1964]



Sec.  3.108  State Department as agent of Department of Veterans Affairs.

    Diplomatic and consular officers of the Department of State are 
authorized to act as agents of the Department of Veterans Affairs and 
therefore a complete claim as set forth in Sec.  3.160(a) or

[[Page 201]]

an intent to file a claim as set forth in Sec.  3.155(b) or evidence 
submitted in support of a claim filed in a foreign country will be 
considered as filed in the Department of Veterans Affairs as of the date 
of receipt by the State Department representative.

    Cross Reference: Evidence from foreign countries. See Sec.  3.202.

[26 FR 1569, Feb. 24, 1961, as amended at 79 FR 57695, Sept. 25, 2014]



Sec.  3.109  Time limit.

    (a) Notice of time limit for filing evidence. (1) If a claimant's 
application is incomplete, the claimant will be notified of the evidence 
necessary to complete the application. If the evidence is not received 
within 1 year from the date of such notification, pension, compensation, 
or dependency and indemnity compensation may not be paid by reason of 
that application (38 U.S.C. 5103(a)). Information concerning the 
whereabouts of a person who has filed claim is not considered evidence.
    (2) The provisions of this paragraph are applicable to original 
initial applications, to applications for increased benefits by reason 
of increased disability, age, or the existence of a dependent, and to 
applications for reopening or resumption of payments. If substantiating 
evidence is required with respect to the veracity of a witness or the 
authenticity of documentary evidence timely filed, there will be allowed 
for the submission of such evidence 1 year from the date of the request 
therefor. However, any evidence to enlarge the proofs and evidence 
originally submitted is not so included.
    (b) Extension of time limit. Time limits within which claimants or 
beneficiaries are required to act to perfect a claim or challenge an 
adverse VA decision may be extended for good cause shown. Where an 
extension is requested after expiration of a time limit, the action 
required of the claimant or beneficiary must be taken concurrent with or 
prior to the filing of a request for extension of the time limit, and 
good cause must be shown as to why the required action could not have 
been taken during the original time period and could not have been taken 
sooner than it was. Denials of time limit extensions are separately 
appealable issues.

(Authority: 38 U.S.C. 501)

[26 FR 1569, Feb. 24, 1961, as amended at 26 FR 2231, Mar. 16, 1961; 29 
FR 1462, Jan. 29, 1964; 30 FR 133, Jan. 7, 1965; 55 FR 13529, Apr. 11, 
1990; 79 FR 57695, Sept. 25, 2014]



Sec.  3.110  Computation of time limit.

    (a) In computing the time limit for any action required of a 
claimant or beneficiary, including the filing of claims or evidence 
requested by VA, the first day of the specified period will be excluded 
and the last day included. This rule is applicable in cases in which the 
time limit expires on a workday. Where the time limit would expire on a 
Saturday, Sunday, or holiday, the next succeeding workday will be 
included in the computation.
    (b) The first day of the specified period referred to in paragraph 
(a) of this section shall be the date of mailing of notification to the 
claimant or beneficiary of the action required and the time limit 
therefor. The date of the letter of notification shall be considered the 
date of mailing for purposes of computing time limits. As to appeals, 
see Sec. Sec.  19.52, 20.203, and 20.110 of this chapter.

(Authority: 38 U.S.C. 501)

[55 FR 13529, Apr. 11, 1990, as amended at 58 FR 32443, June 10, 1993; 
84 FR 168, Jan. 18, 2019]



Sec.  3.111  [Reserved]



Sec.  3.112  Fractions of one cent.

    In all cases where the amount to be paid under any award involves a 
fraction of a cent, the fractional part will be excluded.

[26 FR 1570, Feb. 24, 1961]



Sec.  3.114  Change of law or Department of Veterans Affairs issue.

    (a) Effective date of award. Where pension, compensation, dependency 
and indemnity compensation, or a monetary allowance under 38 U.S.C. 
chapter 18 for an individual who is a child of a Vietnam veteran or 
child of a veteran

[[Page 202]]

with covered service in Korea is awarded or increased pursuant to a 
liberalizing law, or a liberalizing VA issue approved by the Secretary 
or by the Secretary's direction, the effective date of such award or 
increase shall be fixed in accordance with the facts found, but shall 
not be earlier than the effective date of the act or administrative 
issue. Where pension, compensation, dependency and indemnity 
compensation, or a monetary allowance under 38 U.S.C. chapter 18 for an 
individual who is a child of a Vietnam veteran or child of a veteran 
with covered service in Korea is awarded or increased pursuant to a 
liberalizing law or VA issue which became effective on or after the date 
of its enactment or issuance, in order for a claimant to be eligible for 
a retroactive payment under the provisions of this paragraph the 
evidence must show that the claimant met all eligibility criteria for 
the liberalized benefit on the effective date of the liberalizing law or 
VA issue and that such eligibility existed continuously from that date 
to the date of claim or administrative determination of entitlement. The 
provisions of this paragraph are applicable to original and supplemental 
claims as well as claims for increase.
    (1) If a claim is reviewed on the initiative of VA within 1 year 
from the effective date of the law or VA issue, or at the request of a 
claimant received within 1 year from that date, benefits may be 
authorized from the effective date of the law or VA issue.
    (2) If a claim is reviewed on the initiative of VA more than 1 year 
after the effective date of the law or VA issue, benefits may be 
authorized for a period of 1 year prior to the date of administrative 
determination of entitlement.
    (3) If a claim is reviewed at the request of the claimant more than 
1 year after the effective date of the law or VA issue, benefits may be 
authorized for a period of 1 year prior to the date of receipt of such 
request.


(Authority: 38 U.S.C. 1805, 1815, 1821, 1832, 5110(g))

    (b) Discontinuance of benefits. Where the reduction or 
discontinuance of an award is in order because of a change in law or a 
Department of Veterans Affairs issue, or because of a change in 
interpretation of a law or Department of Veterans Affairs issue, the 
payee will be notified at his or her latest address of record of the 
contemplated action and furnished detailed reasons therefor, and will be 
given 60 days for the presentation of additional evidence. If additional 
evidence is not received within that period, the award will be reduced 
or discontinued effective the last day of the month in which the 60-day 
period expired.

(Authority: 38 U.S.C. 5112(b)(6))

[27 FR 11886, Dec. 1, 1962, as amended at 55 FR 13529, Apr. 11, 1990; 62 
FR 17706, Apr. 11, 1997; 65 FR 35282, June 2, 2000; 67 FR 49586, July 
31, 2002; 76 FR 4247, Jan. 25, 2011; 84 FR 168, Jan. 18, 2019; 84 FR 
4336, Feb. 15, 2019]



Sec.  3.115  Access to financial records.

    (a) The Secretary of Veterans Affairs may request from a financial 
institution the names and addresses of its customers. Each such request, 
however, shall include a certification that the information is necessary 
for the proper administration of benefits programs under the laws 
administered by the Secretary, and cannot be obtained by a reasonable 
search of records and information of the Department of Veterans Affairs.
    (b) Information received pursuant to a request referred to in 
paragraph (a) of this section shall not be used for any purpose other 
than the administration of benefits programs under the laws administered 
by the Secretary if the disclosure of that information would otherwise 
be prohibited by any provision of the Right to Financial Privacy Act of 
1978 (12 U.S.C. 3401 through 3422).

(Authority: 38 U.S.C. 5319)

[58 FR 32445, June 10, 1993]

                                 Claims



Sec.  3.150  Forms to be furnished.

    (a) Upon request made in person or in writing by any person applying 
for benefits under the laws administered by the Department of Veterans 
Affairs, the appropriate application form will be furnished.


(Authority: 38 U.S.C. 5102)


[[Page 203]]


    (b) Upon receipt of notice of death of a veteran, the appropriate 
application form will be forwarded for execution by or on behalf of any 
dependent who has apparent entitlement to pension, compensation, or 
dependency and indemnity compensation. If it is not indicated that any 
person would be entitled to such benefits, but there is payable an 
accrued benefit not paid during the veteran's lifetime, the appropriate 
application form will be forwarded to the preferred dependent. Notice of 
the time limit will be included in letters forwarding applications for 
benefits.

    Cross Reference: Extension of time limit. See Sec.  3.109(b).

[26 FR 1570, Feb. 14, 1961, as amended at 30 FR 133, Jan. 7, 1965; 79 FR 
57695, Sept. 25, 2014]



Sec.  3.151  Claims for disability benefits.

    (a) General. A specific claim in the form prescribed by the 
Secretary must be filed in order for benefits to be paid to any 
individual under the laws administered by VA. (38 U.S.C. 5101(a)). A 
claim by a veteran for compensation may be considered to be a claim for 
pension; and a claim by a veteran for pension may be considered to be a 
claim for compensation. The greater benefit will be awarded, unless the 
claimant specifically elects the lesser benefit. (See scope of claim, 
Sec.  3.155(d)(2); complete claim, Sec.  3.160(a); supplemental claims, 
Sec.  3.2501(b)).
    (b) Retroactive disability pension claims. Where disability pension 
entitlement is established based on a claim received by VA on or after 
October 1, 1984, the pension award may not be effective prior to the 
date of receipt of the pension claim unless the veteran specifically 
claims entitlement to retroactive benefits. The claim for retroactivity 
may be filed separately or included in the claim for disability pension, 
but it must be received by VA within one year from the date on which the 
veteran became permanently and totally disabled. Additional requirements 
for entitlement to a retroactive pension award are contained in Sec.  
3.400(b) of this part.
    (c) Issues within a claim. (1) To the extent that a complete claim 
application encompasses a request for more than one determination of 
entitlement, each specific entitlement will be adjudicated and is 
considered a separate issue for purposes of the review options 
prescribed in Sec.  3.2500. A single decision by an agency of original 
jurisdiction may adjudicate multiple issues in this respect, whether 
expressly claimed or determined by VA to be reasonably within the scope 
of the application as prescribed in Sec.  3.155(d)(2). VA will issue a 
decision that addresses each such identified issue within a claim. Upon 
receipt of notice of a decision, a claimant may elect any of the 
applicable review options prescribed in Sec.  3.2500 for each issue 
adjudicated.
    (2) With respect to service-connected disability compensation, an 
issue for purposes of paragraph (c)(1) of this section is defined as 
entitlement to compensation for a particular disability. For example, if 
a decision adjudicates service-connected disability compensation for 
both a knee condition and an ankle condition, compensation for each 
condition is a separate entitlement or issue for which a different 
review option may be elected. However, different review options may not 
be selected for specific components of the knee disability claim, such 
as ancillary benefits, whether a knee injury occurred in service, or 
whether a current knee condition resulted from a service-connected 
injury or condition.
    (d) Evidentiary record. The evidentiary record before the agency of 
original jurisdiction for an initial or supplemental claim includes all 
evidence received by VA before VA issues notice of a decision on the 
claim. Once the agency of original jurisdiction issues notice of a 
decision on a claim, the evidentiary record closes as described in Sec.  
3.103(c)(2) and VA no longer has a duty to assist in gathering evidence 
under Sec.  3.159. (See Sec.  3.155(b), submission of evidence).

(Authority: 38 U.S.C 5110(b)(3))

    Cross Reference: Intent to file a claim. See Sec.  3.155(b).

[50 FR 25981, June 24, 1985, as amended at 79 FR 57695, Sept. 25, 2014; 
84 FR 168, Jan. 18, 2019]



Sec.  3.152  Claims for death benefits.

    (a) A specific claim in the form prescribed by the Secretary (or 
jointly

[[Page 204]]

with the Commissioner of Social Security, as prescribed by Sec.  3.153) 
must be filed in order for death benefits to be paid to any individual 
under the laws administered by VA. (See Sec.  3.400(c) concerning 
effective dates of awards.)


(Authority: 38 U.S.C. 5101(a))

    (b)(1) A claim by a surviving spouse or child for compensation or 
dependency and indemnity compensation will also be considered to be a 
claim for death pension and accrued benefits, and a claim by a surviving 
spouse or child for death pension will be considered to be a claim for 
death compensation or dependency and indemnity compensation and accrued 
benefits.


(Authority: 38 U.S.C. 5101(b)(1))

    (2) A claim by a parent for compensation or dependency and indemnity 
compensation will also be considered to be a claim for accrued benefits.


(Authority: 38 U.S.C. 5101(b)(2))

    (c)(1) Where a child's entitlement to dependency and indemnity 
compensation arises by reason of termination of a surviving spouse's 
right to dependency and indemnity compensation or by reason of attaining 
the age of 18 years, a claim will be required. (38 U.S.C. 5110(e).) (See 
paragraph (c)(4) of this section.) Where the award to the surviving 
spouse is terminated by reason of her or his death, a claim for the 
child will be considered a claim for any accrued benefits which may be 
payable.
    (2) A claim filed by a surviving spouse who does not have 
entitlement will be accepted as a claim for a child or children in her 
or his custody named in the claim.
    (3) Where a claim of a surviving spouse is disallowed for any reason 
whatsoever and where evidence requested in order to determine 
entitlement from a child or children named in the surviving spouse's 
claim is submitted within 1 year from the date of request, requested 
either before or after disallowance of the surviving spouse's claim, an 
award for the child or children will be made as though the disallowed 
claim had been filed solely on their behalf. Otherwise, payments may not 
be made for the child or children for any period prior to the date of 
receipt of a new claim.
    (4) Where payments of pension, compensation or dependency and 
indemnity compensation to a surviving spouse have been discontinued 
because of remarriage or death, or a child becomes eligible for 
dependency and indemnity compensation by reason of attaining the age of 
18 years, and any necessary evidence is submitted within 1 year from 
date of request, an award for the child or children named in the 
surviving spouse's claim will be made on the basis of the surviving 
spouse's claim having been converted to a claim on behalf of the child. 
Otherwise, payments may not be made for any period prior to the date of 
receipt of a new claim.

(Authority: 38 U.S.C 501)

    Cross References: State Department as agent of Department of 
Veterans Affairs. See Sec.  3.108. Change in status of dependents. See 
Sec.  3.651.

[50 FR 25981, June 24, 1985, as amended at 71 FR 44918, Aug. 8, 2006]



Sec.  3.153  Claims filed with Social Security.

    An application on a form jointly prescribed by the Secretary and the 
Commissioner of Social Security filed with the Social Security 
Administration on or after January 1, 1957, will be considered a claim 
for death benefits, and to have been received in the Department of 
Veterans Affairs as of the date of receipt in Social Security 
Administration. The receipt of such an application (or copy thereof) by 
the Department of Veterans Affairs will not preclude a request for any 
necessary evidence.

(Authority: 38 U.S.C. 5105)

[26 FR 1570, Feb. 24, 1961, as amended at 71 FR 44918, Aug. 8, 2006]



Sec.  3.154  Injury due to hospital treatment, etc.

    Claimants must file a complete claim on the appropriate application 
form prescribed by the Secretary when applying for benefits under 38 
U.S.C. 1151 and 38 CFR 3.361. See Sec. Sec.  3.151, 3.160(a), and 
3.400(i) concerning effective dates

[[Page 205]]

of awards; see Sec.  3.155(b) regarding intent to file the appropriate 
application form.

(Authority: 38 U.S.C. 501 and 1151.)

    Cross Reference: Effective Dates. See Sec.  3.400(i). Disability or 
death due to hospitalization, etc. See Sec. Sec.  3.358, 3.361 and 
3.800.

[79 FR 57695, Sept. 25, 2014]



Sec.  3.155  How to file a claim.

    The following paragraphs describe the manner and methods in which a 
claim can be initiated and filed. The provisions of this section are 
applicable to all claims governed by part 3, with the exception that 
paragraph (b) of this section, regarding intent to file a claim, does 
not apply to supplemental claims.
    (a) Request for an application for benefits. A claimant, his or her 
duly authorized representative, a Member of Congress, or some person 
acting as next friend of a claimant who is not of full age or capacity, 
who indicates a desire to file for benefits under the laws administered 
by VA, by a communication or action, to include an electronic mail that 
is transmitted through VA's electronic portal or otherwise, that does 
not meet the standards of a complete claim is considered a request for 
an application form for benefits under Sec.  3.150(a). Upon receipt of 
such a communication or action, the Secretary shall notify the claimant 
and the claimant's representative, if any, of the information necessary 
to complete the application form or form prescribed by the Secretary.
    (b) Intent to file a claim. A claimant, his or her duly authorized 
representative, a Member of Congress, or some person acting as next 
friend of claimant who is not of full age or capacity may indicate a 
claimant's desire to file a claim for benefits by submitting an intent 
to file a claim to VA. An intent to file a claim must provide sufficient 
identifiable or biographical information to identify the claimant. Upon 
receipt of the intent to file a claim, VA will furnish the claimant with 
the appropriate application form prescribed by the Secretary. If VA 
receives a complete application form prescribed by the Secretary, as 
defined in paragraph (a) of Sec.  3.160, appropriate to the benefit 
sought within 1 year of receipt of the intent to file a claim, VA will 
consider the complete claim filed as of the date the intent to file a 
claim was received.
    (1) An intent to file a claim can be submitted in one of the 
following three ways:
    (i) Saved electronic application. When an application otherwise 
meeting the requirements of this paragraph (b) is electronically 
initiated and saved in a claims-submission tool within a VA web-based 
electronic claims application system prior to filing of a complete 
claim, VA will consider that application to be an intent to file a 
claim.
    (ii) Written intent on prescribed intent to file a claim form. The 
submission to an agency of original jurisdiction of a signed and dated 
intent to file a claim, on the form prescribed by the Secretary for that 
purpose, will be accepted as an intent to file a claim.
    (iii) Oral intent communicated to designated VA personnel and 
recorded in writing. An oral statement of intent to file a claim will be 
accepted if it is directed to a VA employee designated to receive such a 
communication, the VA employee receiving this information follows the 
provisions set forth in Sec.  3.217(b), and the VA employee documents 
the date VA received the claimant's intent to file a claim in the 
claimant's records.
    (2) An intent to file a claim must identify the general benefit 
(e.g., compensation, pension), but need not identify the specific 
benefit claimed or any medical condition(s) on which the claim is based. 
To the extent a claimant provides this or other extraneous information 
on the designated form referenced in paragraph (b)(1)(ii) of this 
section that the form does not solicit, the provision of such 
information is of no effect other than that it is added to the file for 
appropriate consideration as evidence in support of a complete claim if 
filed. In particular, if a claimant identifies specific medical 
condition(s) on which the claim is based in an intent to file a claim, 
this extraneous information does not convert the intent to file a claim 
into a complete claim or a substantially complete application. 
Extraneous information provided in an oral communication under

[[Page 206]]

paragraph (b)(1)(iii) of this section is of no effect and generally will 
not be recorded in the record of the claimant's intent to file.
    (3) Upon receipt of an intent to file a claim, the Secretary shall 
notify the claimant and the claimant's representative, if any, of the 
information necessary to complete the appropriate application form 
prescribed by the Secretary.
    (4) If an intent to file a claim is not submitted in the form 
required by paragraph (b)(1) of this section or a complete claim is not 
filed within 1 year of the receipt of the intent to file a claim, VA 
will not take further action unless a new claim or a new intent to file 
a claim is received.
    (5) An intent to file a claim received from a service organization, 
an attorney, or agent indicating a represented claimant's intent to file 
a claim may not be accepted if a power of attorney was not executed at 
the time the communication was written. VA will only accept an oral 
intent to file from a service organization, an attorney, or agent if a 
power of attorney is of record at the time the oral communication is 
received by the designated VA employee.
    (6) VA will not recognize more than one intent to file concurrently 
for the same benefit (e.g., compensation, pension). If an intent to file 
has not been followed by a complete claim, a subsequent intent to file 
regarding the same benefit received within 1 year of the prior intent to 
file will have no effect. If, however, VA receives an intent to file 
followed by a complete claim and later another intent to file for the 
same benefit is submitted within 1 year of the previous intent to file, 
VA will recognize the subsequent intent to file to establish an 
effective date for any award granted for the next complete claim, 
provided it is received within 1 year of the subsequent intent to file.
    (c) Incomplete application form. Upon receipt of a communication 
indicating a belief in entitlement to benefits that is submitted on a 
paper application form prescribed by the Secretary that is not complete 
as defined in Sec.  3.160(a) of this section, the Secretary shall notify 
the claimant and the claimant's representative, if any, of the 
information necessary to complete the application form prescribed by the 
Secretary. If a complete claim is submitted within 1 year of receipt of 
such incomplete application form prescribed by the Secretary, VA will 
consider it as filed as of the date VA received the incomplete 
application form prescribed by the Secretary that did not meet the 
standards of a complete claim. See Sec.  3.160(a) for Complete Claim.
    (d) Claims.--(1) Requirement for complete claim and date of claim. A 
complete claim is required for all types of claims, and will generally 
be considered filed as of the date it was received by VA for an 
evaluation or award of benefits under the laws administered by the 
Department of Veterans Affairs.
    (i) Supplemental claims. Upon receipt of a communication indicating 
a belief in entitlement to benefits that is submitted in writing or 
electronically on a supplemental claim form prescribed by the Secretary 
that is not complete as defined in Sec.  3.160(a) of this section, the 
Secretary shall notify the claimant and the claimant's representative, 
if any, of the information necessary to complete the application form 
prescribed by the Secretary. If VA receives a complete claim within 60 
days of notice by VA that an incomplete claim was filed, it will be 
considered filed as of the date of receipt of the incomplete claim (see 
Sec.  3.2501).
    (ii) For other types of claims. If VA receives a complete claim 
within 1 year of the filing of an intent to file a claim that meets the 
requirements of paragraph (b) of this section, it will be considered 
filed as of the date of receipt of the intent to file a claim. Only one 
complete claim for a benefit (e.g., compensation, pension) may be 
associated with each intent to file a claim for that benefit, though 
multiple issues may be contained within a complete claim. In the event 
multiple complete claims for a benefit are filed within 1 year of an 
intent to file a claim for that benefit, only the first claim filed will 
be associated with the intent to file a claim. In the event that VA 
receives both an intent to file a claim and an incomplete application 
form before the complete claim as defined in Sec.  3.160(a) is filed, 
the complete claim will be considered filed as of the date of receipt of 
whichever

[[Page 207]]

was filed first provided it is perfected within the necessary timeframe, 
but in no event, will the complete claim be considered filed more than 
one year prior to the date of receipt of the complete claim.
    (2) Scope of claim. Once VA receives a complete claim, VA will 
adjudicate as part of the claim entitlement to any ancillary benefits 
that arise as a result of the adjudication decision (e.g., entitlement 
to 38 U.S.C. Chapter 35 Dependents' Educational Assistance benefits, 
entitlement to special monthly compensation under 38 CFR 3.350, 
entitlement to adaptive automobile allowance, etc.). The claimant may, 
but need not, assert entitlement to ancillary benefits at the time the 
complete claim is filed. VA will also consider all lay and medical 
evidence of record in order to adjudicate entitlement to benefits for 
the claimed condition as well as entitlement to any additional benefits 
for complications of the claimed condition, including those identified 
by the rating criteria for that condition in 38 CFR Part 4, VA Schedule 
for Rating Disabilities. VA's decision on an issue within a claim 
implies that VA has determined that evidence of record does not support 
entitlement for any other issues that are reasonably within the scope of 
the issues addressed in that decision. VA's decision that addresses all 
outstanding issues enumerated in the complete claim implies that VA has 
determined evidence of record does not support entitlement for any other 
issues that are reasonably within the scope of the issues enumerated in 
the complete claim.

    Cross Reference:  Complete claim. See Sec.  3.160(a). Effective 
dates. See Sec.  3.400.

[79 FR 57695, Sept. 25, 2014, as amended at 84 FR 168, Jan. 18, 2019]



Sec.  3.156  New evidence.

    New evidence is evidence not previously part of the actual record 
before agency adjudicators.
    (a) New and material evidence. For claims to reopen decided prior to 
the effective date provided in Sec.  19.2(a), the following standards 
apply. A claimant may reopen a finally adjudicated legacy claim by 
submitting new and material evidence. New evidence is evidence not 
previously part of the actual record before agency adjudicators. 
Material evidence means existing evidence that, by itself or when 
considered with previous evidence of record, relates to an unestablished 
fact necessary to substantiate the claim. New and material evidence can 
be neither cumulative nor redundant of the evidence of record at the 
time of the last prior final denial of the claim sought to be reopened, 
and must raise a reasonable possibility of substantiating the claim.


(Authority: 38 U.S.C. 501, 5103A(f), 5108)

    (b) Pending legacy claims not under the modernized review system.New 
and material evidence received prior to the expiration of the appeal 
period, or prior to the appellate decision if a timely appeal has been 
filed (including evidence received prior to an appellate decision and 
referred to the agency of original jurisdiction by the Board of Veterans 
Appeals without consideration in that decision in accordance with the 
provisions of Sec.  20.1304(b)(1) of this chapter), will be considered 
as having been filed in connection with the claim which was pending at 
the beginning of the appeal period.


(Authority: 38 U.S.C. 501)

    (c) Service department records. (1) Notwithstanding any other 
section in this part, at any time after VA issues a decision on a claim, 
if VA receives or associates with the claims file relevant official 
service department records that existed and had not been associated with 
the claims file when VA first decided the claim, VA will reconsider the 
claim, notwithstanding paragraph (a) of this section. Such records 
include, but are not limited to:
    (i) Service records that are related to a claimed in-service event, 
injury, or disease, regardless of whether such records mention the 
veteran by name, as long as the other requirements of paragraph (c) of 
this section are met;
    (ii) Additional service records forwarded by the Department of 
Defense or the service department to VA any time after VA's original 
request for service records; and
    (iii) Declassified records that could not have been obtained because 
the records were classified when VA decided the claim.

[[Page 208]]

    (2) Paragraph (c)(1) of this section does not apply to records that 
VA could not have obtained when it decided the claim because the records 
did not exist when VA decided the claim, or because the claimant failed 
to provide sufficient information for VA to identify and obtain the 
records from the respective service department or from any other 
official source.
    (3) An award made based all or in part on the records identified by 
paragraph (c)(1) of this section is effective on the date entitlement 
arose or the date VA received the previously decided claim, whichever is 
later, or such other date as may be authorized by the provisions of this 
part applicable to the previously decided claim.
    (4) A retroactive evaluation of disability resulting from disease or 
injury subsequently service connected on the basis of the new evidence 
from the service department must be supported adequately by medical 
evidence. Where such records clearly support the assignment of a 
specific rating over a part or the entire period of time involved, a 
retroactive evaluation will be assigned accordingly, except as it may be 
affected by the filing date of the original claim.


(Authority: 38 U.S.C. 501(a))
    (d) New and relevant evidence. On or after the effective date 
provided in Sec.  19.2(a), a claimant may file a supplemental claim as 
prescribed in Sec.  3.2501. If new and relevant evidence, as defined in 
Sec.  3.2501(a)(1), is presented or secured with respect to the 
supplemental claim, the agency of original jurisdiction will 
readjudicate the claim taking into consideration all of the evidence of 
record.

    Cross References: Effective dates--general. See Sec.  3.400. 
Correction of military records. See Sec.  3.400(g).

[27 FR 11887, Dec. 1, 1962, as amended at 55 FR 20148, May 15, 1990; 55 
FR 52275, Dec. 21, 1990; 58 FR 32443, June 10, 1993; 66 FR 45630, Aug. 
29, 2001; 71 FR 52457, Sept. 6, 2006; 84 FR 169, Jan. 18, 2019; 84 FR 
4336, Feb. 15, 2019; 86 FR 15414, Mar. 23, 2021]



Sec.  3.158  Abandoned claims.

    (a) General. Except as provided in Sec.  3.652, where evidence 
requested in connection with an initial claim or supplemental claim or 
for the purpose of determining continued entitlement is not furnished 
within 1 year after the date of request, the claim will be considered 
abandoned. After the expiration of 1 year, further action will not be 
taken unless a new claim is received. Should the right to benefits be 
finally established, pension, compensation, dependency and indemnity 
compensation, or monetary allowance under the provisions of 38 U.S.C. 
chapter 18 based on such evidence shall commence not earlier than the 
date of filing the new claim.


(Authority: 38 U.S.C. 501)

    (b) Department of Veterans Affairs examinations. Where the veteran 
fails without adequate reason to respond to an order to report for 
Department of Veterans Affairs examination within 1 year from the date 
of request and payments have been discontinued, the claim for such 
benefits will be considered abandoned.
    (c) Disappearance. Where payments of pension, compensation, 
dependency and indemnity compensation, or monetary allowance under the 
provisions of 38 U.S.C. chapter 18 have not been made or have been 
discontinued because a payee's present whereabouts is unknown, payments 
will be resumed effective the day following the date of last payment if 
entitlement is otherwise established, upon receipt of a valid current 
address.

    Cross References: Periodic certification of continued eligibility. 
See Sec.  3.652. Failure to report for VA examination. See Sec.  3.655. 
Disappearance of veteran. See Sec.  3.656.

[27 FR 11887, Dec. 1, 1962, as amended at 28 FR 13362, Dec. 10, 1963; 52 
FR 43063, Nov. 9, 1987; 62 FR 51278, Sept. 30, 1997; 67 FR 49586, July 
31, 2002; 84 FR 169, Jan. 18, 2019]



Sec.  3.159  Department of Veterans Affairs assistance in developing claims.

    (a) Definitions. For purposes of this section, the following 
definitions apply:
    (1) Competent medical evidence means evidence provided by a person 
who is qualified through education, training, or experience to offer 
medical diagnoses, statements, or opinions. Competent medical evidence 
may also mean statements conveying sound

[[Page 209]]

medical principles found in medical treatises. It would also include 
statements contained in authoritative writings such as medical and 
scientific articles and research reports or analyses.
    (2) Competent lay evidence means any evidence not requiring that the 
proponent have specialized education, training, or experience. Lay 
evidence is competent if it is provided by a person who has knowledge of 
facts or circumstances and conveys matters that can be observed and 
described by a lay person.
    (3) Substantially complete application means an application 
containing:
    (i) The claimant's name;
    (ii) His or her relationship to the veteran, if applicable;
    (iii) Sufficient service information for VA to verify the claimed 
service, if applicable;
    (iv) The benefit sought and any medical condition(s) on which it is 
based;
    (v) The claimant's signature; and
    (vi) In claims for nonservice-connected disability or death pension 
and parents' dependency and indemnity compensation, a statement of 
income;
    (vii) In supplemental claims, identification or inclusion of 
potentially new evidence (see Sec.  3.2501);
    (viii) For higher-level reviews, identification of the date of the 
decision for which review is sought.
    (4) For purposes of paragraph (c)(4)(i) of this section, event means 
one or more incidents associated with places, types, and circumstances 
of service giving rise to disability.
    (5) Information means non-evidentiary facts, such as the claimant's 
Social Security number or address; the name and military unit of a 
person who served with the veteran; or the name and address of a medical 
care provider who may have evidence pertinent to the claim.
    (b) VA's duty to notify claimants of necessary information or 
evidence. (1) Except as provided in paragraph (3) of this section, when 
VA receives a complete or substantially complete initial or supplemental 
claim, VA will notify the claimant of any information and medical or lay 
evidence that is necessary to substantiate the claim (hereafter in this 
paragraph referred to as the ``notice'') In the notice, VA will inform 
the claimant which information and evidence, if any, that the claimant 
is to provide to VA and which information and evidence, if any, that VA 
will attempt to obtain on behalf of the claimant. The information and 
evidence that the claimant is informed that the claimant is to provide 
must be provided within one year of the date of the notice. If the 
claimant has not responded to the notice within 30 days, VA may decide 
the claim prior to the expiration of the one-year period based on all 
the information and evidence contained in the file, including 
information and evidence it has obtained on behalf of the claimant and 
any VA medical examinations or medical opinions. If VA does so, however, 
and the claimant subsequently provides the information and evidence 
within one year of the date of the notice in accordance with the 
requirements of paragraph (b)(4) of this section, VA must readjudicate 
the claim.


(Authority: 38 U.S.C. 5103)

    (2) If VA receives an incomplete application for benefits, it will 
notify the claimant of the information necessary to complete the 
application and will defer assistance until the claimant submits this 
information.


(Authority: 38 U.S.C. 5102(b), 5103A(3))

    (3) No duty to provide the notice described in paragraph (b)(1) of 
this section arises:
    (i) Upon receipt of a supplemental claim under Sec.  3.2501 within 
one year of the date VA issues notice of a prior decision;
    (ii) Upon receipt of a request for higher-level review under Sec.  
3.2601;
    (iii) Upon receipt of a Notice of Disagreement under Sec.  20.202 of 
this chapter; or
    (iv) When, as a matter of law, entitlement to the benefit claimed 
cannot be established.


(Authority: 38 U.S.C. 5103(a), 5103A(a)(2))

    (4) After VA has issued a notice of decision, submission of 
information and evidence substantiating a claim must be accomplished 
through the proper filing of a review option in accordance

[[Page 210]]

with Sec.  3.2500 on a form prescribed by the Secretary. New and 
relevant evidence may be submitted in connection with either the filing 
of a supplemental claim under Sec.  3.2501 or the filing of a Notice of 
Disagreement with the Board under 38 CFR 20.202, on forms prescribed by 
the Secretary, and election of a Board docket that permits the filing of 
new evidence (see 38 CFR 20.302 and 20.303).
    (c) VA's duty to assist claimants in obtaining evidence. VA has a 
duty to assist claimants in obtaining evidence to substantiate all 
substantially complete initial and supplemental claims, and when a claim 
is returned for readjudication by a higher-level adjudicator or the 
Board after identification of a duty to assist error on the part of the 
agency of original jurisdiction, until the time VA issues notice of a 
decision on a claim or returned claim. VA will make reasonable efforts 
to help a claimant obtain evidence necessary to substantiate the claim. 
VA will not pay any fees charged by a custodian to provide records 
requested. When a claim is returned for readjudication by a higher-level 
adjudicator or the Board after identification of a duty to assist error, 
the agency of original jurisdiction has a duty to correct any other duty 
to assist errors not identified by the higher-level adjudicator or the 
Board.
    (1) Obtaining records not in the custody of a Federal department or 
agency. VA will make reasonable efforts to obtain relevant records not 
in the custody of a Federal department or agency, to include records 
from State or local governments, private medical care providers, current 
or former employers, and other non-Federal governmental sources. Such 
reasonable efforts will generally consist of an initial request for the 
records and, if the records are not received, at least one follow-up 
request. A follow-up request is not required if a response to the 
initial request indicates that the records sought do not exist or that a 
follow-up request for the records would be futile. If VA receives 
information showing that subsequent requests to this or another 
custodian could result in obtaining the records sought, then reasonable 
efforts will include an initial request and, if the records are not 
received, at least one follow-up request to the new source or an 
additional request to the original source.
    (i) The claimant must cooperate fully with VA's reasonable efforts 
to obtain relevant records from non-Federal agency or department 
custodians. The claimant must provide enough information to identify and 
locate the existing records, including the person, company, agency, or 
other custodian holding the records; the approximate time frame covered 
by the records; and, in the case of medical treatment records, the 
condition for which treatment was provided.
    (ii) If necessary, the claimant must authorize the release of 
existing records in a form acceptable to the person, company, agency, or 
other custodian holding the records.


(Authority: 38 U.S.C. 5103A(b))

    (2) Obtaining records in the custody of a Federal department or 
agency. VA will make as many requests as are necessary to obtain 
relevant records from a Federal department or agency. These records 
include but are not limited to military records, including service 
medical records; medical and other records from VA medical facilities; 
records from non-VA facilities providing examination or treatment at VA 
expense; and records from other Federal agencies, such as the Social 
Security Administration. VA will end its efforts to obtain records from 
a Federal department or agency only if VA concludes that the records 
sought do not exist or that further efforts to obtain those records 
would be futile. Cases in which VA may conclude that no further efforts 
are required include those in which the Federal department or agency 
advises VA that the requested records do not exist or the custodian does 
not have them.
    (i) The claimant must cooperate fully with VA's reasonable efforts 
to obtain relevant records from Federal agency or department custodians. 
If requested by VA, the claimant must provide enough information to 
identify and locate the existing records, including the custodian or 
agency holding the records; the approximate time frame covered by the 
records; and, in the case

[[Page 211]]

of medical treatment records, the condition for which treatment was 
provided. In the case of records requested to corroborate a claimed 
stressful event in service, the claimant must provide information 
sufficient for the records custodian to conduct a search of the 
corroborative records.
    (ii) If necessary, the claimant must authorize the release of 
existing records in a form acceptable to the custodian or agency holding 
the records.


(Authority: 38 U.S.C. 5103A(b))

    (3) Obtaining records in compensation claims. In a claim for 
disability compensation, VA will make efforts to obtain the claimant's 
service medical records, if relevant to the claim; other relevant 
records pertaining to the claimant's active military, naval or air 
service that are held or maintained by a governmental entity; VA medical 
records or records of examination or treatment at non-VA facilities 
authorized by VA; and any other relevant records held by any Federal 
department or agency. The claimant must provide enough information to 
identify and locate the existing records including the custodian or 
agency holding the records; the approximate time frame covered by the 
records; and, in the case of medical treatment records, the condition 
for which treatment was provided.


(Authority: 38 U.S.C. 5103A(c))

    (4) Providing medical examinations or obtaining medical opinions. 
(i) In a claim for disability compensation, VA will provide a medical 
examination or obtain a medical opinion based upon a review of the 
evidence of record if VA determines it is necessary to decide the claim. 
A medical examination or medical opinion is necessary if the information 
and evidence of record does not contain sufficient competent medical 
evidence to decide the claim, but:
    (A) Contains competent lay or medical evidence of a current 
diagnosed disability or persistent or recurrent symptoms of disability;
    (B) Establishes that the veteran suffered an event, injury or 
disease in service, or has a disease or symptoms of a disease listed in 
Sec.  3.309, Sec.  3.313, Sec.  3.316, and Sec.  3.317 manifesting 
during an applicable presumptive period provided the claimant has the 
required service or triggering event to qualify for that presumption; 
and
    (C) Indicates that the claimed disability or symptoms may be 
associated with the established event, injury, or disease in service or 
with another service-connected disability.
    (ii) Paragraph (4)(i)(C) could be satisfied by competent evidence 
showing post-service treatment for a condition, or other possible 
association with military service.
    (iii) For requests to reopen a finally adjudicated claim received 
prior to the effective date provided in Sec.  19.2(a) of this chapter, 
this paragraph (c)(4) applies only if new and material evidence is 
presented or secured as prescribed in Sec.  3.156.
    (iv) This paragraph (c)(4) applies to a supplemental claim only if 
new and relevant evidence under Sec.  3.2501 is presented or secured.


(Authority: 38 U.S.C. 5103A(d))

    (d) Circumstances where VA will refrain from or discontinue 
providing assistance. VA will refrain from providing assistance in 
obtaining evidence for an initial or supplemental claim if the 
substantially complete application for benefits indicates that there is 
no reasonable possibility that any assistance VA would provide to the 
claimant would substantiate the claim. VA will discontinue providing 
assistance in obtaining evidence for a claim if the evidence obtained 
indicates that there is no reasonable possibility that further 
assistance would substantiate the claim. Circumstances in which VA will 
refrain from or discontinue providing assistance in obtaining evidence 
include, but are not limited to:
    (1) The claimant's ineligibility for the benefit sought because of 
lack of qualifying service, lack of veteran status, or other lack of 
legal eligibility;
    (2) Claims that are inherently incredible or clearly lack merit; and
    (3) An application requesting a benefit to which the claimant is not 
entitled as a matter of law.


(Authority: 38 U.S.C. 5103A(a)(2))


[[Page 212]]


    (e) Duty to notify claimant of inability to obtain records. (1) If 
VA makes reasonable efforts to obtain relevant non-Federal records but 
is unable to obtain them, or after continued efforts to obtain Federal 
records concludes that it is reasonably certain they do not exist or 
further efforts to obtain them would be futile, VA will provide the 
claimant with oral or written notice of that fact. VA will make a record 
of any oral notice conveyed to the claimant. For non-Federal records 
requests, VA may provide the notice at the same time it makes its final 
attempt to obtain the relevant records. In either case, the notice must 
contain the following information:
    (i) The identity of the records VA was unable to obtain;
    (ii) An explanation of the efforts VA made to obtain the records;
    (iii) A description of any further action VA will take regarding the 
claim, including, but not limited to, notice that VA will decide the 
claim based on the evidence of record unless the claimant submits the 
records VA was unable to obtain; and
    (iv) A notice that the claimant is ultimately responsible for 
providing the evidence.
    (2) If VA becomes aware of the existence of relevant records before 
deciding the claim, VA will notify the claimant of the records and 
request that the claimant provide a release for the records. If the 
claimant does not provide any necessary release of the relevant records 
that VA is unable to obtain, VA will request that the claimant obtain 
the records and provide them to VA.


(Authority: 38 U.S.C. 5103A(b)(2))

    (f) For the purpose of the notice requirements in paragraphs (b) and 
(e) of this section, notice to the claimant means notice to the claimant 
or his or her fiduciary, if any, as well as to his or her 
representative, if any.


(Authority: 38 U.S.C. 5102(b), 5103(a))

    (g) The authority recognized in subsection (g) of 38 U.S.C. 5103A is 
reserved to the sole discretion of the Secretary and will be 
implemented, when deemed appropriate by the Secretary, through the 
promulgation of regulations.


(Authority: 38 U.S.C. 5103A(g))


[66 FR 45630, Aug. 29, 2001, as amended at 73 FR 23356, Apr. 30, 2008; 
84 FR 169, Jan. 18, 2019]



Sec.  3.160  Status of claims.

    (a) Complete claim. A submission of an application form prescribed 
by the Secretary, whether paper or electronic, that meets the following 
requirements:
    (1) A complete claim must provide the name of the claimant; the 
relationship to the veteran, if applicable; and sufficient information 
for VA to verify the claimed service, if applicable.
    (2) A complete claim must be signed by the claimant or a person 
legally authorized to sign for the claimant.
    (3) A complete claim must identify the benefit sought.
    (4) A description of any symptom(s) or medical condition(s) on which 
the benefit is based must be provided to the extent the form prescribed 
by the Secretary so requires.
    (5) For nonservice-connected disability or death pension and 
parents' dependency and indemnity compensation claims, a statement of 
income must be provided to the extent the form prescribed by the 
Secretary so requires; and
    (6) For supplemental claims, potentially new evidence must be 
identified or included.
    (b) Original claim. The initial complete claim for one or more 
benefits on an application form prescribed by the Secretary.
    (c) Pending claim. A claim which has not been finally adjudicated.
    (d) Finally adjudicated claim. A claim that is adjudicated by the 
Department of Veterans Affairs as either allowed or disallowed is 
considered finally adjudicated when:
    (1) For legacy claims not subject to the modernized review system, 
whichever of the following occurs first:
    (i) The expiration of the period in which to file a Notice of 
Disagreement, pursuant to the provisions of Sec.  19.52(a) or Sec.  
20.502(a) of this chapter, as applicable; or
    (ii) Disposition on appellate review.

[[Page 213]]

    (2) For claims under the modernized review system, the expiration of 
the period in which to file a review option available under Sec.  3.2500 
or disposition on judicial review where no such review option is 
available.
    (e) Reopened claims prior to effective date of modernized review 
system. An application for a benefit received prior to the effective 
date provided in Sec.  19.2(a) of this chapter, after final disallowance 
of an earlier claim that is subject to readjudication on the merits 
based on receipt of new and material evidence related to the finally 
adjudicated claim, or any claim based on additional evidence or a 
request for a personal hearing submitted more than 90 days following 
notification to the appellant of the certification of an appeal and 
transfer of applicable records to the Board of Veterans' Appeals which 
was not considered by the Board in its decision and was referred to the 
agency of original jurisdiction for consideration as provided in Sec.  
20.1304(b)(1) of this chapter. As of the effective date provided in 
Sec.  19.2(a) of this chapter, claimants may no longer file to reopen a 
claim, but may file a supplemental claim as prescribed in Sec.  3.2501 
to apply for a previously disallowed benefit. A request to reopen a 
finally decided claim that has not been adjudicated as of the effective 
date will be processed as a supplemental claim subject to the modernized 
review system.


(Authority: 38 U.S.C. 501)


[27 FR 11887, Dec. 1, 1962, as amended at 31 FR 12056, Sept. 15, 1966; 
55 FR 20148, May 15, 1990; 58 FR 32445, June 10, 1993; 79 FR 57696, 
Sept. 25, 2014; 84 FR 170, Jan. 18, 2019]



Sec.  3.161  [Reserved]

                          Evidence Requirements



Sec.  3.200  Testimony certified or under oath.

    (a) All oral testimony presented by claimants and witnesses on their 
behalf before any rating or authorization body will be under oath or 
affirmation. (See Sec.  3.103(c).)
    (b) All written testimony submitted by the claimant or in his or her 
behalf for the purpose of establishing a claim for service connection 
will be certified or under oath or affirmation. This includes records, 
examination reports, and transcripts material to the issue received by 
the Department of Veterans Affairs at the instance of the claimant or in 
his or her behalf or requested by the Department of Veterans Affairs 
from State, county, municipal, recognized private institutions, and 
contract hospitals.

[40 FR 36329, Aug. 20, 1975]



Sec.  3.201  Exchange of evidence; Social Security and Department of 
Veterans Affairs.

    (a) A claimant for dependency and indemnity compensation may elect 
to furnish to the Department of Veterans Affairs in support of that 
claim copies of evidence which was previously furnished to the Social 
Security Administration or to have the Department of Veterans Affairs 
obtain such evidence from the Social Security Administration. For the 
purpose of determining the earliest effective date for payment of 
dependency and indemnity compensation, such evidence will be deemed to 
have been received by the Department of Veterans Affairs on the date it 
was received by the Social Security Administration.
    (b) A copy or certification of evidence filed in the Department of 
Veterans Affairs in support of a claim for dependency and indemnity 
compensation will be furnished the Social Security Administration upon 
request from the agency.

(Authority: 38 U.S.C. 501(a) and 5105)

    Cross Reference: Claims filed with Social Security. See Sec.  3.153.

[26 FR 1571, Feb. 24, 1961, as amended at 58 FR 25562, Apr. 27, 1993]



Sec.  3.202  Evidence from foreign countries.

    (a) Except as provided in paragraph (b) of this section, where an 
affidavit or other document is required to be executed under oath before 
an official in a foreign country, the signature of that official must be 
authenticated by a United States Consular Officer in that jurisdiction 
or by the State Department. Where the United States has no consular 
representative in a foreign

[[Page 214]]

country, such authentication may be made as follows:
    (1) By a consular agent of a friendly government whereupon the 
signature and seal of the official of the friendly government may be 
authenticated by the State Department; or
    (2) By the nearest American consul who will attach a certificate 
showing the result of the investigation concerning its authenticity.
    (b) Authentication will not be required: (1) On documents approved 
by the Deputy Minister of Veterans Affairs, Department of Veterans 
Affairs, Ottawa, Canada: or
    (2) When it is indicated that the attesting officer is authorized to 
administer oaths for general purposes and the document bears his or her 
signature and seal; or
    (3) When the document is executed before a Department of Veterans 
Affairs employee authorized to administer oaths; or
    (4) When a copy of a public or church record from any foreign 
country purports to establish birth, adoption, marriage, annulment, 
divorce, or death, provided it bears the signature and seal of the 
custodian of such record and there is no conflicting evidence in the 
file which would serve to create doubt as to the correctness of the 
record; or
    (5) When a copy of the public or church record from one of the 
countries comprising the United Kingdom, namely: England, Scotland, 
Wales, or Northern Ireland, purports to establish birth, marriage, or 
death, provided it bears the signature or seal or stamp of the custodian 
of such record and there is no evidence which would serve to create 
doubt as to the correctness of the records; or
    (6) When affidavits prepared in the Republic of the Philippines are 
certified by a Department of Veterans Affairs representative located in 
the Philippines having authority to administer oaths.
    (c) Photocopies of original documents meeting the requirements of 
this section will be accepted if they satisfy the requirements of Sec.  
3.204 of this part.

(Authority: 38 U.S.C. 501)

    Cross Reference: State Department as agent of Department of Veterans 
Affairs. See Sec.  3.108.

[26 FR 1571, Feb. 24, 1961, as amended at 40 FR 36329, Aug. 20, 1975; 52 
FR 19348, May 22, 1987; 59 FR 46338, Sept. 8, 1994]



Sec.  3.203  Service records as evidence of service and character of
discharge.

    (a) Evidence submitted by a claimant. For the purpose of 
establishing entitlement to pension, compensation, dependency and 
indemnity compensation or burial benefits the Department of Veterans 
Affairs may accept evidence of service submitted by a claimant (or sent 
directly to the Department of Veterans Affairs by the service 
department), such as a DD Form 214, Certificate of Release or Discharge 
from Active Duty, or original Certificate of Discharge, without 
verification from the appropriate service department if the evidence 
meets the following conditions:
    (1) The evidence is a document issued by the service department. A 
copy of an original document is acceptable if the copy was issued by the 
service department or if the copy was issued by a public custodian of 
records who certifies that it is a true and exact copy of the document 
in the custodian's custody or, if the copy was submitted by an 
accredited agent, attorney or service organization representative who 
has successfully completed VA-prescribed training on military records, 
and who certifies that it is a true and exact copy of either an original 
document or of a copy issued by the service department or a public 
custodian of records; and
    (2) The document contains needed information as to length, time and 
character of service; and
    (3) In the opinion of the Department of Veterans Affairs the 
document is genuine and the information contained in it is accurate.
    (b) Additional requirements for pension claimants. In addition to 
meeting the requirements of paragraph (a) of this section, a document 
submitted to establish a creditable period of wartime service for 
pension entitlement may be accepted without verification if the document 
(or other evidence of record) shows:

[[Page 215]]

    (1) Service of 4 months or more; or
    (2) Discharge for disability incurred in line of duty; or
    (3) Ninety days creditable service based on records from the service 
department such as hospitalization for 90 days for a line of duty 
disability.
    (c) Verification from the service department. When the claimant does 
not submit evidence of service or the evidence submitted does not meet 
the requirements of paragraph (a) of this section (and paragraph (b) of 
this section in pension claims), the Department of Veterans Affairs 
shall request verification of service from the service department. 
However, payment of nonservice-connected burial benefits may be 
authorized, if otherwise in order, based upon evidence of service which 
VA relied upon to authorize payment of compensation or pension during 
the veteran's lifetime, provided that there is no evidence which would 
serve to create doubt as to the correctness of that service evidence. If 
it appears that a length of service requirement may not be met (e.g., 
the 90 days wartime service requirement to receive pension under 38 
U.S.C. 1521(j)), the Department of Veterans Affairs shall request a 
complete statement of service to determine if there are any periods of 
active service that are required to be excluded under Sec.  3.15.

[45 FR 72654, Nov. 3, 1980, as amended at 46 FR 51246, Oct. 19, 1981; 58 
FR 37857, July 14, 1993; 58 FR 42623, Aug. 10, 1993; 66 FR 19858, Apr. 
18, 2001]



Sec.  3.204  Evidence of dependents and age.

    (a)(1) Except as provided in paragraph (a)(2) of this section, VA 
will accept, for the purpose of determining entitlement to benefits 
under laws administered by VA, the statement of a claimant as proof of 
marriage, dissolution of a marriage, birth of a child, or death of a 
dependent, provided that the statement contains: the date (month and 
year) and place of the event; the full name and relationship of the 
other person to the claimant; and, where the claimant's dependent child 
does not reside with the claimant, the name and address of the person 
who has custody of the child. In addition, a claimant must provide the 
social security number of any dependent on whose behalf he or she is 
seeking benefits (see Sec.  3.216).
    (2) VA shall require the types of evidence indicated in Sec. Sec.  
3.205 through 3.211 where: the claimant does not reside within a state; 
the claimant's statement on its face raises a question of its validity; 
the claimant's statement conflicts with other evidence of record; or, 
there is a reasonable indication, in the claimant's statement or 
otherwise, of fraud or misrepresentation of the relationship in 
question.


(Authority: 38 U.S.C. 5124)

    (b) Marriage or birth. The classes of evidence to be furnished for 
the purpose of establishing marriage, dissolution of marriage, age, 
relationship, or death, if required under the provisions of paragraph 
(a)(2), are indicated in Sec. Sec.  3.205 through 3.211 in the order of 
preference. Failure to furnish the higher class, however, does not 
preclude the acceptance of a lower class if the evidence furnished is 
sufficient to prove the point involved.
    (c) Acceptability of photocopies. Photocopies of documents necessary 
to establish birth, death, marriage or relationship under the provisions 
of Sec. Sec.  3.205 through 3.215 of this part are acceptable as 
evidence if the Department of Veterans Affairs is satisfied that the 
copies are genuine and free from alteration. Otherwise, VA may request a 
copy of the document certified over the signature and official seal of 
the person having custody of such record.

(Authority: 38 U.S.C. 501)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0624)

[26 FR 1572, Feb. 24, 1961, as amended at 40 FR 53581, Nov. 19, 1975; 45 
FR 72655, Nov. 3, 1980; 59 FR 46338, Sept. 8, 1994; 61 FR 56626, Nov. 4, 
1996; 66 FR 56614, Nov. 9, 2001]



Sec.  3.205  Marriage.

    (a) Proof of marriage. Marriage is established by one of the 
following types of evidence:
    (1) Copy or abstract of the public record of marriage, or a copy of 
the church record of marriage, containing sufficient data to identify 
the parties,

[[Page 216]]

the date and place of marriage, and the number of prior marriages if 
shown on the official record.
    (2) Official report from service department as to marriage which 
occurred while the veteran was in service.
    (3) The affidavit of the clergyman or magistrate who officiated.
    (4) The original certificate of marriage, if the Department of 
Veterans Affairs is satisfied that it is genuine and free from 
alteration.
    (5) The affidavits or certified statements of two or more 
eyewitnesses to the ceremony.
    (6) In jurisdictions where marriages other than by ceremony are 
recognized the affidavits or certified statements of one or both of the 
parties to the marriage, if living, setting forth all of the facts and 
circumstances concerning the alleged marriage, such as the agreement 
between the parties at the beginning of their cohabitation, the period 
of cohabitation, places and dates of residences, and whether children 
were born as the result of the relationship. This evidence should be 
supplemented by affidavits or certified statements from two or more 
persons who know as the result of personal observation the reputed 
relationship which existed between the parties to the alleged marriage 
including the periods of cohabitation, places of residences, whether the 
parties held themselves out as married, and whether they were generally 
accepted as such in the communities in which they lived.
    (7) Any other secondary evidence which reasonably supports a belief 
by the Adjudicating activity that a valid marriage actually occurred.
    (b) Valid marriage. In the absence of conflicting information, proof 
of marriage which meets the requirements of paragraph (a) of this 
section together with the claimant's certified statement concerning the 
date, place and circumstances of dissolution of any prior marriage may 
be accepted as establishing a valid marriage, provided that such facts, 
if they were to be corroborated by record evidence, would warrant 
acceptance of the marriage as valid. Where necessary to a determination 
because of conflicting information or protest by a party having an 
interest therein, proof of termination of a prior marriage will be shown 
by proof of death, or a certified copy or a certified abstract of final 
decree of divorce or annulment specifically reciting the effects of the 
decree.
    (c) Marriages deemed valid. Where a surviving spouse has submitted 
proof of marriage in accordance with paragraph (a) of this section and 
also meets the requirements of Sec.  3.52, the claimant's signed 
statement that he or she had no knowledge of an impediment to the 
marriage to the veteran will be accepted, in the absence of information 
to the contrary, as proof of that fact.

(Authority: 38 U.S.C. 501)

    Cross References: Marriages deemed valid. See Sec.  3.52. 
Definitions; marriage. See Sec.  3.1(j). Evidence of dependents and age. 
See Sec.  3.204.

[26 FR 1572, Feb. 24, 1961, as amended at 27 FR 6281, July 3, 1962; 36 
FR 20946, Nov. 2, 1971; 40 FR 53581, Nov. 19, 1975; 45 FR 72655, Nov. 3, 
1980; 47 FR 28096, June 29, 1982; 52 FR 19349, May 22, 1987; 58 FR 
37857, July 14, 1993; 59 FR 46338, Sept. 8, 1994; 62 FR 5529, Feb. 6, 
1997]



Sec.  3.206  Divorce.

    The validity of a divorce decree regular on its face, will be 
questioned by the Department of Veterans Affairs only when such validity 
is put in issue by a party thereto or a person whose interest in a claim 
for Department of Veterans Affairs benefits would be affected thereby. 
In cases where recognition of the decree is thus brought into question:
    (a) Where the issue is whether the veteran is single or married 
(dissolution of a subsisting marriage), there must be a bona fide 
domicile in addition to the standards of the granting jurisdiction 
respecting validity of divorce;
    (b) Where the issue is the validity of marriage to a veteran 
following a divorce, the matter of recognition of the divorce by the 
Department of Veterans Affairs (including any question of bona fide 
domicile) will be determined according to the laws of the jurisdictions 
specified in Sec.  3.1(j).
    (c) Where a foreign divorce has been granted the residents of a 
State whose laws consider such decrees to be valid, it will thereafter 
be considered as valid under the laws of the jurisdictions

[[Page 217]]

specified in Sec.  3.1(j) in the absence of a determination to the 
contrary by a court of last resort in those jurisdictions.

    Cross Reference: Evidence of dependents and age. See Sec.  3.204.

[27 FR 6281, July 3, 1962, as amended at 35 FR 16831, Oct. 31, 1970; 40 
FR 53581, Nov. 19, 1975; 52 FR 19349, May 22, 1987]



Sec.  3.207  Void or annulled marriage.

    Proof that a marriage was void or has been annulled should consist 
of:
    (a) Void. A certified statement from the claimant setting forth the 
circumstances which rendered the marriage void, together with such other 
evidence as may be required for a determination.
    (b) Annulled. A copy or abstract of the decree of annulment. A 
decree regular on its face will be accepted unless there is reason to 
question the basic authority of the court to render annulment decrees or 
there is evidence indicating that the annulment may have been obtained 
through fraud by either party or by collusion.

    Cross References: Effective dates, void or annulled marriage. See 
Sec.  3.400 (u) and (v). Evidence of dependents and age. See Sec.  
3.204.

[28 FR 2904, Mar. 3, 1963, as amended at 40 FR 53581, Nov. 19, 1975; 52 
FR 19349, May 22, 1987; 59 FR 46338, Sept. 8, 1994]



Sec.  3.208  Claims based on attained age.

    In claims for pension where the age of the veteran or surviving 
spouse is material, the statements of age will be accepted where they 
are in agreement with other statements in the record as to age. However, 
where there is a variance in such records, the youngest age will be 
accepted subject to the submission of evidence as outlined in Sec.  
3.209.

    Cross Reference: Evidence of dependents and age. See Sec.  3.204.

[40 FR 53581, Nov. 19, 1975, as amended at 52 FR 19349, May 22, 1987]



Sec.  3.209  Birth.

    Age or relationship is established by one of the following types of 
evidence. If the evidence submitted for proof of age or relationship 
indicates a difference in the name of the person as shown by other 
records, the discrepancy is to be reconciled by an affidavit or 
certified statement identifying the person having the changed name as 
the person whose name appears in the evidence of age or relationship.
    (a) A copy or abstract of the public record of birth. Such a record 
established more than 4 years after the birth will be accepted as proof 
of age or relationship if, it is not inconsistent with material of 
record with the Department of Veterans Affairs, or if it shows on its 
face that it is based upon evidence which would be acceptable under this 
section.
    (b) A copy of the church record of baptism. Such a record of baptism 
performed more than 4 years after birth will not be accepted as proof of 
age or relationship unless it is consistent with material of record with 
the Department of Veterans Affairs, which will include at least one 
reference to age or relationship made at a time when such reference was 
not essential to establishing entitlement to the benefit claimed.
    (c) Official report from the service department as to birth which 
occurred while the veteran was in service.
    (d) Affidavit or a certified statement of the physician or midwife 
in attendance at birth.
    (e) Copy of Bible or other family record certified to by a notary 
public or other officer with authority to administer oaths, who should 
state in what year the Bible or other book in which the record appears 
was printed, whether the record bears any erasures or other marks of 
alteration, and whether from the appearance of the writing he or she 
believes the entries to have been made at the time purported.
    (f) Affidavits or certified statements of two or more persons, 
preferably disinterested, who will state their ages, showing the name, 
date, and place of birth of the person whose age or relationship is 
being established, and that to their own knowledge such person is the 
child of such parents (naming the parents) and stating the source of 
their knowledge.
    (g) Other evidence which is adequate to establish the facts in 
issue, including census records, original baptismal records, hospital 
records, insurance

[[Page 218]]

policies, school, employment, immigration, or naturalization records.

(Authority: 38 U.S.C. 501)

    Cross Reference: Evidence of dependents and age. See Sec.  3.204.

[26 FR 1573, Feb. 24, 1961, as amended at 27 FR 1899, Feb. 28, 1962; 40 
FR 53581, Nov. 19, 1975; 47 FR 28096, June 29, 1982; 52 FR 19349, May 
22, 1987; 59 FR 46338, Sept. 8, 1994]



Sec.  3.210  Child's relationship.

    (a) Legitimate child. Where it is necessary to determine the 
legitimacy of a child, evidence will be required to establish the 
legality of the marriage of the mother of the child to the veteran or to 
show that the child is otherwise legitimate by State laws together with 
evidence of birth as outlined in Sec.  3.209. Where the legitimacy of a 
child is not a factor, evidence to establish legitimacy will not be 
required: Provided, That, evidence is on file which meets the 
requirements of paragraph (b) of this section sufficient to warrant 
recognition of the relationship of the child without regard to 
legitimacy.
    (b) Illegitimate child. As to the mother of an illegitimate child, 
proof of birth is all that is required. As to the father, the 
sufficiency of evidence will be determined in accordance with the facts 
in the individual case. Proof of such relationship will consist of:
    (1) An acknowledgment in writing signed by him; or
    (2) Evidence that he has been identified as the child's father by a 
judicial decree ordering him to contribute to the child's support or for 
other purposes; or
    (3) Any other secondary evidence which reasonably supports a finding 
of relationship, as determined by an official authorized to approve such 
findings, such as:
    (i) A copy of the public record of birth or church record of 
baptism, showing that the veteran was the informant and was named as 
parent of the child; or
    (ii) Statements of persons who know that the veteran accepted the 
child as his; or
    (iii) Information obtained from service department or public 
records, such as school or welfare agencies, which shows that with his 
knowledge the veteran was named as the father of the child.
    (c) Adopted child. Except as provided in paragraph (c)(1) of this 
section evidence of relationship will include a copy of the decree of 
adoption or a copy of the adoptive placement agreement and such other 
evidence as may be necessary.
    (1) In jurisdictions where petition must be made to the court for 
release of adoption documents or information, or where release of such 
documents or information is prohibited, the following may be accepted to 
establish the fact of adoption:
    (i) As to a child adopted into the veteran's family, a copy of the 
child's revised birth certificate.
    (ii) As to a child adopted out of the veteran's family, a statement 
over the signature of the judge or the clerk of the court setting forth 
the child's former name and the date of adoption, or a certified 
statement by the veteran, the veteran's surviving spouse, apportionee, 
or their fiduciaries setting forth the child's former name, date of 
birth, and the date and fact of adoption together with evidence 
indicating that the child's original public record of birth has been 
removed from such records. Where application is made for an 
apportionment under Sec.  3.458(d) on behalf of a child adopted out of 
the veteran's family, the evidence must be sufficient to establish the 
veteran as the natural parent of the child.
    (2) As to a child adopted by the veteran's surviving spouse after 
the veteran's death, the statement of the adoptive parent or custodian 
of the child will be accepted in absence of information to the contrary, 
to show that the child was a member of the veteran's household at the 
date of the veteran's death and that recurring contributions were not 
being received for the child's maintenance sufficient to provide for the 
major portion of the child's support, from any person other than the 
veteran or surviving spouse or from any public or private welfare 
organization which furnished services or assistance to children. (Pub. 
L. 86-195)
    (d) Stepchild. Evidence of relationship of a stepchild will consist 
of proof of birth as outlined in Sec.  3.209, evidence of

[[Page 219]]

the marriage of the veteran to the natural parent of the child, and 
evidence that the child is a member of the veteran's household or was a 
member of the veteran's household at the date of the veteran's death.

    Cross Reference: Evidence of dependents and age. See Sec.  3.204.

[26 FR 1573, Feb. 24, 1961, as amended at 27 FR 1899, Feb. 28, 1962; 28 
FR 2959, Mar. 26, 1963; 38 FR 871, Jan. 5, 1973; 47 FR 28096, June 29, 
1982; 52 FR 19349, May 22, 1987; 59 FR 46338, Sept. 8, 1994]



Sec.  3.211  Death.

    Death should be established by one of the following types of 
evidence:
    (a)(1) A copy of the public record of the State or community where 
death occurred.
    (2) A copy of a coroner's report of death or a verdict of a 
coroner's jury of the State or community where death occurred, provided 
such report or verdict properly identified the deceased.
    (b) Where death occurs in a hospital or institution under the 
control of the United States Government:
    (1) A death certificate signed by a medical officer; or
    (2) A clinical summary or other report showing fact and date of 
death signed by a medical officer.
    (c) An official report of death of a member of a uniformed service 
from the Secretary of the department concerned where death occurs while 
deceased was on the retired list, in an inactive duty status, or in the 
active service.
    (d) Where death occurs abroad:
    (1) A United States consular report of death bearing the signature 
and seal of the United States consul; or
    (2) A copy of the public record of death authenticated (see Sec.  
3.202(b)(4) for exception) by the United States consul or other agency 
of the State Department; or
    (3) An official report of death from the head of the department 
concerned, where the deceased person was, at the time of death, a 
civilian employee of such department.
    (e) If the foregoing evidence cannot be furnished, the reason must 
be stated. The fact of death may then be established by the affidavits 
of persons who have personal knowledge of the fact of death, have viewed 
the body of the deceased, know it to be the body of the person whose 
death is being established, setting forth all the facts and 
circumstances concerning the death, place, date, time, and cause 
thereof.
    (f) If proof of death, as defined in paragraphs (a) through (e) of 
this section cannot be furnished, a finding of fact of death, where 
death is otherwise shown by competent evidence, may be made by an 
official authorized to approve such findings. Where it is indicated that 
the veteran died under circumstances which precluded recovery or 
identification of the body, the fact of death should be established by 
the best evidence, which from the nature of the case must be supposed to 
exist.
    (g) In the absence of evidence to the contrary, a finding of fact of 
death made by another Federal agency will be accepted for the purposes 
of paragraph (f) of this section.

    Cross Reference: Evidence of dependents and age. See Sec.  3.204.

[26 FR 1573, Feb. 24, 1961, as amended at 27 FR 1899, Feb. 28, 1962; 52 
FR 19349, May 22, 1987; 59 FR 46338, Sept. 8, 1994]



Sec.  3.212  Unexplained absence for 7 years.

    (a) If satisfactory evidence is produced establishing the fact of 
the continued and unexplained absence of any individual from his or her 
home and family for a period of 7 years or more and that a diligent 
search disclosed no evidence of his or her existence after the date of 
disappearance, and if evidence as provided in Sec.  3.211 cannot be 
furnished, the death of such individual as of the expiration of such 
period may be considered as sufficiently proved.
    (b) No State law providing for presumption of death will be 
applicable to claims for benefits under laws administered by the 
Department of Veterans Affairs and the finding of death will be final 
and conclusive except where suit is filed for insurance under 38 U.S.C. 
1984.


(Authority: 38 U.S.C. 108)

    (c) In the absence of evidence to the contrary, a finding of death 
made by

[[Page 220]]

another Federal agency will be accepted if the finding meets the 
requirements of paragraph (a) of this section.

    Cross Reference: Evidence of dependents and age. See Sec.  3.204.

[26 FR 1573, Feb. 24, 1961, as amended at 27 FR 1899, Feb. 28, 1962; 52 
FR 19349, May 22, 1987]



Sec.  3.213  Change of status affecting entitlement.

    (a) General. For the purpose of establishing entitlement to a higher 
rate of pension, compensation, or dependency and indemnity compensation 
based on the existence of a dependent, VA will require evidence which 
satisfies the requirements of Sec.  3.204. For the purpose of reducing 
or discontinuing such benefits, a statement by a claimant or payee 
setting forth the month and year of change of status which would result 
in a reduction or discontinuance of benefits to that person will be 
accepted, in the absence of contradictory information. This includes:
    (1) Veteran. A statement by the veteran setting forth the month and 
year of death of a spouse, child, or dependent parent.
    (2) Surviving spouse. A statement by the surviving spouse or 
remarried surviving spouse setting forth the month and year of 
remarriage and any change of name. (An award for a child or children who 
are otherwise entitled may be made to commence the day following the 
date of discontinuance of any payments to the surviving spouse.)
    (3) Child. A statement by the veteran or surviving spouse (where an 
additional allowance is being paid to the veteran or surviving spouse 
for a child), or fiduciary, setting forth the month and year of the 
child's death, marriage, or discontinuance of school attendance. A 
similar statement by a child who is receiving payments direct will be 
accepted to establish the child's marriage or the discontinuance of 
school attendance. Where appropriate, the month and year of 
discontinuance of school attendance will be required in addition to the 
month and year of death or marriage of a child.


(Authority: 38 U.S.C. 501)

    (4) Parent. A statement by a parent setting forth the month and 
year:
    (i) Of marriage or remarriage;
    (ii) When two parents or a parent and spouse ceased living together;
    (iii) When two parents or a parent and spouse resumed living 
together following a period of separation;
    (iv) Of divorce or death of a spouse.
    (b) Date not reported. If the month and year of the event is not 
reported, the award will be reduced or discontinued, whichever is 
appropriate, effective date of last payment. The payee will be requested 
to furnish within 60 days from the date of request a statement setting 
forth the date of the event. Where payments are continued at a reduced 
rate, the award will be discontinued effective date of last payment if 
the required statement is not received within the 60-day period. 
Payments on a discontinued award may be resumed, if otherwise in order, 
from the date of discontinuance if the necessary information is received 
within 1 year from the date of request; otherwise from the date of 
receipt of a new claim.
    (c) Contradictory information. Where there is reason to believe that 
the event reported may have occurred at an earlier date, formal proof 
will be required.

    Cross References: Abandoned claims. See Sec.  3.158. Change in 
status of dependents. See Sec.  3.651. Material change in income, net 
worth or change in status. See Sec.  3.660. Evidence of dependents and 
age. See Sec.  3.204.

[26 FR 1574, Feb. 24, 1961, as amended at 27 FR 1899, Feb. 28, 1962; 27 
FR 11888, Dec. 1, 1962; 52 FR 19349, May 22, 1987; 61 FR 56626, Nov. 4, 
1996]



Sec.  3.214  Court decisions; unremarried surviving spouses.

    Effective July 15, 1958, a decision rendered by a Federal court in 
an action to which the United States was a party holding that a 
surviving spouse of a veteran has not remarried will be followed in 
determining eligibility for pension, compensation or dependency and 
indemnity compensation.

    Cross References: Abandoned claims. See Sec.  3.158. Change in 
status of dependents. See Sec.  3.651. Dependency, income and estate. 
See

[[Page 221]]

Sec.  3.660. Evidence of dependents and age. See Sec.  3.204.

[31 FR 2782, Feb. 16, 1966, as amended at 52 FR 19349, May 22, 1987]



Sec.  3.215  Termination of marital relationship or conduct.

    On or after January 1, 1971, benefits may be resumed to an unmarried 
surviving spouse upon filing of an application and submission of 
satisfactory evidence that the surviving spouse has ceased living with 
another person and holding himself or herself out openly to the public 
as that person's spouse or that the surviving spouse has terminated a 
relationship or conduct which had created an inference or presumption of 
remarriage or related to open or notorious adulterous cohabitation or 
similar conduct, if the relationship terminated prior to November 1, 
1990. Such evidence may consist of, but is not limited to, the surviving 
spouse's certified statement of the fact.

[57 FR 10426, Mar. 26, 1992, as amended at 58 FR 32445, June 10, 1993]



Sec.  3.216  Mandatory disclosure of social security numbers.

    Any person who applies for or receives any compensation or pension 
benefit as defined in Sec. Sec.  3.3, 3.4, or 3.5 of this part, or a 
monetary allowance under 38 U.S.C. chapter 18, shall, as a condition for 
receipt or continued receipt of benefits, furnish the Department of 
Veterans Affairs upon request with his or her social security number and 
the social security number of any dependent or beneficiary on whose 
behalf, or based upon whom, benefits are sought or received. However, no 
one shall be required to furnish a social security number for any person 
to whom none has been assigned. Benefits will be terminated if a 
beneficiary fails to furnish the Department of Veterans Affairs with his 
or her social security number or the social security number of any 
dependent or beneficiary on whose behalf, or based upon whom, benefits 
are sought or received, within 60 days from the date the beneficiary is 
requested to furnish the social security number.

(Authority: 38 U.S.C. 1832, 5101(c))

(Approved by the Office of Management and Budget under control number 
2900-0522)

[57 FR 8268, Mar. 9, 1992, as amended at 57 FR 27935, June 23, 1992; 65 
FR 35282, June 2, 2000; 67 FR 49586, July 31, 2002; 76 FR 4248, Jan. 25, 
2011]



Sec.  3.217  Submission of statements or information affecting entitlement
to benefits.

    (a) For purposes of this part, unless specifically provided 
otherwise, the submission of information or a statement that affects 
entitlement to benefits by e-mail, facsimile, or other written 
electronic means, will satisfy a requirement or authorization that the 
statement or information be submitted in writing.

    Note to paragraph (a): Section 3.217(a) merely concerns the 
submission of information or a statement in writing. Other requirements 
specified in this part, such as a requirement to use a specific form, to 
provide specific information, to provide a signature, or to provide a 
certified statement, must still be met.

    (b) For purposes of this part, unless specifically provided 
otherwise, VA may take action affecting entitlement to benefits based on 
oral or written information or statements provided to VA by a 
beneficiary or his or her fiduciary. However, VA may not take action 
based on oral information or statements unless the VA employee receiving 
the information meets the following conditions:
    (1) During the conversation in which the information or statement is 
provided, the VA employee:
    (i) Identifies himself or herself as a VA employee who is authorized 
to receive the information or statement (these are VA employees 
authorized to take actions under Sec. Sec.  2.3 or 3.100 of this 
chapter);
    (ii) Verifies the identity of the provider as either the beneficiary 
or his or her fiduciary by obtaining specific information about the 
beneficiary that can be verified from the beneficiary's VA records, such 
as Social Security number, date of birth, branch of military service, 
dates of military service, or other information; and

[[Page 222]]

    (iii) Informs the provider that the information or statement will be 
used for the purpose of calculating benefit amounts; and
    (2) During or following the conversation in which the information or 
statement is provided, the VA employee documents in the beneficiary's VA 
records the specific information or statement provided, the date such 
information or statement was provided, the identity of the provider, the 
steps taken to verify the identity of the provider as being either the 
beneficiary or his or her fiduciary, and that he or she informed the 
provider that the information would be used for the purpose of 
calculating benefit amounts.

    Authority: 38 U.S.C. 501, 1115, 1506, 5104.

[66 FR 56614, Nov. 9, 2001]

                      Dependency, Income and Estate

  Regulations Applicable to Programs in Effect Prior to January 1, 1979



Sec.  3.250  Dependency of parents; compensation.

    (a) Income--(1) Conclusive dependency. Dependency of a parent (other 
than one who is residing in a foreign country) will be held to exist 
where the monthy income does not exceed:
    (i) $400 for a mother or father not living together;
    (ii) $660 for a mother and father, or remarried parent and spouse, 
living together:
    (iii) $185 for each additional ``member of the family'' as defined 
in paragraph (b)(2).


(Authority: 38 U.S.C. 102(a))

    (2) Excess income. Where the income exceeds the monthly amounts 
stated in paragraph (a)(1) of this section dependency will be determined 
on the facts in the individual case under the principles outlined in 
paragraph (b) of this section. In such cases, dependency will not be 
held to exist if it is reasonable that some part of the corpus of the 
claimant's estate be consumed for his or her maintenance.
    (3) Foreign residents. There is no conclusive presumption of 
dependency. Dependency will be determined on the facts in the individual 
case under the principles outlined in this section.
    (b) Basic rule. Dependency will be held to exist if the father or 
mother of the veteran does not have an income sufficient to provide 
reasonable maintenance for such father or mother and members of his or 
her family under legal age and for dependent adult members of the family 
if the dependency of such adult member results from mental or physical 
incapacity.
    (1) ``Reasonable Maintenance'' includes not only housing, food, 
clothing, and medical care sufficient to sustain life, but such items 
beyond the bare necessities as well as other requirements reasonably 
necessary to provide those conveniences and comforts of living suitable 
to and consistent with the parents' reasonable mode of life.
    (2) ``Member of the family'' means a person (other than spouse) 
including a relative in the ascending as well as descending class, whom 
the father or mother is under moral or legal obligation to support. In 
determining whether other members of the family under legal age are 
factors in necessary expenses of the mother or father, consideration 
will be given to any income from business or property (including trusts) 
actually available, directly or indirectly, to the mother or father for 
the support of the minor but not to the corpus of the estate or the 
income of the minor which is not so available.
    (c) Inception of dependency. The fact that the veteran has made 
habitual contributions to the father or mother, or both, is not 
conclusive evidence that dependency existed but will be considered in 
connection with all other evidence. In death claims, it is not material 
whether dependency arose prior or subsequent to the veteran's death. 
(See Sec.  3.1000(d)(3) as to accrued.)


(Authority: 38 U.S.C. 102(a))

    (d) Remarriage. Dependency will not be denied solely because of 
remarriage (38 U.S.C. 102(b)(1)). Compensation may be continued if the 
parent submits evidence to show that dependency exists, considering the 
combined income and expenses of the parent and spouse.

[28 FR 29, Jan. 1, 1963, as amended at 40 FR 16065, Apr. 9, 1975; 49 FR 
47004, Nov. 30, 1984; 61 FR 20727, May 8, 1996]

[[Page 223]]



Sec.  3.251  Income of parents; dependency and indemnity compensation.

    (a) Annual income limitations and rates. (1) Dependency and 
indemnity compensation is not payable to a parent or parents whose 
annual income exceeds the limitations set forth in 38 U.S.C. 1315 (b), 
(c), or (d).
    (2) Where there is only one parent, and the parent has remarried and 
is living with his or her spouse, dependency and indemnity compensation 
will be paid under either the formula in 38 U.S.C. 1315(b)(1) or the 
formula in 38 U.S.C. 1315(d), whichever will provide the greater monthly 
rate of dependency and indemnity compensation. The total combined annual 
income of the parent and spouse will be counted.


(Authority: 38 U.S.C. 1315)

    (3) Where the claim is based on service in the Commonwealth Army of 
the Philippines, or as a guerrilla or as a Philippine Scout under 
section 14, Pub. L. 190, 79th Congress, the income limitation will be at 
a rate of $0.50 for each dollar. See Sec.  3.100(b).


(Authority: 38 U.S.C. 107)

    (4) If the remarriage of a parent has been terminated, or the parent 
is separated from his or her spouse, the rate of dependency and 
indemnity compensation for the parent will be that which would be 
payable if there were one parent alone or two parents not living 
together, whichever is applicable.
    (5) Where there are two parents living and only one parent has filed 
claim, the rate of dependency and indemnity compensation will be that 
which would be payable if both parents had filed claim.
    (b) Basic rule. Payments of any kind or from any source will be 
counted as income unless specifically excluded. Income will be counted 
for the calendar year in which it is received and total income for the 
full calendar year will be considered except as provided in Sec.  3.260.

[28 FR 29, Jan. 1, 1963, as amended at 31 FR 14455, Nov. 10, 1966; 40 FR 
16065, Apr. 9, 1975; 41 FR 15411, Apr. 13, 1976; 60 FR 18355, Apr. 11, 
1995]



Sec.  3.252  Annual income; pension; Mexican border period and later
war periods.

    (a) Annual income limitations; old-law pension. Where the right to 
old-law pension is payable under section 306(b) of Pub. L. 95-588 (92 
Stat. 2497), pension is not payable if the pensioner's annual income 
exceeds the income limitations prescribed by Sec.  3.26(c).
    (b) Annual income and net worth limitations; Pub. L. 86-211. Pension 
is not payable to a veteran, surviving spouse or child whose annual 
income exceeds the limitations set forth in 38 U.S.C. 1521, 1541 or 
1542; or to a veteran, surviving spouse or child if it is reasonable 
that some part of the claimant's estate be consumed for his or her 
maintenance. Where a veteran and spouse are living together, the 
separate income of the spouse will be considered as the veteran's income 
as provided in Sec.  3.262(b).


(Authority: 38 U.S.C. 1543)

    (c) Basic rule. Payments of any kind or from any source will be 
counted as income unless specifically excluded. Income will be counted 
for the calendar year in which it is received and total income for the 
full calendar year will be considered except as provided in Sec.  3.260.
    (d) Veteran with a spouse. For the purpose of determining 
eligibility under paragraph (b) of this section the pension rates 
provided by 38 U.S.C. 1521(c) may be authorized for a married veteran if 
he or she is living with or, if estranged, is reasonably contributing to 
the support of his or her spouse. The determination of ``reasonable'' 
contribution will be based on all the circumstances in the case, 
considering the income and estate of the veteran and the separate income 
and estate of the spouse. Apportionment of the veteran's pension under 
Sec.  3.451 meets the requirement of reasonable contribution.
    (e) Surviving spouse with a child--(1) Child. The term ``child'' 
means a child as defined in Sec.  3.57. Where a veteran's child is born 
after the veteran dies, the surviving spouse will not be considered a 
surviving spouse with a child prior to the child's date of birth.
    (2) Veteran's child not in surviving spouse's custody. Where the 
veteran was

[[Page 224]]

survived by a surviving spouse and by a child, the income increments for 
a surviving spouse and child apply even though the child is not the 
child of the surviving spouse and not in his or her custody.
    (3) Income of child. The separate income received by a child or 
children, regardless of custody, will not be considered in computing the 
surviving spouse's income. Where the separate income of the child is 
turned over to the surviving spouse, only so much of the money as is 
left after deducting any expenses for maintenance of the child will be 
considered the surviving spouse's income.
    (4) Alternative rate. Whenever the monthly pension rate payable to 
the surviving spouse under the formula in 38 U.S.C. 1541(c) is less than 
the rate payable for one child under section 1542 if the surviving 
spouse were not entitled, the surviving spouse will be paid the child's 
rate.
    (f) Income over maximum; reduced aid and attendance allowance. 
Beginning January 1, 1977, veterans in need of regular aid and 
attendance who are not receiving pension because their income exceeds 
the applicable statutory limitation may be eligible for a reduced aid 
and attendance allowance. The amount payable is the regular aid and 
attendance allowance authorized by 38 U.S.C. 1521(d)(1) reduced by 16.6 
percent for each $100, or portion thereof, by which the veteran's annual 
income exceeds the applicable maximum income limitation. The reduced aid 
and attendance allowance is payable when:
    (1) A veteran in need of regular aid and attendance is denied 
pension under 38 U.S.C. 1521 solely because the veteran's annual income 
exceeds the applicable maximum income limitation in 38 U.S.C. 1521 
(b)(3) and (c)(3); or
    (2) Pension payable under 38 U.S.C. 1521 to a veteran in need of 
regular aid and attendance is discontinued solely because the veteran's 
annual income exceeds the applicable maximum income limitation in 38 
U.S.C. 1521 (b)(3) or (c)(3); and
    (3) The veteran's annual income exceeds the applicable maximum 
income limitation in 38 U.S.C. 1521 (b)(3) or (c)(3) by an amount not 
greater than the amount specified in 38 U.S.C. 1521 (d)(2).

    Cross References: Basic pension determinations. See Sec.  3.314. 
Determination of permanent need for regular aid and attendance and 
``permanently bedridden''. See Sec.  3.352.

[28 FR 30, Jan. 1, 1963, as amended at 40 FR 16065, Apr. 9, 1975; 41 FR 
15411, Apr. 13, 1976; 41 FR 56803, Dec. 30, 1976; 44 FR 45935, Aug. 6, 
1979; 61 FR 20727, May 8, 1996; 62 FR 5529, Feb. 6, 1997]



Sec. Sec.  3.253-3.255  [Reserved]



Sec.  3.256  Eligibility reporting requirements.

    (a) Obligation to report changes in factors affecting entitlement. 
Any individual who has applied for or receives pension or parents' 
dependency and indemnity compensation must promptly notify the Secretary 
of any change affecting entitlement in any of the following:
    (1) Income;
    (2) Net worth or corpus of estate;
    (3) Marital status;
    (4) Nursing home patient status;
    (5) School enrollment status of a child 18 years of age or older; or
    (6) Any other factor that affects entitlement to benefits under the 
provisions of this part.
    (b) Eligibility verification reports. (1) For purposes of this 
section the term eligibility verification report means a form prescribed 
by the Secretary that is used to request income, net worth (if 
applicable), dependency status, and any other information necessary to 
determine or verify entitlement to pension or parents' dependency and 
indemnity compensation.
    (2) VA will not require old law or section 306 pensioners to submit 
eligibility verification reports unless the Secretary determines that 
doing so is necessary to preserve program integrity.
    (3) Except for a parent who has attained 72 years of age and has 
been paid dependency and indemnity compensation during two consecutive 
calendar years, the Secretary shall require an eligibility verification 
report from individuals receiving parents' dependency and indemnity 
compensation under the following circumstances:
    (i) If the Social Security Administration has not verified the 
beneficiary's

[[Page 225]]

Social Security number and, if the beneficiary is married, his or her 
spouse's Social Security number.
    (ii) If there is reason to believe that the beneficiary or, if the 
spouse's income could affect entitlement, his or her spouse may have 
received income other than Social Security during the current or 
previous calendar year; or
    (iii) If the Secretary determines that an eligibility verification 
report is necessary to preserve program integrity.
    (4) An individual who applies for or receives pension or parents' 
dependency and indemnity compensation as defined in Sec. Sec.  3.3 or 
3.5 of this part shall, as a condition of receipt or continued receipt 
of benefits, furnish the Department of Veterans Affairs an eligibility 
verification report upon request.
    (c) If VA requests that a claimant or beneficiary submit an 
eligibility verification report but he or she fails to do so within 60 
days of the date of the VA request, the Secretary shall suspend the 
award or disallow the claim.

(Authority: Sec. 306(a)(2) and (b)(3), Pub. L. 95-588, 92 Stat. 2508-
2509; 38 U.S.C. 1315(e))

(The Office of Management and Budget has approved the information 
collection requirements in this section under control numbers 2900-0101 
and 2900-0624)

[63 FR 53595, Oct. 6, 1998, as amended at 66 FR 56614, Nov. 9, 2001; 73 
FR 40466, July 15, 2008]



Sec.  3.257  Children; no surviving spouse entitled.

    Where pension is not payable to a surviving spouse because his or 
her annual income exceeds the statutory limitation or because of his or 
her net worth, payments will be made to or for the child or children as 
if there were no surviving spouse.

[62 FR 5529, Feb. 6, 1997]



Sec. Sec.  3.258-3.259  [Reserved]



Sec.  3.260  Computation of income.

    For entitlement to pension or dependency and indemnity compensation, 
income will be counted for the calendar year in which it is received.
    (a) Installments. Income will be determined by the total amount 
received or anticipated during the calendar year.
    (b) Deferred determinations. Where there is doubt as to the amount 
of the anticipated income, pension or dependency and indemnity 
compensation will be allowed at the lowest appropriate rate or will be 
withheld, as may be in order, until the end of the calendar year when 
the total income received during the year may be determined.
    (c) Proportionate income limitations; excess income. A proportionate 
income limitation will be established under the conditions set forth in 
paragraph (d) of this section except where application of a 
proportionate income limitation would result in payment of a lower rate 
than would be payable on the basis of income for the full calendar year.
    (d) Proportionate income limitations; computation. Income 
limitations will be computed proportionately for the purpose of 
determining initial entitlement, or for resuming payments on an award 
which was discontinued for a reason other than excess income or a change 
in marital or dependency status. A proportionate income limitation will 
be established for the period from the date of entitlement to the end of 
that calendar year. The total amount of income received by the claimant 
during that period will govern the payment of benefits. Income received 
prior to the date of entitlement will be disregarded.
    (e) Proportionate income limitations; spouse. In determining whether 
proportionate computation is applicable to a claim under Pub. L. 86-211 
(73 Stat. 432), the total income for the calendar year of entitlement of 
both veteran and that of the spouse available for use of the veteran 
will be considered. If a proportionate income limitation is then 
applicable, it will be applied to both the veteran's and the spouse's 
income. The spouse's income will not be included, however, where his or 
her total income for the calendar year does not exceed $1,200.
    (f) Rate changes. In years after that for which entitlement to 
pension or dependency and indemnity compensation has been established or 
reestablished as provided in paragraph (d) of this section, total income 
for the calendar year will govern the payment of benefits. Where there 
is a change in the

[[Page 226]]

conditions of entitlement because of a change in marital or dependency 
status, entitlement for each period will be determined separately. For 
the period when the claimant was married or had a dependent, the rate 
payable will be determined under the annual income limitation or 
increment applicable to a claimant who is married or has a dependent. 
For the period when the claimant was unmarried or without a dependent, 
the rate payable will be determined under the annual income limitation 
or increment applicable to a claimant who is not married or has no 
dependent. Since these determinations will be based on total income for 
the calendar year, it is not material whether such income was received 
before or after the change of status.
    (g) Fractions of dollars. In computing a claimant's annual income a 
fraction of a dollar will be disregarded for the purpose of determining 
entitlement to monthly payments of pension and dependency and indemnity 
compensation.

(Authority: 38 U.S.C. 1315(g)(2); 1503(b))

[28 FR 30, Jan. 1, 1963, as amended at 29 FR 2944, Mar. 4, 1964; 37 FR 
6677, Apr. 1, 1972; 40 FR 16066, Apr. 9, 1975]



Sec.  3.261  Character of income; exclusions and estates.

    The following factors will be considered in determining whether a 
claimant meets the requirements of Sec. Sec.  3.250, 3.251 and 3.252 
with reference to dependency, income limitations and corpus of estate:
    (a) Income.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 Dependency and         Pension; old-law     Pension; section 306
               Income                 Dependency (parents)   indemnity compensation   (veterans, surviving   (veterans, surviving          See--
                                                                    (parents)        spouses and children)  spouses and children)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Total income from employment,    Included..............  Included..............  Included.............  Included.............  Sec.   3.262(a).
 business, investments, or rents.
(2) Income of spouse...............  ......do..............  ......do..............  Excluded.............  ......do.............  Sec.   3.262(b).
(3) Earnings of members of family    ......do..............  Excluded..............  ......do.............  Excluded.............  Sec.   3.250(b)(2).
 under legal age.                                                                                                                  Sec.   3.252(e)(3).
(4) Earned income of child-claimant  ......................  ......................  Included.............  ......do.............
(5) Gifts, including contributions
 from adult members of family:
  Property.........................  ......do..............  Included..............  ......do.............  ......do.............  Sec.   3.262(k).
  Money............................  ......do..............  ......do..............  ......do.............  Included.............
(6) Value of maintenance by          Excluded..............  Excluded..............  Excluded.............  Excluded.............  Sec.   3.262(c).
 relative, friend, or organization.
(7) Rental value of property owned   ......do..............  ......do..............  ......do.............  ......do.............
 by and resided in by claimant.
(8) Charitable donations...........  ......do..............  ......do..............  Included.............  ......do.............  Sec.   3.262(d).
(9) Family allowance authorized by   Included..............  Included..............  ......do.............  Included.............
 service personnel.
(10) Reasonable value of allowances  ......do..............  ......do..............  ......do.............  Included except as
 to person in service in addition                                                                            earned income of
 to base pay.                                                                                                child-claimant.
(11) Mustering-out pay.............  Excluded..............  ......do..............  Excluded.............  ......do.............
(12) Six-months' death gratuity....  ......do..............  Excluded..............  ......do.............  Excluded.............
(13) Bonus or similar cash gratuity  Excluded..............  Excluded..............  Excluded.............  Excluded.............
 paid by any State based on service
 in Armed Forces of United States.
(14) Retired Serviceman's Family
 Protection Plan; Survivor Benefit
 Plan (10 U.S.C. ch. 73):
  Retired Serviceman's Family
   Protection Plan (Subch. I):
    Annuities......................  ......do..............  ......do..............  ......do.............  ......do.............
    Refund (10 U.S.C. 1446)........  Included..............  Included..............  Included.............  Included.............
  Survivor Benefit Plan (Subch. II)  ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(e).
   (Pub. L. 92-425; 86 Stat. 706).
Annuity under Sec.   653, Pub. L.    Included..............  Included..............  Excluded.............  Excluded.............  Sec.   3.262(r)
 100-456.
(15) Retirement pay received direct  Included..............  Included..............  Included.............  Included.............  Sec.   3.262(e).
 from service department.            ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(h).
(16) Retirement benefits; general..  ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(e).

[[Page 227]]

 
(17) Social security benefits:
  Old age and survivors', and        Included..............  Included..............  Included.............  Included.............  Sec.   3.262(f).
   disability insurance.
    Charitable programs............  Excluded..............  Excluded..............  ......do.............  Excluded.............
    Lump-sum death payments........  Included..............  ......do..............  ......do.............  ......do.............
    Supplemental security income...  Excluded..............  Excluded..............  ......do.............  ......do.............
(18) Railroad Retirement benefits..  ......do..............  Included..............  Disability pension--   Included.............  Sec.   3.262(g).
                                                                                      Excluded Death
                                                                                      pension--Included.
(19) Retirement pay waived under     Excluded..............  Excluded..............  Excluded.............  ......do.............  Sec.   3.262(h).
 Federal statute.
(20) Department of Veterans Affairs
 payments:
  Pension..........................  Excluded..............  Excluded..............  Excluded.............  Excluded.............
  Compensation and dependency and    ......do..............  ......do..............  ......do.............  ......do.............
   indemnity compensation.
  World War I adjusted compensation  ......do..............  Included..............  ......do.............  Included.............
  U.S. Government life insurance or  Excluded..............  Excluded..............  Excluded.............  Excluded.............
   national service life insurance
   for disability or death,
   maturity of endowment policies,
   and dividends, including special
   and termination dividends.
  Servicemembers' group life         ......do..............  ......do..............  ......do.............  ......do.............
   insurance.
  Veterans' group life insurance...  ......do..............  ......do..............  ......do.............  ......do.............
  Servicemembers' indemnity........  ......do..............  ......do..............  ......do.............  ......do.............
  Subsistence allowance (38 U.S.C.   Included..............  Included..............  Included.............  Included.............
   ch. 31).
  Veterans educational assistance    ......do..............  ......do..............  ......do.............  ......do.............
   in excess of amounts expended
   for training (38 U.S.C. ch. 34).
  Educational assistance (38 U.S.C.  ......................  ......................  Excluded.............  Excluded.............
   ch. 35).
  Special allowance under 38 U.S.C.  Excluded..............  Included..............  ......do.............  Included.............
   1312(a).
  Statutory burial allowance.......  ......do..............  Excluded..............  ......do.............  Excluded.............
  Accrued..........................  ......do..............  Included, except        ......do.............  Included, except
                                                              accrued as                                     accrued as
                                                              reimbursement.                                 reimbursement.
(21) Compensation (civilian) for     Included..............  Included..............  Included.............  Included.............  Sec.   3.262(i).
 injury or death.
(22) Contributions by a public or
 private employer to a:
  Public or private health or        Excluded..............  Excluded..............  Excluded.............  Excluded.............
   hospitalization plan for an
   active or retired employee.
  Retired employee as reimbursement  Included..............  Included..............  Excluded.............  Excluded.............
   for premiums for supplementary
   medical insurance benefits under
   the Social Security Program
   (Pub. L. 91-588; 84 Stat. 1580).
(23) Overtime pay; Government        Included..............  Included..............  Disability pension--   Included.............
 employees.                                                                           Excluded. Death
                                                                                      pension--Included.
(24) Commercial life insurance;      Included (as received)  Included (as received)  Included (special      Included (as           Sec.   3.262(j).
 disability, accident, or health                                                      provision).            received).
 insurance, less payments of
 medical or hospital expenses
 resulting from the accident or
 disease for which payments are
 made.
(25) Commercial annuities or         ......do..............  Included (special       ......do.............  Included (special      Sec.   3.262(j).
 endowments.                                                  provision).                                    provision).
(26) Dividends from commercial       Excluded..............  Excluded..............  Excluded.............  Excluded.............
 insurance.
(27) Insurance under Merchant        Included..............  Included..............  Included.............  Included.............
 Marine Act of 1936, as amended.

[[Page 228]]

 
(28) Reimbursement for casualty      Included..............  Excluded..............  Included.............  Included.............  Sec.   3.262(t)
 loss (Pub. L. 100-687).
Other fire Insurance...............  Excluded..............  Excluded..............  Excluded.............  Excluded.............  Sec.   3.262(t)
(29) Bequests, devises and
 inheritances:
  Property.........................  Included..............  Excluded..............  Included.............  ......do.............  Sec.   3.262(k).
  Money............................  ......do..............  Included..............  ......do.............  Included.............
  Joint bank accounts..............  ......do..............  ......do..............  ......do.............  Excluded.............  Sec.   3.262(k)(1).
(30) Profit from sale of property..  Excluded..............  Excluded..............  Excluded.............  Excluded.............  Sec.   3.262(k).
(31) Jury duty or obligatory civic   ......do..............  ......do..............  ......do.............  ......do.............
 duties.
(32) Relocation payments (Pub. L.    ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(c).
 90-448; Pub. L. 90-495).
(33) The following programs
 administered by the ACTION Agency:
  Foster Grandparent Program and     ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(q)(1).
   Older Americans Community
   Service Programs payments (Pub.
   L. 93-29; 87 Stat. 55).
  Volunteers in Service to America   ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(q)(2).
   (VISTA), University Year for
   ACTION (UYA), Program for Local
   Services (PLS), ACTION
   Cooperative Volunteers (ACV),
   Foster Grandparent Program
   (FGP), and Older American
   Community Service Programs,
   Retired Senior Volunteer Program
   (RSVP), Senior Companion Program
   (Pub. L. 93-113; 87 Stat. 394).
(34) The Service Corps of Retired    ......do..............  ......do..............  ......do.............  ......do.............  Sec.   3.262(q)(2).
 Executives (SCORE) and Active
 Corps of Executives (ACE)
 administered by the Small Business
 Administration. (Pub. L. 93-113;
 87 Stat. 394).
(35) Income received under Section   Excluded..............  Excluded..............  Included.............  Included.............  Sec.   3.262(t)
 6 of the Radiation Exposure
 Compensation Act (Pub. L. 101-426).
(36) Income received from income     Excluded..............  Excluded..............  Excluded.............  Excluded.............  Sec.   3.262(u)
 tax returns.
(37) Other amounts excluded from     Excluded..............  Excluded..............  Excluded.............  Excluded.............  Sec.   3.262(v)
 income by statute.                                                                                                                Sec.   3.279
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ The compensation received through a crime victim compensation program will be excluded from income computations unless the total amount of
  assistance received from all federally funded programs is sufficient to fully compensate the claimant for losses suffered as a result of the crime.

    (b) Deduction of amounts paid by claimant.

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                        Pension; old-law     Pension; section 306
                                                                 Dependency and       (veterans, surviving   (veterans, surviving
             Deduction                Dependency (parents)   indemnity compensation       spouses, and           spouses, and               See
                                                                                           children)              children)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Unusual medical expenses.......  Not authorized........  Authorized............  Not authorized.......  Authorized...........  Sec.  Sec.
                                                                                                                                    3.262(b)(1) and (1).
(2) Veteran: just debts, expenses    Not authorized........  Authorized, except      Not authorized.......  Authorized...........  Sec.  Sec.   3.262(m)
 of last illness and burial.                                  debts.                                                                and (o).
(3) Veteran's spouse or child:       Not authorized........  Not authorized........  Not authorized.......  Authorized...........  Sec.   3.262(n).
 expenses of last illness and
 burial.
(4) Parent's spouse: just debts;     Not authorized........  Authorized............  .....................  .....................  Sec.   3.262(o).
 expenses of last illness and
 burial.
(5) Prepayment on real property      Not authorized........  Not authorized........  Not authorized.......  Authorized...........  Sec.  Sec.
 mortgages after death of spouse                                                                                                    3.262(k)(6).
 (Pub. L. 91-588).
--------------------------------------------------------------------------------------------------------------------------------------------------------

    (c) Corpus of estate.

[[Page 229]]



--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                             Pension; section 306
                                                                 Dependency and         Pension; old-law     (veterans, surviving
                                      Dependency (parents)   indemnity compensation    (veterans, widows,        spouses, and               See
                                                                                         and children)            children)
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                     Considered              Not considered........  Not considered.......  Considered...........  Sec.   3.263.
                                      conditionally........
--------------------------------------------------------------------------------------------------------------------------------------------------------


[28 FR 31, Jan. 1, 1963, as amended at 29 FR 15205, Nov. 11, 1964; 31 FR 
15632, Dec. 13, 1966; 33 FR 15286, Oct. 15, 1968; 36 FR 8446, May 6, 
1971; 37 FR 6677, Apr. 1, 1972; 37 FR 7092, Apr. 8, 1972; 37 FR 21436, 
Oct. 11, 1972; 38 FR 872, Jan. 5, 1973; 38 FR 26804, Sept. 26, 1973; 38 
FR 28826, Oct. 17, 1973; 40 FR 13305, Mar. 26, 1975; 40 FR 57459, Dec. 
10, 1975; 41 FR 17386, Apr. 26, 1976; 42 FR 43834, Aug. 31, 1977; 57 FR 
59298, Dec. 15, 1992; 58 FR 12174, Mar. 3, 1993; 58 FR 31909, June 7, 
1993; 58 FR 33766, June 21, 1993; 59 FR 37696, July 25, 1994; 60 FR 
2522, Jan. 10, 1995; 60 FR 18355, Apr. 11, 1995; 62 FR 51278, Sept. 30, 
1997; 67 FR 49586, July 31, 2002; 68 FR 60852, Oct. 24, 2003; 70 FR 
15591, Mar. 28, 2005; 76 FR 4248, Jan. 25, 2011; 83 FR 47268, Sept 18, 
2018]



Sec.  3.262  Evaluation of income.

    (a) Total income. All income from sources such as wages, salaries, 
earnings, bonuses from employers, income from a business or profession 
or from investments or rents as well as the fair value of personal 
services, goods or room and board received in lieu thereof will be 
included.
    (1) Salary is not determined by ``takehome'' pay, but includes 
deductions made under a retirement act or plan and amounts withheld by 
virtue of income tax laws.
    (2) The gross income from a business or profession may be reduced by 
the necessary operating expenses, such as cost of goods sold, or 
expenditures for rent, taxes, and upkeep. Depreciation is not a 
deductible expense. The cost of repairs or replacement may be deducted. 
The value of an increase in stock inventory of a business is not 
considered income.
    (3) A loss sustained in operating a business, profession, or farm or 
from investments may not be deducted from income derived from any other 
source.
    (b) Income of spouse. Income of the spouse will be determined under 
the rules applicable to income of the claimant.
    (1) Parents. Where the mother and father, or remarried parent and 
spouse are living together, the total combined income will be considered 
in determining dependency, or in determining the rate of dependency and 
indemnity compensation payable to the parent. This rule is equally 
applicable where both parents have remarried and each is living with his 
or her spouse. If the remarriage of a parent has been terminated, or the 
parent is separated from his or her spouse, income of the spouse will be 
excluded.
    (2) Veterans. The separate income of the spouse of a disabled 
veteran who is entitled to pension under laws in effect on June 30, 
1960, will not be considered. Where pension is payable under section 
306(a) of Pub. L. 95-588, to a veteran who is living with a spouse there 
will be included as income of the veteran all income of the spouse in 
excess of whichever is the greater, the amount of the spouse income 
exclusion specified in section 306(a)(2)(B) of Pub. L. 95-588 as 
increased from time to time under section 306 (a)(3) of Pub. L. 95-588 
or the total earned income of the spouse, which is reasonably available 
to or for the veteran, unless hardship to the veteran would result. Each 
time there is an increase in the spouse income exclusion pursuant to 
section 306(a)(3) of Pub. L. 95-588, the actual amount of the exclusion 
will be published in the ``Notices'' section of the Federal Register. 
The presumption that inclusion of such income is available to the 
veteran and would not work a hardship on him or her may be rebutted by 
evidence of unavailability or of expenses beyond the usual family 
requirements.


(Authority: 38 U.S.C. 1521(f); sec. 306(a)(2)(B) of Pub. L. 95-588)

    (c) Maintenance. The value of maintenance furnished by a relative, 
friend, or

[[Page 230]]

a charitable organization (civic or governmental) will not be considered 
income. Where the claimant is maintained in a rest home or other 
community institution or facility, public or private, because of 
impaired health or advanced age, money paid to the home or to the 
claimant to cover the cost of maintenance will not be considered income, 
regardless of whether it is furnished by a relative, friend or 
charitable organization. The expense of maintenance is not deductible if 
it is paid from the claimant's income, except as provided in paragraph 
(l) of this section in claims for dependency and indemnity compensation.
    (d) Charitable donations. Charitable donations from public or 
private relief or welfare organizations will not be considered income 
except in claims for pension under laws in effect on June 30, 1960. In 
the latter cases, additional charitable allowances received by a 
claimant for members of his or her family may not be divided per capita 
in determining the amount of the claimant's income.
    (e) Retirement benefits; general. Retirement benefits, including an 
annuity or endowment, paid under a Federal, State, municipal, or private 
business or industrial plan are considered income as limited by this 
paragraph. Where the payments received consist of part principal and 
part interest, interest will not be counted separately.
    (1) Protected pension. Except as provided in this paragraph (e)(1), 
effective January 1, 1965, in determining income for pension purposes 
under laws in effect on June 30, 1960, 10 percent of the retirement 
payments received by a veteran, surviving spouse, or child will be 
excluded. The remaining 90 percent will be considered income as 
received. Where the retirement benefit is based on the claimant's own 
employment, payments will not be considered income until the amount of 
the claimant's personal contribution (as distinguished from amounts 
contributed by the employer) has been received. Thereafter the 10 
percent exclusion will apply.
    (2) Pension; Pub. L. 86-211. Except as provided in this 
subparagraph, effective January 1, 1965, in determining income for 
pension purposes, under Pub. L. 86-211 (73 Stat. 432), 10 percent of the 
retirement payments received by a veteran, the veteran's spouse, 
surviving spouse, or child will be excluded. The remaining 90 percent 
will be considered income as received. Where a person was receiving or 
entitled to receive pension and retirement benefits based on his or her 
own employment on December 31, 1964, the retirement payments will not be 
considered income until the amount of the claimant personal contribution 
(as distinguished from amounts contributed by the employer) has been 
received. Thereafter the 10 percent exclusion will apply.
    (3) Compensation. In determining dependency of a parent for 
compensation purposes, all payments will be considered income as 
received.
    (4) Dependency and indemnity compensation. Except as provided in 
this subparagraph, effective January 1, 1967, in determining income for 
dependency and indemnity compensation purposes, 10 percent of the 
retirement payments received by a deceased veteran's parent or by the 
parent's spouse will be excluded. The remaining 90 percent will be 
considered income as received. Where a parent was receiving or entitled 
to receive dependency and indemnity compensation and retirement benefits 
based on his or her own employment on December 31, 1966, the retirement 
payments will not be considered income until the amount of the 
claimant's personal contribution (as distinguished from amounts 
contributed by the employer) has been received. Thereafter the 10 
percent exclusion will apply.


(Authority: 38 U.S.C. 1315(g), 1503(a)(6))

    (f) Social security benefits. Old age and survivor's insurance and 
disability insurance under title II of the Social Security Act will be 
considered income as a retirement benefit under the rules contained in 
paragraph (e) of this section. Benefits received under noncontributory 
programs, such as old age assistance, aid to dependent children, and 
supplemental security income are subject to the rules contained in 
paragraph (d) of this section applicable to charitable donations. The 
lumpsum death payment under title II of the Social Security Act will be 
considered as

[[Page 231]]

income except in claims for dependency and indemnity compensation and 
for pension under Pub. L. 86-211 (73 Stat. 432).
    (g) Railroad retirement benefits--(1) Parents, surviving spouses and 
children. Retirement benefits received from the Railroad Retirement 
Board will be considered as income under the rules contained in 
paragraph (e) of this section. (See paragraph (h) of this section as to 
waivers.)
    (2) Veterans. Effective July 1, 1959, retirement benefits received 
from the Railroad Retirement Board were excluded from consideration as 
income in determining eligibility for disability pension. (45 U.S.C. 
228s-1) This exclusion continues to be applicable to claims under laws 
in effect on June 30, 1960. For purposes of section 306 pension, such 
retirement benefits will be considered as income under the rules 
contained in paragraph (e) of this section.
    (h) Retirement benefits waived. Except as provided in this 
paragraph, retirement benefits (pension or retirement payments) which 
have been waived will be included as income. For the purpose of 
determining dependency of a parent, or eligibility of a parent for 
dependency and indemnity compensation or eligibility of a veteran, 
surviving spouse, or child for pension under laws in effect on June 30, 
1960, retirement benefits from the following sources which have been 
waived pursuant to Federal statute will not be considered as income:
    (1) Civil Service Retirement and Disability Fund;
    (2) Railroad Retirement Board (see paragraph (g)(2) of this 
section);
    (3) District of Columbia, firemen, policemen, or public school 
teachers;
    (4) Former lighthouse service.
    (i) Compensation (civilian) for injury or death. (1) Compensation 
paid by the Bureau of Employees' Compensation, Department of Labor (of 
the United States), or by Social Security Administration, or by Railroad 
Retirement Board, or pursuant to any workmen's compensation or 
employer's liability statute, or damages collected because of personal 
injury or death, less medical, legal, or other expenses incident to the 
injury or death, or the collection or recovery of such moneys will be 
considered income as received, except as provided in paragraph (i)(2) of 
this section. The criteria of paragraph (i)(1) of this section are for 
application as to all medical expenditures after such award or 
settlement.


(Authority: Pub. L. 92-198, 85 Stat. 663)

    (2) For pension, effective October 7, 1966, and for dependency and 
indemnity compensation effective January 1, 1967, if payments based on 
permanent and total disability or death are received from the Bureau of 
Employees' Compensation, Social Security Administration or Railroad 
Retirement Board, or pursuant to any workmen's compensation or 
employer's liability statute, there will be excluded 10 percent of the 
payments received after deduction of medical, legal, and other expenses 
as authorized by paragraph (i)(1) of this section. The 10 percent 
exclusion does not apply to damages collected incident to a tort suit 
under other than an employer's liability law of the United States or a 
political subdivision of the United States, or to determinations of 
dependency for compensation purposes.
    (j) Commercial insurance--(1) Annuity or endowment insurance. For 
pension, effective January 1, 1965, or for dependency and indemnity 
compensation, effective January 1, 1967, the provisions of paragraph (e) 
of this section apply. In such cases, 10 percent of the payments 
received will be excluded. In dependency and indemnity compensation 
claims, where the parent is receiving or entitled to receive dependency 
and indemnity compensation on December 31, 1966, and is also receiving 
or entitled to receive annuity payments on that date, or endowment 
insurance matures on or before that date, no part of the payments 
received will be considered income until the full amount of the 
consideration has been received, after which 10 percent of the amount 
received will be excluded. For compensation, the full amount of each 
payment is considered income as received.
    (2) Life insurance; general. In determining dependency, or 
eligibility for dependency and indemnity compensation, or for section 
306 pension the full

[[Page 232]]

amount of payments is considered income as received. For section 306 
pension, effective October 7, 1966, and for dependency and indemnity 
compensation, effective January 1, 1967, 10 percent of the payments 
received will be excluded.
    (3) Life insurance; old-law pension. For pension under laws in 
effect on June 30, 1960, 10 percent of the payments received will be 
excluded. Where it is considered that life insurance was received in a 
lump sum in the calendar year in which the veteran died and payments are 
actually received in succeeding years, no part of the payments received 
in succeeding years will be considered income until an amount equal to 
the lump-sum face value of the policy has been received, after which 10 
percent of the payments received will be excluded. The 10 percent 
exclusion is authorized effective October 7, 1966.
    (4) Disability, accident or health insurance. For pension, effective 
October 7, 1966, and for dependency and indemnity compensation, 
effective January 1, 1967, there will be excluded 10 percent of the 
payments received for disability after deduction of medical, legal, or 
other expenses incident to the disability. For compensation, after 
deduction of such expenses, the full amount of payments is considered 
income as received.
    (k) Property--(1) Ownership. The terms of the recorded deed or other 
evidence of title will constitute evidence of ownership of real or 
personal property. This includes property acquired through purchase, 
bequest or inheritance except that, effective January 1, 1971, amounts 
in joint accounts in banks and similar institutions acquired by reason 
of the death of another joint owner shall not be considered income of a 
survivor for section 306 pension purposes. With the foregoing exception, 
if property is owned jointly each person will be considered as owning a 
proportionate share. The claimant's share of property held in 
partnership will be determined on the facts found. In the absence of 
evidence to the contrary, the claimant's statement as to the terms of 
ownership will be accepted.


(Authority: Sec. 306, Pub. L. 95-588; 92 Stat. 2508)

    (2) Income-producing property. Income received from real or personal 
property owned by the claimant will be counted. The claimant's share 
will be determined in proportion to his right according to the rules of 
ownership.
    (3) Sale of property. Except as provided in paragraphs (k)(4) and 
(5) of this section, net profit from the sale of real or personal 
property will be counted. In determining net profit from the sale of 
property owned prior to the date of entitlement, the value at the date 
of entitlement will be considered in relation to the selling price. 
Where payments are received in installments, payments will not be 
considered income until the claimant has received amounts equal to the 
value of the property at the date of entitlement. Principal and interest 
will not be counted separately.
    (4) Homes. Net profit from the sale of the claimant's residence 
which is received during the calendar year of sale will not be 
considered as income under the following conditions:
    (i) To the extent that it is applied within the calendar year of the 
sale, or the succeeding calendar year, to the purchase price of another 
residence as his principal dwelling;
    (ii) Such application of the net profit is reported within 1 year 
following the date so applied, and
    (iii) The net profit is so applied after January 10, 1962, to a 
purchase made after said date.

This exclusion will not apply where the net profit is applied to the 
price of a home purchased earlier than the calendar year preceding the 
calendar year of sale of the old residence.
    (5) Sale of property; section 306 pension and dependency and 
indemnity compensation. For pension under section 306 pension and for 
dependency and indemnity compensation, profit from the sale of real or 
personal property other than in the course of a business will not be 
considered income. This applies to property acquired either before or 
after the date of entitlement. Any amounts received in excess of the 
sales price will be counted as income. Where payments are received in 
installments, principal and interest will not be counted separately. For 
pension, this provision is effective January 1, 1965;

[[Page 233]]

for dependency and indemnity compensation, January 1, 1967.


(Authority: 38 U.S.C. 1503(a)(10); 38 U.S.C. 1315(g))

    (6) Payments on mortgages on real property; section 306 pension. 
Effective January 1, 1971, for the purposes of section 306 pension, an 
amount equaling any prepayments made by a veteran or surviving spouse on 
a mortgage or similar type security instrument in existence at the death 
of veteran or spouse on real property which prior to the death was the 
principal residence of the veteran and spouse will be excluded from 
consideration as income if such payment was made after the death and 
prior to the close of the year succeeding the year of death.


(Authority: 38 U.S.C. 1503(a)(14))

    (l) Unusual medical expenses. Within the provisions of paragraphs 
(l)(1) through (4) of this section there will be excluded from the 
amount of the claimant's annual income any unreimbursed amounts which 
have been paid within the calendar year for unusual medical expenses 
regardless of the year the indebtedness was incurred. The term unusual 
means excessive. It does not describe the nature of a medical condition 
but rather the amount expended for medical treatment in relationship to 
the claimant's resources available for sustaining a reasonable mode of 
life. Unreimbursed expenditures which exceed 5 percent of the claimant's 
reported annual income will be considered unusual. Health, accident, 
sickness and hospitalization insurance premiums will be included as 
medical expenses in determining whether the claimant's unreimbursed 
medical expenses meet the criterion for unusual. A claimant's statement 
as to amounts expended for medical expenses ordinarily will be accepted 
unless the circumstances create doubt as to its credibility. An estimate 
based on a clear and reasonable expectation that unusual medical 
expenditure will be realized may be accepted for the purpose of 
authorizing prospective payments of benefits subject to necessary 
adjustment in the award upon receipt of an amended estimate or after the 
end of the calendar year upon receipt of an income questionnaire. For 
the definition of what constitutes a medical expense, see Sec.  3.278, 
Deductible medical expenses.
    (1) Veterans. For the purpose of section 306 pension, there will be 
excluded unreimbursed amounts paid by the veteran for unusual medical 
expenses of self, spouse, and other relatives of the veteran in the 
ascending as well as descending class who are members or constructive 
members of the veteran's household and whom the veteran has a moral or 
legal obligation to support.
    (2) Surviving spouses. For the purpose of section 306 pension, there 
will be excluded unreimbursed amounts paid by the surviving spouse for 
the unusual medical expenses of self, the veteran's children, and other 
relatives of the surviving spouse in the ascending as well as descending 
class who are members or constructive members of the surviving spouse's 
household and whom the surviving spouse has a moral or legal obligation 
to support.
    (3) Children. For the purpose of section 306 pension, there will be 
excluded unreimbursed amounts paid by a child for the unusual medical 
expenses of self, parent, and brothers and sisters of the child.
    (4) Parents. For dependency and indemnity compensation purposes 
there will be excluded unreimbursed amounts paid by the parent for the 
unusual medical expenses of self, spouse, and other relatives of the 
parent in the ascending as well as descending class who are members or 
constructive members of the parent's household and whom the parent has a 
moral or legal obligation to support. If the combined annual income of 
the parent and the parent's spouse is the basis for dependency and 
indemnity compensation, the exclusion is applicable to the combined 
annual income and extends to the unusual unreimbursed medical expenses 
of the spouse's relatives in the ascending as well as descending class 
who are members or constructive members of the household and whom the 
parent's spouse has a moral or legal obligation to support.


(Authority: 38 U.S.C. 1315(f)(3); Sec. 306, Pub. L. 95-588; 92 Stat. 
2508)


[[Page 234]]


    (m) Veteran's final expenses; pension. In claims for pension under 
section 306, there will be excluded, as provided in paragraph (p) of 
this section:
    (1) From the income of a surviving spouse, amounts equal to amounts 
paid for the expenses of the veteran's last illness;
    (2) From the income of a surviving spouse, or of a child of a 
deceased veteran where there is no surviving spouse, amounts equal to 
amounts paid by the surviving spouse or child for the veteran's just 
debts, for the expenses of the veteran's last illness, and burial to the 
extent such expenses are not reimbursed by the Department of Veterans 
Affairs. The term ``just debts'' does not include any debt that is 
secured by real or personal property.


(Authority: Sec. 306, Pub. L. 95-588; 92 Stat. 2508)

    (n) Final expenses of veteran's spouse or child; pension. In claims 
for pension under section 306, there will be excluded, as provided in 
paragraph (p) of this section:
    (1) From the income of a veteran, amounts equal to amounts paid by 
the veteran for the last illness and burial of the veteran's deceased 
spouse or child; and
    (2) From the income of a spouse or surviving spouse, amounts equal 
to amounts paid by her as spouse or surviving spouse of the deceased 
veteran for the last illness and burial of a child of such veteran.


(Authority: Sec. 306, Pub. L. 95-588; 92 Stat. 2508)

    (o) Final expenses of veteran or parent's spouse; dependency and 
indemnity compensation. In claims for dependency and indemnity 
compensation there will be excluded from the income of a parent, as 
provided in paragraph (p) of this section, amounts equal to amounts paid 
by the parent for:
    (1) The expenses of the veteran's last illness and burial to the 
extent that such expenses are not reimbursed under 38 U.S.C. ch. 23.
    (2) The parent's deceased spouse's just debts, the expenses of the 
spouse's last illness to the extent such expenses are not reimbursed 
under 38 U.S.C. ch. 51 and the expenses of the spouse's burial to the 
extent that such expenses are not reimbursed under 38 U.S.C. ch. 23 or 
51. The term ``just debts'' does not include any debt that is secured by 
real or personal property.


(Authority: 38 U.S.C. 1315(f))

    (p) Final expenses; year of exclusion. For the purpose of paragraphs 
(m), (n) and (o) of this section, in the absence of contradictory 
information, the claimant's statement will be accepted as to the nature, 
amount and date of payment, and identity of the creditor. Except as 
provided in this paragraph, payments will be deducted from annual income 
for the year in which such payments are made. Payments made by a 
veteran, the spouse or surviving spouse of a veteran, child or, in 
dependency and indemnity compensation claims, by a parent during the 
calendar year following the year in which the veteran, spouse or child 
died may be deducted from the claimant's income for the year of last 
illness or burial if this deduction is advantageous to the claimant.
    (q) Volunteer programs--(1) Payments under Foster Grandparent 
Program and Older Americans Community Service Programs. Effective May 3, 
1973, compensation received under the Foster Grandparent Program and the 
Older Americans Community Service Programs will be excluded from income 
in claims for compensation, pension and dependency and indemnity 
compensation.


(Authority: Pub. L. 93-29; 87 Stat. 55)

    (2) Payments under domestic volunteer service act programs. 
Effective October 1, 1973, compensation or reimbursement received under 
a Domestic Volunteer Service Act Program (including Volunteers in 
Service to America (VISTA), University Year for ACTION (UYA), Program 
for Local Services (PLS), ACTION Cooperative Volunteers (ACV), Foster 
Grandparent Program (FGP) and Older American Community Service Program, 
Retired Senior Volunteer Program (RSVP), Senior Companion Program, 
Service Corps of Retired Executives (SCORE) and Active Corps of 
Executives (ACE), will be excluded

[[Page 235]]

from income in claims for compensation, pension and dependency and 
indemnity compensation.


(Authority: Pub. L. 93-113; 87 Stat. 394)

    (r) Survivor benefit annuity. For the purposes of old law pension 
and section 306 pension, there shall be excluded from computation of 
income annuity paid by the Department of Defense under the authority of 
section 653, Public Law 100-456 to qualified surviving spouses of 
veterans who died prior to November 1, 1953. (September 29, 1988)


(Authority: Sec. 653, Pub. L. 100-456; 102 Stat. 1991)

    (s) Reimbursement for casualty loss. The following sources of 
reimbursements for casualty loss will not be considered as income in 
determining entitlement to benefits under the programs specified. 
Amounts to be excluded from computation in parens' dependency and 
indemnity compensation claims are limited to amounts of reimbursement 
which do not exceed the greater of the fair market value or the 
reasonable replacement cost of the property involved at the time 
immediately preceding the loss.
    (1) Reimbursement for casualty loss of any kind in determining 
entitlement to parents' dependency and indemnity compensation benefits. 
For purposes of paragraph (t) of this section, the term ``casualty 
loss'' means the complete or partial destruction of property resulting 
from an identifiable event of a sudden, unexpected or unusual nature.
    (2) Proceeds from fire insurance in determining dependency of a 
parent for compensation purposes or in determining entitlement to old-
law and section 306 pension benefits.


(Authority: 38 U.S.C. 1315(f))

    (t) Radiation Exposure Compensation Act. For the purposes of 
parents' dependency and indemnity compensation and dependency of parents 
under Sec.  3.250, there shall be excluded from income computation 
payments under Section 6 of the Radiation Exposure Compensation Act of 
1990.


(Authority: 42 U.S.C. 2210 note)

    (u) Income tax returns. VA will exclude from income payments from 
income tax returns. See Sec.  3.279(d)(1).


(Authority: 26 U.S.C. 6409)

    (v) Statutory exclusions. Other amounts excluded from income by 
statute. See Sec.  3.279. VA will exclude from income any amount 
designated by statute as not countable as income, regardless of whether 
or not it is listed in this section or in Sec.  3.279.

(Authority: 42 U.S.C. 1395w-141(g)(6))

[28 FR 32, Jan. 1, 1963]

    Editorial Note: For Federal Register citations affecting Sec.  
3.262, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  3.263  Corpus of estate; net worth.

    (a) General. The following rules are for application in determining 
the corpus of estate of a parent where dependency is a factor under 
Sec.  3.250, and the net worth of a veteran, surviving spouse, or child 
where pension is subject to Pub. L. 86-211 (73 Stat. 432) under Sec.  
3.252(b). Only the estate of the parent, in claims based on dependency, 
or the estate of the veteran, surviving spouse, or child-claimant in 
claims for pension, will be considered. In the absence of contradictory 
information, the claimant's statement as to ownership and estimate of 
value will be accepted.
    (b) Definition. Corpus of estate and net worth mean the market 
value, less mortgages or other encumbrances, of all real and personal 
property owned by the claimant except the claimant's dwelling (single-
family unit) including a reasonable lot area, and personal effects 
suitable to and consistent with the claimant's reasonable mode of life.
    (c) Ownership. See Sec.  3.262(k).
    (d) Evaluation. In determining whether some part of the claimant's 
estate should be consumed for his or her maintenance, consideration will 
be given to the amount of the claimant's income, together with the 
following factors: whether the property can be readily converted into 
cash at no substantial sacrifice; ability to dispose of property as 
limited by community property laws; life expectancy; number

[[Page 236]]

of dependents who meet the requirements of Sec.  3.250(b)(2); potential 
rate of depletion, including unusual medical expenses under the 
principles outlined in Sec.  3.262(l) for the claimant and his or her 
dependents.
    (e) VA will exclude from the corpus of estate or net worth any 
amount designated by statute as not countable as a resource. See Sec.  
3.279.

(Authority: 42 U.S.C. 1395w-141(g)(6))

[28 FR 33, Jan. 1, 1963, as amended at 39 FR 28527, Aug. 8, 1974; 44 FR 
45936, Aug. 6, 1979; 57 FR 59299, Dec. 15, 1992; 58 FR 33767, June 21, 
1993; 62 FR 51279, Sept. 30, 1997; 67 FR 49587, July 31, 2002; 68 FR 
60852, Oct. 24, 2003; 70 FR 15591, Mar. 28, 2005; 76 FR 4248, Jan. 25, 
2011; 83 FR 47269, Sept. 18, 2018]



Sec.  3.270  Applicability of various dependency, income and estate
regulations.

    (a) Sections 3.250 through 3.263 and 3.278 through 3.279. These 
sections are applicable to dependency, income and estate determinations 
needed to determine entitlement or continued entitlement for the 
following programs:
    (1) Parents' death compensation.
    (2) Old-law pension.
    (3) Section 306 pension.
    (4) Parents' dependency and indemnity compensation.

    Note: Citations to title 38 U.S.C. in Sec. Sec.  3.250 through 3.263 
and 3.278 through 3.279 referring to section 306 or old-law pension 
generally refer to provisions of law in effect on December 31, 1978.

    (b) Sections 3.271 through 3.279. These sections apply to income and 
estate determinations of entitlement to the improved disability and 
death pension program which became effective January 1, 1979.

[44 FR 45936, Aug. 6, 1979, as amended at 83 FR 47269, Sept. 18, 2018]

  Regulations Applicable to the Improved Pension Program Which Became 
                        Effective January 1, 1979

    Source: 44 FR 45936, Aug. 6, 1979, unless otherwise noted.



Sec.  3.271  Computation of income.

    (a) General. Payments of any kind from any source shall be counted 
as income during the 12-month annualization period in which received 
unless specifically excluded under Sec.  3.272.


(Authority: 38 U.S.C. 501)

    (1) Recurring income. Recurring income means income which is 
received or anticipated in equal amounts and at regular intervals (e.g., 
weekly, monthly, quarterly, etc.), and which will continue throughout an 
entire 12-month annualization period. The amount of recurring income for 
pension purposes will be the amount received or anticipated during a 12-
month annualization period. Recurring income which terminates prior to 
being counted for at least one full 12-month annualization period will 
be treated as nonrecurring income for computation purposes.
    (2) Irregular income. Irregular income means income which is 
received or anticipated during a 12-month annualization period, but 
which is received in unequal amounts or at irregular intervals. The 
amount of irregular income for pension purposes will be the amount 
received or anticipated during a 12-month annualization period following 
initial receipt of such income.
    (3) Nonrecurring income. Nonrecurring income means income received 
or anticipated on a one-time basis during a 12-month annualization 
period (e.g., an inheritance). Pension computations of income will 
include nonrecurring income for a full 12-month annualization period 
following receipt of the income.
    (b) Salary. Salary means the gross amount of a person's earnings or 
wages before any deductions are made for such things as taxes, 
insurance, retirement plans, social security, etc.
    (c) Business, farm or professional income. (1) This includes gross 
income from a business, farm or profession as reduced by the necessary 
operating expenses such as cost of goods sold, or expenditures for rent, 
taxes, and upkeep, or costs of repairs or replacements. The value of an 
increase in stock inventory of a business is not considered income.
    (2) Depreciation is not a deductible expense.
    (3) A loss sustained in operating a business, profession, farm, or 
from investments, may not be deducted from income derived from any other 
source.
    (d) Income from property. Income from real or personal property is 
countable

[[Page 237]]

as income of the property's owner. The terms of a recorded deed or other 
evidence of title shall constitute evidence of ownership. This includes 
property acquired through purchase, gift, devise, or descent. If 
property is owned jointly, income of the various owners shall be 
determined in proportion to shares of ownership of the property. The 
owner's shares of income held in partnership shall be determined on the 
basis of the facts found.
    (e) Installments. Income shall be determined by the total amount 
received or anticipated during a 12-month annualization period.


(Authority: 38 U.S.C. 501)

    (f) Deferred determinations. (1) When an individual is unable to 
predict with certainty the amount of countable annual income, the annual 
rate of improved pension shall be reduced by the greatest amount of 
anticipated countable income until the end of the 12-month annualization 
period, when total income received during that period will be determined 
and adjustments in pension payable made accordingly.


(Authority: 38 U.S.C. 501)

    (2) When a claimed dependent is shown to have income which exceeds 
the additional amount of benefits payable based on the claimed 
dependency, but evidence requirements of Sec.  3.204, Sec.  3.205, Sec.  
3.209, or Sec.  3.210 have not been met, the maximum annual rate of 
improved pension shall be determined without consideration of the 
claimed dependency. This amount shall be reduced by an amount which 
includes the income of the unestablished dependent. Adjustments in 
computation of the maximum annual rate of improved pension shall occur 
following receipt of evidence necessary to establish the dependency.


(Authority: 38 U.S.C. 501(a))

    (g) Compensation (civilian) for injury or death. Compensation paid 
by the United States Department of Labor, Office of Workers' 
Compensation Programs, Social Security Administration, or the Railroad 
Retirement Board, or pursuant to any worker's compensation or employer's 
liability statute, or damages collected because of personal injury or 
death, will be considered income as received. However, medical, legal or 
other expenses incident to the injury or death, or incident to the 
collection or recovery of the amount of the award or settlement, may be 
deducted. The criteria in Sec.  3.272(g) apply as to all medical 
expenditures after the award or settlement.


(Authority: 38 U.S.C. 501)

    (h) Fractions of dollars. Fractions of dollars will be disregarded 
in computing annual income.
    (i) Waiver of receipt of income. Potential income that is not 
excludable under Sec.  3.272 or Sec.  3.279 but is waived by an 
individual is included as countable income of the individual. However, 
if an individual withdraws a claim for Social Security benefits, after a 
finding of entitlement to those benefits, in order to maintain 
eligibility for unreduced Social Security benefits upon reaching a 
particular age, VA will not regard this potential income as having been 
waived and will therefore not count it.

(Authority: 38 U.S.C. 1503 (a)).

[44 FR 45936, Aug. 6, 1979, as amended at 53 FR 23235, June 21, 1988; 57 
FR 59299, Dec. 15, 1992; 83 FR 47269, Sept. 18, 2018]



Sec.  3.272  Exclusions from income.

    The following shall be excluded from countable income for the 
purpose of determining entitlement to improved pension. Unless otherwise 
provided, expenses deductible under this section are deductible only 
during the 12-month annualization period in which they were paid.


(Authority: 38 U.S.C. 501)

    (a) Welfare. Donations from public or private relief, welfare, or 
charitable organizations.


(Authority: 38 U.S.C. 1503(a)(1))

    (b) Maintenance. The value of maintenance furnished by a relative, 
friend, or

[[Page 238]]

a charitable organization (civic or governmental) will not be considered 
income. Where the individual is maintained in a rest home or other 
community institution or facility, public or private, because of 
impaired health or advanced age, money paid to the home or the 
individual to cover the cost of maintenance will not be considered 
income, regardless of whether it is furnished by a relative, friend, or 
charitable organization. The expense of maintenance is not deductible if 
it is paid from the individual's income.


(Authority: 38 U.S.C. 501, 1503(a)(1))

    (c) Department of Veterans Affairs pension benefits. Payments under 
chapter 15 of title 38, United States Code, including accrued pension 
benefits payable under 38 U.S.C. 5121.


(Authority: 38 U.S.C. 1503(a)(2))

    (d) Reimbursement for casualty loss. Reimbursement of any kind for 
any casualty loss. The amount to be excluded is not to exceed the 
greater of the fair market value or the reasonable replacement cost of 
the property involved at the time immediately preceding the loss. For 
purposes of this paragraph, the term ``casualty loss'' means the 
complete or partial destruction of property resulting from an 
identifiable event of a sudden, unexpected or unusual nature.


(Authority: 38 U.S.C. 1503(a)(5))

    (e) Profit from sale of property. Profit realized from the 
disposition of real or personal property other than in the course of 
business, except amounts received in excess of the sales price, for 
example, interest on deferred sales is included as income. In 
installment sales, any payments received until the sales price is 
recovered are not included as income, but any amounts received which 
exceed the sales price are included, regardless of whether they 
represent principal or interest.


(Authority: 38 U.S.C. 1503(a)(6))

    (f) Joint accounts. Amounts in joint accounts in banks and similar 
institutions acquired by reason of death of the other joint owner.


(Authority: 38 U.S.C. 1503(a)(7))

    (g) Medical expenses. Within the provisions of the following 
paragraphs, there will be excluded from the amount of an individual's 
annual income any unreimbursed amounts which have been paid within the 
12-month annualization period for medical expenses regardless of when 
the indebtedness was incurred. An estimate based on a clear and 
reasonable expectation that unusual medical expenditure will be realized 
may be accepted for the purpose of authorizing prospective payments of 
benefits subject to necessary adjustment in the award upon receipt of an 
amended estimate, or after the end of the 12-month annualization period 
upon receipt of an eligibility verification report. For the definition 
of what constitutes a medical expense, see Sec.  3.278, Deductible 
medical expenses.


(Authority: 38 U.S.C. 501)

    (1) Veteran's income. Unreimbursed medical expenses will be excluded 
when all of the following requirements are met:
    (i) They were or will be paid by a veteran or spouse for medical 
expenses of the veteran, spouse, children, parents and other relatives 
for whom there is a moral or legal obligation of support;
    (ii) They were or will be incurred on behalf of a person who is a 
member or a constructive member of the veteran's or spouse's household; 
and
    (iii) They were or will be in excess of 5 percent of the applicable 
maximum annual pension rate or rates for the veteran (including 
increased pension for family members but excluding increased pension 
because of need for aid and attendance or being housebound) as in effect 
during the 12-month annualization period in which the medical expenses 
were paid.
    (2) Surviving spouse's income. Unreimbursed medical expenses will be 
excluded when all of the following requirements are met:
    (i) They were or will be paid by a surviving spouse for medical 
expenses of the spouse, veteran's children, parents

[[Page 239]]

and other relatives for whom there is a moral or legal obligation of 
support;
    (ii) They were or will be incurred on behalf of a person who is a 
member or a constructive member of the spouse's household; and
    (iii) They were or will be in excess of 5 percent of the applicable 
maximum annual pension rate or rates for the spouse (including increased 
pension for family members but excluding increased pension because of 
need for aid and attendance or being housebound) as in effect during the 
12-month annualization period in which the medical expenses were paid.


(Authority: 38 U.S.C. 501)

    (3) Children's income. Unreimbursed amounts paid by a child for 
medical expenses of self, parent, brothers and sisters, to the extent 
that such amounts exceed 5 percent of the maximum annual pension rate or 
rates payable to the child during the 12-month annualization period in 
which the medical expenses were paid.


(Authority: 38 U.S.C. 501)

    (h) Expenses of last illnesses, burials, and just debts. Expenses 
specified in paragraphs (h)(1) and (h)(2) of this section which are paid 
during the calendar year following that in which death occurred may be 
deducted from annual income for the 12-month annualization period in 
which they were paid or from annual income for any 12-month 
annualization period which begins during the calendar year of death, 
whichever is to the claimant's advantage. Otherwise, such expenses are 
deductible only for the 12-month annualization period in which they were 
paid.


(Authority: 38 U.S.C. 501)

    (1) Veteran's final expenses. (i) Amounts paid by a spouse before a 
veteran's death for expenses of the veteran's last illness will be 
deducted from the income of the surviving spouse.


(Authority: 38 U.S.C. 1503(a)(3))

    (ii) Amounts paid by a surviving spouse or child of a veteran for 
the veteran's just debts, expenses of last illness and burial (to the 
extent such burial expenses are not reimbursed under chapter 23 of title 
38 U.S.C.) will be deducted from the income of the surviving spouse or 
child. The term ``just debts'' does not include any debt that is secured 
by real or personal property.


(Authority: 38 U.S.C. 1503(a)(3))

    (2) Spouse or child's final expenses. (i) Amounts paid by a veteran 
for the expenses of the last illness and burial of the veteran's 
deceased spouse or child will be deducted from the veteran's income.
    (ii) Amounts paid by a veteran's spouse or surviving spouse for 
expenses of the last illness and burial of the veteran's child will be 
deducted from the spouse's or surviving spouse's income.


(Authority: 38 U.S.C. 1503(a)(4))

    (i) Educational expenses. Amounts equal to expenses paid by a 
veteran or surviving spouse pursuing a course of education or vocational 
rehabilitation or training, to include amounts paid for tuition, fees, 
books, and materials, and in the case of a veteran or surviving spouse 
in need of regular aid and attendance, unreimbursed amounts paid for 
unusual transportation expenses in connection with the pursuit of such 
course. Unusual transportation expenses are those exceeding the 
reasonable expenses which would have been incurred by a nondisabled 
person using an appropriate means of transportation (public 
transportation, if reasonably available).


(Authority: 38 U.S.C. 1503(a)(9))

    (j) Child's income. In the case of a child, any current work income 
received during the year, to the extent that the total amount of such 
income does not exceed an amount equal to the sum of the following:
    (1) The lowest amount of gross income for which a Federal income tax 
return must be filed, as specified in section 6012(a) of the Internal 
Revenue Code of 1954, by an individual who is not married (as determined 
under section 143 of such Code), and is not a surviving spouse (as 
defined in section 2(a) of such Code), and is not a head of

[[Page 240]]

household (as defined in section 2(b) of such Code); and
    (2) If the child is pursuing a course of postsecondary education or 
vocational rehabilitation or training, the amount paid by the child for 
those educational expenses including the amount paid for tuition, fees, 
books, and materials.


(Authority: 38 U.S.C. 1503(a)(10))

    (k) Veterans' benefits from States and municipalities. VA will 
exclude from income payments from a State or municipality to a veteran 
of a monetary benefit that is paid as a veterans' benefit due to injury 
or disease. VA will exclude up to $5,000 of such benefit in any 
annualization period.


(Authority: 38 U.S.C. 1503(a)(11))

    (l) Distributions of funds under 38 U.S.C. 1718. Distributions from 
the Department of Veterans Affairs Special Therapeutic and 
Rehabilitation Activities Fund as a result of participation in a 
therapeutic or rehabilitation activity under 38 U.S.C. 1718 and payments 
from participation in a program of rehabilitative services provided as 
part of the care furnished by a State home and which is approved by VA 
as conforming to standards for activities under 38 U.S.C. 1718 shall be 
considered donations from a public or private relief or welfare 
organization and shall not be countable as income for pension purposes.


(Authority: 38 U.S.C. 1718(f))

    (m) Hardship exclusion of child's available income. When hardship is 
established under the provisions of Sec.  3.23(d)(6) of this part, there 
shall be excluded from the available income of any child or children an 
amount equal to the amount by which annual expenses necessary for 
reasonable family maintenance exceed the sum of countable annual income 
plus VA pension entitlement computed without consideration of this 
exclusion. The amount of this exclusion shall not exceed the available 
income of any child or children, and annual expenses necessary for 
reasonable family maintenance shall not include any expenses which were 
considered in determining the available income of the child or children 
or the countable annual income of the veteran or surviving spouse.


(Authority: 38 U.S.C. 1521(h), 1541(g))

    (n) Survivor benefit annuity. Annuity paid by the Department of 
Defense under the authority of section 653, Public Law 100-456 to 
qualified surviving spouses of veterans who died prior to November 1, 
1953. (September 29, 1988)


(Authority: Sec. 653, Pub. L. 100-456; 102 Stat. 1991)

    (o) Cash surrender value of life insurance. That portion of proceeds 
from the cash surrender of a life insurance policy which represents a 
return of insurance premiums.


(Authority: 38 U.S.C. 501(a))

    (p) Radiation Exposure Compensation Act. Any payment made under 
Section 6 of the Radiation Exposure Compensation Act of 1990.


(Authority: 42 U.S.C. 2210 note)

    (q) Life insurance proceeds. Lump-sum proceeds of any life insurance 
policy on a veteran.


(Authority: 38 U.S.C. 1503(a)(12))

    (r) Income tax returns. VA will exclude from income payments from 
income tax returns. See Sec.  3.279(e)(1).


(Authority: 26 U.S.C. 6409)

    (s) Reimbursements for loss. VA will exclude from income payments 
described in 38 U.S.C. 1503(a)(5).


(Authority: 38 U.S.C. 1503(a)(5))

    (t) Statutory exclusions. Other amounts excluded from income by 
statute. See Sec.  3.279. VA will exclude from income any amount 
designated by statute as not countable as income, regardless of whether 
or not it is listed in this section or in Sec.  3.279.

[44 FR 45936, Aug. 6, 1979]

    Editorial Note: For Federal Register citations affecting Sec.  
3.272, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.

[[Page 241]]



Sec.  3.273  Rate computation.

    The commencement date of change in benefit payments based on rate 
computations under the provisions of this section will be determined 
under the provisions of Sec.  3.31 or Sec.  3.660.
    (a) Initial award. For the purpose of determining initial 
entitlement, or for resuming payments on an award which was previously 
discontinued, the monthly rate of pension payable to a beneficiary shall 
be computed by reducing the beneficiary's applicable maximum pension 
rate by the beneficiary's countable income on the effective date of 
entitlement and dividing the remainder by 12. Effective June 1, 1983, 
the provisions of Sec.  3.29(b) apply to this paragraph. Recomputation 
of rates due to changes in the maximum annual pension rate or rate of 
income following the initial date of entitlement are subject to the 
provisions of paragraph (b) of this section.
    (b) Running awards--(1) Change in maximum annual pension rate. 
Whenever there is change in a beneficiary's applicable maximum annual 
pension rate, the monthly rate of pension payable shall be computed by 
reducing the new applicable maximum annual pension rate by the 
beneficiary's countable income on the effective date of the change in 
the applicable maximum annual pension rate, and dividing the remainder 
by 12. Effective June 1, 1983, the provisions of Sec.  3.29(b) apply to 
this paragraph.
    (2) Change in amount of income. Whenever there is a change in a 
beneficiary's amount of countable income the monthly rate of pension 
payable shall be computed by reducing the beneficiary's applicable 
maximum annual pension rate by the beneficiary's new amount of countable 
income on the effective date of the change in the amount of income, and 
dividing the remainder by 12. Effective June 1, 1983, the provisions of 
Sec.  3.29(b) apply to this paragraph.
    (c) Nonrecurring income. The amount of any nonrecurring countable 
income (e.g. an inheritance) received by a beneficiary shall be added to 
the beneficiary's annual rate of income for a 12-month annualization 
period commencing on the effective date on which the nonrecurring income 
is countable.


(Authority: 38 U.S.C. 501)

    (d) Recurring and irregular income. The amount of recurring and 
irregular income anticipated or received by a beneficiary shall be added 
to determine the beneficiary's annual rate of income for a 12-month 
annualization period commencing at the beginning of the 12-month 
annualization, subject to the provisions of Sec.  3.660(a)(2) of this 
chapter.

[44 FR 45936, Aug. 6, 1979, as amended at 48 FR 34472, July 29, 1983; 57 
FR 59300, Dec. 15, 1992]



Sec.  3.274  Net worth and VA pension.

    (a) Net worth limit. For purposes of entitlement to VA pension, the 
net worth limit effective October 18, 2018 is $123,600. This limit will 
be increased by the same percentage as the Social Security increase 
whenever there is a cost-of-living increase in benefit amounts payable 
under section 215(i) of title II of the Social Security Act (42 U.S.C. 
415(i)). VA will publish the current limit on its website at 
www.benefits.va.gov/pension/.
    (b) When a claimant's or beneficiary's net worth exceeds the limit. 
Except as provided in paragraph (h)(2) of this section, VA will deny or 
discontinue pension if a claimant's or beneficiary's net worth exceeds 
the net worth limit in paragraph (a) of this section.
    (1) Net worth. Net worth means the sum of a claimant's or 
beneficiary's assets and annual income.
    (2) Asset calculation. VA will calculate a claimant's or 
beneficiary's assets under this section and Sec.  3.275.
    (3) Annual income calculation. VA will calculate a claimant's or 
beneficiary's annual income under Sec.  3.271, and will include the 
annual income of dependents as required by law. See Sec. Sec.  
3.23(d)(4), 3.23(d)(5), and 3.24 for more information on annual income 
included when VA calculates a claimant's or beneficiary's pension 
entitlement rate. In calculating annual income for this purpose, VA will 
subtract all applicable deductible expenses, to include appropriate 
prospective medical expenses under Sec.  3.272(g).

[[Page 242]]

    (4) Example of net worth calculation. For purposes of this example, 
presume the net worth limit is $123,600. A claimant's assets total 
$117,000 and annual income is $9,000. Therefore, adding the claimant's 
annual income to assets produces net worth of $126,000. This amount 
exceeds the net worth limit.
    (c) Assets of other individuals included as claimant's or 
beneficiary's assets--(1) Claimant or beneficiary is a veteran. A 
veteran's assets include the assets of the veteran as well as the assets 
of his or her spouse, if the veteran has a spouse.
    (2) Claimant or beneficiary is a surviving spouse. A surviving 
spouse's assets include only the assets of the surviving spouse.
    (3) Claimant or beneficiary is a surviving child. (i) If a surviving 
child has no custodian or is in the custody of an institution, the 
child's assets include only the assets of the child.
    (ii) If a surviving child has a custodian other than an institution, 
the child's assets include the assets of the child as well as the assets 
of the custodian. If the child is in the joint custody of his or her 
natural or adoptive parent and a stepparent, the child's assets also 
include the assets of the stepparent. See Sec.  3.57(d) for more 
information on child custody for pension purposes.
    (d) How a child's net worth affects a veteran's or surviving 
spouse's pension entitlement. VA will not consider a child to be a 
veteran's or surviving spouse's dependent child for pension purposes if 
the child's net worth exceeds the net worth limit in paragraph (a) of 
this section.
    (1) Dependent child and potential dependent child. For the purposes 
of this section--
    (i) ``Dependent child'' refers to a child for whom a veteran or a 
surviving spouse is entitled to an increased maximum annual pension 
rate.
    (ii) ``Potential dependent child'' refers to a child who is excluded 
from a veteran's or surviving spouse's pension award solely or partly 
because of this paragraph (d). References in this section to ``dependent 
child'' include a potential dependent child.
    (2) Dependent child net worth. A dependent child's net worth is the 
sum of his or her annual income and the value of his or her assets.
    (3) Dependent child asset calculation. VA will calculate the value 
of a dependent child's assets under this section and Sec.  3.275. A 
dependent child's assets include the child's assets only.
    (4) Dependent child annual income calculation. VA will calculate a 
dependent child's annual income under Sec.  3.271, and will include the 
annual income of the child as well as the annual income of the veteran 
or surviving spouse that would be included if VA were calculating a 
pension entitlement rate for the veteran or surviving spouse.
    (e) When VA calculates net worth. VA calculates net worth only when:
    (1) VA has received--
    (i) An original pension claim;
    (ii) A new pension claim after a period of non-entitlement;
    (iii) A request to establish a new dependent; or
    (iv) Information that a veteran's, surviving spouse's, or child's 
net worth has increased or decreased; and
    (2) The claimant or beneficiary meets the other factors necessary 
for pension entitlement as provided in Sec.  3.3(a)(3) and (b)(4).

    Note to paragraph (e): If the evidence shows that net worth exceeds 
the net worth limit, VA may decide the pension claim before determining 
if the claimant meets other entitlement factors. VA will notify the 
claimant of the entitlement factors that have not been established.

    (f) How net worth decreases. Net worth may decrease in three ways: 
Assets can decrease, annual income can decrease, or both assets and 
annual income can decrease.
    (1) How assets decrease. A veteran, surviving spouse, or child, or 
someone acting on their behalf, may decrease assets by spending them on 
any item or service for which fair market value is received unless the 
item or items purchased are themselves part of net worth. See Sec.  
3.276(a)(4) for the definition of ``fair market value.'' The expenses 
must be those of the veteran, surviving spouse, or child, or a relative 
of the veteran, surviving spouse, or child. The relative must be a 
member or constructive member of the veteran's, surviving spouse's, or 
child's household.

[[Page 243]]

    (2) How annual income decreases. See Sec. Sec.  3.271 through 3.273.
    (3) Example 1. For purposes of this example, presume the net worth 
limit is $123,600 and the maximum annual pension rate (MAPR) is $12,000. 
A claimant has assets of $115,000 and annual income of $9,000. Adding 
annual income to assets produces a net worth of $124,000, which exceeds 
the net worth limit. However, the claimant is a patient in a nursing 
home and pays annual unreimbursed nursing home fees of $29,000. 
Reasonably predictable unreimbursed medical expenses are deductible from 
annual income under Sec.  3.272(g) to the extent that they exceed 5 
percent of the applicable MAPR. VA subtracts the projected expenditures 
that exceed 5 percent of the applicable MAPR (here, $28,400) from annual 
income, which decreases annual income to zero. The claimant's net worth 
is now $115,000; therefore, net worth is within the limit to qualify for 
VA pension.
    (4) Example 2. For purposes of this example, presume the net worth 
limit is $123,600 and the MAPR is $12,000. A claimant has assets of 
$123,000 and annual income of $9,500. Adding annual income to assets 
produces a net worth of $132,500, which exceeds the net worth limit. The 
claimant pays reasonably predictable annual unreimbursed medical 
expenses of $9,000. Unreimbursed medical expenses are deductible from 
annual income under Sec.  3.272(g) to the extent that they exceed 5 
percent of the applicable MAPR. VA subtracts the projected expenditures 
that exceed 5 percent of the applicable MAPR (here, $8,400) from annual 
income, which decreases annual income to $1,100. This decreases net 
worth to $124,100, which is still over the limit. VA must deny the claim 
for excessive net worth.
    (g) Effective dates of pension entitlement or increased entitlement 
after a denial, reduction, or discontinuance based on excessive net 
worth--(1) Scope of paragraph. This paragraph (g) applies when VA has:
    (i) Discontinued pension or denied pension entitlement for a 
veteran, surviving spouse, or surviving child based on the veteran's, 
surviving spouse's, or surviving child's excessive net worth; or
    (ii) Reduced pension or denied increased pension entitlement for a 
veteran or surviving spouse based on a dependent child's excessive net 
worth.
    (2) Effective date of entitlement or increased entitlement. The 
effective date of entitlement or increased entitlement is the day net 
worth ceases to exceed the limit. For this effective date to apply, the 
claimant or beneficiary must submit a certified statement that net worth 
has decreased and VA must receive the certified statement before the 
pension claim has become finally adjudicated under Sec.  3.160. This 
means that VA must receive the certified statement within 1 year after 
its decision notice to the claimant concerning the denial, reduction, or 
discontinuance unless the claimant appeals VA's decision. Otherwise, the 
effective date is the date VA receives a new pension claim. In 
accordance with Sec.  3.277(a), VA may require the claimant or 
beneficiary to submit additional evidence as the individual 
circumstances may require.
    (h) Reduction or discontinuance of beneficiary's pension entitlement 
based on excessive net worth--(1) Effective date of reduction or 
discontinuance. When an increase in a beneficiary's or dependent child's 
net worth results in a pension reduction or discontinuance because net 
worth exceeds the limit, the effective date of reduction or 
discontinuance is the last day of the calendar year in which net worth 
exceeds the limit.
    (2) Net worth decreases before the effective date. If net worth 
decreases to the limit or below the limit before the effective date 
provided in paragraph (h)(1) of this section, VA will not reduce or 
discontinue the pension award on the basis of excessive net worth.
    (i) Additional effective-date provisions for dependent children--(1) 
Establishing a dependent child on veteran's or surviving spouse's 
pension award results in increased pension entitlement. When 
establishing a dependent child on a veteran's or surviving spouse's 
pension award results in increased pension entitlement for the veteran 
or surviving spouse, VA will apply the effective-date provisions in 
paragraphs (g) and (h) of this section.

[[Page 244]]

    (2) Establishing a dependent child on veteran's or surviving 
spouse's pension award results in decreased pension entitlement. (i) 
When a dependent child's non-excessive net worth results in decreased 
pension entitlement for the veteran or surviving spouse, the effective 
date of the decreased pension entitlement rate (i.e., VA action to add 
the child to the award) is the end of the year that the child's net 
worth decreases.
    (ii) When a dependent child's excessive net worth results in 
increased pension entitlement for the veteran or surviving spouse, the 
effective date of the increased pension entitlement rate (i.e., VA 
action to remove the child from the award) is the date that VA receives 
a claim for an increased rate based on the child's net worth increase.

(Authority: 38 U.S.C. 1522, 1543, 5110, 5112)

[83 FR 47269, Sept 18, 2018]



Sec.  3.275  How VA determines the asset amount for pension net worth
determinations.

    (a) Definitions pertaining to assets--(1) Assets. The term assets 
means the fair market value of all property that an individual owns, 
including all real and personal property, unless excluded under 
paragraph (b) of this section, less the amount of mortgages or other 
encumbrances specific to the mortgaged or encumbered property. VA will 
consider the terms of the recorded deed or other evidence of title to be 
proof of ownership of a particular asset. See also Sec.  3.276(a)(4), 
which defines ``fair market value.''
    (2) Claimant. (i) Except as provided in paragraph (a)(2)(ii) of this 
section, for the purposes of this section and Sec.  3.276, claimant 
means a pension beneficiary, a dependent spouse, or a dependent or 
potential dependent child as described in Sec.  3.274(d), as well as a 
veteran, surviving spouse, or surviving child pension applicant.
    (ii) For the purpose of paragraph (b)(1) of this section, claimant 
means a pension beneficiary or applicant who is a veteran, a surviving 
spouse, or a surviving child.
    (3) Residential lot area. For purposes of this section, residential 
lot area means the lot on which a residence sits that does not exceed 2 
acres (87,120 square feet), unless the additional acreage is not 
marketable.
    (b) Exclusions from assets. Assets do not include the following:
    (1) Primary residence. The value of a claimant's primary residence 
(single-family unit), including the residential lot area, in which the 
claimant has an ownership interest. VA recognizes one primary residence 
per claimant. If the residence is sold after pension entitlement is 
established, any net proceeds from the sale is an asset except to the 
extent the proceeds are used to purchase another residence within the 
same calendar year as the year in which the sale occurred.
    (i) Personal mortgage not deductible. VA will not subtract from a 
claimant's assets the amount of any mortgages or encumbrances on a 
claimant's primary residence.
    (ii) Claimant not residing in primary residence. Although rental 
income counts as annual income as provided in Sec.  3.271(d), VA will 
not include a claimant's primary residence as an asset even if the 
claimant resides in any of the following as defined in Sec.  3.278(b):
    (A) A nursing home or medical foster home;
    (B) A care facility other than a nursing home; or
    (C) The home of a family member for health care or custodial care.

    (2) Personal effects. Value of personal effects suitable to and 
consistent with a reasonable mode of life, such as appliances and family 
transportation vehicles.
    (3) Radiation Exposure Compensation Act payments. Payments made 
under section 6 of the Radiation Exposure Compensation Act of 1990.


(Authority: 42 U.S.C. 2210 (note))

    (4) Ricky Ray Hemophilia Relief Fund payments. Payments made under 
section 103(c) and excluded under section 103(h)(2) of the Ricky Ray 
Hemophilia Relief Fund Act of 1998.


(Authority: 42 U.S.C. 300c-22 (note))

    (5) Energy Employees Occupational Illness Compensation Program 
payments.

[[Page 245]]

Payments made under the Energy Employees Occupational Illness 
Compensation Program.


(Authority: 42 U.S.C. 7385e(2))

    (6) Payments to Aleuts. Payments made to certain Aleuts under 50 
U.S.C. App. 1989c-5.


(Authority: 50 U.S.C. App. 1989c-5(d)(2))

    (7) Statutory exclusions. Other amounts excluded from assets by 
statute. See Sec.  3.279. VA will exclude from assets any amount 
designated by statute as not countable as a resource, regardless of 
whether or not it is listed in this section or in Sec.  3.279.

(Authority: 38 U.S.C. 1522, 1543)

[83 FR 47271, Sept. 18, 2018]



Sec.  3.276  Asset transfers and penalty periods.

    (a) Asset transfer definitions. For purposes of this section--
    (1) Claimant has the same meaning as defined in Sec.  
3.275(a)(2)(i).
    (2) Covered asset means an asset that--
    (i) Was part of a claimant's net worth;
    (ii) Was transferred for less than fair market value; and
    (iii) If not transferred, would have caused or partially caused the 
claimant's net worth to exceed the net worth limit under Sec.  3.274(a).
    (3) Covered asset amount means the monetary amount by which a 
claimant's net worth would have exceeded the limit due to the covered 
asset alone if the uncompensated value of the covered asset had been 
included in net worth.
    (i) Example 1. For purposes of this example, presume the net worth 
limit under Sec.  3.274(a) is $123,600. A claimant's assets total 
$115,900 and his annual income is zero. However, the claimant 
transferred $30,000 by giving it to a friend. If the claimant had not 
transferred the $30,000, his net worth would have been $145,900, which 
exceeds the net worth limit. The claimant's covered asset amount is 
$22,300, because this is the amount by which the claimant's net worth 
would have exceeded the limit due to the covered asset.
    (ii) Example 2. For purposes of this example, presume the net worth 
limit under Sec.  3.274(a) is $123,600. A claimant's annual income is 
zero and her total assets are $125,000, which exceeds the net worth 
limit. In addition, the claimant transferred $30,000 by giving $20,000 
to her married son and giving $10,000 to a friend. The claimant's 
covered asset amount is $30,000 because this is the amount by which the 
claimant's net worth would have exceeded the limit due to the covered 
assets alone.
    (4) Fair market value means the price at which an asset would change 
hands between a willing buyer and a willing seller, neither being under 
any compulsion to buy or to sell and both having reasonable knowledge of 
relevant facts. VA will use the best available information to determine 
fair market value, such as inspections, appraisals, public records, and 
the market value of similar property if applicable.
    (5) Transfer for less than fair market value means--
    (i) Selling, conveying, gifting, or exchanging an asset for an 
amount less than the fair market value of the asset; or
    (ii) A voluntary asset transfer to, or purchase of, any financial 
instrument or investment that reduces net worth by transferring the 
asset to, or purchasing, the instrument or investment unless the 
claimant establishes that he or she has the ability to liquidate the 
entire balance of the asset for the claimant's own benefit. If the 
claimant establishes that the asset can be liquidated, the asset is 
included as net worth. Examples of such instruments or investments 
include--
    (A) Annuities. Annuity means a financial instrument that provides 
income over a defined period of time for an initial payment of 
principal.
    (B) Trusts. Trust means a legal instrument by which an individual 
(the grantor) transfers property to an individual or an entity (the 
trustee), who manages the property according to the terms of the trust, 
whether for the grantor's own benefit or for the benefit of another 
individual.
    (6) Uncompensated value means the difference between the fair market 
value of an asset and the amount of compensation an individual receives

[[Page 246]]

for it. In the case of a trust, annuity, or other financial instrument 
or investment described in paragraph (a)(5)(ii) of this section, 
uncompensated value means the amount of money or the monetary value of 
any other type of asset transferred to such a trust, annuity, or other 
financial instrument or investment.
    (7) Look-back period means the 36-month period immediately preceding 
the date on which VA receives either an original pension claim or a new 
pension claim after a period of non-entitlement. This definition does 
not include any date before October 18, 2018.
    (8) Penalty period means a period of non-entitlement, calculated 
under paragraph (e) of this section, due to transfer of a covered asset.
    (b) General statement of policy pertaining to pension and covered 
assets. VA pension is a needs-based benefit and is not intended to 
preserve the estates of individuals who have the means to support 
themselves. Accordingly, a claimant may not create pension entitlement 
by transferring covered assets. VA will review the terms and conditions 
of asset transfers made during the 36-month look-back period to 
determine whether the transfer constituted transfer of a covered asset. 
However, VA will disregard asset transfers made before October 18, 2018. 
In accordance with Sec.  3.277(a), for any asset transfer, VA may 
require a claimant to provide evidence such as a Federal income tax 
return transcript, the terms of a gift, trust, or annuity, or the terms 
of a recorded deed or other evidence of title.
    (c) Exception for transfers as a result of fraud or unfair business 
practice. An asset transferred as the result of fraud, 
misrepresentation, or unfair business practice related to the sale or 
marketing of financial products or services for purposes of establishing 
entitlement to VA pension will not be considered a covered asset. 
Evidence supporting this exception may include, but is not limited to, a 
complaint contemporaneously filed with State, local, or Federal 
authorities reporting the incident.
    (d) Exception for transfers to certain trusts. VA will not consider 
as a covered asset an asset that a veteran, a veteran's spouse, or a 
veteran's surviving spouse transfers to a trust established on behalf of 
a child of the veteran if:
    (1) VA rates or has rated the child incapable of self-support under 
Sec.  3.356; and
    (2) There is no circumstance under which distributions from the 
trust can be used to benefit the veteran, the veteran's spouse, or the 
veteran's surviving spouse.
    (e) Penalty periods and calculations. When a claimant transfers a 
covered asset during the look-back period, VA will assess a penalty 
period not to exceed 5 years. VA will calculate the length of the 
penalty period by dividing the total covered asset amount by the monthly 
penalty rate described in paragraph (e)(1) of this section and rounding 
the quotient down to the nearest whole number. The result is the number 
of months for which VA will not pay pension.
    (1) Monthly penalty rate. The monthly penalty rate is the maximum 
annual pension rate (MAPR) under 38 U.S.C. 1521(d)(2) for a veteran in 
need of aid and attendance with one dependent that is in effect as of 
the date of the pension claim, divided by 12, and rounded down to the 
nearest whole dollar. The monthly penalty rate is located on VA's 
website at www.benefits.va.gov/pension.
    (2) Beginning date of penalty period. When a claimant transfers a 
covered asset or assets during the look-back period, the penalty period 
begins on the first day of the month that follows the date of the 
transfer. If there was more than one transfer, the penalty period will 
begin on the first day of the month that follows the date of the last 
transfer.
    (3) Entitlement upon ending of penalty period. VA will consider that 
the claimant, if otherwise qualified, is entitled to benefits effective 
the last day of the last month of the penalty period, with a payment 
date as of the first day of the following month in accordance with Sec.  
3.31.
    (4) Example of penalty period calculation. VA receives a pension 
claim in November 2018. The claimant's net worth is equal to the net 
worth limit.

[[Page 247]]

However, the claimant transferred covered assets totaling $10,000 on 
August 20, 2018, and September 23, 2018. Therefore, the total covered 
asset amount is $10,000, and the penalty period begins on October 1, 
2018. Assume the MAPR for a veteran in need of aid and attendance with 
one dependent in effect in November 2018 is $24,000. The monthly penalty 
rate is $2,000. The penalty period is $10,000/$2,000 per month = 5 
months. The fifth month of the penalty period is February 2019. The 
claimant may be entitled to pension effective February 28, 2019, with a 
payment date of March 1, 2019, if other entitlement requirements are 
met.
    (5) Penalty period recalculations. VA will not recalculate a penalty 
period under this section unless--
    (i) The original calculation is shown to be erroneous; or
    (ii) VA receives evidence showing that some or all covered assets 
were returned to the claimant before the date of claim or within 60 days 
after the date of VA's notice to the claimant of VA's decision 
concerning the penalty period. If covered assets are returned to the 
claimant, VA will recalculate or eliminate the penalty period. For this 
exception to apply, VA must receive the evidence not later than 90 days 
after the date of VA's notice to the claimant of VA's decision 
concerning the penalty period. Once covered assets are returned, a 
claimant may reduce net worth at the time of transfer under the 
provisions of Sec.  3.274(f).

(Authority: 38 U.S.C. 1522, 1543, 1506(1))

(The Office of Management and Budget has approved the information 
collection requirement in this section under control numbers 2900-0002, 
and 2900-0004.)

[83 FR 47271, Sept. 18, 2018]



Sec.  3.277  Eligibility reporting requirements.

    (a) Evidence of entitlement. As a condition of granting or 
continuing pension, the Department of Veterans Affairs may require from 
any person who is an applicant for or a recipient of pension such 
information, proofs, and evidence as is necessary to determine the 
annual income and the value of the corpus of the estate of such person, 
and of any spouse or child for whom the person is receiving or is to 
receive increased pension (such child is hereinafter in this section 
referred to as a dependent child), and, in the case of a child applying 
for or in receipt of pension in his or her own behalf (hereinafter in 
this section referred to as a surviving child), of any person with whom 
such child is residing who is legally responsible for such child's 
support.
    (b) Obligation to report changes in factors affecting entitlement. 
Any individual who has applied for or receives pension must promptly 
notify the Secretary of any change affecting entitlement in any of the 
following:
    (1) Income;
    (2) Net worth or corpus of estate;
    (3) Marital status;
    (4) Nursing home patient status;
    (5) School enrollment status of a child 18 years of age or older; or
    (6) Any other factor that affects entitlement to benefits under the 
provisions of this Part.
    (c) Eligibility verification reports. (1) For purposes of this 
section the term eligibility verification report means a form prescribed 
by the Secretary that is used to request income, net worth, dependency 
status, and any other information necessary to determine or verify 
entitlement to pension.
    (2) The Secretary may require an eligibility verification report 
under the following circumstances:
    (i) If the Social Security Administration has not verified the 
beneficiary's Social Security number and, if the beneficiary is married, 
his or her spouse's Social Security number;
    (ii) If there is reason to believe that the beneficiary or his or 
her spouse may have received income other than Social Security during 
the current or previous calendar year; or
    (iii) If the Secretary determines that an eligibility verification 
report is necessary to preserve program integrity.
    (3) An individual who applies for or receives pension as defined in 
Sec.  3.3 of this part shall, as a condition of receipt or continued 
receipt of benefits, furnish the Department of Veterans Affairs an 
eligibility verification report upon request.
    (d) If VA requests that a claimant or beneficiary submit an 
eligibility verification report but he or she fails

[[Page 248]]

to do so within 60 days of the date of the VA request, the Secretary 
shall suspend the award or disallow the claim.

(Authority: 38 U.S.C. 1506)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control numbers 2900-0101 
and 2900-0624)

[44 FR 45936, Aug. 6, 1979, as amended at 60 FR 51922, Oct. 4, 1995; 65 
FR 16827, Mar. 30, 2000; 66 FR 56614, Nov. 9, 2001; 83 FR 47272, Sept. 
18, 2018]



Sec.  3.278  Deductible medical expenses.

    (a) Scope. This section identifies medical expenses that VA may 
deduct from countable income for purposes of three of its needs-based 
programs: Pension, section 306 pension, and parents' dependency and 
indemnity compensation (DIC). Payments for such medical expenses must be 
unreimbursed to be deductible from income.
    (b) Definitions. For the purposes of this section--
    (1) Health care provider means:
    (i) An individual licensed by a State or country to provide health 
care in the State or country in which the individual provides the health 
care. The term includes, but is not limited to, a physician, physician 
assistant, psychologist, chiropractor, registered nurse, licensed 
vocational nurse, licensed practical nurse, and physical or occupational 
therapist; or
    (ii) A nursing assistant or home health aide who is supervised by a 
licensed health care provider as defined in paragraph (b)(1)(i) of this 
section.
    (2) Activities of daily living (ADLs) mean basic self-care 
activities and consist of bathing or showering, dressing, eating, 
toileting, transferring, and ambulating within the home or living area. 
Transferring means an individual's moving himself or herself from one 
position to another, such as getting in and out of bed.
    (3) Instrumental activities of daily living (IADLs) mean independent 
living activities, such as shopping, food preparation, housekeeping, 
laundering, managing finances, handling medications, using the 
telephone, and transportation for non-medical purposes.
    (4) Custodial care means regular:
    (i) Assistance with two or more ADLs; or
    (ii) Supervision because an individual with a physical, mental, 
developmental, or cognitive disorder requires care or assistance on a 
regular basis to protect the individual from hazards or dangers incident 
to his or her daily environment.
    (5) Nursing home means a facility defined in Sec.  3.1(z)(1) or (2). 
If the facility is not located in a State, the facility must be licensed 
in the country in which it is located.
    (6) Medical foster home means a privately-owned residence, 
recognized and approved by VA under 38 CFR 17.73(d), that offers a non-
institutional alternative to nursing home care for veterans who are 
unable to live alone safely due to chronic or terminal illness.
    (7) Care facility other than a nursing home means a facility in 
which a disabled individual receives health care or custodial care under 
the provisions of paragraph (d) of this section. A facility must be 
licensed if facilities of that type are required to be licensed in the 
State or country in which the facility is located. A facility that is 
residential must be staffed 24 hours per day with care providers. The 
providers do not have to be licensed health care providers.
    (8) Needs A&A or is housebound refers to a disabled individual who 
meets the criteria in Sec.  3.351 for needing regular aid and attendance 
(A&A) or being housebound and is a:
    (i) Veteran;
    (ii) Surviving spouse;
    (iii) Parent (for parents' DIC purposes); or
    (iv) Spouse of a living veteran with a service-connected disability 
rated at least 30 percent disabling, who is receiving pension.
    (c) Medical expenses for VA purposes. Generally, medical expenses 
for VA needs-based benefit purposes are payments for items or services 
that are medically necessary; that improve a disabled individual's 
functioning; or that prevent, slow, or ease an individual's functional 
decline. Medical expenses may include, but are not limited to, the 
payments specified in paragraphs (c)(1) through (7) of this section.

[[Page 249]]

    (1) Care by a health care provider. Payments to a health care 
provider for services performed within the scope of the provider's 
professional capacity are medical expenses. Cosmetic procedures that a 
health care provider performs to improve a congenital or accidental 
deformity or related to treatment for a diagnosed medical condition are 
medical expenses.
    (2) Medications, medical supplies, medical equipment, and medical 
food, vitamins, and supplements. Payments for prescription and non-
prescription medication procured lawfully under Federal law, as well as 
payments for medical supplies or medical equipment, are medical 
expenses. Medically necessary food, vitamins, and supplements as 
prescribed or directed by a health care provider authorized to write 
prescriptions are medical expenses.
    (3) Adaptive equipment. Payments for adaptive devices or service 
animals, including veterinary care, used to assist a person with an 
ongoing disability are medical expenses. Medical expenses do not include 
non-prescription food, boarding, grooming, or other routine expenses of 
owning an animal.
    (4) Transportation expenses. Payments for transportation for medical 
purposes, such as the cost of transportation to and from a health care 
provider's office by taxi, bus, or other form of public transportation 
are medical expenses. The cost of transportation for medical purposes by 
privately owned vehicle (POV), including mileage, parking, and tolls, is 
a medical expense. For transportation in a POV, VA limits the deductible 
mileage rate to the current POV mileage reimbursement rate specified by 
the United States General Services Administration (GSA). The current 
amount can be obtained from www.gsa.gov or on VA's website at 
www.benefits.va.gov/pension/. Amounts by which transportation expenses 
set forth in this paragraph (c)(4) exceed the amounts of other VA or 
non-VA reimbursements for the expense are medical expenses.
    (i) Example. In February 2013, a veteran drives 60 miles round trip 
to a VA medical center and back. The veteran is reimbursed $24.90 from 
the Veterans Health Administration. The POV mileage reimbursement rate 
specified by GSA is $0.565 per mile, so the transportation expense is 
$0.565/mile * 60 miles = $33.90. For VA needs-based benefits purposes, 
the unreimbursed amount, here, the difference between $33.90 and $24.90, 
is a medical expense.
    (ii) [Reserved]
    (5) Health insurance premiums. Payments for health, medical, 
hospitalization, and long-term care insurance premiums are medical 
expenses. Premiums for Medicare Parts A, B, and D and for long-term care 
insurance are medical expenses.
    (6) Smoking cessation products. Payments for items and services 
specifically related to smoking cessation are medical expenses.
    (7) Institutional forms of care and in-home care. As provided in 
paragraph (d) of this section.
    (d) Institutional forms of care and in-home care. This paragraph (d) 
applies with respect to claims for a medical expense deduction for 
institutional forms of care or in-home care received on or after October 
18, 2018 that VA has not previously granted.
    (1) Hospitals, nursing homes, medical foster homes, and inpatient 
treatment centers. Payments to hospitals, nursing homes, medical foster 
homes, and inpatient treatment centers (including inpatient treatment 
centers for drug or alcohol addiction), including the cost of meals and 
lodging charged by such facilities, are medical expenses.
    (2) In-home care. Payments for assistance with ADLs and IADLs by an 
in-home attendant are medical expenses as long as the attendant provides 
the disabled individual with health care or custodial care. Payments 
must be commensurate with the number of hours that the provider attends 
to the disabled person. The attendant must be a health care provider 
unless--
    (i) The disabled individual needs A&A or is housebound; or
    (ii) A physician, physician assistant, certified nurse practitioner, 
or clinical nurse specialist states in writing that, due to a physical, 
mental, developmental, or cognitive disorder, the individual requires 
the health care or custodial care that the in-home attendant provides.

[[Page 250]]

    (3) Care facilities other than nursing homes. (i) Care in a facility 
may be provided by the facility, contracted by the facility, obtained 
from a third-party provider, or provided by family or friends.
    (ii) Payments for health care provided by a health care provider are 
medical expenses.
    (iii) The provider does not need to be a health care provider, and 
payments for assistance with ADLs and IADLs are medical expenses, if the 
disabled individual is receiving health care or custodial care in the 
facility and--
    (A) The disabled individual needs A&A or is housebound; or
    (B) A physician, physician assistant, certified nurse practitioner, 
or clinical nurse specialist states in writing that, due to a physical, 
mental, developmental, or cognitive disorder, the individual needs to be 
in a protected environment.
    (iv) Payments for meals and lodging (and other facility expenses not 
directly related to health care or custodial care) are medical expenses 
if:
    (A) The facility provides or contracts for health care or custodial 
care for the disabled individual; or
    (B) A physician, physician assistant, certified nurse practitioner, 
or clinical nurse specialist states in writing that the individual must 
reside in the facility (or a similar facility) to separately contract 
with a third-party provider to receive health care or custodial care or 
to receive (paid or unpaid) health care or custodial care from family or 
friends.
    (e) Non-medical expenses for VA purposes. Payments for items and 
services listed in paragraphs (e)(1) through (4) of this section are not 
medical expenses for VA needs-based benefit purposes. The list is not 
all-inclusive.
    (1) Maintenance of general health. Payments for items or services 
that benefit or maintain general health, such as vacations and dance 
classes, are not medical expenses.
    (2) Cosmetic procedures. Except as provided in paragraph (c)(1) of 
this section, cosmetic procedures are not medical expenses.
    (3) Meals and lodging. Except as provided in paragraph (d) of this 
section, payments for meals and lodging are not medical expenses.
    (4) Assistance with IADLs. Except as provided in paragraph (d) of 
this section, payments for assistance with IADLs are not medical 
expenses.
    CROSS REFERENCES: For the rules governing how medical expenses are 
deducted, see Sec.  3.272(g) (regarding pension) and Sec.  3.262(l) 
(regarding section 306 pension and parents' DIC).

(Authority: 38 U.S.C. 501(a), 1315(f)(3), 1503(a)(8), 1506(1))

(The Office of Management and Budget has approved the information 
collection requirement in this section under control numbers 2900-0002, 
2900-0004, and 2900-0161.)

[83 FR 47272, Sept. 18, 2018]



Sec.  3.279  Statutory exclusions from income or assets (net worth or corpus of the estate).

    This section sets forth payments that Federal statutes exclude from 
income for the purpose of determining entitlement to any VA-administered 
benefit that is based on financial need. Some of the exclusions also 
apply to assets (pension), also known as net worth or the corpus of the 
estate (section 306 pension and parents as dependents for compensation). 
VA will exclude from income or assets any amount designated by statute 
as not countable as income or resources, regardless of whether or not it 
is listed in this section.

----------------------------------------------------------------------------------------------------------------
                                                         Assets (corpus of
       Program or payment               Income              the estate)                   Authority
----------------------------------------------------------------------------------------------------------------
(a) COMPENSATION OR RESTITUTION
 PAYMENTS:

[[Page 251]]

 
    (1) Relocation payments.     Excluded............  Included............  42 U.S.C. 4636.
     Payments to individuals
     displaced as a direct
     result of programs or
     projects undertaken by a
     Federal agency or with
     Federal financial
     assistance under the
     Uniform Relocation
     Assistance and Real
     Property Acquisition
     Policies Act of 1970, as
     amended.
    (2) Crime victim             Excluded............  Excluded............  42 U.S.C. 10602(c).
     compensation. Amounts
     received as compensation
     under the Victims of Crime
     Act of 1984 unless the
     total amount of assistance
     received from all
     federally funded programs
     is sufficient to fully
     compensate the claimant
     for losses suffered as a
     result of the crime.
    (3) Restitution to           Excluded............  Excluded............  50 U.S.C. App. 1989b-4(f).
     individuals of Japanese
     ancestry. Payments made as
     restitution under Public
     Law 100-383 to an
     individual of Japanese
     ancestry who was interned,
     evacuated, or relocated
     during the period of
     December 7, 1941, through
     June 30, 1946, pursuant to
     any law, Executive Order,
     Presidential proclamation,
     directive, or other
     official action respecting
     these individuals.
    (4) Victims of Nazi          Excluded............  Excluded............  42 U.S.C. 1437a note.
     persecution. Payments made
     to individuals because of
     their status as victims of
     Nazi persecution.
    (5) Agent Orange settlement  Excluded............  Excluded............  Sec. 1, Public Law 101-201.
     payments. Payments made
     from the Agent Orange
     Settlement Fund or any
     other fund established
     pursuant to the settlement
     in the In Re Agent Orange
     product liability
     litigation, M.D.L. No. 381
     (E.D.N.Y.).
    (6) Chapter 18 benefits.     Excluded............  Excluded............  38 U.S.C. 1833(c).
     Allowances paid under 38
     U.S.C. chapter 18 to a
     veteran's child with a
     birth defect.

[[Page 252]]

 
    (7) Flood mitigation         Excluded............  Excluded............  42 U.S.C. 4031.
     activities. Assistance
     provided under the
     National Flood Insurance
     Act of 1968, as amended.
(b) PAYMENTS TO NATIVE
 AMERICANS:
    (1) Indian Tribal Judgment   Excluded............  Excluded............  25 U.S.C. 1407.
     Fund distributions. All
     Indian Tribal Judgment
     Fund distributions
     excluded from income and
     assets while such funds
     are held in trust. First
     $2,000 per year of income
     received by individual
     Indians under the Indian
     Tribal Judgment Funds Use
     or Distribution Act in
     satisfaction of a judgment
     of the United States Court
     of Federal Claims excluded
     from income.
    (2) Interests of individual  Excluded............  Excluded............  25 U.S.C. 1408.
     Indians in trust or
     restricted lands.
     Interests of individual
     Indians in trust or
     restricted lands excluded
     from assets. First $2,000
     per year of income
     received by individual
     Indians that is derived
     from interests in trust or
     restricted lands excluded
     from income.
    (3) Per Capita               Excluded............  Excluded............  25 U.S.C. 117b,
     Distributions Act. First                                                25 U.S.C. 1407.
     $2,000 per year of per
     capita distributions to
     members of a tribe from
     funds held in trust by the
     Secretary of the Interior
     for an Indian tribe. All
     funds excluded from income
     and assets while funds are
     held in trust.
    (4) Submarginal land.        Excluded............  Excluded............  25 U.S.C. 459e.
     Income derived from
     certain submarginal land
     of the United States that
     is held in trust for
     certain Indian tribes.
    (5) Old Age Assistance       Excluded............  Excluded............  25 U.S.C. 2307.
     Claims Settlement Act. Up
     to $2,000 per year of per
     capita distributions under
     the Old Age Assistance
     Claims Settlement Act.

[[Page 253]]

 
    (6) Alaska Native Claims     Excluded............  Excluded............  43 U.S.C. 1626(c).
     Settlement Act. Any of the
     following, if received
     from a Native Corporation,
     under the Alaska Native
     Claims Settlement Act:
        (i) Cash, including
         cash dividends on
         stocks and bonds, up
         to a maximum of $2,000
         per year;
        (ii) Stock, including
         stock issued as a
         dividend or
         distribution;
        (iii) Bonds that are
         subject to the
         protection under 43
         U.S.C. 1606(h) until
         voluntarily and
         expressly sold or
         pledged by the
         shareholder after the
         date of distribution;
        (iv) A partnership
         interest;
        (v) Land or an interest
         in land, including
         land received as a
         dividend or
         distribution on stock;
        (vi) An interest in a
         settlement trust.
    (7) Maine Indian Claims      Excluded............  Excluded............  25 U.S.C. 1728.
     Settlement Act. Payments
     received under the Maine
     Indian Claims Settlement
     Act of 1980.
    (8) Cobell Settlement.       Excluded for one      Excluded for one      Sec. 101, Public Law 111-291.
     Payments received under      year.                 year.
     Cobell v. Salazar, Civil
     Action No. 96-1285 (TFH)
     (D.D.C.).
(c) WORK-RELATED PAYMENTS:
    (1) Workforce investment.    Excluded............  Included............  29 U.S.C. 3241(a)(2).
     Allowances, earnings, and
     payments to individuals
     participating in programs
     under the Workforce
     Investment Act of 1998.

[[Page 254]]

 
    (2) AmeriCorps               Excluded............  Included............  42 U.S.C. 12637(d).
     participants. Allowances,
     earnings, and payments to
     AmeriCorps participants
     under the National and
     Community Service Act of
     1990.
    (3) Volunteer work.          Excluded............  Excluded............  42 U.S.C. 5044(f).
     Compensation or
     reimbursement to
     volunteers involved in
     programs administered by
     the Corporation for
     National and Community
     Service, unless the
     payments are equal to or
     greater than the minimum
     wage. The minimum wage is
     either that under the Fair
     Labor Standards Act of
     1938 (29 U.S.C. 201 et
     seq.) or that under the
     law of the State where the
     volunteers are serving,
     whichever is greater.
(d) MISCELLANEOUS PAYMENTS:
    (1) Income tax refunds.      Excluded............  Excluded for one      26 U.S.C. 6409.
     Income tax refunds,                                year.
     including the Federal
     Earned Income Credit and
     advance payments with
     respect to a refundable
     credit.
    (2) Food stamps. Value of    Excluded............  Excluded............  7 U.S.C. 2017(b).
     the allotment provided to
     an eligible household
     under the Food Stamp
     Program.
    (3) Food for children.       Excluded............  Excluded............  42 U.S.C. 1780(b).
     Value of free or reduced-
     price for food under the
     Child Nutrition Act of
     1966.
    (4) Child care. Value of     Excluded............  Included............  42 U.S.C. 9858q.
     any child care provided or
     arranged (or any amount
     received as payment for
     such care or reimbursement
     for costs incurred for
     such care) under the Child
     Care and Development Block
     Grant Act of 1990.
    (5) Services for housing     Excluded............  Included............  42 U.S.C. 8011(j)(2).
     recipients. Value of
     services, but not wages,
     provided to a resident of
     an eligible housing
     project under a congregate
     services program under the
     Cranston-Gonzalez National
     Affordable Housing Act.

[[Page 255]]

 
    (6) Home energy assistance.  Excluded............  Excluded............  42 U.S.C. 8624(f).
     The amount of any home
     energy assistance payments
     or allowances provided
     directly to, or indirectly
     for the benefit of, an
     eligible household under
     the Low-Income Home Energy
     Assistance Act of 1981.
    (7) Programs for older       Excluded............  Included............  42 U.S.C. 3020a(b).
     Americans. Payments, other
     than wages or salaries,
     received from programs
     funded under the Older
     Americans Act of 1965, 42
     U.S.C. 3001.
    (8) Student financial aid.   Excluded............  Excluded............  20 U.S.C. 1087uu, 2414(a).
     Amounts of student
     financial assistance
     received under Title IV of
     the Higher Education Act
     of 1965, including Federal
     work-study programs,
     Bureau of Indian Affairs
     student assistance
     programs, or vocational
     training under the Carl D.
     Perkins Vocational and
     Technical Education Act of
     1998.
    (9) Retired Serviceman's     Excluded............  Included............  10 U.S.C. 1441.
     Family Protection Plan
     annuities. Annuities
     received under subchapter
     I of the Retired
     Serviceman's Family
     Protection Plan.
----------------------------------------------------------------------------------------------------------------


(Authority: 38 U.S.C. 501(a))

[83 FR 47274, Sept. 18, 2018]

        Ratings and Evaluations; Basic Entitlement Considerations



Sec.  3.300  Claims based on the effects of tobacco products.

    (a) For claims received by VA after June 9, 1998, a disability or 
death will not be considered service-connected on the basis that it 
resulted from injury or disease attributable to the veteran's use of 
tobacco products during service. For the purpose of this section, the 
term ``tobacco products'' means cigars, cigarettes, smokeless tobacco, 
pipe tobacco, and roll-your-own tobacco.
    (b) The provisions of paragraph (a) of this section do not prohibit 
service connection if:
    (1) The disability or death resulted from a disease or injury that 
is otherwise shown to have been incurred or aggravated during service. 
For purposes of this section, ``otherwise shown'' means that the 
disability or death can be service-connected on some basis other than 
the veteran's use of tobacco products during service, or that the 
disability became manifest or death occurred during service; or
    (2) The disability or death resulted from a disease or injury that 
appeared to the required degree of disability

[[Page 256]]

within any applicable presumptive period under Sec. Sec.  3.307, 3.309, 
3.313, or 3.316; or
    (3) Secondary service connection is established for ischemic heart 
disease or other cardiovascular disease under Sec.  3.310(b).
    (c) For claims for secondary service connection received by VA after 
June 9, 1998, a disability that is proximately due to or the result of 
an injury or disease previously service-connected on the basis that it 
is attributable to the veteran's use of tobacco products during service 
will not be service-connected under Sec.  3.310(a).

(Authority: 38 U.S.C. 501(a), 1103, 1103 note)

[66 FR 18198, Apr. 6, 2001]



Sec.  3.301  Line of duty and misconduct.

    (a) Line of duty. Direct service connection may be granted only when 
a disability or cause of death was incurred or aggravated in line of 
duty, and not the result of the veteran's own willful misconduct or, for 
claims filed after October 31, 1990, the result of his or her abuse of 
alcohol or drugs.


(Authority: 38 U.S.C. 105)

    (b) Willful misconduct. Disability pension is not payable for any 
condition due to the veteran's own willful misconduct.


(Authority: 38 U.S.C. 1521)

    (c) Specific applications; willful misconduct. For the purpose of 
determining entitlement to service-connected and nonservice-connected 
benefits the definitions in Sec. Sec.  3.1 (m) and (n) of this part 
apply except as modified within paragraphs (c)(1) through (c)(3) of this 
section. The provisions of paragraphs (c)(2) and (c)(3) of this section 
are subject to the provisions of Sec.  3.302 of this part where 
applicable.


(Authority: 38 U.S.C. 501)

    (1) Venereal disease. The residuals of venereal disease are not to 
be considered the result of willful misconduct. Consideration of service 
connection for residuals of venereal disease as having been incurred in 
service requires that the initial infection must have occurred during 
active service. Increase in service of manifestations of venereal 
disease will usually be held due to natural progress unless the facts of 
record indicate the increase in manifestations was precipitated by 
trauma or by the conditions of the veteran's service, in which event 
service connection may be established by aggravation. Medical principles 
pertaining to the incubation period and its relation to the course of 
the disease; i.e., initial or acute manifestation, or period and course 
of secondary and late residuals manifested, will be considered when time 
of incurrence of venereal disease prior to or after entry into service 
is at issue. In the issue of service connection, whether the veteran 
complied with service regulations and directives for reporting the 
disease and undergoing treatment is immaterial after November 14, 1972, 
and the service department characterization of acquisition of the 
disease as willful misconduct or as not in line of duty will not govern.
    (2) The simple drinking of alcoholic beverage is not of itself 
willful misconduct. The deliberate drinking of a known poisonous 
substance or under conditions which would raise a presumption to that 
effect will be considered willful misconduct. If, in the drinking of a 
beverage to enjoy its intoxicating effects, intoxication results 
proximately and immediately in disability or death, the disability or 
death will be considered the result of the person's willful misconduct. 
Organic diseases and disabilities which are a secondary result of the 
chronic use of alcohol as a beverage, whether out of compulsion or 
otherwise, will not be considered of willful misconduct origin. (See 
Sec. Sec.  21.1043, 21.5041, and 21.7051 of this title regarding the 
disabling effects of chronic alcoholism for the purpose of extending 
delimiting periods under education or rehabilitation programs.)


(Authority: 38 U.S.C. 501)

    (3) Drug usage. The isolated and infrequent use of drugs by itself 
will not be considered willful misconduct; however, the progressive and 
frequent use of drugs to the point of addiction will be considered 
willful misconduct.

[[Page 257]]

Where drugs are used to enjoy or experience their effects and the 
effects result proximately and immediately in disability or death, such 
disability or death will be considered the result of the person's 
willful misconduct. Organic diseases and disabilities which are a 
secondary result of the chronic use of drugs and infections coinciding 
with the injection of drugs will not be considered of willful misconduct 
origin. (See paragraph (d) of this section regarding service connection 
where disability or death is a result of abuse of drugs.) Where drugs 
are used for therapeutic purposes or where use of drugs or addiction 
thereto, results from a service-connected disability, it will not be 
considered of misconduct origin.


(Authority: 38 U.S.C. 105, 1110, 1121, 1131, 1301, and 1521(a))

    (d) Line of duty; abuse of alcohol or drugs. An injury or disease 
incurred during active military, naval, or air service shall not be 
deemed to have been incurred in line of duty if such injury or disease 
was a result of the abuse of alcohol or drugs by the person on whose 
service benefits are claimed. For the purpose of this paragraph, alcohol 
abuse means the use of alcoholic beverages over time, or such excessive 
use at any one time, sufficient to cause disability to or death of the 
user; drug abuse means the use of illegal drugs (including prescription 
drugs that are illegally or illicitly obtained), the intentional use of 
prescription or non-prescription drugs for a purpose other than the 
medically intended use, or the use of substances other than alcohol to 
enjoy their intoxicating effects.

(Authority: 38 U.S.C. 105(a))

    Cross References: In line of duty. See Sec.  3.1(m). Willful 
misconduct. See Sec.  3.1(n). Extended period of eligibility. See 
Sec. Sec.  21.1043 and 21.7051. Periods of entitlement. See Sec.  
21.5041.

[26 FR 1579, Feb. 24, 1961, as amended at 37 FR 24662, Nov. 18, 1972; 54 
FR 31951, Aug. 3, 1989; 55 FR 13530, Apr. 11, 1990; 60 FR 27408, May 24, 
1995]



Sec.  3.302  Service connection for mental unsoundness in suicide.

    (a) General. (1) In order for suicide to constitute willful 
misconduct, the act of self-destruction must be intentional.
    (2) A person of unsound mind is incapable of forming an intent (mens 
rea, or guilty mind, which is an essential element of crime or willful 
misconduct).
    (3) It is a constant requirement for favorable action that the 
precipitating mental unsoundness be service connected.
    (b) Evidence of mental condition. (1) Whether a person, at the time 
of suicide, was so unsound mentally that he or she did not realize the 
consequence of such an act, or was unable to resist such impulse is a 
question to be determined in each individual case, based on all 
available lay and medical evidence pertaining to his or her mental 
condition at the time of suicide.
    (2) The act of suicide or a bona fide attempt is considered to be 
evidence of mental unsoundness. Therefore, where no reasonable adequate 
motive for suicide is shown by the evidence, the act will be considered 
to have resulted from mental unsoundness.
    (3) A reasonable adequate motive for suicide may be established by 
affirmative evidence showing circumstances which could lead a rational 
person to self-destruction.
    (c) Evaluation of evidence. (1) Affirmative evidence is necessary to 
justify reversal of service department findings of mental unsoundness 
where Department of Veterans Affairs criteria do not otherwise warrant 
contrary findings.
    (2) In all instances any reasonable doubt should be resolved 
favorably to support a finding of service connection (see Sec.  3.102).

    Cross Reference: Cause of death. See Sec.  3.312.

[28 FR 183, Jan. 8, 1963, as amended at 54 FR 31951, Aug. 3, 1989; 55 FR 
13530, Apr. 11, 1990]

               Ratings and Evaluations; Service Connection



Sec.  3.303  Principles relating to service connection.

    (a) General. Service connection connotes many factors but basically 
it means that the facts, shown by evidence, establish that a particular 
injury or disease resulting in disability was incurred coincident with 
service in the Armed Forces, or if preexisting such service, was 
aggravated therein.

[[Page 258]]

This may be accomplished by affirmatively showing inception or 
aggravation during service or through the application of statutory 
presumptions. Each disabling condition shown by a veteran's service 
records, or for which he seeks a service connection must be considered 
on the basis of the places, types and circumstances of his service as 
shown by service records, the official history of each organization in 
which he served, his medical records and all pertinent medical and lay 
evidence. Determinations as to service connection will be based on 
review of the entire evidence of record, with due consideration to the 
policy of the Department of Veterans Affairs to administer the law under 
a broad and liberal interpretation consistent with the facts in each 
individual case.
    (b) Chronicity and continuity. With chronic disease shown as such in 
service (or within the presumptive period under Sec.  3.307) so as to 
permit a finding of service connection, subsequent manifestations of the 
same chronic disease at any later date, however remote, are service 
connected, unless clearly attributable to intercurrent causes. This rule 
does not mean that any manifestation of joint pain, any abnormality of 
heart action or heart sounds, any urinary findings of casts, or any 
cough, in service will permit service connection of arthritis, disease 
of the heart, nephritis, or pulmonary disease, first shown as a clearcut 
clinical entity, at some later date. For the showing of chronic disease 
in service there is required a combination of manifestations sufficient 
to identify the disease entity, and sufficient observation to establish 
chronicity at the time, as distinguished from merely isolated findings 
or a diagnosis including the word ``Chronic.'' When the disease identity 
is established (leprosy, tuberculosis, multiple sclerosis, etc.), there 
is no requirement of evidentiary showing of continuity. Continuity of 
symptomatology is required only where the condition noted during service 
(or in the presumptive period) is not, in fact, shown to be chronic or 
where the diagnosis of chronicity may be legitimately questioned. When 
the fact of chronicity in service is not adequately supported, then a 
showing of continuity after discharge is required to support the claim.
    (c) Preservice disabilities noted in service. There are medical 
principles so universally recognized as to constitute fact (clear and 
unmistakable proof), and when in accordance with these principles 
existence of a disability prior to service is established, no additional 
or confirmatory evidence is necessary. Consequently with notation or 
discovery during service of such residual conditions (scars; fibrosis of 
the lungs; atrophies following disease of the central or peripheral 
nervous system; healed fractures; absent, displaced or resected parts of 
organs; supernumerary parts; congenital malformations or hemorrhoidal 
tags or tabs, etc.) with no evidence of the pertinent antecedent active 
disease or injury during service the conclusion must be that they 
preexisted service. Similarly, manifestation of lesions or symptoms of 
chronic disease from date of enlistment, or so close thereto that the 
disease could not have originated in so short a period will establish 
preservice existence thereof. Conditions of an infectious nature are to 
be considered with regard to the circumstances of the infection and if 
manifested in less than the respective incubation periods after 
reporting for duty, they will be held to have preexisted service. In the 
field of mental disorders, personality disorders which are characterized 
by developmental defects or pathological trends in the personality 
structure manifested by a lifelong pattern of action or behavior, 
chronic psychoneurosis of long duration or other psychiatric 
symptomatology shown to have existed prior to service with the same 
manifestations during service, which were the basis of the service 
diagnosis, will be accepted as showing preservice origin. Congenital or 
developmental defects, refractive error of the eye, personality 
disorders and mental deficiency as such are not diseases or injuries 
within the meaning of applicable legislation.
    (d) Postservice initial diagnosis of disease. Service connection may 
be granted for any disease diagnosed after discharge, when all the 
evidence, including that pertinent to service, establishes that the 
disease was incurred in

[[Page 259]]

service. Presumptive periods are not intended to limit service 
connection to diseases so diagnosed when the evidence warrants direct 
service connection. The presumptive provisions of the statute and 
Department of Veterans Affairs regulations implementing them are 
intended as liberalizations applicable when the evidence would not 
warrant service connection without their aid.

[26 FR 1579, Feb. 24, 1961]



Sec.  3.304  Direct service connection; wartime and peacetime.

    (a) General. The basic considerations relating to service connection 
are stated in Sec.  3.303. The criteria in this section apply only to 
disabilities which may have resulted from service in a period of war or 
service rendered on or after January 1, 1947.
    (b) Presumption of soundness. The veteran will be considered to have 
been in sound condition when examined, accepted and enrolled for 
service, except as to defects, infirmities, or disorders noted at 
entrance into service, or where clear and unmistakable (obvious or 
manifest) evidence demonstrates that an injury or disease existed prior 
thereto and was not aggravated by such service. Only such conditions as 
are recorded in examination reports are to be considered as noted.


(Authority: 38 U.S.C. 1111)

    (1) History of preservice existence of conditions recorded at the 
time of examination does not constitute a notation of such conditions 
but will be considered together with all other material evidence in 
determinations as to inception. Determinations should not be based on 
medical judgment alone as distinguished from accepted medical 
principles, or on history alone without regard to clinical factors 
pertinent to the basic character, origin and development of such injury 
or disease. They should be based on thorough analysis of the evidentiary 
showing and careful correlation of all material facts, with due regard 
to accepted medical principles pertaining to the history, 
manifestations, clinical course, and character of the particular injury 
or disease or residuals thereof.
    (2) History conforming to accepted medical principles should be 
given due consideration, in conjunction with basic clinical data, and be 
accorded probative value consistent with accepted medical and 
evidentiary principles in relation to value consistent with accepted 
medical evidence relating to incurrence, symptoms and course of the 
injury or disease, including official and other records made prior to, 
during or subsequent to service, together with all other lay and medical 
evidence concerning the inception, development and manifestations of the 
particular condition will be taken into full account.
    (3) Signed statements of veterans relating to the origin, or 
incurrence of any disease or injury made in service if against his or 
her own interest is of no force and effect if other data do not 
establish the fact. Other evidence will be considered as though such 
statement were not of record.


(Authority: 10 U.S.C. 1219)

    (c) Development. The development of evidence in connection with 
claims for service connection will be accomplished when deemed necessary 
but it should not be undertaken when evidence present is sufficient for 
this determination. In initially rating disability of record at the time 
of discharge, the records of the service department, including the 
reports of examination at enlistment and the clinical records during 
service, will ordinarily suffice. Rating of combat injuries or other 
conditions which obviously had their inception in service may be 
accomplished pending receipt of copy of the examination at enlistment 
and all other service records.
    (d) Combat. Satisfactory lay or other evidence that an injury or 
disease was incurred or aggravated in combat will be accepted as 
sufficient proof of service connection if the evidence is consistent 
with the circumstances, conditions or hardships of such service even 
though there is no official record of such incurrence or aggravation.


(Authority: 38 U.S.C. 1154(b))

    (e) Prisoners of war. Where disability compensation is claimed by a 
former prisoner of war, omission of history or findings from clinical 
records made

[[Page 260]]

upon repatriation is not determinative of service connection, 
particularly if evidence of comrades in support of the incurrence of the 
disability during confinement is available. Special attention will be 
given to any disability first reported after discharge, especially if 
poorly defined and not obviously of intercurrent origin. The 
circumstances attendant upon the individual veteran's confinement and 
the duration thereof will be associated with pertinent medical 
principles in determining whether disability manifested subsequent to 
service is etiologically related to the prisoner of war experience.
    (f) Posttraumatic stress disorder. Service connection for 
posttraumatic stress disorder requires medical evidence diagnosing the 
condition in accordance with Sec.  4.125(a) of this chapter; a link, 
established by medical evidence, between current symptoms and an in-
service stressor; and credible supporting evidence that the claimed in-
service stressor occurred. The following provisions apply to claims for 
service connection of posttraumatic stress disorder diagnosed during 
service or based on the specified type of claimed stressor:
    (1) If the evidence establishes a diagnosis of posttraumatic stress 
disorder during service and the claimed stressor is related to that 
service, in the absence of clear and convincing evidence to the 
contrary, and provided that the claimed stressor is consistent with the 
circumstances, conditions, or hardships of the veteran's service, the 
veteran's lay testimony alone may establish the occurrence of the 
claimed in-service stressor.
    (2) If the evidence establishes that the veteran engaged in combat 
with the enemy and the claimed stressor is related to that combat, in 
the absence of clear and convincing evidence to the contrary, and 
provided that the claimed stressor is consistent with the circumstances, 
conditions, or hardships of the veteran's service, the veteran's lay 
testimony alone may establish the occurrence of the claimed in-service 
stressor.
    (3) If a stressor claimed by a veteran is related to the veteran's 
fear of hostile military or terrorist activity and a VA psychiatrist or 
psychologist, or a psychiatrist or psychologist with whom VA has 
contracted, confirms that the claimed stressor is adequate to support a 
diagnosis of posttraumatic stress disorder and that the veteran's 
symptoms are related to the claimed stressor, in the absence of clear 
and convincing evidence to the contrary, and provided the claimed 
stressor is consistent with the places, types, and circumstances of the 
veteran's service, the veteran's lay testimony alone may establish the 
occurrence of the claimed in-service stressor. For purposes of this 
paragraph, ``fear of hostile military or terrorist activity'' means that 
a veteran experienced, witnessed, or was confronted with an event or 
circumstance that involved actual or threatened death or serious injury, 
or a threat to the physical integrity of the veteran or others, such as 
from an actual or potential improvised explosive device; vehicle-
imbedded explosive device; incoming artillery, rocket, or mortar fire; 
grenade; small arms fire, including suspected sniper fire; or attack 
upon friendly military aircraft, and the veteran's response to the event 
or circumstance involved a psychological or psycho-physiological state 
of fear, helplessness, or horror.
    (4) If the evidence establishes that the veteran was a prisoner-of-
war under the provisions of Sec.  3.1(y) of this part and the claimed 
stressor is related to that prisoner-of-war experience, in the absence 
of clear and convincing evidence to the contrary, and provided that the 
claimed stressor is consistent with the circumstances, conditions, or 
hardships of the veteran's service, the veteran's lay testimony alone 
may establish the occurrence of the claimed in-service stressor.
    (5) If a posttraumatic stress disorder claim is based on in-service 
personal assault, evidence from sources other than the veteran's service 
records may corroborate the veteran's account of the stressor incident. 
Examples of such evidence include, but are not limited to: records from 
law enforcement authorities, rape crisis centers, mental health 
counseling centers, hospitals, or physicians; pregnancy tests or tests 
for sexually transmitted diseases; and statements from family members, 
roommates, fellow service members, or

[[Page 261]]

clergy. Evidence of behavior changes following the claimed assault is 
one type of relevant evidence that may be found in these sources. 
Examples of behavior changes that may constitute credible evidence of 
the stressor include, but are not limited to: a request for a transfer 
to another military duty assignment; deterioration in work performance; 
substance abuse; episodes of depression, panic attacks, or anxiety 
without an identifiable cause; or unexplained economic or social 
behavior changes. VA will not deny a posttraumatic stress disorder claim 
that is based on in-service personal assault without first advising the 
claimant that evidence from sources other than the veteran's service 
records or evidence of behavior changes may constitute credible 
supporting evidence of the stressor and allowing him or her the 
opportunity to furnish this type of evidence or advise VA of potential 
sources of such evidence. VA may submit any evidence that it receives to 
an appropriate medical or mental health professional for an opinion as 
to whether it indicates that a personal assault occurred.


(Authority: 38 U.S.C. 501(a), 1154)

[26 FR 1580, Feb. 24, 1961, as amended at 31 FR 4680, Mar. 19, 1966; 39 
FR 34530, Sept. 26, 1974; 58 FR 29110, May 19, 1993; 64 FR 32808, June 
18, 1999; 67 FR 10332, Mar. 7, 2002; 70 FR 23029, May 4, 2005; 73 FR 
64210, Oct. 29, 2008; 75 FR 39852, July 13, 2010]



Sec.  3.305  Direct service connection; peacetime service before 
January 1, 1947.

    (a) General. The basic considerations relating to service connection 
are stated in Sec.  3.303. The criteria in this section apply only to 
disabilities which may have resulted from service other than in a period 
of war before January 1, 1947.
    (b) Presumption of soundness. A peacetime veteran who has had 
active, continuous service of 6 months or more will be considered to 
have been in sound condition when examined, accepted and enrolled for 
service, except as to defects, infirmities or disorders noted at the 
time thereof, or where evidence or medical judgment, as distinguished 
from medical fact and principles, establishes that an injury or disease 
preexisted service. Any evidence acceptable as competent to indicate the 
time of existence or inception of the condition may be considered. 
Determinations based on medical judgment will take cognizance of the 
time of inception or manifestation of disease or injury following 
entrance into service, as shown by proper service authorities in service 
records, entries or reports. Such records will be accorded reasonable 
weight in consideration of other evidence and sound medical reasoning. 
Opinions may be solicited from Department of Veterans Affairs medical 
authorities when considered necessary.
    (c) Campaigns and expeditions. In considering claims of veterans who 
engaged in combat during campaigns or expeditions satisfactory lay or 
other evidence of incurrence or aggravation in such combat of an injury 
or disease, if consistent with the circumstances, conditions or 
hardships of such service will be accepted as sufficient proof of 
service connection, even when there is no official record of incurrence 
or aggravation. Service connection for such injury or disease may be 
rebutted by clear and convincing evidence to the contrary.

[26 FR 1580, Feb. 24, 1961, as amended at 28 FR 3088, Mar. 29, 1963; 39 
FR 34530, Sept. 26, 1974]



Sec.  3.306  Aggravation of preservice disability.

    (a) General. A preexisting injury or disease will be considered to 
have been aggravated by active military, naval, or air service, where 
there is an increase in disability during such service, unless there is 
a specific finding that the increase in disability is due to the natural 
progress of the disease.


(Authority: 38 U.S.C. 1153)

    (b) Wartime service; peacetime service after December 31, 1946. 
Clear and unmistakable evidence (obvious or manifest) is required to 
rebut the presumption of aggravation where the preservice disability 
underwent an increase in severity during service. This includes medical 
facts and principles which may be considered to determine

[[Page 262]]

whether the increase is due to the natural progress of the condition. 
Aggravation may not be conceded where the disability underwent no 
increase in severity during service on the basis of all the evidence of 
record pertaining to the manifestations of the disability prior to, 
during and subsequent to service.
    (1) The usual effects of medical and surgical treatment in service, 
having the effect of ameliorating disease or other conditions incurred 
before enlistment, including postoperative scars, absent or poorly 
functioning parts or organs, will not be considered service connected 
unless the disease or injury is otherwise aggravated by service.
    (2) Due regard will be given the places, types, and circumstances of 
service and particular consideration will be accorded combat duty and 
other hardships of service. The development of symptomatic 
manifestations of a preexisting disease or injury during or proximately 
following action with the enemy or following a status as a prisoner of 
war will establish aggravation of a disability.


(Authority: 38 U.S.C. 1154)

    (c) Peacetime service prior to December 7, 1941. The specific 
finding requirement that an increase in disability is due to the natural 
progress of the condition will be met when the available evidence of a 
nature generally acceptable as competent shows that the increase in 
severity of a disease or injury or acceleration in progress was that 
normally to be expected by reason of the inherent character of the 
condition, aside from any extraneous or contributing cause or influence 
peculiar to military service. Consideration will be given to the 
circumstances, conditions, and hardships of service.

[26 FR 1580, Feb. 24, 1961, as amended at 57 FR 59296, Dec. 15, 1992]



Sec.  3.307  Presumptive service connection for chronic, tropical, or
prisoner-of-war related disease, disease associated with exposure to 
certain herbicide agents, or disease associated with exposure to 
contaminants in the water supply at Camp Lejeune; wartime and service
on or after January 1, 1947.

    (a) General. A chronic, tropical, or prisoner of war related 
disease, a disease associated with exposure to certain herbicide agents, 
or a disease associated with exposure to contaminants in the water 
supply at Camp Lejeune listed in Sec.  3.309 will be considered to have 
been incurred in or aggravated by service under the circumstances 
outlined in this section even though there is no evidence of such 
disease during the period of service. No condition other than one listed 
in Sec.  3.309(a) will be considered chronic.
    (1) Service. The veteran must have served 90 days or more during a 
war period or after December 31, 1946. The requirement of 90 days' 
service means active, continuous service within or extending into or 
beyond a war period, or which began before and extended beyond December 
31, 1946, or began after that date. Any period of service is sufficient 
for the purpose of establishing the presumptive service connection of a 
specified disease under the conditions listed in Sec.  3.309(c) and (e). 
Any period of service is sufficient for the purpose of establishing the 
presumptive service connection of a specified disease under the 
conditions listed in Sec.  3.309(f), as long as the period of service 
also satisfies the requirements to establish a presumption of exposure 
to contaminants in the water supply at Camp Lejeune under paragraph 
(a)(7)(iii) of this section.
    (2) Separation from service. For the purpose of paragraph (a)(3) and 
(4) of this section the date of separation from wartime service will be 
the date of discharge or release during a war period, or if service 
continued after the war, the end of the war period. In claims based on 
service on or after January 1, 1947, the date of separation will be the 
date of discharge or release from the period of service on which the 
claim is based.
    (3) Chronic disease. The disease must have become manifest to a 
degree of 10

[[Page 263]]

percent or more within 1 year (for Hansen's disease (leprosy) and 
tuberculosis, within 3 years; multiple sclerosis, within 7 years) from 
the date of separation from service as specified in paragraph (a)(2) of 
this section.
    (4) Tropical disease. The disease must have become manifest to a 
degree of 10 percent or more within 1 year from date of separation from 
service as specified in paragraph (a)(2) of this section, or at a time 
when standard accepted treatises indicate that the incubation period 
commenced during such service. The resultant disorders or diseases 
originating because of therapy administered in connection with a 
tropical disease or as a preventative may also be service connected.


(Authority: 38 U.S.C. 1112)

    (5) Diseases specific as to former prisoners of war. The diseases 
listed in Sec.  3.309(c) shall have become manifest to a degree of 10 
percent or more at any time after discharge or release from active 
service.


(Authority: 38 U.S.C. 1112)

    (6) Diseases associated with exposure to certain herbicide agents. 
(i) For the purposes of this section, the term ``herbicide agent'' means 
a chemical in an herbicide used in support of the United States and 
allied military operations in the Republic of Vietnam during the period 
beginning on January 9, 1962, and ending on May 7, 1975, specifically: 
2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram.


(Authority: 38 U.S.C. 1116(a)(4))

    (ii) The diseases listed at Sec.  3.309(e) shall have become 
manifest to a degree of 10 percent or more at any time after service, 
except that chloracne or other acneform disease consistent with 
chloracne, porphyria cutanea tarda, and early-onset peripheral 
neuropathy shall have become manifest to a degree of 10 percent or more 
within a year after the last date on which the veteran was exposed to an 
herbicide agent during active military, naval, or air service.
    (iii) A veteran who, during active military, naval, or air service, 
served in the Republic of Vietnam during the period beginning on January 
9, 1962, and ending on May 7, 1975, shall be presumed to have been 
exposed during such service to an herbicide agent, unless there is 
affirmative evidence to establish that the veteran was not exposed to 
any such agent during that service. The last date on which such a 
veteran shall be presumed to have been exposed to an herbicide agent 
shall be the last date on which he or she served in the Republic of 
Vietnam during the period beginning on January 9, 1962, and ending on 
May 7, 1975. ``Service in the Republic of Vietnam'' includes service in 
the waters offshore and service in other locations if the conditions of 
service involved duty or visitation in the Republic of Vietnam.
    (iv) A veteran who, during active military, naval, or air service, 
served between April 1, 1968, and August 31, 1971, in a unit that, as 
determined by the Department of Defense, operated in or near the Korean 
DMZ in an area in which herbicides are known to have been applied during 
that period, shall be presumed to have been exposed during such service 
to an herbicide agent, unless there is affirmative evidence to establish 
that the veteran was not exposed to any such agent during that service. 
See also 38 CFR 3.814(c)(2).
    (v) An individual who performed service in the Air Force or Air 
Force Reserve under circumstances in which the individual concerned 
regularly and repeatedly operated, maintained, or served onboard C-123 
aircraft known to have been used to spray an herbicide agent during the 
Vietnam era shall be presumed to have been exposed during such service 
to an herbicide agent. For purposes of this paragraph, ``regularly and 
repeatedly operated, maintained, or served onboard C-123 aircraft'' 
means that the individual was assigned to an Air Force or Air Force 
Reserve squadron when the squadron was permanently assigned one of the 
affected aircraft and the individual had an Air Force Specialty Code 
indicating duties as a flight, ground maintenance, or medical crew 
member on such aircraft. Such exposure constitutes an injury under 38 
U.S.C. 101(24)(B) and (C). If an individual described in this paragraph 
develops a disease listed in 38 CFR 3.309(e) as specified in paragraph

[[Page 264]]

(a)(6)(ii) of this section, it will be presumed that the individual 
concerned became disabled during that service for purposes of 
establishing that the individual served in the active military, naval, 
or air service.
    (7) Diseases associated with exposure to contaminants in the water 
supply at Camp Lejeune. (i) For the purposes of this section, 
contaminants in the water supply means the volatile organic compounds 
trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl 
chloride, that were in the on-base water-supply systems located at 
United States Marine Corps Base Camp Lejeune, during the period 
beginning on August 1, 1953, and ending on December 31, 1987.
    (ii) The diseases listed in Sec.  3.309(f) shall have become 
manifest to a degree of 10 percent or more at any time after service.
    (iii) A veteran, or former reservist or member of the National 
Guard, who had no less than 30 days (consecutive or nonconsecutive) of 
service at Camp Lejeune during the period beginning on August 1, 1953, 
and ending on December 31, 1987, shall be presumed to have been exposed 
during such service to the contaminants in the water supply, unless 
there is affirmative evidence to establish that the individual was not 
exposed to contaminants in the water supply during that service. The 
last date on which such a veteran, or former reservist or member of the 
National Guard, shall be presumed to have been exposed to contaminants 
in the water supply shall be the last date on which he or she served at 
Camp Lejeune during the period beginning on August 1, 1953, and ending 
on December 31, 1987. For purposes of this section, service at Camp 
Lejeune means any service within the borders of the entirety of the 
United States Marine Corps Base Camp Lejeune and Marine Corps Air 
Station New River, North Carolina, during the period beginning on August 
1, 1953, and ending on December 31, 1987, as established by military 
orders or other official service department records.
    (iv) Exposure described in paragraph (a)(7)(iii) of this section is 
an injury under 38 U.S.C. 101(24)(B) and (C). If an individual described 
in paragraph (a)(7)(iii) of this section develops a disease listed in 
Sec.  3.309(f), VA will presume that the individual concerned became 
disabled during that service for purposes of establishing that the 
individual served in the active military, naval, or air service.


(Authority: 38 U.S.C. 501(a), 1116(a)(3), and 1821)

    (b) Evidentiary basis. The factual basis may be established by 
medical evidence, competent lay evidence or both. Medical evidence 
should set forth the physical findings and symptomatology elicited by 
examination within the applicable period. Lay evidence should describe 
the material and relevant facts as to the veteran's disability observed 
within such period, not merely conclusions based upon opinion. The 
chronicity and continuity factors outlined in Sec.  3.303(b) will be 
considered. The diseases listed in Sec.  3.309(a) will be accepted as 
chronic, even though diagnosed as acute because of insidious inception 
and chronic development, except: (1) Where they result from intercurrent 
causes, for example, cerebral hemorrhage due to injury, or active 
nephritis or acute endocarditis due to intercurrent infection (with or 
without identification of the pathogenic micro-organism); or (2) where a 
disease is the result of drug ingestion or a complication of some other 
condition not related to service. Thus, leukemia will be accepted as a 
chronic disease whether diagnosed as acute or chronic. Unless the 
clinical picture is clear otherwise, consideration will be given as to 
whether an acute condition is an exacerbation of a chronic disease.


(Authority: 38 U.S.C. 1112)

    (c) Prohibition of certain presumptions. No presumptions may be 
invoked on the basis of advancement of the disease when first definitely 
diagnosed for the purpose of showing its existence to a degree of 10 
percent within the applicable period. This will not be interpreted as 
requiring that the disease be diagnosed in the presumptive period, but 
only that there be then shown by acceptable medical or lay evidence 
characteristic manifestations of the disease to the required degree, 
followed without unreasonable time lapse by definite

[[Page 265]]

diagnosis. Symptomatology shown in the prescribed period may have no 
particular significance when first observed, but in the light of 
subsequent developments it may gain considerable significance. Cases in 
which a chronic condition is shown to exist within a short time 
following the applicable presumptive period, but without evidence of 
manifestations within the period, should be developed to determine 
whether there was symptomatology which in retrospect may be identified 
and evaluated as manifestation of the chronic disease to the required 
10-percent degree.
    (d) Rebuttal of service incurrence or aggravation. (1) Evidence 
which may be considered in rebuttal of service incurrence of a disease 
listed in Sec.  3.309 will be any evidence of a nature usually accepted 
as competent to indicate the time of existence or inception of disease, 
and medical judgment will be exercised in making determinations relative 
to the effect of intercurrent injury or disease. The expression 
``affirmative evidence to the contrary'' will not be taken to require a 
conclusive showing, but such showing as would, in sound medical 
reasoning and in the consideration of all evidence of record, support a 
conclusion that the disease was not incurred in service. As to tropical 
diseases the fact that the veteran had no service in a locality having a 
high incidence of the disease may be considered as evidence to rebut the 
presumption, as may residence during the period in question in a region 
where the particular disease is endemic. The known incubation periods of 
tropical diseases should be used as a factor in rebuttal of presumptive 
service connection as showing inception before or after service.
    (2) The presumption of aggravation provided in this section may be 
rebutted by affirmative evidence that the preexisting condition was not 
aggravated by service, which may include affirmative evidence that any 
increase in disability was due to an intercurrent disease or injury 
suffered after separation from service or evidence sufficient, under 
Sec.  3.306 of this part, to show that the increase in disability was 
due to the natural progress of the preexisting condition.

(Authority: 38 U.S.C. 101(24), 501(a), 1116(a)(3), and 1821)

[26 FR 1581, Feb. 24, 1961, as amended at 35 FR 18281, Dec. 1, 1970; 39 
FR 34530, Sept. 26, 1974; 43 FR 45347, Oct. 2, 1978; 47 FR 11655, Mar. 
18, 1982; 58 FR 29109, May 19, 1993; 59 FR 5106, Feb. 3, 1994; 59 FR 
29724, June 9, 1994; 61 FR 57588, Nov. 7, 1996; 62 FR 35422, July 1, 
1997; 67 FR 67793, Nov. 7, 2002; 68 FR 34541, June 10, 2003; 76 FR 4248, 
Jan. 25, 2011; 78 FR 54766, Sept. 6, 2013; 80 FR 35248, June 19, 2015; 
82 FR 4184, Jan. 13, 2017]



Sec.  3.308  Presumptive service connection; peacetime service before
January 1, 1947.

    (a) Chronic disease. There is no provision for presumptive service 
connection for chronic disease as distinguished from tropical diseases 
referred to in paragraph (b) of this section based on peacetime service 
before January 1, 1947.
    (b) Tropical disease. In claims based on peacetime service before 
January 1, 1947, a veteran of 6 months or more service who contracts a 
tropical disease listed in Sec.  3.309(b) or a resultant disorder or 
disease originating because of therapy administered in connection with a 
tropical disease or as a preventative, will be considered to have 
incurred such disability in service when it is shown to exist to the 
degree of 10 percent or more within 1 year after separation from active 
service, or at a time when standard and accepted treatises indicate that 
the incubation period commenced during active service unless shown by 
clear and unmistakable evidence not to have been of service origin. The 
requirement of 6 months or more service means active, continuous 
service, during one or more enlistment periods.

(Authority: 38 U.S.C. 1133)

[39 FR 34530, Sept. 26, 1974]



Sec.  3.309  Disease subject to presumptive service connection.

    (a) Chronic diseases. The following diseases shall be granted 
service connection although not otherwise established as incurred in or 
aggravated by service if manifested to a compensable degree within the 
applicable time limits under Sec.  3.307 following service in a

[[Page 266]]

period of war or following peacetime service on or after January 1, 
1947, provided the rebuttable presumption provisions of Sec.  3.307 are 
also satisfied.

Anemia, primary.
Arteriosclerosis.
Arthritis.
Atrophy, progressive muscular.
Brain hemorrhage.
Brain thrombosis.
Bronchiectasis.
Calculi of the kidney, bladder, or gallbladder.

    Cardiovascular-renal disease, including hypertension. (This term 
applies to combination involvement of the type of arteriosclerosis, 
nephritis, and organic heart disease, and since hypertension is an early 
symptom long preceding the development of those diseases in their more 
obvious forms, a disabling hypertension within the 1-year period will be 
given the same benefit of service connection as any of the chronic 
diseases listed.)

Cirrhosis of the liver.
Coccidioidomycosis.
Diabetes mellitus.
Encephalitis lethargica residuals.
Endocarditis. (This term covers all forms of valvular heart disease.)
Endocrinopathies.
Epilepsies.
Hansen's disease.
Hodgkin's disease.
Leukemia.
Lupus erythematosus, systemic.
Myasthenia gravis.
Myelitis.
Myocarditis.
Nephritis.
Other organic diseases of the nervous system.
Osteitis deformans (Paget's disease).
Osteomalacia.
Palsy, bulbar.
Paralysis agitans.
Psychoses.
Purpura idiopathic, hemorrhagic.
Raynaud's disease.
Sarcoidosis.
Scleroderma.
Sclerosis, amyotrophic lateral.
Sclerosis, multiple.
Syringomyelia.
Thromboangiitis obliterans (Buerger's disease).
Tuberculosis, active.
Tumors, malignant, or of the brain or spinal cord or peripheral nerves.
Ulcers, peptic (gastric or duodenal) (A proper diagnosis of gastric or 
duodenal ulcer (peptic ulcer) is to be considered established if it 
represents a medically sound interpretation of sufficient clinical 
findings warranting such diagnosis and provides an adequate basis for a 
differential diagnosis from other conditions with like symptomatology; 
in short, where the preponderance of evidence indicates gastric or 
duodenal ulcer (peptic ulcer). Whenever possible, of course, laboratory 
findings should be used in corroboration of the clinical data.

    (b) Tropical diseases. The following diseases shall be granted 
service connection as a result of tropical service, although not 
otherwise established as incurred in service if manifested to a 
compensable degree within the applicable time limits under Sec.  3.307 
or Sec.  3.308 following service in a period of war or following 
peacetime service, provided the rebuttable presumption provisions of 
Sec.  3.307 are also satisfied.

Amebiasis.
Blackwater fever.
Cholera.
Dracontiasis.
Dysentery.
Filariasis.
Leishmaniasis, including kala-azar.
Loiasis.
Malaria.
Onchocerciasis.
Oroya fever.
Pinta.
Plague.
Schistosomiasis.
Yaws.
Yellow fever.
Resultant disorders or diseases originating because of therapy 
administered in connection with such diseases or as a preventative 
thereof.

    (c) Diseases specific as to former prisoners of war. (1) If a 
veteran is a former prisoner of war, the following diseases shall be 
service connected if manifest to a degree of disability of 10 percent or 
more at any time after discharge or release from active military, naval, 
or air service even though there is no record of such disease during 
service, provided the rebuttable presumption provisions of Sec.  3.307 
are also satisfied.
Psychosis.
Any of the anxiety states.
Dysthymic disorder (or depressive neurosis).
Organic residuals of frostbite, if it is determined that the veteran was 
interned in climatic conditions consistent with the occurrence of 
frostbite.
Post-traumatic osteoarthritis.

[[Page 267]]

Atherosclerotic heart disease or hypertensive vascular disease 
(including hypertensive heart disease) and their complications 
(including myocardial infarction, congestive heart failure, arrhythmia).
Stroke and its complications.
On or after October 10, 2008, Osteoporosis, if the Secretary determines 
that the veteran has posttraumatic stress disorder (PTSD).
    (2) If the veteran:
    (i) Is a former prisoner of war and;
    (ii) Was interned or detained for not less than 30 days, the 
following diseases shall be service connected if manifest to a degree of 
10 percent or more at any time after discharge or release from active 
military, naval, or air service even though there is no record of such 
disease during service, provided the rebuttable presumption provisions 
of Sec.  3.307 are also satisfied.
Avitaminosis.
Beriberi (including beriberi heart disease).
Chronic dysentery.
Helminthiasis.
Malnutrition (including optic atrophy associated with malnutrition).
Pellagra.
Any other nutritional deficiency.
Irritable bowel syndrome.
Peptic ulcer disease.
Peripheral neuropathy except where directly related to infectious 
causes.
Cirrhosis of the liver.
On or after September 28, 2009, Osteoporosis.


(Authority: 38 U.S.C. 1112(b))

    (d) Diseases specific to radiation-exposed veterans. (1) The 
diseases listed in paragraph (d)(2) of this section shall be service-
connected if they become manifest in a radiation-exposed veteran as 
defined in paragraph (d)(3) of this section, provided the rebuttable 
presumption provisions of Sec.  3.307 of this part are also satisfied.
    (2) The diseases referred to in paragraph (d)(1) of this section are 
the following:
    (i) Leukemia (other than chronic lymphocytic leukemia).
    (ii) Cancer of the thyroid.
    (iii) Cancer of the breast.
    (iv) Cancer of the pharynx.
    (v) Cancer of the esophagus.
    (vi) Cancer of the stomach.
    (vii) Cancer of the small intestine.
    (viii) Cancer of the pancreas.
    (ix) Multiple myeloma.
    (x) Lymphomas (except Hodgkin's disease).
    (xi) Cancer of the bile ducts.
    (xii) Cancer of the gall bladder.
    (xiii) Primary liver cancer (except if cirrhosis or hepatitis B is 
indicated).
    (xiv) Cancer of the salivary gland.
    (xv) Cancer of the urinary tract.
    (xvi) Bronchiolo-alveolar carcinoma.
    (xvii) Cancer of the bone.
    (xviii) Cancer of the brain.
    (xix) Cancer of the colon.
    (xx) Cancer of the lung.
    (xxi) Cancer of the ovary.

    Note: For the purposes of this section, the term ``urinary tract'' 
means the kidneys, renal pelves, ureters, urinary bladder, and urethra.


(Authority: 38 U.S.C. 1112(c)(2))

    (3) For purposes of this section:
    (i) The term radiation-exposed veteran means either a veteran who 
while serving on active duty, or an individual who while a member of a 
reserve component of the Armed Forces during a period of active duty for 
training or inactive duty training, participated in a radiation-risk 
activity.
    (ii) The term radiation-risk activity means:
    (A) Onsite participation in a test involving the atmospheric 
detonation of a nuclear device.
    (B) The occupation of Hiroshima or Nagasaki, Japan, by United States 
forces during the period beginning on August 6, 1945, and ending on July 
1, 1946.
    (C) Internment as a prisoner of war in Japan (or service on active 
duty in Japan immediately following such internment) during World War II 
which resulted in an opportunity for exposure to ionizing radiation 
comparable to that of the United States occupation forces in Hiroshima 
or Nagasaki, Japan, during the period beginning on August 6, 1945, and 
ending on July 1, 1946.
    (D)(1) Service in which the service member was, as part of his or 
her official military duties, present during a total of at least 250 
days before February 1, 1992, on the grounds of a gaseous diffusion 
plant located in Paducah, Kentucky, Portsmouth, Ohio, or the area 
identified as K25 at Oak Ridge, Tennessee, if, during such service the 
veteran:
    (i) Was monitored for each of the 250 days of such service through 
the use of

[[Page 268]]

dosimetry badges for exposure at the plant of the external parts of 
veteran's body to radiation; or
    (ii) Served for each of the 250 days of such service in a position 
that had exposures comparable to a job that is or was monitored through 
the use of dosimetry badges; or
    (2) Service before January 1, 1974, on Amchitka Island, Alaska, if, 
during such service, the veteran was exposed to ionizing radiation in 
the performance of duty related to the Long Shot, Milrow, or Cannikin 
underground nuclear tests.
    (3) For purposes of paragraph (d)(3)(ii)(D)(1) of this section, the 
term ``day'' refers to all or any portion of a calendar day.
    (E) Service in a capacity which, if performed as an employee of the 
Department of Energy, would qualify the individual for inclusion as a 
member of the Special Exposure Cohort under section 3621(14) of the 
Energy Employees Occupational Illness Compensation Program Act of 2000 
(42 U.S.C. 7384l(14)).
    (iii) The term atmospheric detonation includes underwater nuclear 
detonations.
    (iv) The term onsite participation means:
    (A) During the official operational period of an atmospheric nuclear 
test, presence at the test site, or performance of official military 
duties in connection with ships, aircraft or other equipment used in 
direct support of the nuclear test.
    (B) During the six month period following the official operational 
period of an atmospheric nuclear test, presence at the test site or 
other test staging area to perform official military duties in 
connection with completion of projects related to the nuclear test 
including decontamination of equipment used during the nuclear test.
    (C) Service as a member of the garrison or maintenance forces on 
Eniwetok during the periods June 21, 1951, through July 1, 1952, August 
7, 1956, through August 7, 1957, or November 1, 1958, through April 30, 
1959.
    (D) Assignment to official military duties at Naval Shipyards 
involving the decontamination of ships that participated in Operation 
Crossroads.
    (v) For tests conducted by the United States, the term operational 
period means:
    (A) For Operation TRINITY the period July 16, 1945 through August 6, 
1945.
    (B) For Operation CROSSROADS the period July 1, 1946 through August 
31, 1946.
    (C) For Operation SANDSTONE the period April 15, 1948 through May 
20, 1948.
    (D) For Operation RANGER the period January 27, 1951 through 
February 6, 1951.
    (E) For Operation GREENHOUSE the period April 8, 1951 through June 
20, 1951.
    (F) For Operation BUSTER-JANGLE the period October 22, 1951 through 
December 20, 1951.
    (G) For Operation TUMBLER-SNAPPER the period April 1, 1952 through 
June 20, 1952.
    (H) For Operation IVY the period November 1, 1952 through December 
31, 1952.
    (I) For Operation UPSHOT-KNOTHOLE the period March 17, 1953 through 
June 20, 1953.
    (J) For Operation CASTLE the period March 1, 1954 through May 31, 
1954.
    (K) For Operation TEAPOT the period February 18, 1955 through June 
10, 1955.
    (L) For Operation WIGWAM the period May 14, 1955 through May 15, 
1955.
    (M) For Operation REDWING the period May 5, 1956 through August 6, 
1956.
    (N) For Operation PLUMBBOB the period May 28, 1957 through October 
22, 1957.
    (O) For Operation HARDTACK I the period April 28, 1958 through 
October 31, 1958.
    (P) For Operation ARGUS the period August 27, 1958 through September 
10, 1958.
    (Q) For Operation HARDTACK II the period September 19, 1958 through 
October 31, 1958.
    (R) For Operation DOMINIC I the period April 25, 1962 through 
December 31, 1962.
    (S) For Operation DOMINIC II/PLOWSHARE the period July 6, 1962 
through August 15, 1962.
    (vi) The term ``occupation of Hiroshima or Nagasaki, Japan, by 
United States forces'' means official military

[[Page 269]]

duties within 10 miles of the city limits of either Hiroshima or 
Nagasaki, Japan, which were required to perform or support military 
occupation functions such as occupation of territory, control of the 
population, stabilization of the government, demilitarization of the 
Japanese military, rehabilitation of the infrastructure or deactivation 
and conversion of war plants or materials.
    (vii) Former prisoners of war who had an opportunity for exposure to 
ionizing radiation comparable to that of veterans who participated in 
the occupation of Hiroshima or Nagasaki, Japan, by United States forces 
shall include those who, at any time during the period August 6, 1945, 
through July 1, 1946:
    (A) Were interned within 75 miles of the city limits of Hiroshima or 
within 150 miles of the city limits of Nagasaki, or
    (B) Can affirmatively show they worked within the areas set forth in 
paragraph (d)(3)(vii)(A) of this section although not interned within 
those areas, or
    (C) Served immediately following internment in a capacity which 
satisfies the definition in paragraph (d)(3)(vi) of this section, or
    (D) Were repatriated through the port of Nagasaki.


(Authority: 38 U.S.C. 1110, 1112, 1131)

    (e) Disease associated with exposure to certain herbicide agents. If 
a veteran was exposed to an herbicide agent during active military, 
naval, or air service, the following diseases shall be service-connected 
if the requirements of Sec.  3.307(a)(6) are met even though there is no 
record of such disease during service, provided further that the 
rebuttable presumption provisions of Sec.  3.307(d) are also satisfied.

AL amyloidosis
Chloracne or other acneform disease consistent with chloracne
Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset 
diabetes)
Hodgkin's disease
Ischemic heart disease (including, but not limited to, acute, subacute, 
and old myocardial infarction; atherosclerotic cardiovascular disease 
including coronary artery disease (including coronary spasm) and 
coronary bypass surgery; and stable, unstable and Prinzmetal's angina)
All chronic B-cell leukemias (including, but not limited to, hairy-cell 
leukemia and chronic lymphocytic leukemia)
Multiple myeloma
Non-Hodgkin's lymphoma
Parkinson's disease
Early-onset peripheral neuropathy
Porphyria cutanea tarda
Prostate cancer
Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea)
Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's 
sarcoma, or mesothelioma)

    Note 1: The term ``soft-tissue sarcoma'' includes the following:
Adult fibrosarcoma
Dermatofibrosarcoma protuberans
Malignant fibrous histiocytoma
Liposarcoma
Leiomyosarcoma
Epithelioid leiomyosarcoma (malignant leiomyoblastoma)
Rhabdomyosarcoma
Ectomesenchymoma
Angiosarcoma (hemangiosarcoma and lymphangiosarcoma)
Proliferating (systemic) angioendotheliomatosis
Malignant glomus tumor
Malignant hemangiopericytoma
Synovial sarcoma (malignant synovioma)
Malignant giant cell tumor of tendon sheath
Malignant schwannoma, including malignant schwannoma with 
rhabdomyoblastic differentiation (malignant Triton tumor), glandular and 
epithelioid malignant schwannomas
Malignant mesenchymoma
Malignant granular cell tumor
Alveolar soft part sarcoma
Epithelioid sarcoma
Clear cell sarcoma of tendons and aponeuroses
Extraskeletal Ewing's sarcoma
Congenital and infantile fibrosarcoma
Malignant ganglioneuroma
    Note 2: For purposes of this section, the term ischemic heart 
disease does not include hypertension or peripheral manifestations of 
arteriosclerosis such as peripheral vascular disease or stroke, or any 
other condition that does not qualify within the generally accepted 
medical definition of Ischemic heart disease.
    (f) Disease associated with exposure to contaminants in the water 
supply at Camp Lejeune. If a veteran, or former reservist or member of 
the National Guard, was exposed to contaminants in the water supply at 
Camp Lejeune during military service and the exposure meets the 
requirements of Sec.  3.307(a)(7),

[[Page 270]]

the following diseases shall be service-connected even though there is 
no record of such disease during service, subject to the rebuttable 
presumption provisions of Sec.  3.307(d).
    (1) Kidney cancer.
    (2) Liver cancer.
    (3) Non-Hodgkin's lymphoma.
    (4) Adult leukemia.
    (5) Multiple myeloma.
    (6) Parkinson's disease.
    (7) Aplastic anemia and other myelodysplastic syndromes.
    (8) Bladder cancer.

(Authority: 38 U.S.C. 501(a) and 1112(b))

[41 FR 55873, Dec. 23, 1976]

    Editorial Note: For Federal Register citations affecting Sec.  
3.309, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  3.310  Disabilities that are proximately due to, or aggravated by,
service-connected disease or injury.

    (a) General. Except as provided in Sec.  3.300(c), disability which 
is proximately due to or the result of a service-connected disease or 
injury shall be service connected. When service connection is thus 
established for a secondary condition, the secondary condition shall be 
considered a part of the original condition.
    (b) Aggravation of nonservice-connected disabilities. Any increase 
in severity of a nonservice-connected disease or injury that is 
proximately due to or the result of a service-connected disease or 
injury, and not due to the natural progress of the nonservice-connected 
disease, will be service connected. However, VA will not concede that a 
nonservice-connected disease or injury was aggravated by a service-
connected disease or injury unless the baseline level of severity of the 
nonservice-connected disease or injury is established by medical 
evidence created before the onset of aggravation or by the earliest 
medical evidence created at any time between the onset of aggravation 
and the receipt of medical evidence establishing the current level of 
severity of the nonservice-connected disease or injury. The rating 
activity will determine the baseline and current levels of severity 
under the Schedule for Rating Disabilities (38 CFR part 4) and determine 
the extent of aggravation by deducting the baseline level of severity, 
as well as any increase in severity due to the natural progress of the 
disease, from the current level.


(Authority: 38 U.S.C. 1110 and 1131)

    (c) Cardiovascular disease. Ischemic heart disease or other 
cardiovascular disease developing in a veteran who has a service-
connected amputation of one lower extremity at or above the knee or 
service-connected amputations of both lower extremities at or above the 
ankles, shall be held to be the proximate result of the service-
connected amputation or amputations.
    (d) Traumatic brain injury. (1) In a veteran who has a service-
connected traumatic brain injury, the following shall be held to be the 
proximate result of the service-connected traumatic brain injury (TBI), 
in the absence of clear evidence to the contrary:
    (i) Parkinsonism, including Parkinson's disease, following moderate 
or severe TBI;
    (ii) Unprovoked seizures following moderate or severe TBI;
    (iii) Dementias of the following types: presenile dementia of the 
Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, 
if manifest within 15 years following moderate or severe TBI;
    (iv) Depression if manifest within 3 years of moderate or severe 
TBI, or within 12 months of mild TBI; or
    (v) Diseases of hormone deficiency that result from hypothalamo-
pituitary changes if manifest within 12 months of moderate or severe 
TBI.
    (2) Neither the severity levels nor the time limits in paragraph 
(d)(1) of this section preclude a finding of service connection for 
conditions shown by evidence to be proximately due to service-connected 
TBI. If a claim does not meet the requirements of paragraph (d)(1) with 
respect to the time of manifestation or the severity of the TBI, or 
both, VA will develop and decide the claim under generally applicable 
principles of service connection without regard to paragraph (d)(1).
    (3)(i) For purposes of this section VA will use the following table 
for determining the severity of a TBI:

[[Page 271]]



------------------------------------------------------------------------
            Mild                    Moderate               Severe
------------------------------------------------------------------------
Normal structural imaging...  Normal or abnormal    Normal or abnormal
                               structural imaging.   structural imaging.
LOC = 0-30 min..............  LOC  30    LOC  24
                               min and < 24 hours.   hrs.
                             -------------------------------------------
AOC = a moment up to 24 hrs.   AOC  24 hours. Severity based
                                           on other criteria.
                             -------------------------------------------
PTA = 0-1 day...............  PTA  1     PTA  7
                               and < 7 days.         days.
GCS = 13-15.................  GCS = 9-12..........  GCS = 3-8.
------------------------------------------------------------------------

    Note: The factors considered are:

    Structural imaging of the brain.
    LOC--Loss of consciousness.
    AOC--Alteration of consciousness/mental state.
    PTA--Post-traumatic amnesia.
    GCS--Glasgow Coma Scale. (For purposes of injury stratification, the 
Glasgow Coma Scale is measured at or after 24 hours.)
    (ii) The determination of the severity level under this paragraph is 
based on the TBI symptoms at the time of injury or shortly thereafter, 
rather than the current level of functioning. VA will not require that 
the TBI meet all the criteria listed under a certain severity level in 
order to classify the TBI at that severity level. If a TBI meets the 
criteria in more than one category of severity, then VA will rank the 
TBI at the highest level in which a criterion is met, except where the 
qualifying criterion is the same at both levels.

(Authority: 38 U.S.C. 501, 1110 and 1131)

[44 FR 50340, Aug. 28, 1979, as amended at 66 FR 18198, Apr. 6, 2001; 71 
FR 52747, Sept. 7, 2006; 78 FR 76208, Dec. 17, 2013]



Sec.  3.311  Claims based on exposure to ionizing radiation.

    (a) Determinations of exposure and dose--(1) Dose assessment. In all 
claims in which it is established that a radiogenic disease first became 
manifest after service and was not manifest to a compensable degree 
within any applicable presumptive period as specified in Sec.  3.307 or 
Sec.  3.309, and it is contended the disease is a result of exposure to 
ionizing radiation in service, an assessment will be made as to the size 
and nature of the radiation dose or doses. When dose estimates provided 
pursuant to paragraph (a)(2) of this section are reported as a range of 
doses to which a veteran may have been exposed, exposure at the highest 
level of the dose range reported will be presumed.


(Authority: 38 U.S.C. 501)

    (2) Request for dose information. Where necessary pursuant to 
paragraph (a)(1) of this section, dose information will be requested as 
follows:
    (i) Atmospheric nuclear weapons test participation claims. In claims 
based upon participation in atmospheric nuclear testing, dose data will 
in all cases be requested from the appropriate office of the Department 
of Defense.
    (ii) Hiroshima and Nagasaki occupation claims. In all claims based 
on participation in the American occupation of Hiroshima or Nagasaki, 
Japan, prior to July 1, 1946, dose data will be requested from the 
Department of Defense.
    (iii) Other exposure claims. In all other claims involving radiation 
exposure, a request will be made for any available records concerning 
the veteran's exposure to radiation. These records normally include but 
may not be limited to the veteran's Record of Occupational Exposure to 
Ionizing Radiation (DD Form 1141), if maintained, service medical 
records, and other records which may contain information pertaining to 
the veteran's radiation dose in service. All such records will be 
forwarded to the Under Secretary for Health, who will be responsible for 
preparation of a dose estimate, to the extent feasible, based on 
available methodologies.
    (3) Referral to independent expert. When necessary to reconcile a 
material difference between an estimate of dose, from a credible source, 
submitted by or on behalf of a claimant, and dose data derived from 
official military records, the estimates and supporting documentation 
shall be referred to an independent expert, selected by the Director of 
the National Institutes of Health, who shall prepare a separate

[[Page 272]]

radiation dose estimate for consideration in adjudication of the claim. 
For purposes of this paragraph:
    (i) The difference between the claimant's estimate and dose data 
derived from official military records shall ordinarily be considered 
material if one estimate is at least double the other estimate.
    (ii) A dose estimate shall be considered from a ``credible source'' 
if prepared by a person or persons certified by an appropriate 
professional body in the field of health physics, nuclear medicine or 
radiology and if based on analysis of the facts and circumstances of the 
particular claim.
    (4) Exposure. In cases described in paragraph (a)(2)(i) and (ii) of 
this section:
    (i) If military records do not establish presence at or absence from 
a site at which exposure to radiation is claimed to have occurred, the 
veteran's presence at the site will be conceded.
    (ii) Neither the veteran nor the veteran's survivors may be required 
to produce evidence substantiating exposure if the information in the 
veteran's service records or other records maintained by the Department 
of Defense is consistent with the claim that the veteran was present 
where and when the claimed exposure occurred.
    (b) Initial review of claims. (1) When it is determined:
    (i) A veteran was exposed to ionizing radiation as a result of 
participation in the atmospheric testing of nuclear weapons, the 
occupation of Hiroshima or Nagasaki, Japan, from September 1945 until 
July 1946, or other activities as claimed;
    (ii) The veteran subsequently developed a radiogenic disease; and
    (iii) Such disease first became manifest within the period specified 
in paragraph (b)(5) of this section; before its adjudication the claim 
will be referred to the Under Secretary for Benefits for further 
consideration in accordance with paragraph (c) of this section. If any 
of the foregoing 3 requirements has not been met, it shall not be 
determined that a disease has resulted from exposure to ionizing 
radiation under such circumstances.
    (2) For purposes of this section the term ``radiogenic disease'' 
means a disease that may be induced by ionizing radiation and shall 
include the following:
    (i) All forms of leukemia except chronic lymphatic (lymphocytic) 
leukemia;
    (ii) Thyroid cancer;
    (iii) Breast cancer;
    (iv) Lung cancer;
    (v) Bone cancer;
    (vi) Liver cancer;
    (vii) Skin cancer;
    (viii) Esophageal cancer;
    (ix) Stomach cancer;
    (x) Colon cancer;
    (xi) Pancreatic cancer;
    (xii) Kidney cancer;
    (xiii) Urinary bladder cancer;
    (xiv) Salivary gland cancer;
    (xv) Multiple myeloma;
    (xvi) Posterior subcapsular cataracts;
    (xvii) Non-malignant thyroid nodular disease;
    (xviii) Ovarian cancer;
    (xix) Parathyroid adenoma;
    (xx) Tumors of the brain and central nervous system;
    (xxi) Cancer of the rectum;
    (xxii) Lymphomas other than Hodgkin's disease;
    (xxiii) Prostate cancer; and
    (xxiv) Any other cancer.


(Authority: 38 U.S.C. 501)

    (3) Public Law 98-542 requires VA to determine whether sound medical 
and scientific evidence supports establishing a rule identifying 
polycythemia vera as a radiogenic disease. VA has determined that sound 
medical and scientific evidence does not support including polycythemia 
vera on the list of known radiogenic diseases in this regulation. Even 
so, VA will consider a claim based on the assertion that polycythemia 
vera is a radiogenic disease under the provisions of paragraph (b)(4) of 
this section.


(Authority: Pub. L. 98-542, section 5(b)(2)(A)(i), (iii)).

    (4) If a claim is based on a disease other than one of those listed 
in paragraph (b)(2) of this section, VA shall nevertheless consider the 
claim under the provisions of this section provided that the claimant 
has cited or submitted competent scientific or medical

[[Page 273]]

evidence that the claimed condition is a radiogenic disease.
    (5) For the purposes of paragraph (b)(1) of this section:
    (i) Bone cancer must become manifest within 30 years after exposure;
    (ii) Leukemia may become manifest at any time after exposure;
    (iii) Posterior subcapsular cataracts must become manifest 6 months 
or more after exposure; and
    (iv) Other diseases specified in paragraph (b)(2) of this section 
must become manifest 5 years or more after exposure.


(Authority: 38 U.S.C. 501; Pub. L. 98-542)

    (c) Review by Under Secretary for Benefits. (1) When a claim is 
forwarded for review pursuant to paragraph (b)(1) of this section, the 
Under Secretary for Benefits shall consider the claim with reference to 
the factors specified in paragraph (e) of this section and may request 
an advisory medical opinion from the Under Secretary for Health.
    (i) If after such consideration the Under Secretary for Benefits is 
convinced sound scientific and medical evidence supports the conclusion 
it is at least as likely as not the veteran's disease resulted from 
exposure to radiation in service, the Under Secretary for Benefits shall 
so inform the regional office of jurisdiction in writing. The Under 
Secretary for Benefits shall set forth the rationale for this 
conclusion, including an evaluation of the claim under the applicable 
factors specified in paragraph (e) of this section.
    (ii) If the Under Secretary for Benefits determines there is no 
reasonable possibility that the veteran's disease resulted from 
radiation exposure in service, the Under Secretary for Benefits shall so 
inform the regional office of jurisidiction in writing, setting forth 
the rationale for this conclusion.
    (2) If the Under Secretary for Benefits, after considering any 
opinion of the Under Secretary for Health, is unable to conclude whether 
it is at least as likely as not, or that there is no reasonable 
possibility, the veteran's disease resulted from radiation exposure in 
service, the Under Secretary for Benefits shall refer the matter to an 
outside consultant in accordance with paragraph (d) of this section.
    (3) For purposes of paragraph (c)(1) of this section, ``sound 
scientific evidence'' means observations, findings, or conclusions which 
are statistically and epidemiologically valid, are statistically 
significant, are capable of replication, and withstand peer review, and 
``sound medical evidence'' means observations, findings, or conclusions 
which are consistent with current medical knowledge and are so 
reasonable and logical as to serve as the basis of management of a 
medical condition.
    (d) Referral to outside consultants. (1) Referrals pursuant to 
paragraph (c) of this section shall be to consultants selected by the 
Under Secretary for Health from outside VA, upon the recommendation of 
the Director of the National Cancer Institute. The consultant will be 
asked to evaluate the claim and provide an opinion as to the likelihood 
the disease is a result of exposure as claimed.
    (2) The request for opinion shall be in writing and shall include a 
description of:
    (i) The disease, including the specific cell type and stage, if 
known, and when the disease first became manifest;
    (ii) The circumstances, including date, of the veteran's exposure;
    (iii) The veteran's age, gender, and pertinent family history;
    (iv) The veteran's history of exposure to known carcinogens, 
occupationally or otherwise;
    (v) Evidence of any other effects radiation exposure may have had on 
the veteran; and
    (vi) Any other information relevant to determination of causation of 
the veteran's disease.

The Under Secretary for Benefits shall forward, with the request, copies 
of pertinent medical records and, where available, dose assessments from 
official sources, from credible sources as defined in paragraph 
(a)(3)(ii) of this section, and from an independent expert pursuant to 
paragraph (a)(3) of this section.
    (3) The consultant shall evaluate the claim under the factors 
specified in paragraph (e) of this section and respond in writing, 
stating whether it is

[[Page 274]]

either likely, unlikely, or approximately as likely as not the veteran's 
disease resulted from exposure to ionizing radiation in service. The 
response shall set forth the rationale for the consultant's conclusion, 
including the consultant's evaluation under the applicable factors 
specified in paragraph (e) of this section. The Under Secretary for 
Benefits shall review the consultant's response and transmit it with any 
comments to the regional office of jurisdiction for use in adjudication 
of the claim.
    (e) Factors for consideration. Factors to be considered in 
determining whether a veteran's disease resulted from exposure to 
ionizing radiation in service include:
    (1) The probable dose, in terms of dose type, rate and duration as a 
factor in inducing the disease, taking into account any known 
limitations in the dosimetry devices employed in its measurement or the 
methodologies employed in its estimation;
    (2) The relative sensitivity of the involved tissue to induction, by 
ionizing radiation, of the specific pathology;
    (3) The veteran's gender and pertinent family history;
    (4) The veteran's age at time of exposure;
    (5) The time-lapse between exposure and onset of the disease; and
    (6) The extent to which exposure to radiation, or other carcinogens, 
outside of service may have contributed to development of the disease.
    (f) Adjudication of claim. The determination of service connection 
will be made under the generally applicable provisions of this part, 
giving due consideration to all evidence of record, including any 
opinion provided by the Under Secretary for Health or an outside 
consultant, and to the evaluations published pursuant to Sec.  1.17 of 
this title. With regard to any issue material to consideration of a 
claim, the provisions of Sec.  3.102 of this title apply.
    (g) Willful misconduct and supervening cause. In no case will 
service connection be established if the disease is due to the veteran's 
own willful misconduct, or if there is affirmative evidence to establish 
that a supervening, nonservice-related condition or event is more likely 
the cause of the disease.

(Authority: Pub. L. 98-542)

[50 FR 34459, Aug. 26, 1985, as amended at 54 FR 42803, Oct. 18, 1989; 
58 FR 16359, Mar. 26, 1993. Redesignated at 59 FR 5107, Feb. 3, 1994, 
and amended at 59 FR 45975, Sept. 6, 1994; 60 FR 9628, Feb. 21, 1995; 60 
FR 53277, Oct. 13, 1995; 63 FR 50994, Sept. 24, 1998; 67 FR 6871, Feb. 
14, 2002]



Sec.  3.312  Cause of death.

    (a) General. The death of a veteran will be considered as having 
been due to a service-connected disability when the evidence establishes 
that such disability was either the principal or a contributory cause of 
death. The issue involved will be determined by exercise of sound 
judgment, without recourse to speculation, after a careful analysis has 
been made of all the facts and circumstances surrounding the death of 
the veteran, including, particularly, autopsy reports.
    (b) Principal cause of death. The service-connected disability will 
be considered as the principal (primary) cause of death when such 
disability, singly or jointly with some other condition, was the 
immediate or underlying cause of death or was etiologically related 
thereto.
    (c) Contributory cause of death. (1) Contributory cause of death is 
inherently one not related to the principal cause. In determining 
whether the service-connected disability contributed to death, it must 
be shown that it contributed substantially or materially; that it 
combined to cause death; that it aided or lent assistance to the 
production of death. It is not sufficient to show that it casually 
shared in producing death, but rather it must be shown that there was a 
causal connection.
    (2) Generally, minor service-connected disabilities, particularly 
those of a static nature or not materially affecting a vital organ, 
would not be held to have contributed to death primarily due to 
unrelated disability. In the same category there would be included 
service-connected disease or injuries of any evaluation (even though 
evaluated as

[[Page 275]]

100 percent disabling) but of a quiescent or static nature involving 
muscular or skeletal functions and not materially affecting other vital 
body functions.
    (3) Service-connected diseases or injuries involving active 
processes affecting vital organs should receive careful consideration as 
a contributory cause of death, the primary cause being unrelated, from 
the viewpoint of whether there were resulting debilitating effects and 
general impairment of health to an extent that would render the person 
materially less capable of resisting the effects of other disease or 
injury primarily causing death. Where the service-connected condition 
affects vital organs as distinguished from muscular or skeletal 
functions and is evaluated as 100 percent disabling, debilitation may be 
assumed.
    (4) There are primary causes of death which by their very nature are 
so overwhelming that eventual death can be anticipated irrespective of 
coexisting conditions, but, even in such cases, there is for 
consideration whether there may be a reasonable basis for holding that a 
service-connected condition was of such severity as to have a material 
influence in accelerating death. In this situation, however, it would 
not generally be reasonable to hold that a service-connected condition 
accelerated death unless such condition affected a vital organ and was 
of itself of a progressive or debilitating nature.

    Cross References: Reasonable doubt. See Sec.  3.102. Service 
connection for mental unsoundness in suicide. See Sec.  3.302.

[26 FR 1582, Feb. 24, 1961, as amended at 54 FR 34981, Aug. 23, 1989; 54 
FR 42803, Oct. 18, 1989]



Sec.  3.313  Claims based on service in Vietnam.

    (a) Service in Vietnam. Service in Vietnam includes service in the 
waters offshore, or service in other locations if the conditions of 
service involved duty or visitation in Vietnam.
    (b) Service connection based on service in Vietnam. Service in 
Vietnam during the Vietnam Era together with the development of non-
Hodgkin's lymphoma manifested subsequent to such service is sufficient 
to establish service connection for that disease.

(Authority: 38 U.S.C. 501)

[55 FR 43124, Oct. 26, 1990]



Sec.  3.314  Basic pension determinations.

    (a) Prior to the Mexican border period. While pensions are granted 
based on certain service prior to the Mexican border period, the only 
rating factors in claims therefor are:
    (1) Claims based on service of less than 90 days in the Spanish-
American War require a rating determination as to whether the veteran 
was discharged or released from service for a service-connected 
disability or had at the time of separation from service a service-
connected disability, shown by official service records, which in 
medical judgment would have warranted a discharge for disability. 
Eligibility in such cases requires a finding that the disability was 
incurred in or aggravated by service in line of duty without benefit of 
presumptive provisions of law or Department of Veterans Affairs 
regulations.


(Authority: 38 U.S.C. 1512)

    (2) Veterans entitled to pension on the basis of service in the 
Spanish-American War may be entitled to an increased rate of pension if 
rated as being in need of regular aid and attendance. Veterans who have 
elected pension under Pub. L. 86-211 (73 Stat. 432) who are not rated as 
being in need of regular aid and attendance may be entitled to increased 
pension based on 100 percent permanent disability together with 
independent disability of 60 percent or more or by reason of being 
permanently housebound as provided in Sec.  3.351 (d).


(Authority: 38 U.S.C. 1502 (b), (c), 512)

    (b) Mexican border period and later war periods. Non-service-
connected disability and death pension may be paid based on service in 
the Mexican border period, World War I, World War II, the Korean 
conflict and the Vietnam era. Rating determinations in such claims will 
be required in the following situations:

[[Page 276]]

    (1) Claims based on service of less than 90 days may require a 
determination as to whether the veteran was discharged or released from 
service for a service-connected disability or had at the time of 
separation from service a service-connected disability, shown by 
official service records, which in medical judgment would have warranted 
a discharge for disability. Eligibility in such cases requires a finding 
that the disability was incurred in or aggravated by service in line of 
duty without benefit of presumptive provisions of law or Department of 
Veterans Affairs regulations (38 U.S.C. 1521(g)(2)) unless, in the case 
of death pension, the veteran was, at the time of death, receiving (or 
entitled to receive) compensation or retirement pay based upon a wartime 
service-connected disability.


(Authority: 38 U.S.C. 1541(a) and 1542(a))

    (2) Determinations of permanent total disability for pension 
purposes will be based on non-service-connected disability or combined 
non-service-connected and service-connected disabilities not the result 
of willful misconduct. However, for pension under Pub. L. 86-211 (73 
Stat. 432), permanent and total disability will be presumed where the 
veteran has attained age 65 or effective January 1, 1977, where the 
veteran became unemployable after age 65.


(Authority: 38 U.S.C. 1502(a), 1523(a))

    (3) Veterans entitled to nonservice-connected disability pension may 
be entitled to an increased rate of pension if rated as being in need of 
regular aid and attendance. Veterans entitled to protected pension or 
pension under Pub. L. 86-211 (73 Stat. 432) who are not rated as being 
in need of regular aid and attendance may be entitled to increased 
pension based on a 100 percent permanent disability together with 
independent disability of 60 percent or more or by reason of being 
permanently housebound as provided in Sec.  3.351 (d) or (e).

(Authority: 38 U.S.C. 1502 (b), (c), 1521)

[31 FR 4680, Mar. 19, 1966, as amended at 32 FR 13224, Sept. 19, 1967; 
36 FR 8446, May 6, 1971; 40 FR 56434, Dec. 3, 1975; 41 FR 56804, Dec. 
30, 1976; 61 FR 20438, May 7, 1996]



Sec.  3.315  Basic eligibility determinations; dependents, loans, 
education.

    (a) Child over 18 years. A child of a veteran may be considered a 
``child'' after age 18 for purposes of benefits under title 38, United 
States Code (except ch. 19 and sec. 8502(b) of ch. 85), if found by a 
rating determination to have become, prior to age 18, permanently 
incapable of self-support.


(Authority: 38 U.S.C. 101(4)(B))

    (b) Loans. If a veteran of World War II the Korean conflict or the 
Vietnam era had less than 90 days of service, or if a veteran who served 
after July 25, 1947, and prior to June 27, 1950, or after January 31, 
1955, and prior to August 5, 1964, or after May 7, 1975, has less than 
181 days of service on active duty as defined in Sec. Sec.  36.4301 and 
36.4501, eligibility of the veteran for a loan under 38 U.S.C. ch. 37 
requires a determination that the veteran was discharged or released 
because of a service-connected disability or that the official service 
department records show that he or she had at the time of separation 
from service a service-connected disability which in medical judgment 
would have warranted a discharge for disability. These determinations 
are subject to the presumption of incurrence under Sec.  3.304(b). 
Determinations based on World War II, Korean conflict and Vietnam era 
service are also subject to the presumption of aggravation under Sec.  
3.306(b) while determination based on service on or after February 1, 
1955, and before August 5, 1964, or after May 7, 1975, are subject to 
the presumption of aggravation under Sec.  3.306 (a) and (c). The 
provisions of this paragraph are also applicable, regardless of length 
of service, in determining eligibility to the maximum period of 
entitlement based on discharge or release for a service-connected 
disability. (See also the minimum service requirements of Sec.  3.12a.)


(Authority: 38 U.S.C. 3702, 3707)

    (c) Veterans' educational assistance. (1) A determination is 
required as to whether a veteran was discharged or released from active 
duty service because of a service-connected disability

[[Page 277]]

(or whether the official service department records show that the 
veteran had at time of separation from service a service-connected 
disability which in medical judgment would have warranted discharge for 
disability) whenever any of the following circumstances exist:
    (i) The veteran applies for benefits under 38 U.S.C. chapter 32, the 
minimum active duty service requirements of 38 U.S.C. 5303A apply to him 
or her, and the veteran would be eligible for such benefits only if--
    (A) He or she was discharged or released from active duty for a 
disability incurred or aggravated in line of duty, or
    (B) He or she has a disability that VA has determined to be 
compensable under 38 U.S.C. chapter 11; or
    (ii) The veteran applies for benefits under 38 U.S.C. chapter 30 
and--
    (A) The evidence of record does not clearly show either that the 
veteran was discharged or released from active duty for disability or 
that the veteran's discharge or release from active duty was unrelated 
to disability, and
    (B) The veteran is eligible for basic educational assistance except 
for the minimum length of active duty service requirements of Sec.  
21.7042(a) or Sec.  21.7044(a) of this chapter.
    (2) A determination is required as to whether a veteran was 
discharged or released from service in the Selected Reserve for a 
service-connected disability or for a medical condition which preexisted 
the veteran's having become a member of the Selected Reserve and which 
VA determines is not service connected when the veteran applies for 
benefits under 38 U.S.C. chapter 30 and--
    (i) Either the veteran would be eligible for basic educational 
assistance under that chapter only if he or she was discharged from the 
Selected Reserve for a service-connected disability, or for a medical 
condition which preexisted the veteran's having become a member of the 
Selected Reserve and which VA finds is not service connected, or
    (ii) The veteran is entitled to basic educational assistance and 
would be entitled to receive it at the rates stated in Sec.  21.7136(a) 
or Sec.  21.7137(a) of this chapter only if he or she was discharged 
from the Selected Reserve for a service-connected disability or for a 
medical condition which preexisted the veteran's having become a member 
of the Selected Reserve and which VA finds is not service connected.
    (3) A determination is required as to whether a reservist has been 
unable to pursue a program of education due to a disability which has 
been incurred in or aggravated by service in the Selected Reserve when--
    (i) The reservist is otherwise entitled to educational assistance 
under 10 U.S.C. chapter 1606, and
    (ii) He or she applies for an extension of his or her eligibility 
period.
    (4) The determinations required by paragraphs (c)(1) through (c)(3) 
of this section are subject to the presumptions of incurrence under 
Sec.  3.304(b) and aggravation under Sec.  3.306 (a) and (c) of this 
part, based on service rendered after May 7, 1975.

(Authority: 38 U.S.C. 3011(a)(1)(A)(ii), 3012(b)(1), 3202(1)(A), 10 
U.S.C. 16133(b))

[38 FR 871, Jan. 5, 1973, as amended at 42 FR 22869, May 5, 1977; 50 FR 
53315, Dec. 31, 1985; 51 FR 1510, Jan. 14, 1986; 55 FR 25974, June 26, 
1990; 61 FR 67950, Dec. 26, 1996]



Sec.  3.316  Claims based on chronic effects of exposure to mustard gas
and Lewisite.

    (a) Except as provided in paragraph (b) of this section, exposure to 
the specified vesicant agents during active military service under the 
circumstances described below together with the subsequent development 
of any of the indicated conditions is sufficient to establish service 
connection for that condition:
    (1) Full-body exposure to nitrogen or sulfur mustard during active 
military service together with the subsequent development of chronic 
conjunctivitis, keratitis, corneal opacities, scar formation, or the 
following cancers: Nasopharyngeal; laryngeal; lung (except 
mesothelioma); or squamous cell carcinoma of the skin.
    (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite 
during active military service together with the subsequent development 
of a chronic

[[Page 278]]

form of laryngitis, bronchitis, emphysema, asthma or chronic obstructive 
pulmonary disease.
    (3) Full-body exposure to nitrogen mustard during active military 
service together with the subsequent development of acute nonlymphocytic 
leukemia.
    (b) Service connection will not be established under this section if 
the claimed condition is due to the veteran's own willful misconduct 
(See Sec.  3.301(c)) or there is affirmative evidence that establishes a 
nonservice-related supervening condition or event as the cause of the 
claimed condition (See Sec.  3.303).

[59 FR 42499, Aug. 18, 1994]



Sec.  3.317  Compensation for certain disabilities occurring in Persian
Gulf veterans.

    (a) Compensation for disability due to undiagnosed illness and 
medically unexplained chronic multisymptom illnesses. (1) Except as 
provided in paragraph (a)(7) of this section, VA will pay compensation 
in accordance with chapter 11 of title 38, United States Code, to a 
Persian Gulf veteran who exhibits objective indications of a qualifying 
chronic disability, provided that such disability:
    (i) Became manifest either during active military, naval, or air 
service in the Southwest Asia theater of operations, or to a degree of 
10 percent or more not later than December 31, 2021; and
    (ii) By history, physical examination, and laboratory tests cannot 
be attributed to any known clinical diagnosis.
    (2)(i) For purposes of this section, a qualifying chronic disability 
means a chronic disability resulting from any of the following (or any 
combination of the following):
    (A) An undiagnosed illness;
    (B) A medically unexplained chronic multisymptom illness that is 
defined by a cluster of signs or symptoms, such as:
    (1) Chronic fatigue syndrome;
    (2) Fibromyalgia;
    (3) Functional gastrointestinal disorders (excluding structural 
gastrointestinal diseases).

    Note to paragraph (a)(2)(i)(B)(3): Functional gastrointestinal 
disorders are a group of conditions characterized by chronic or 
recurrent symptoms that are unexplained by any structural, endoscopic, 
laboratory, or other objective signs of injury or disease and may be 
related to any part of the gastrointestinal tract. Specific functional 
gastrointestinal disorders include, but are not limited to, irritable 
bowel syndrome, functional dyspepsia, functional vomiting, functional 
constipation, functional bloating, functional abdominal pain syndrome, 
and functional dysphagia. These disorders are commonly characterized by 
symptoms including abdominal pain, substernal burning or pain, nausea, 
vomiting, altered bowel habits (including diarrhea, constipation), 
indigestion, bloating, postprandial fullness, and painful or difficult 
swallowing. Diagnosis of specific functional gastrointestinal disorders 
is made in accordance with established medical principles, which 
generally require symptom onset at least 6 months prior to diagnosis and 
the presence of symptoms sufficient to diagnose the specific disorder at 
least 3 months prior to diagnosis.

    (ii) For purposes of this section, the term medically unexplained 
chronic multisymptom illness means a diagnosed illness without 
conclusive pathophysiology or etiology, that is characterized by 
overlapping symptoms and signs and has features such as fatigue, pain, 
disability out of proportion to physical findings, and inconsistent 
demonstration of laboratory abnormalities. Chronic multisymptom 
illnesses of partially understood etiology and pathophysiology, such as 
diabetes and multiple sclerosis, will not be considered medically 
unexplained.
    (3) For purposes of this section, ``objective indications of chronic 
disability'' include both ``signs,'' in the medical sense of objective 
evidence perceptible to an examining physician, and other, non-medical 
indicators that are capable of independent verification.
    (4) For purposes of this section, disabilities that have existed for 
6 months or more and disabilities that exhibit intermittent episodes of 
improvement and worsening over a 6-month period will be considered 
chronic. The 6-month period of chronicity will be measured from the 
earliest date on which the pertinent evidence establishes that the signs 
or symptoms of the disability first became manifest.
    (5) A qualifying chronic disability referred to in this section 
shall be rated using evaluation criteria from part 4 of this chapter for 
a disease or injury in

[[Page 279]]

which the functions affected, anatomical localization, or symptomatology 
are similar.
    (6) A qualifying chronic disability referred to in this section 
shall be considered service connected for purposes of all laws of the 
United States.
    (7) Compensation shall not be paid under this section for a chronic 
disability:
    (i) If there is affirmative evidence that the disability was not 
incurred during active military, naval, or air service in the Southwest 
Asia theater of operations; or
    (ii) If there is affirmative evidence that the disability was caused 
by a supervening condition or event that occurred between the veteran's 
most recent departure from active duty in the Southwest Asia theater of 
operations and the onset of the disability; or
    (iii) If there is affirmative evidence that the disability is the 
result of the veteran's own willful misconduct or the abuse of alcohol 
or drugs.
    (b) Signs or symptoms of undiagnosed illness and medically 
unexplained chronic multisymptom illnesses. For the purposes of 
paragraph (a)(1) of this section, signs or symptoms which may be 
manifestations of undiagnosed illness or medically unexplained chronic 
multisymptom illness include, but are not limited to:
    (1) Fatigue.
    (2) Signs or symptoms involving skin.
    (3) Headache.
    (4) Muscle pain.
    (5) Joint pain.
    (6) Neurological signs or symptoms.
    (7) Neuropsychological signs or symptoms.
    (8) Signs or symptoms involving the respiratory system (upper or 
lower).
    (9) Sleep disturbances.
    (10) Gastrointestinal signs or symptoms.
    (11) Cardiovascular signs or symptoms.
    (12) Abnormal weight loss.
    (13) Menstrual disorders.
    (c) Presumptive service connection for infectious diseases. (1) 
Except as provided in paragraph (c)(4) of this section, a disease listed 
in paragraph (c)(2) of this section will be service connected if it 
becomes manifest in a veteran with a qualifying period of service, 
provided the provisions of paragraph (c)(3) of this section are also 
satisfied.
    (2) The diseases referred to in paragraph (c)(1) of this section are 
the following:
    (i) Brucellosis.
    (ii) Campylobacter jejuni.
    (iii) Coxiella burnetii (Q fever).
    (iv) Malaria.
    (v) Mycobacterium tuberculosis.
    (vi) Nontyphoid Salmonella.
    (vii) Shigella.
    (viii) Visceral leishmaniasis.
    (ix) West Nile virus.
    (3) The diseases listed in paragraph (c)(2) of this section will be 
considered to have been incurred in or aggravated by service under the 
circumstances outlined in paragraphs (c)(3)(i) and (ii) of this section 
even though there is no evidence of such disease during the period of 
service.
    (i) With three exceptions, the disease must have become manifest to 
a degree of 10 percent or more within 1 year from the date of separation 
from a qualifying period of service as specified in paragraph (c)(3)(ii) 
of this section. Malaria must have become manifest to a degree of 10 
percent or more within 1 year from the date of separation from a 
qualifying period of service or at a time when standard or accepted 
treatises indicate that the incubation period commenced during a 
qualifying period of service. There is no time limit for visceral 
leishmaniasis or tuberculosis to have become manifest to a degree of 10 
percent or more.
    (ii) For purposes of this paragraph (c), the term qualifying period 
of service means a period of service meeting the requirements of 
paragraph (e) of this section or a period of active military, naval, or 
air service on or after September 19, 2001, in Afghanistan.
    (4) A disease listed in paragraph (c)(2) of this section shall not 
be presumed service connected:
    (i) If there is affirmative evidence that the disease was not 
incurred during a qualifying period of service; or
    (ii) If there is affirmative evidence that the disease was caused by 
a supervening condition or event that occurred between the veteran's 
most recent departure from a qualifying period

[[Page 280]]

of service and the onset of the disease; or
    (iii) If there is affirmative evidence that the disease is the 
result of the veteran's own willful misconduct or the abuse of alcohol 
or drugs.
    (d) Long-term health effects potentially associated with infectious 
diseases. (1) A report of the Institute of Medicine of the National 
Academy of Sciences has identified the following long-term health 
effects that potentially are associated with the infectious diseases 
listed in paragraph (c)(2) of this section. These health effects and 
diseases are listed alphabetically and are not categorized by the level 
of association stated in the National Academy of Sciences report (see 
Table to Sec.  3.317). If a veteran who has or had an infectious disease 
identified in column A also has a condition identified in column B as 
potentially related to that infectious disease, VA must determine, based 
on the evidence in each case, whether the column B condition was caused 
by the infectious disease for purposes of paying disability 
compensation. This does not preclude a finding that other manifestations 
of disability or secondary conditions were caused by an infectious 
disease.
    (2) If a veteran presumed service connected for one of the diseases 
listed in paragraph (c)(2) of this section is diagnosed with one of the 
diseases listed in column ``B'' in the table within the time period 
specified for the disease in the same table, if a time period is 
specified or, otherwise, at any time, VA will request a medical opinion 
as to whether it is at least as likely as not that the condition was 
caused by the veteran having had the associated disease in column ``A'' 
in that same table.

 Table to Sec.   3.317--Long-Term Health Effects Potentially Associated
                        With Infectious Diseases
------------------------------------------------------------------------
                                                      B
                 A                 -------------------------------------
                                                   Disease
------------------------------------------------------------------------
Brucellosis.......................   Arthritis.
                                     Cardiovascular,
                                     nervous, and respiratory system
                                     infections.
                                     Chronic
                                     meningitis and meningoencephalitis.
                                     Deafness.
                                     Demyelinating
                                     meningovascular syndromes.
                                     Episcleritis.
                                     Fatigue,
                                     inattention, amnesia, and
                                     depression.
                                     Guillain-
                                     Barr[eacute] syndrome.
                                     Hepatic
                                     abnormalities, including
                                     granulomatous hepatitis.
                                     Multifocal
                                     choroiditis.
                                     Myelitis-
                                     radiculoneuritis.
                                     Nummular
                                     keratitis.
                                     Papilledema.
                                     Optic neuritis.
                                    
                                     Orchioepididymitis and infections
                                     of the genitourinary system.
                                     Sensorineural
                                     hearing loss.
                                     Spondylitis.
                                     Uveitis.
Campylobacter jejuni..............   Guillain-
                                     Barr[eacute] syndrome if manifest
                                     within 2 months of the infection.
                                     Reactive
                                     Arthritis if manifest within 3
                                     months of the infection.
                                     Uveitis if
                                     manifest within 1 month of the
                                     infection.
Coxiella burnetii (Q fever).......   Chronic
                                     hepatitis.
                                     Endocarditis.
                                     Osteomyelitis.
                                     Post-Q-fever
                                     chronic fatigue syndrome.
                                     Vascular
                                     infection.
Malaria...........................   Demyelinating
                                     polyneuropathy.
                                     Guillain-
                                     Barr[eacute] syndrome.
                                     Hematologic
                                     manifestations (particularly anemia
                                     after falciparum malaria and
                                     splenic rupture after vivax
                                     malaria).
                                     Immune-complex
                                     glomerulonephritis.
                                     Neurologic
                                     disease, neuropsychiatric disease,
                                     or both.
                                     Ophthalmologic
                                     manifestations, particularly
                                     retinal hemorrhage and scarring.
                                     Plasmodium
                                     falciparum.
                                     Plasmodium
                                     malariae.
                                     Plasmodium ovale.
                                     Plasmodium vivax.
                                     Renal disease,
                                     especially nephrotic syndrome.
Mycobacterium tuberculosis........   Active
                                     tuberculosis.

[[Page 281]]

 
                                     Long-term adverse
                                     health outcomes due to irreversible
                                     tissue damage from severe forms of
                                     pulmonary and extrapulmonary
                                     tuberculosis and active
                                     tuberculosis.
Nontyphoid Salmonella.............   Reactive
                                     Arthritis if manifest within 3
                                     months of the infection.
Shigella..........................   Hemolytic-uremic
                                     syndrome if manifest within 1 month
                                     of the infection.
                                     Reactive
                                     Arthritis if manifest within 3
                                     months of the infection.
Visceral leishmaniasis............   Delayed
                                     presentation of the acute clinical
                                     syndrome.
                                     Post-kala-azar
                                     dermal leishmaniasis if manifest
                                     within 2 years of the infection.
                                     Reactivation of
                                     visceral leishmaniasis in the
                                     context of future
                                     immunosuppression.
West Nile virus...................   Variable
                                     physical, functional, or cognitive
                                     disability.
------------------------------------------------------------------------

    (e) Service. For purposes of this section:
    (1) The term Persian Gulf veteran means a veteran who served on 
active military, naval, or air service in the Southwest Asia theater of 
operations during the Persian Gulf War.
    (2) The Southwest Asia theater of operations refers to Iraq, Kuwait, 
Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, 
Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of 
Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace 
above these locations.

(Authority: 38 U.S.C. 1117, 1118)

[75 FR 59970, Sept. 29, 2010, as amended at 75 FR 61356, Oct. 5, 2010; 
75 FR 61997, Oct. 7, 2010; 76 FR 41698, July 15, 2011; 76 FR 81836, Dec. 
29, 2011; 81 FR 71384, Oct. 17, 2016]



Sec.  3.318  Presumptive service connection for amyotrophic lateral 
sclerosis.

    (a) Except as provided in paragraph (b) of this section, the 
development of amyotrophic lateral sclerosis manifested at any time 
after discharge or release from active military, naval, or air service 
is sufficient to establish service connection for that disease.
    (b) Service connection will not be established under this section:
    (1) If there is affirmative evidence that amyotrophic lateral 
sclerosis was not incurred during or aggravated by active military, 
naval, or air service;
    (2) If there is affirmative evidence that amyotrophic lateral 
sclerosis is due to the veteran's own willful misconduct; or
    (3) If the veteran did not have active, continuous service of 90 
days or more.

(Authority: 38 U.S.C. 501(a)(1))

[73 FR 54693, Sept. 23, 2008]



Sec. Sec.  3.319-3.320  [Reserved]

    Cross References: \1\

    Permanent and total disability ratings for pension purposes. See 
Sec.  3.342. Special monthly dependency and indemnity compensation, 
death compensation and pension ratings. See Sec.  3.351. Determination 
of permanent need for regular aid and attendance and ``permanently 
bedridden.'' See Sec.  3.352. Conditions which determine permanent 
incapacity for self-support. See Sec.  3.356.
---------------------------------------------------------------------------

    \1\ 39 FR 5315, Feb. 12, 1974.
---------------------------------------------------------------------------



Sec.  3.321  General rating considerations.

    (a) Use of rating schedule. The 1945 Schedule for Rating 
Disabilities will be used for evaluating the degree of disabilities in 
claims for disability compensation, disability and death pension, and in 
eligibility determinations. The provisions contained in the rating 
schedule will represent as far as can practicably be determined, the 
average impairment in earning capacity in civil occupations resulting 
from disability.


(Authority: 38 U.S.C. 1155)

    (b) Extra-schedular ratings in unusual cases--(1) Disability 
compensation. Ratings shall be based, as far as practicable, upon the 
average impairments of earning capacity with the additional proviso that 
the Secretary shall from time to time readjust this schedule of ratings 
in accordance with experience. To accord justice to the exceptional case 
where the schedular evaluation is

[[Page 282]]

inadequate to rate a single service-connected disability, the Director 
of Compensation Service or his or her delegate is authorized to approve 
on the basis of the criteria set forth in this paragraph (b), an extra-
schedular evaluation commensurate with the average impairment of earning 
capacity due exclusively to the disability. The governing norm in these 
exceptional cases is a finding by the Director of Compensation Service 
or delegatee that application of the regular schedular standards is 
impractical because the disability is so exceptional or unusual due to 
such related factors as marked interference with employment or frequent 
periods of hospitalization.
    (2) Pension. Where the evidence of record establishes that an 
applicant for pension who is basically eligible fails to meet the 
disability requirements based on the percentage standards of the rating 
schedule but is found to be unemployable by reason of his or her 
disability(ies), age, occupational background and other related factors, 
the following are authorized to approve on an extra-schedular basis a 
permanent and total disability rating for pension purposes: the Veterans 
Service Center Manager or the Pension Management Center Manager; or 
where regular schedular standards are met as of the date of the rating 
decision, the rating board.
    (3) Effective dates. The effective date of these extra-schedular 
evaluations granting or increasing benefits will be in accordance with 
Sec.  3.400(b)(1) and (2) as to original and supplemental claims and in 
accordance with Sec.  3.400(o) in claims for increased benefits.
    (c) Advisory opinion. Cases in which application of the schedule is 
not understood or the propriety of an extra-schedular rating is 
questionable may be submitted to Central Office for advisory opinion.

    Cross References: Effective dates; disability benefits. See Sec.  
3.400(b). Effective dates; increases. See Sec.  3.400(o).

[26 FR 1583, Feb. 24, 1961, as amended at 29 FR 1463, Jan. 29, 1964; 37 
FR 10442, May 23, 1972; 39 FR 5315, Feb. 12, 1974; 39 FR 32988, Sept. 
13, 1974; 40 FR 57459, Dec. 10, 1975; 61 FR 20727, May 8, 1996; 74 FR 
26959, June 5, 2009; 79 FR 2100, Jan. 13, 2014; 82 FR 57835, Dec. 8, 
2017; 84 FR 170, Jan. 18, 2019]



Sec.  3.322  Rating of disabilities aggravated by service.

    (a) Aggravation of preservice disability. In cases involving 
aggravation by active service, the rating will reflect only the degree 
of disability over and above the degree of disability existing at the 
time of entrance into active service, whether the particular condition 
was noted at the time of entrance into active service, or whether it is 
determined upon the evidence of record to have existed at that time. It 
is necessary to deduct from the present evaluation the degree, if 
ascertainable, of the disability existing at the time of entrance into 
active service, in terms of the rating schedule except that if the 
disability is total (100 percent) no deduction will be made. If the 
degree of disability at the time of entrance into service is not 
ascertainable in terms of the schedule, no deduction will be made.
    (b) Aggravation of service-connected disability. Where a disease or 
injury incurred in peacetime service is aggravated during service in a 
period of war, or conversely, where a disease or injury incurred in 
service during a period of war is aggravated during peacetime service, 
the entire disability flowing from the disease or injury will be service 
connected based on the war service.

    Cross References: Principles relating to service connection. See 
Sec.  3.303. Aggravation of preservice disability. See Sec.  3.306.

[26 FR 1583, Feb. 24, 1961]



Sec.  3.323  Combined ratings.

    (a) Compensation--(1) Same type of service. When there are two or 
more service-connected compensable disabilities a combined evaluation 
will be made following the tables and rules prescribed in the 1945 
Schedule for Rating Disabilities.
    (2) Wartime and peacetime service. Evaluation of wartime and 
peacetime service-connected compensable disabilities will be combined to 
provide for the payment of wartime rates of compensation. (38 U.S.C. 
1157) Effective July 1, 1973, it is immaterial whether the disabilities 
are wartime or peacetime service-connected since all disabilities are 
compensable under 38

[[Page 283]]

U.S.C. 1114 and 1115 on and after that date.
    (b) Pension--(1) Nonservice-connected disabilities. Evaluation of 
two or more nonservice-connected disabilities not the result of the 
veteran's own willful misconduct will be combined as provided in 
paragraph (a)(1) of this section.
    (2) Service-connected and nonservice-connected disabilities. 
Evaluations for service-connected disabilities may be combined with 
evaluations for disabilities not shown to be service connected and not 
the result of the veteran's own willful misconduct.

    Cross References: ``Willful misconduct.'' See Sec.  3.1(n). Pension. 
See Sec.  3.3. Line of duty and misconduct. See Sec.  3.301. Service 
connection for mental unsoundness in suicide. See Sec.  3.302.

[26 FR 1583, Feb. 24, 1961, as amended at 38 FR 21923, Aug. 14, 1973; 61 
FR 20438, May 7, 1996]



Sec.  3.324  Multiple noncompensable service-connected disabilities.

    Whenever a veteran is suffering from two or more separate permanent 
service-connected disabilities of such character as clearly to interfere 
with normal employability, even though none of the disabilities may be 
of compensable degree under the 1945 Schedule for Rating Disabilities 
the rating agency is authorized to apply a 10-percent rating, but not in 
combination with any other rating.

[40 FR 56435, Dec. 3, 1975]



Sec.  3.325  [Reserved]



Sec.  3.326  Examinations.

    For purposes of this section, the term examination includes periods 
of hospital observation when required by VA.
    (a) Where there is a claim for disability compensation or pension 
but medical evidence accompanying the claim is not adequate for rating 
purposes, a Department of Veterans Affairs examination will be 
authorized. This paragraph applies to original and supplemental claims 
as well as claims for increase submitted by a veteran, surviving spouse, 
parent, or child. Individuals for whom an examination has been scheduled 
are required to report for the examination.
    (b) Provided that it is otherwise adequate for rating purposes, any 
hospital report, or any examination report, from any government or 
private institution may be accepted for rating a claim without further 
examination. However, monetary benefits to a former prisoner of war will 
not be denied unless the claimant has been offered a complete physical 
examination conducted at a Department of Veterans Affairs hospital or 
outpatient clinic.
    (c) Provided that it is otherwise adequate for rating purposes, a 
statement from a private physician may be accepted for rating a claim 
without further examination.

(Authority: 38 U.S.C. 5107(a))

    Cross Reference: Failure to report for VA examination. See Sec.  
3.655.

[60 FR 52864, Oct. 11, 1995, as amended at 66 FR 45632, Aug. 29, 2001; 
84 FR 170, Jan. 18, 2019]



Sec.  3.327  Reexaminations.

    (a) General. Reexaminations, including periods of hospital 
observation, will be requested whenever VA determines there is a need to 
verify either the continued existence or the current severity of a 
disability. Generally, reexaminations will be required if it is likely 
that a disability has improved, or if evidence indicates there has been 
a material change in a disability or that the current rating may be 
incorrect. Individuals for whom reexaminations have been authorized and 
scheduled are required to report for such reexaminations. Paragraphs (b) 
and (c) of this section provide general guidelines for requesting 
reexaminations, but shall not be construed as limiting VA's authority to 
request reexaminations, or periods of hospital observation, at any time 
in order to ensure that a disability is accurately rated.


(Authority: 38 U.S.C. 501)

    (b) Compensation cases--(1) Scheduling reexaminations. Assignment of 
a prestabilization rating requires reexamination within the second 6 
months period following separation from service. Following initial 
Department of Veterans Affairs examination, or any scheduled future or 
other examination, reexamination, if in order, will be

[[Page 284]]

scheduled within not less than 2 years nor more than 5 years within the 
judgment of the rating board, unless another time period is elsewhere 
specified.
    (2) No periodic future examinations will be requested. In service-
connected cases, no periodic reexamination will be scheduled: (i) When 
the disability is established as static;
    (ii) When the findings and symptoms are shown by examinations 
scheduled in paragraph (b)(2)(i) of this section or other examinations 
and hospital reports to have persisted without material improvement for 
a period of 5 years or more;
    (iii) Where the disability from disease is permanent in character 
and of such nature that there is no likelihood of improvement;
    (iv) In cases of veterans over 55 years of age, except under unusual 
circumstances;
    (v) When the rating is a prescribed scheduled minimum rating; or
    (vi) Where a combined disability evaluation would not be affected if 
the future examination should result in reduced evaluation for one or 
more conditions.
    (c) Pension cases. In nonservice-connected cases in which the 
permanent total disability has been confirmed by reexamination or by the 
history of the case, or with obviously static disabilities, further 
reexaminations will not generally be requested. In other cases further 
examination will not be requested routinely and will be accomplished 
only if considered necessary based upon the particular facts of the 
individual case. In the cases of veterans over 55 years of age, 
reexamination will be requested only under unusual circumstances.

    Cross Reference: Failure to report for VA examination. See Sec.  
3.655.

[26 FR 1585, Feb. 24, 1961, as amended at 30 FR 11855, Sept. 16, 1965; 
36 FR 14467, Aug. 6, 1971; 55 FR 49521, Nov. 29, 1990; 60 FR 27409, May 
24, 1995]



Sec.  3.328  lndependent medical opinions.

    (a) General. When warranted by the medical complexity or controversy 
involved in a pending claim, an advisory medical opinion may be obtained 
from one or more medical experts who are not employees of VA. Opinions 
shall be obtained from recognized medical schools, universities, clinics 
or medical institutions with which arrangements for such opinions have 
been made, and an appropriate official of the institution shall select 
the individual expert(s) to render an opinion.
    (b) Requests. A request for an independent medical opinion in 
conjunction with a claim pending before VA may be initiated by the 
office having jurisdiction over the claim, by the claimant, or by his or 
her duly appointed representative. The request must be submitted in 
writing and must set forth in detail the reasons why the opinion is 
necessary. All such requests shall be submitted through the Veterans 
Service Center Manager or Pension Management Center Manager of the 
office having jurisdiction over the claim, and those requests which in 
the judgment of the Veterans Service Center Manager or Pension 
Management Center Manager merit consideration shall be referred to the 
Compensation Service or the Pension and Fiduciary Service for approval.
    (c) Approval. (1) Requests for independent medical opinions shall be 
approved when one of the following conditions is met:
    (i) The director of each Service from which a benefit is sought, or 
his or her designee, determines that the issue under consideration poses 
a medical problem of such complexity or controversy as to justify 
solicitation of an independent medical opinion; or
    (ii) The independent medical opinion is required to fulfill the 
instructions contained in a remand order from the Board of Veterans' 
Appeals.
    (2) A determination that an independent medical opinion is not 
warranted may be contested only as part of an appeal to the Board of 
Veterans' Appeals on the merits of the decision rendered on the primary 
issue by VA.
    (d) Notification. The Compensation Service or the Pension and 
Fiduciary Service shall notify the claimant when the request for an 
independent medical opinion has been approved with regard to his or her 
claim and shall furnish the claimant with a copy of the opinion when it 
is received. If, in the judgment

[[Page 285]]

of the Secretary, disclosure of the independent medical opinion would be 
harmful to the physical or mental health of the claimant, disclosure 
shall be subject to the special procedures set forth in Sec.  1.577 of 
this chapter.

(Authority: 38 U.S.C. 5109, 5701(b)(1); 5 U.S.C. 552a(f)(3))

[55 FR 18602, May 3, 1990, as amended at 79 FR 2100, Jan. 13, 2014; 84 
FR 170, Jan. 18, 2019]



Sec.  3.329  [Reserved]



Sec.  3.330  Resumption of rating when veteran subsequently reports for
Department of Veterans Affairs examination.

    Such ratings will be governed by the provisions of Sec.  3.158, 
``Abandoned Claims,'' and Sec.  3.655, ``Failure to report for 
Department of Veterans Affairs examination.'' The period following the 
termination or reduction for which benefits are precluded by the cited 
regulations will be stated in the rating. If the evidence is 
insufficient to evaluate disability during any period following the 
termination or reduction for which payments are not otherwise precluded, 
the rating will contain a notation reading ``Evidence insufficient to 
evaluate from _____ to ______.

    Cross Reference: Failure to report for Department of Veterans 
Affairs examination. See Sec.  3.655.

[29 FR 3623, Mar. 21, 1964]



Sec. Sec.  3.331-3.339  [Reserved]



Sec.  3.340  Total and permanent total ratings and unemployability.

    (a) Total disability ratings--(1) General. Total disability will be 
considered to exist when there is present any impairment of mind or body 
which is sufficient to render it impossible for the average person to 
follow a substantially gainful occupation. Total disability may or may 
not be permanent. Total ratings will not be assigned, generally, for 
temporary exacerbations or acute infectious diseases except where 
specifically prescribed by the schedule.
    (2) Schedule for rating disabilities. Total ratings are authorized 
for any disability or combination of disabilities for which the Schedule 
for Rating Disabilities prescribes a 100 percent evaluation or, with 
less disability, where the requirements of paragraph 16, page 5 of the 
rating schedule are present or where, in pension cases, the requirements 
of paragraph 17, page 5 of the schedule are met.
    (3) Ratings of total disability on history. In the case of 
disabilities which have undergone some recent improvement, a rating of 
total disability may be made, provided:
    (i) That the disability must in the past have been of sufficient 
severity to warrant a total disability rating;
    (ii) That it must have required extended, continuous, or 
intermittent hospitalization, or have produced total industrial 
incapacity for at least 1 year, or be subject to recurring, severe, 
frequent, or prolonged exacerbations; and
    (iii) That it must be the opinion of the rating agency that despite 
the recent improvement of the physical condition, the veteran will be 
unable to effect an adjustment into a substantially gainful occupation. 
Due consideration will be given to the frequency and duration of totally 
incapacitating exacerbations since incurrence of the original disease or 
injury, and to periods of hospitalization for treatment in determining 
whether the average person could have reestablished himself or herself 
in a substantially gainful occupation.
    (b) Permanent total disability. Permanence of total disability will 
be taken to exist when such impairment is reasonably certain to continue 
throughout the life of the disabled person. The permanent loss or loss 
of use of both hands, or of both feet, or of one hand and one foot, or 
of the sight of both eyes, or becoming permanently helpless or bedridden 
constitutes permanent total disability. Diseases and injuries of long 
standing which are actually totally incapacitating will be regarded as 
permanently and totally disabling when the probability of permanent 
improvement under treatment is remote. Permanent total disability 
ratings may not be granted as a result of any incapacity from acute 
infectious disease, accident, or injury, unless there is present one of 
the recognized combinations or permanent loss of use of extremities or 
sight, or the person is

[[Page 286]]

in the strict sense permanently helpless or bedridden, or when it is 
reasonably certain that a subsidence of the acute or temporary symptoms 
will be followed by irreducible totality of disability by way of 
residuals. The age of the disabled person may be considered in 
determining permanence.
    (c) Insurance ratings. A rating of permanent and total disability 
for insurance purposes will have no effect on ratings for compensation 
or pension.

[26 FR 1585, Feb. 24, 1961, as amended at 46 FR 47541, Sept. 29, 1981]



Sec.  3.341  Total disability ratings for compensation purposes.

    (a) General. Subject to the limitation in paragraph (b) of this 
section, total-disability compensation ratings may be assigned under the 
provisions of Sec.  3.340. However, if the total rating is based on a 
disability or combination of disabilities for which the Schedule for 
Rating Disabilities provides an evaluation of less than 100 percent, it 
must be determined that the service-connected disabilities are 
sufficient to produce unemployability without regard to advancing age.


(Authority: 38 U.S.C. 1155)

    (b) Incarcerated veterans. A total rating for compensation purposes 
based on individual unemployability which would first become effective 
while a veteran is incarcerated in a Federal, State or local penal 
institution for conviction of a felony, shall not be assigned during 
such period of incarceration. However, where a rating for individual 
unemployability exists prior to incarceration for a felony and routine 
review is required, the case will be reconsidered to determine if 
continued eligibility for such rating exists.


(Authority: 38 U.S.C. 5313(c))

    (c) Program for vocational rehabilitation. Each time a veteran is 
rated totally disabled on the basis of individual unemployability during 
the period beginning after January 31, 1985, the Vocational 
Rehabilitation and Employment Service will be notified so that an 
evaluation may be offered to determine whether the achievement of a 
vocational goal by the veteran is reasonably feasible.

(Authority: 38 U.S.C. 1163)

[46 FR 47541, Sept. 29, 1981, as amended at 50 FR 52774, Dec. 26, 1985; 
55 FR 17271, Apr. 24, 1990l; 58 FR 32445, June 10, 1993; 68 FR 34542, 
June 10, 2003]



Sec.  3.342  Permanent and total disability ratings for pension purposes.

    (a) General. Permanent total disability ratings for pension purposes 
are authorized for disabling conditions not the result of the veteran's 
own willful misconduct whether or not they are service connected.


(Authority: 38 U.S.C. 1502(a))

    (b) Criteria. In addition to the criteria for determining total 
disability and permanency of total disability contained in Sec.  3.340, 
the following special considerations apply in pension cases:
    (1) Permanent total disability pension ratings will be authorized 
for congenital, developmental, hereditary or familial conditions, 
provided the other requirements for entitlement are met.
    (2) The permanence of total disability will be established as of the 
earliest date consistent with the evidence in the case. Active pulmonary 
tuberculosis not otherwise established as permanently and totally 
disabling will be presumed so after 6 months' hospitalization without 
improvement. The same principle may be applied with other types of 
disabilities requiring hospitalization for indefinite periods. The need 
for hospitalization for periods shorter or longer than 6 months may be a 
proper basis for determining permanence. Where, in application of this 
principle, it is necessary to employ a waiting period to determine 
permanence of totality of disability and a report received at the end of 
such period shows the veteran's condition is unimproved, permanence may 
be established as of the date of entrance into the hospital. Similarly, 
when active pulmonary tuberculosis is improved after 6 months' 
hospitalization but still diagnosed as active after 12 months' 
hospitalization permanence will also be established as of the date of 
entrance into the hospital. In other cases the

[[Page 287]]

rating will be effective the date the evidence establishes permanence.
    (3) Special consideration must be given the question of permanence 
in the case of veterans under 40 years of age. For such veterans, 
permanence of total disability requires a finding that the end result of 
treatment and adjustment to residual handicaps (rehabilitation) will be 
permanent disability of the required degree precluding more than 
marginal employment. Severe diseases and injuries, including multiple 
fractures or the amputation of a single extremity, should not be taken 
to establish permanent and total disability until it is shown that the 
veteran after treatment and convalescence, has been unable to secure or 
follow employment because of the disability and through no fault of the 
veteran.
    (4) The following shall not be considered as evidence of 
employability:
    (i) Employment as a member-employer or similar employment obtained 
only in competition with disabled persons.
    (ii) Participation in, or the receipt of a distribution of funds as 
a result of participation in, a therapeutic or rehabilitation activity 
under 38 U.S.C. 1718.


(Authority: 38 U.S.C. 1718(f))

    (5) The authority granted the Secretary under 38 U.S.C. 1502(a)(2) 
to classify as permanent and total those diseases and disorders, the 
nature and extent of which, in the Secretary judgment, will justify such 
determination, will be exercised under Sec.  3.321(b).
    (c) Temporary program of vocational rehabilitation training for 
certain pension recipients. (1) When a veteran under age 45 is awarded 
disability pension during the period beginning on February 1, 1985, and 
ending on December 31, 1995, the Vocational Rehabilitation and 
Employment Division will be notified so that an evaluation may be made, 
as provided in Sec.  21.6050, to determine that veteran's potential for 
rehabilitation.
    (2) If a veteran secures employment within the scope of a vocational 
goal identified in his or her individualized written vocational 
rehabilitation plan, or in a related field which requires reasonably 
developed skills and the use of some or all of the training or services 
furnished the veteran under such plan, not later than one year after 
eligibility to counseling under Sec.  21.6040(b)(1) of this chapter 
expires, the veteran's permanent and total evaluation for pension 
purposes shall not be terminated by reason of the veteran's capacity to 
engage in such employment until the veteran has maintained that 
employment for a period of not less than 12 consecutive months.

(Authority: 38 U.S.C. 1524(c))

[26 FR 1586, Feb. 24, 1961, as amended at 26 FR 9674, Oct. 13, 1961; 29 
FR 3624, Mar. 21, 1964; 39 FR 14944, Apr. 18, 1974; 46 FR 47541, Sept. 
29, 1981; 50 FR 52775, Dec. 26, 1985; 53 FR 23235, June 21, 1988; 55 FR 
17271, Apr. 24, 1990; 56 FR 25044, June 3, 1991; 56 FR 65851, Dec. 19, 
1991; 58 FR 32445, June 10, 1993]



Sec.  3.343  Continuance of total disability ratings.

    (a) General. Total disability ratings, when warranted by the 
severity of the condition and not granted purely because of hospital, 
surgical, or home treatment, or individual unemployability will not be 
reduced, in the absence of clear error, without examination showing 
material improvement in physical or mental condition. Examination 
reports showing material improvement must be evaluated in conjunction 
with all the facts of record, and consideration must be given 
particularly to whether the veteran attained improvement under the 
ordinary conditions of life, i.e., while working or actively seeking 
work or whether the symptoms have been brought under control by 
prolonged rest, or generally, by following a regimen which precludes 
work, and, if the latter, reduction from total disability ratings will 
not be considered pending reexamination after a period of employment (3 
to 6 months).
    (b) Tuberculosis; compensation. In service-connected cases, 
evaluations for active or inactive tuberculosis will be governed by the 
Schedule for Rating Disabilities (part 4 of this chapter). Where in the 
opinion of the rating board the veteran at the expiration of the period 
during which a total rating is provided will not be able to maintain 
inactivity of the disease process under the ordinary conditions of life, 
the case will be submitted under Sec.  3.321.

[[Page 288]]

    (c) Individual unemployability. (1) In reducing a rating of 100 
percent service-connected disability based on individual 
unemployability, the provisions of Sec.  3.105(e) are for application 
but caution must be exercised in such a determination that actual 
employability is established by clear and convincing evidence. When in 
such a case the veteran is undergoing vocational rehabilitation, 
education or training, the rating will not be reduced by reason thereof 
unless there is received evidence of marked improvement or recovery in 
physical or mental conditions or of employment progress, income earned, 
and prospects of economic rehabilitation, which demonstrates 
affirmatively the veteran's capacity to pursue the vocation or 
occupation for which the training is intended to qualify him or her, or 
unless the physical or mental demands of the course are obviously 
incompatible with total disability. Neither participation in, nor the 
receipt of remuneration as a result of participation in, a therapeutic 
or rehabilitation activity under 38 U.S.C. 1718 shall be considered 
evidence of employability.


(Authority: 38 U.S.C. 1718(f))

    (2) If a veteran with a total disability rating for compensation 
purposes based on individual unemployability begins to engage in a 
substantially gainful occuption during the period beginning after 
January 1, 1985, the veteran's rating may not be reduced solely on the 
basis of having secured and followed such substantially gainful 
occupation unless the veteran maintains the occupation for a period of 
12 consecutive months. For purposes of this subparagraph, temporary 
interruptions in employment which are of short duration shall not be 
considered breaks in otherwise continuous employment.

(Authority: 38 U.S.C. 1163(a))

    Cross Reference: Protection, total disability. See Sec.  3.951(b).

[33 FR 16273, Nov. 6, 1968, as amended at 39 FR 14944, Apr. 29, 1974; 50 
FR 52775, Dec. 26, 1985; 53 FR 23236, June 21, 1988; 55 FR 17271, Apr. 
24, 1990; 57 FR 10426, Mar. 26, 1992; 58 FR 32445, June 10, 1993; 58 FR 
46865, Sept. 3, 1993]



Sec.  3.344  Stabilization of disability evaluations.

    (a) Examination reports indicating improvement. Rating agencies will 
handle cases affected by change of medical findings or diagnosis, so as 
to produce the greatest degree of stability of disability evaluations 
consistent with the laws and Department of Veterans Affairs regulations 
governing disability compensation and pension. It is essential that the 
entire record of examinations and the medical-industrial history be 
reviewed to ascertain whether the recent examination is full and 
complete, including all special examinations indicated as a result of 
general examination and the entire case history. This applies to 
treatment of intercurrent diseases and exacerbations, including hospital 
reports, bedside examinations, examinations by designated physicians, 
and examinations in the absence of, or without taking full advantage of, 
laboratory facilities and the cooperation of specialists in related 
lines. Examinations less full and complete than those on which payments 
were authorized or continued will not be used as a basis of reduction. 
Ratings on account of diseases subject to temporary or episodic 
improvement, e.g., manic depressive or other psychotic reaction, 
epilepsy, psychoneurotic reaction, arteriosclerotic heart disease, 
bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc., 
will not be reduced on any one examination, except in those instances 
where all the evidence of record clearly warrants the conclusion that 
sustained improvement has been demonstrated. Ratings on account of 
diseases which become comparatively symptom free (findings absent) after 
prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart 
disease, etc., will not be reduced on examinations reflecting the 
results of bed rest. Moreover, though material improvement in the 
physical or mental condition is clearly reflected the rating agency will 
consider whether the evidence makes it reasonably certain that the 
improvement will be maintained under the ordinary conditions of life. 
When syphilis of the central nervous system or alcoholic deterioration 
is diagnosed following a long prior history

[[Page 289]]

of psychosis, psychoneurosis, epilepsy, or the like, it is rarely 
possible to exclude persistence, in masked form, of the preceding 
innocently acquired manifestations. Rating boards encountering a change 
of diagnosis will exercise caution in the determination as to whether a 
change in diagnosis represents no more than a progression of an earlier 
diagnosis, an error in prior diagnosis or possibly a disease entity 
independent of the service-connected disability. When the new diagnosis 
reflects mental deficiency or personality disorder only, the possibility 
of only temporary remission of a super-imposed psychiatric disease will 
be borne in mind.
    (b) Doubtful cases. If doubt remains, after according due 
consideration to all the evidence developed by the several items 
discussed in paragraph (a) of this section, the rating agency will 
continue the rating in effect, citing the former diagnosis with the new 
diagnosis in parentheses, and following the appropriate code there will 
be added the reference ``Rating continued pending reexamination ___ 
months from this date, Sec.  3.344.'' The rating agency will determine 
on the basis of the facts in each individual case whether 18, 24 or 30 
months will be allowed to elapse before the reexamination will be made.
    (c) Disabilities which are likely to improve. The provisions of 
paragraphs (a) and (b) of this section apply to ratings which have 
continued for long periods at the same level (5 years or more). They do 
not apply to disabilities which have not become stabilized and are 
likely to improve. Reexaminations disclosing improvement, physical or 
mental, in these disabilities will warrant reduction in rating.

[26 FR 1586, Feb. 24, 1961; 58 FR 53660, Oct. 18, 1993]

                      Ratings for Special Purposes



Sec.  3.350  Special monthly compensation ratings.

    The rates of special monthly compensation stated in this section are 
those provided under 38 U.S.C. 1114.
    (a) Ratings under 38 U.S.C. 1114(k). Special monthly compensation 
under 38 U.S.C. 1114(k) is payable for each anatomical loss or loss of 
use of one hand, one foot, both buttocks, one or more creative organs, 
blindness of one eye having only light perception, deafness of both 
ears, having absence of air and bone conduction, complete organic 
aphonia with constant inability to communicate by speech or, in the case 
of a woman veteran, loss of 25% or more of tissue from a single breast 
or both breasts in combination (including loss by mastectomy or partial 
mastectomy), or following receipt of radiation treatment of breast 
tissue. This special compensation is payable in addition to the basic 
rate of compensation otherwise payable on the basis of degree of 
disability, provided that the combined rate of compensation does not 
exceed the monthly rate set forth in 38 U.S.C. 1114(l) when authorized 
in conjunction with any of the provisions of 38 U.S.C. 1114 (a) through 
(j) or (s). When there is entitlement under 38 U.S.C. 1114 (l) through 
(n) or an intermediate rate under (p) such additional allowance is 
payable for each such anatomical loss or loss of use existing in 
addition to the requirements for the basic rates, provided the total 
does not exceed the monthly rate set forth in 38 U.S.C. 1114(o). The 
limitations on the maximum compensation payable under this paragraph are 
independent of and do not preclude payment of additional compensation 
for dependents under 38 U.S.C. 1115, or the special allowance for aid 
and attendance provided by 38 U.S.C. 1114(r).
    (1) Creative organ. (i) Loss of a creative organ will be shown by 
acquired absence of one or both testicles (other than undescended 
testicles) or ovaries or other creative organ. Loss of use of one 
testicle will be established when examination by a board finds that:
    (a) The diameters of the affected testicle are reduced to one-third 
of the corresponding diameters of the paired normal testicle, or
    (b) The diameters of the affected testicle are reduced to one-half 
or less of the corresponding normal testicle and there is alteration of 
consistency so that the affected testicle is considerably harder or 
softer than the corresponding normal testicle; or
    (c) If neither of the conditions (a) or (b) is met, when a biopsy, 
recommended by a board including a

[[Page 290]]

genitourologist and accepted by the veteran, establishes the absence of 
spermatozoa.
    (ii) When loss or loss of use of a creative organ resulted from 
wounds or other trauma sustained in service, or resulted from operations 
in service for the relief of other conditions, the creative organ 
becoming incidentally involved, the benefit may be granted.
    (iii) Loss or loss of use traceable to an elective operation 
performed subsequent to service, will not establish entitlement to the 
benefit. If, however, the operation after discharge was required for the 
correction of a specific injury caused by a preceding operation in 
service, it will support authorization of the benefit. When the 
existence of disability is established meeting the above requirements 
for nonfunctioning testicle due to operation after service, resulting in 
loss of use, the benefit may be granted even though the operation is one 
of election. An operation is not considered to be one of election where 
it is advised on sound medical judgment for the relief of a pathological 
condition or to prevent possible future pathological consequences.
    (iv) Atrophy resulting from mumps followed by orchitis in service is 
service connected. Since atrophy is usually perceptible within 1 to 6 
months after infection subsides, an examination more than 6 months after 
the subsidence of orchitis demonstrating a normal genitourinary system 
will be considered in determining rebuttal of service incurrence of 
atrophy later demonstrated. Mumps not followed by orchitis in service 
will not suffice as the antecedent cause of subsequent atrophy for the 
purpose of authorizing the benefit.
    (2) Foot and hand. (i) Loss of use of a hand or a foot will be held 
to exist when no effective function remains other than that which would 
be equally well served by an amputation stump at the site of election 
below elbow or knee with use of a suitable prosthetic appliance. The 
determination will be made on the basis of the actual remaining 
function, whether the acts of grasping, manipulation, etc., in the case 
of the hand, or of balance, propulsion, etc., in the case of the foot, 
could be accomplished equally well by an amputation stump with 
prosthesis; for example:
    (a) Extremely unfavorable complete ankylosis of the knee, or 
complete ankylosis of two major joints of an extremity, or shortening of 
the lower extremity of 3\1/2\ inches or more, will constitute loss of 
use of the hand or foot involved.
    (b) Complete paralysis of the external popliteal nerve (common 
peroneal) and consequent footdrop, accompanied by characteristic organic 
changes including trophic and circulatory disturbances and other 
concomitants confirmatory of complete paralysis of this nerve, will be 
taken as loss of use of the foot.
    (3) Both buttocks. (i) Loss of use of both buttocks shall be deemed 
to exist when there is severe damage by disease or injury to muscle 
group XVII, bilateral, (diagnostic code 5317) and additional disability 
making it impossible for the disabled person, without assistance, to 
rise from a seated position and from a stooped position (fingers to toes 
position) and to maintain postural stability (the pelvis upon head of 
femur). The assistance may be done by the person's own hands or arms, 
and, in the matter of postural stability, by a special appliance.


(Authority: 38 U.S.C. 1114(k))

    (ii) Special monthly compensation for loss or loss of use of both 
lower extremities (38 U.S.C. 1114(l) through (n)) will not preclude 
additional compensation under 38 U.S.C. 1114(k) for loss of use of both 
buttocks where appropriate tests clearly substantiate that there is such 
additional loss.
    (4) Eye. Loss of use or blindness of one eye, having only light 
perception, will be held to exist when there is inability to recognize 
test letters at 1 foot and when further examination of the eye reveals 
that perception of objects, hand movements, or counting fingers cannot 
be accomplished at 3 feet. Lesser extents of vision, particularly 
perception of objects, hand movements, or counting fingers at distances 
less than 3 feet is considered of negligible utility.

[[Page 291]]

    (5) Deafness. Deafness of both ears, having absence of air and bone 
conduction will be held to exist where examination in a Department of 
Veterans Affairs authorized audiology clinic under current testing 
criteria shows bilateral hearing loss is equal to or greater than the 
minimum bilateral hearing loss required for a maximum rating evaluation 
under the rating schedule.


(Authority: Pub. L. 88-20)

    (6) Aphonia. Complete organic aphonia will be held to exist where 
there is a disability of the organs of speech which constantly precludes 
communication by speech.


(Authority: Pub. L. 88-22)

    (b) Ratings under 38 U.S.C. 1114(l). The special monthly 
compensation provided by 38 U.S.C. 1114(l) is payable for anatomical 
loss or loss of use of both feet, one hand and one foot, blindness in 
both eyes with visual acuity of 5/200 or less or being permanently 
bedridden or so helpless as to be in need of regular aid and attendance.
    (1) Extremities. The criteria for loss and loss of use of an 
extremity contained in paragraph (a)(2) of this section are applicable.
    (2) Eyes, bilateral. 5/200 visual acuity or less bilaterally 
qualifies for entitlement under 38 U.S.C. 1114(l). However, evaluation 
of 5/200 based on acuity in excess of that degree but less than 10/200 
(Sec.  4.83 of this chapter), does not qualify. Concentric contraction 
of the field of vision beyond 5 degrees in both eyes is the equivalent 
of 5/200 visual acuity.
    (3) Need for aid and attendance. The criteria for determining that a 
veteran is so helpless as to be in need of regular aid and attendance 
are contained in Sec.  3.352(a).
    (4) Permanently bedridden. The criteria for rating are contained in 
Sec.  3.352(a). Where possible, determinations should be on the basis of 
permanently bedridden rather than for need of aid and attendance (except 
where 38 U.S.C. 1114(r) is involved) to avoid reduction during 
hospitalization where aid and attendance is provided in kind.
    (c) Ratings under 38 U.S.C. 1114(m). (1) The special monthly 
compensation provided by 38 U.S.C. 1114(m) is payable for any of the 
following conditions:
    (i) Anatomical loss or loss of use of both hands;
    (ii) Anatomical loss or loss of use of both legs at a level, or with 
complications, preventing natural knee action with prosthesis in place;
    (iii) Anatomical loss or loss of use of one arm at a level, or with 
complications, preventing natural elbow action with prosthesis in place 
with anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place;
    (iv) Blindness in both eyes having only light perception;
    (v) Blindness in both eyes leaving the veteran so helpless as to be 
in need of regular aid and attendance.
    (2) Natural elbow or knee action. In determining whether there is 
natural elbow or knee action with prosthesis in place, consideration 
will be based on whether use of the proper prosthetic appliance requires 
natural use of the joint, or whether necessary motion is otherwise 
controlled, so that the muscles affecting joint motion, if not already 
atrophied, will become so. If there is no movement in the joint, as in 
ankylosis or complete paralysis, use of prosthesis is not to be 
expected, and the determination will be as though there were one in 
place.
    (3) Eyes, bilateral. With visual acuity 5/200 or less or the vision 
field reduced to 5 degree concentric contraction in both eyes, 
entitlement on account of need for regular aid and attendance will be 
determined on the facts in the individual case.
    (d) Ratings under 38 U.S.C. 1114(n). The special monthly 
compensation provided by 38 U.S.C. 1114(n) is payable for any of the 
conditions which follow: Amputation is a prerequisite except for loss of 
use of both arms and blindness without light perception in both eyes. If 
a prosthesis cannot be worn at the present level of amputation but could 
be applied if there were a reamputation at a higher level, the 
requirements of this paragraph are not met; instead, consideration will 
be given to loss of natural elbow or knee action.

[[Page 292]]

    (1) Anatomical loss or loss of use of both arms at a level or with 
complications, preventing natural elbow action with prosthesis in place;
    (2) Anatomical loss of both legs so near the hip as to prevent use 
of a prosthetic appliance;
    (3) Anatomical loss of one arm so near the shoulder as to prevent 
use of a prosthetic appliance with anatomical loss of one leg so near 
the hip as to prevent use of a prosthetic appliance;
    (4) Anatomical loss of both eyes or blindness without light 
perception in both eyes.
    (e) Ratings under 38 U.S.C. 1114 (o). (1) The special monthly 
compensation provided by 38 U.S.C. 1114(o) is payable for any of the 
following conditions:
    (i) Anatomical loss of both arms so near the shoulder as to prevent 
use of a prosthetic appliance;
    (ii) Conditions entitling to two or more of the rates (no condition 
being considered twice) provided in 38 U.S.C. 1114(l) through (n);
    (iii) Bilateral deafness rated at 60 percent or more disabling (and 
the hearing impairment in either one or both ears is service connected) 
in combination with service-connected blindness with bilateral visual 
acuity 20/200 or less.
    (iv) Service-connected total deafness in one ear or bilateral 
deafness rated at 40 percent or more disabling (and the hearing 
impairment in either one of both ears is service-connected) in 
combination with service-connected blindness of both eyes having only 
light perception or less.
    (2) Paraplegia. Paralysis of both lower extremities together with 
loss of anal and bladder sphincter control will entitle to the maximum 
rate under 38 U.S.C. 1114(o), through the combination of loss of use of 
both legs and helplessness. The requirement of loss of anal and bladder 
sphincter control is met even though incontinence has been overcome 
under a strict regimen of rehabilitation of bowel and bladder training 
and other auxiliary measures.
    (3) Combinations. Determinations must be based upon separate and 
distinct disabilities. This requires, for example, that where a veteran 
who had suffered the loss or loss of use of two extremities is being 
considered for the maximum rate on account of helplessness requiring 
regular aid and attendance, the latter must be based on need resulting 
from pathology other than that of the extremities. If the loss or loss 
of use of two extremities or being permanently bedridden leaves the 
person helpless, increase is not in order on account of this 
helplessness. Under no circumstances will the combination of ``being 
permanently bedridden'' and ``being so helpless as to require regular 
aid and attendance'' without separate and distinct anatomical loss, or 
loss of use, of two extremities, or blindness, be taken as entitling to 
the maximum benefit. The fact, however, that two separate and distinct 
entitling disabilities, such as anatomical loss, or loss of use of both 
hands and both feet, result from a common etiological agent, for 
example, one injury or rheumatoid arthritis, will not preclude maximum 
entitlement.
    (4) Helplessness. The maximum rate, as a result of including 
helplessness as one of the entitling multiple disabilities, is intended 
to cover, in addition to obvious losses and blindness, conditions such 
as the loss of use of two extremities with absolute deafness and nearly 
total blindness or with severe multiple injuries producing total 
disability outside the useless extremities, these conditions being 
construed as loss of use of two extremities and helplessness.
    (f) Intermediate or next higher rate. An intermediate rate 
authorized by this paragraph shall be established at the arithmetic 
mean, rounded to the nearest dollar, between the two rates concerned.


(Authority: 38 U.S.C. 1114 (p))

    (1) Extremities. (i) Anatomical loss or loss of use of one foot with 
anatomical loss or loss of use of one leg at a level, or with 
complications preventing natural knee action with prosthesis in place, 
shall entitle to the rate between 38 U.S.C. 1114(l) and (m).
    (ii) Anatomical loss or loss of use of one foot with anatomical loss 
of one leg so near the hip as to prevent use of prosthetic appliance 
shall entitle to the rate under 38 U.S.C. 1114(m).
    (iii) Anatomical loss or loss of use of one foot with anatomical 
loss or loss of

[[Page 293]]

use of one arm at a level, or with complications, preventing natural 
elbow action with prosthesis in place, shall entitle to the rate between 
38 U.S.C. 1114(l) and (m).
    (iv) Anatomical loss or loss of use of one foot with anatomical loss 
or loss of use of one arm so near the shoulder as to prevent use of a 
prosthetic appliance shall entitle to the rate under 38 U.S.C. 1114(m).
    (v) Anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place 
with anatomical loss of one leg so near the hip as to prevent use of a 
prosthetic appliance, shall entitle to the rate between 38 U.S.C. 
1114(m) and (n).
    (vi) Anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place 
with anatomical loss or loss of use of one hand, shall entitle to the 
rate between 38 U.S.C. 1114 (l) and (m).
    (vii) Anatomical loss or loss of use of one leg at a level, or with 
complications, preventing natural knee action with prosthesis in place 
with anatomical loss of one arm so near the shoulder as to prevent use 
of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 
1114 (m) and (n).
    (viii) Anatomical loss of one leg so near the hip as to prevent use 
of a prosthetic appliance with anatomical loss or loss of use of one 
hand shall entitle to the rate under 38 U.S.C. 1114(m).
    (ix) Anatomical loss of one leg so near the hip as to prevent use of 
a prosthetic appliance with anatomical loss or loss of use of one arm at 
a level, or with complications, preventing natural elbow action with 
prosthesis in place, shall entitle to the rate between 38 U.S.C. 1114 
(m) and (n).
    (x) Anatomical loss or loss of use of one hand with anatomical loss 
or loss of use of one arm at a level, or with complications, preventing 
natural elbow action with prosthesis in place, shall entitle to the rate 
between 38 U.S.C. 1114 (m) and (n).
    (xi) Anatomical loss or loss of use of one hand with anatomical loss 
of one arm so near the shoulder as to prevent use of a prosthetic 
appliance shall entitle to the rate under 38 U.S.C. 1114(n).
    (xii) Anatomical loss or loss of use of one arm at a level, or with 
complications, preventing natural elbow action with prosthesis in place 
with anatomical loss of one arm so near the shoulder as to prevent use 
of a prosthetic appliance, shall entitle to the rate between 38 U.S.C. 
1114 (n) and (o).
    (2) Eyes, bilateral, and blindness in connection with deafness and/
or loss or loss of use of a hand or foot.
    (i) Blindness of one eye with 5/200 visual acuity or less and 
blindness of the other eye having only light perception will entitle to 
the rate between 38 U.S.C. 1114 (l) and (m).
    (ii) Blindness of one eye with 5/200 visual acuity or less and 
anatomical loss of, or blindness having no light

perception in the other eye, will entitle to a rate equal to 38 U.S.C. 
1114(m).
    (iii) Blindness of one eye having only light perception and 
anatomical loss of, or blindness having no light perception in the other 
eye, will entitle to a rate between 38 U.S.C. 1114 (m) and (n).
    (iv) Blindness in both eyes with visual acuity of 5/200 or less, or 
blindness in both eyes rated under subparagraph (2) (i) or (ii) of this 
paragraph, when accompanied by service-connected total deafness in one 
ear, will afford entitlement to the next higher intermediate rate of if 
the veteran is already entitled to an intermediate rate, to the next 
higher statutory rate under 38 U.S.C. 1114, but in no event higher than 
the rate for (o).
    (v) Blindness in both eyes having only light perception or less, or 
rated under subparagraph (2)(iii) of this paragraph, when accompanied by 
bilateral deafness (and the hearing impairment in either one or both 
ears is service-connected) rated at 10 or 20 percent disabling, will 
afford entitlement to the next higher intermediate rate, or if the 
veteran is already entitled to an intermediate rate, to the next higher 
statutory rate under 38 U.S.C. 1114, but in no event higher than the 
rate for (o).


(Authority: Sec. 112, Pub. L. 98-223)

    (vi) Blindness in both eyes rated under 38 U.S.C. 1114 (l), (m) or 
(n), or rated under subparagraphs (2)(i), (ii) or (iii) of this 
paragraph, when accompanied by bilaterial deafness rated at no less than 
30 percent, and the hearing

[[Page 294]]

impairment in one or both ears is service-connected, will afford 
entitlement to the next higher statutory rate under 38 U.S.C. 1114, or 
if the veteran is already entitled to an intermediate rate, to the next 
higher intermediate rate, but in no event higher than the rate for (o).


(Authority: 38 U.S.C. 1114(p))

    (vii) Blindness in both eyes rated under 38 U.S.C. 1114 (l), (m), or 
(n), or under the intermediate or next higher rate provisions of this 
subparagraph, when accompanied by:
    (A) Service-connected loss or loss of use of one hand, will afford 
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or, 
if the veteran is already entitled to an intermediate rate, to the next 
higher intermediate rate, but in no event higher than the rate for (o); 
or
    (B) Service-connected loss or loss of use of one foot which by 
itself or in combination with another compensable disability would be 
ratable at 50 percent or more, will afford entitlement to the next 
higher statutory rate under 38 U.S.C. 1114 or, if the veteran is already 
entitled to an intermediate rate, to the next higher intermediate rate, 
but in no event higher than the rate for (o); or
    (C) Service-connected loss or loss of use of one foot which is 
ratable at less than 50 percent and which is the only compensable 
disability other than bilateral blindness, will afford entitlement to 
the next higher intermediate rate or, if the veteran is already entitled 
to an intermediate rate, to the next higher statutory rate under 38 
U.S.C. 1114, but in no event higher than the rate for (o).


(Authority: 38 U.S.C. 1114(p))

    (3) Additional independent 50 percent disabilities. In addition to 
the statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the 
intermediate or next higher rate provisions outlined above, additional 
single permanent disability or combinations of permanent disabilities 
independently ratable at 50 percent or more will afford entitlement to 
the next higher intermediate rate or if already entitled to an 
intermediate rate to the next higher statutory rate under 38 U.S.C. 
1114, but not above the (o) rate. In the application of this 
subparagraph the disability or disabilities independently ratable at 50 
percent or more must be separate and distinct and involve different 
anatomical segments or bodily systems from the conditions establishing 
entitlement under 38 U.S.C. 1114 (l) through (n) or the intermediate 
rate provisions outlined above. The graduated ratings for arrested 
tuberculosis will not be utilized in this connection, but the permanent 
residuals of tuberculosis may be utilized.
    (4) Additional independent 100 percent ratings. In addition to the 
statutory rates payable under 38 U.S.C. 1114 (l) through (n) and the 
intermediate or next higher rate provisions outlined above additional 
single permanent disability independently ratable at 100 percent apart 
from any consideration of individual unemployability will afford 
entitlement to the next higher statutory rate under 38 U.S.C. 1114 or if 
already entitled to an intermediate rate to the next higher intermediate 
rate, but in no event higher than the rate for (o). In the application 
of this subparagraph the single permanent disability independently 
ratable at 100 percent must be separate and distinct and involve 
different anatomical segments or bodily systems from the conditions 
establishing entitlement under 38 U.S.C. 1114 (l) through (n) or the 
intermediate rate provisions outlined above.
    (i) Where the multiple loss or loss of use entitlement to a 
statutory or intermediate rate between 38 U.S.C. 1114 (l) and (o) is 
caused by the same etiological disease or injury, that disease or injury 
may not serve as the basis for the independent 50 percent or 100 percent 
unless it is so rated without regard to the loss or loss of use.
    (ii) The graduated ratings for arrested tuberculosis will not be 
utilized in this connection, but the permanent residuals of tuberculosis 
may be utilized.
    (5) Three extremities. Anatomical loss or loss of use, or a 
combination of anatomical loss and loss of use, of three extremities 
shall entitle a veteran to the next higher rate without regard to 
whether that rate is a statutory rate or an intermediate rate. The 
maximum

[[Page 295]]

monthly payment under this provision may not exceed the amount stated in 
38 U.S.C. 1114(p).
    (g) Inactive tuberculosis (complete arrest). The rating criteria for 
determining inactivity of tuberculosis are set out in Sec.  3.375.
    (1) For a veteran who was receiving or entitled to receive 
compensation for tuberculosis on August 19, 1968, the minimum monthly 
rate is $67. This minimum special monthly compensation is not to be 
combined with or added to any other disability compensation.
    (2) For a veteran who was not receiving or entitled to receive 
compensation for tuberculosis on August 19, 1968, the special monthly 
compensation authorized by paragraph (g)(1) of this section is not 
payable.
    (h) Special aid and attendance benefit; 38 U.S.C. 1114(r)--(1) 
Maximum compensation cases. A veteran receiving the maximum rate under 
38 U.S.C. 1114 (o) or (p) who is in need of regular aid and attendance 
or a higher level of care is entitled to an additional allowance during 
periods he or she is not hospitalized at United States Government 
expense. (See Sec.  3.552(b)(2) as to continuance following admission 
for hospitalization.) Determination of this need is subject to the 
criteria of Sec.  3.352. The regular or higher level aid and attendance 
allowance is payable whether or not the need for regular aid and 
attendance or a higher level of care was a partial basis for entitlement 
to the maximum rate under 38 U.S.C. 1114 (o) or (p), or was based on an 
independent factual determination.
    (2) Entitlement to compensation at the intermediate rate between 38 
U.S.C. 1114 (n) and (o) plus special monthly compensation under 38 
U.S.C. 1114(k). A veteran receiving compensation at the intermediate 
rate between 38 U.S.C. 1114 (n) and (o) plus special monthly 
compensation under 38 U.S.C. 1114(k) who establishes a factual need for 
regular aid and attendance or a higher level of care, is also entitled 
to an additional allowance during periods he or she is not hospitalized 
at United States Government expense. (See Sec.  3.552(b)(2) as to 
continuance following admission for hospitalization.) Determination of 
the factual need for aid and attendance is subject to the criteria of 
Sec.  3.352:
    (3) Amount of the allowance. The amount of the additional allowance 
payable to a veteran in need of regular aid and attendance is specified 
in 38 U.S.C. 1114(r)(1). The amount of the additional allowance payable 
to a veteran in need of a higher level of care is specified in 38 U.S.C. 
1114(r)(2). The higher level aid and attendance allowance authorized by 
38 U.S.C. 1114(r)(2) is payable in lieu of the regular aid and 
attendance allowance authorized by 38 U.S.C. 1114(r)(1).
    (i) Total plus 60 percent, or housebound; 38 U.S.C. 1114(s). The 
special monthly compensation provided by 38 U.S.C. 1114(s) is payable 
where the veteran has a single service-connected disability rated as 100 
percent and,
    (1) Has additional service-connected disability or disabilities 
independently ratable at 60 percent, separate and distinct from the 100 
percent service-connected disability and involving different anatomical 
segments or bodily systems, or
    (2) Is permanently housebound by reason of service-connected 
disability or disabilities. This requirement is met when the veteran is 
substantially confined as a direct result of service-connected 
disabilities to his or her dwelling and the immediate premises or, if 
institutionalized, to the ward or clinical areas, and it is reasonably 
certain that the disability or disabilities and resultant confinement 
will continue throughout his or her lifetime.
    (j) Special aid and attendance benefit for residuals of traumatic 
brain injury (38 U.S.C. 1114(t)). The special monthly compensation 
provided by 38 U.S.C. 1114(t) is payable to a veteran who, as the result 
of service-connected disability, is in need of regular aid and 
attendance for the residuals of traumatic brain injury, is not eligible 
for compensation under 38 U.S.C. 1114(r)(2), and in the absence of such 
regular aid and attendance would require hospitalization, nursing home 
care, or other residential institutional care. Determination of this 
need is subject to the criteria of Sec.  3.352.
    (1) A veteran described in this paragraph (j) shall be entitled to 
the

[[Page 296]]

amount equal to the compensation authorized under 38 U.S.C. 1114(o) or 
the maximum rate authorized under 38 U.S.C. 1114(p) and, in addition to 
such compensation, a monthly allowance equal to the rate described in 38 
U.S.C. 1114(r)(2) during periods he or she is not hospitalized at United 
States Government expense. (See Sec.  3.552(b)(2) as to continuance 
following admission for hospitalization.)
    (2) An allowance authorized under 38 U.S.C. 1114(t) shall be paid in 
lieu of any allowance authorized by 38 U.S.C. 1114(r)(1).

(Authority: 38 U.S.C. 501, 38 U.S.C. 1114(t))

[26 FR 1587, Feb. 24, 1961, as amended at 27 FR 4739, May 18, 1962; 28 
FR 1587, Feb. 20, 1963; 28 FR 5671, June 11, 1963; 40 FR 54245, Nov. 21, 
1975; 45 FR 25392, Apr. 15, 1980; 46 FR 47541, Sept. 29, 1981; 48 FR 
41161, Sept. 14, 1983; 49 FR 47003, Nov. 30, 1984; 54 FR 34981, Aug. 23, 
1989; 60 FR 12886, Mar. 9, 1995; 67 FR 6873, Feb. 14, 2002; 68 FR 55467, 
Sept. 26, 2003; 74 FR 11483, Mar. 18, 2009; 83 FR 20736, May 8, 2018]



Sec.  3.351  Special monthly dependency and indemnity compensation, 
death compensation, pension and spouse's compensation ratings.

    (a) General. This section sets forth criteria for determining 
whether:
    (1) Increased pension is payable to a veteran by reason of need for 
aid and attendance or by reason of being housebound.


(Authority: 38 U.S.C. 1521(d), (e))

    (2) Increased compensation is payable to a veteran by reason of the 
veteran's spouse being in need of aid and attendance.


(Authority: 38 U.S.C. 1115(1)(E))

    (3) Increased dependency and indemnity compensation is payable to a 
surviving spouse or parent by reason of being in need of aid and 
attendance.


(Authority: 38 U.S.C. 1311(c), 1315(h))

    (4) Increased dependency and indemnity compensation is payable to a 
surviving spouse who is not in need of aid and attendance but is 
housebound.


(Authority: 38 U.S.C. 1311(d))

    (5) Increased pension is payable to a surviving spouse by reason of 
need for aid and attendance, or if not in need of aid and attendance, by 
reason of being housebound.


(Authority: 38 U.S.C. 1541(d), (e))

    (6) Increased death compensation is payable to a surviving spouse by 
reason of being in need of aid and attendance.


(Authority: 38 U.S.C. 1122)

    (b) Aid and attendance; need. Need for aid and attendance means 
helplessness or being so nearly helpless as to require the regular aid 
and attendance of another person. The criteria set forth in paragraph 
(c) of this section will be applied in determining whether such need 
exists.
    (c) Aid and attendance; criteria. The veteran, spouse, surviving 
spouse or parent will be considered in need of regular aid and 
attendance if he or she:
    (1) Is blind or so nearly blind as to have corrected visual acuity 
of 5/200 or less, in both eyes, or concentric contraction of the visual 
field to 5 degrees or less; or
    (2) Is a patient in a nursing home because of mental or physical 
incapacity; or
    (3) Establishes a factual need for aid and attendance under the 
criteria set forth in Sec.  3.352(a).


(Authority: 38 U.S.C. 1502(b))

    (d) Housebound, or permanent and total plus 60 percent; disability 
pension. The rate of pension payable to a veteran who is entitled to 
pension under 38 U.S.C. 1521 and who is not in need of regular aid and 
attendance shall be as prescribed in 38 U.S.C. 1521(e) if, in addition 
to having a single permanent disability rated 100 percent disabling 
under the Schedule for Rating Disabilities (not including ratings based 
upon unemployability under Sec.  4.17 of this chapter) the veteran:
    (1) Has additional disability or disabilities independently ratable 
at 60 percent or more, separate and distinct from the permanent 
disability rated as 100 percent disabling and involving different 
anatomical segments or bodily systems, or

[[Page 297]]

    (2) Is ``permanently housebound'' by reason of disability or 
disabilities. This requirement is met when the veteran is substantially 
confined to his or her dwelling and the immediate premises or, if 
institutionalized, to the ward or clinical area, and it is reasonably 
certain that the disability or disabilities and resultant confinement 
will continue throughout his or her lifetime.


(Authority: 38 U.S.C. 1502(c), 1521(e))

    (e) Housebound; dependency and indemnity compensation. The monthly 
rate of dependency and indemnity compensation payable to a surviving 
spouse who does not qualify for increased dependency and indemnity 
compensation under 38 U.S.C. 1311(c) based on need for regular aid and 
attendance shall be increased by the amount specified in 38 U.S.C. 
1311(d) if the surviving spouse is permanently housebound by reason of 
disability. The ``permanently housebound'' requirement is met when the 
surviving spouse is substantially confined to his or her home (ward or 
clinical areas, if institutionalized) or immediate premises by reason of 
disability or disabilities which it is reasonably certain will remain 
throughout the surviving spouse's lifetime.


(Authority: 38 U.S.C. 1311(d))

    (f) Housebound; improved pension; death. The annual rate of death 
pension payable to a surviving spouse who does not qualify for an annual 
rate of death pension payable under Sec.  3.23(a)(6) based on need for 
aid and attendance shall be as set forth in Sec.  3.23(a)(7) if the 
surviving spouse is permanently housebound by reason of disability. The 
``permanently housebound'' requirement is met when the surviving spouse 
is substantially confined to his or her home (ward or clinical areas, if 
institutionalized) or immediate premises by reason of disability or 
disabilities which it is reasonably certain will remain throughout the 
surviving spouse's lifetime.

(Authority: 38 U.S.C. 1541(e))

[44 FR 45939, Aug. 6, 1979]



Sec.  3.352  Criteria for determining need for aid and attendance and
``permanently bedridden.''

    (a) Basic criteria for regular aid and attendance and permanently 
bedridden. The following will be accorded consideration in determining 
the need for regular aid and attendance (Sec.  3.351(c)(3): inability of 
claimant to dress or undress himself (herself), or to keep himself 
(herself) ordinarily clean and presentable; frequent need of adjustment 
of any special prosthetic or orthopedic appliances which by reason of 
the particular disability cannot be done without aid (this will not 
include the adjustment of appliances which normal persons would be 
unable to adjust without aid, such as supports, belts, lacing at the 
back, etc.); inability of claimant to feed himself (herself) through 
loss of coordination of upper extremities or through extreme weakness; 
inability to attend to the wants of nature; or incapacity, physical or 
mental, which requires care or assistance on a regular basis to protect 
the claimant from hazards or dangers incident to his or her daily 
environment. ``Bedridden'' will be a proper basis for the determination. 
For the purpose of this paragraph ``bedridden'' will be that condition 
which, through its essential character, actually requires that the 
claimant remain in bed. The fact that claimant has voluntarily taken to 
bed or that a physician has prescribed rest in bed for the greater or 
lesser part of the day to promote convalescence or cure will not 
suffice. It is not required that all of the disabling conditions 
enumerated in this paragraph be found to exist before a favorable rating 
may be made. The particular personal functions which the veteran is 
unable to perform should be considered in connection with his or her 
condition as a whole. It is only necessary that the evidence establish 
that the veteran is so helpless as to need regular aid and attendance, 
not that there be a constant need. Determinations that the veteran is so 
helpless, as to be in need of regular aid and attendance will not be 
based solely upon an opinion that the claimant's condition is such as 
would require him or her to be in bed. They must be based on the actual 
requirement of personal assistance from others.

[[Page 298]]

    (b) Basic criteria for the higher level aid and attendance 
allowance. (1) A veteran is entitled to the higher level aid and 
attendance allowance authorized by Sec.  3.350(h) in lieu of the regular 
aid and attendance allowance when all of the following conditions are 
met:
    (i) The veteran is entitled to the compensation authorized under 38 
U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 
U.S.C. 1114(p).
    (ii) The veteran meets the requirements for entitlement to the 
regular aid and attendance allowance in paragraph (a) of this section.
    (iii) The veteran needs a ``higher level of care'' (as defined in 
paragraph (b)(3) of this section) than is required to establish 
entitlement to the regular aid and attendance allowance, and in the 
absence of the provision of such higher level of care the veteran would 
require hospitalization, nursing home care, or other residential 
institutional care.
    (2) A veteran is entitled to the higher level aid and attendance 
allowance authorized by Sec.  3.350(j) in lieu of the regular aid and 
attendance allowance when all of the following conditions are met:
    (i) As a result of service-connected residuals of traumatic brain 
injury, the veteran meets the requirements for entitlement to the 
regular aid and attendance allowance in paragraph (a) of this section.
    (ii) As a result of service-connected residuals of traumatic brain 
injury, the veteran needs a ``higher level of care'' (as defined in 
paragraph (b)(3) of this section) than is required to establish 
entitlement to the regular aid and attendance allowance, and in the 
absence of the provision of such higher level of care the veteran would 
require hospitalization, nursing home care, or other residential 
institutional care.
    (3) Need for a higher level of care shall be considered to be need 
for personal health-care services provided on a daily basis in the 
veteran's home by a person who is licensed to provide such services or 
who provides such services under the regular supervision of a licensed 
health-care professional. Personal health-care services include (but are 
not limited to) such services as physical therapy, administration of 
injections, placement of indwelling catheters, and the changing of 
sterile dressings, or like functions which require professional health-
care training or the regular supervision of a trained health-care 
professional to perform. A licensed health-care professional includes 
(but is not limited to) a doctor of medicine or osteopathy, a registered 
nurse, a licensed practical nurse, or a physical therapist licensed to 
practice by a State or political subdivision thereof.
    (4) The term ``under the regular supervision of a licensed health-
care professional'', as used in paragraph (b)(3) of this section, means 
that an unlicensed person performing personal health-care services is 
following a regimen of personal health-care services prescribed by a 
health-care professional, and that the health-care professional consults 
with the unlicensed person providing the health-care services at least 
once each month to monitor the prescribed regimen. The consultation need 
not be in person; a telephone call will suffice.
    (5) A person performing personal health-care services who is a 
relative or other member of the veteran's household is not exempted from 
the requirement that he or she be a licensed health-care professional or 
be providing such care under the regular supervision of a licensed 
health-care professional.
    (6) The provisions of paragraph (b) of this section are to be 
strictly construed. The higher level aid-and-attendance allowance is to 
be granted only when the veteran's need is clearly established and the 
amount of services required by the veteran on a daily basis is 
substantial.
    (c) Attendance by relative. The performance of the necessary aid and 
attendance service by a relative of the beneficiary or other member of 
his or her household will not prevent the granting of the additional 
allowance.

(Authority: 38 U.S.C. 501, 1114(r)(2), 1114(t))

[41 FR 29680, July 19, 1976, as amended at 44 FR 22720, Apr. 17, 1979; 
60 FR 27409, May 24, 1995; 83 FR 20737, May 8, 2018]

[[Page 299]]



Sec.  3.353  Determinations of incompetency and competency.

    (a) Definition of mental incompetency. A mentally incompetent person 
is one who because of injury or disease lacks the mental capacity to 
contract or to manage his or her own affairs, including disbursement of 
funds without limitation.
    (b) Authority. (1) Rating agencies have sole authority to make 
official determinations of competency and incompetency for purposes of: 
insurance (38 U.S.C. 1922), and, subject to Sec.  13.110 of this 
chapter, disbursement of benefits. Such determinations are final and 
binding on field stations for these purposes.
    (2) Where the beneficiary is rated incompetent, the Veterans Service 
Center Manager will develop information as to the beneficiary's social, 
economic and industrial adjustment; appoint (or recommend appointment 
of) a fiduciary as provided in Sec.  13.100 of this chapter; select a 
method of disbursing payment as provided in Sec.  13.100 of this 
chapter, or in the case of a married beneficiary, appoint the 
beneficiary's spouse to receive payments as provided in Sec.  13.100 of 
this chapter; and authorize disbursement of the benefit.
    (3) If in the course of fulfilling the responsibilities assigned in 
paragraph (b)(2) the Veterans Service Center Manager develops evidence 
indicating that the beneficiary may be capable of administering the 
funds payable without limitation, he or she will refer that evidence to 
the rating agency with a statement as to his or her findings. The rating 
agency will consider this evidence, together with all other evidence of 
record, to determine whether its prior determination of incompetency 
should remain in effect. Reexamination may be requested as provided in 
Sec.  3.327(a) if necessary to properly evaluate the beneficiary's 
mental capacity to contract or manage his or her own affairs.
    (c) Medical opinion. Unless the medical evidence is clear, 
convincing and leaves no doubt as to the person's incompetency, the 
rating agency will make no determination of incompetency without a 
definite expression regarding the question by the responsible medical 
authorities. Considerations of medical opinions will be in accordance 
with the principles in paragraph (a) of this section. Determinations 
relative to incompetency should be based upon all evidence of record and 
there should be a consistent relationship between the percentage of 
disability, facts relating to commitment or hospitalization and the 
holding of incompetency.
    (d) Presumption in favor of competency. Where reasonable doubt 
arises regarding a beneficiary's mental capacity to contract or to 
manage his or her own affairs, including the disbursement of funds 
without limitation, such doubt will be resolved in favor of competency 
(see Sec.  3.102 on reasonable doubt).
    (e) Due process. Whenever it is proposed to make an incompetency 
determination, the beneficiary will be notified of the proposed action 
and of the right to a hearing as provided in Sec.  3.103. Such notice is 
not necessary if the beneficiary has been declared incompetent by a 
court of competent jurisdiction or if a guardian has been appointed for 
the beneficiary based upon a court finding of incompetency. If a hearing 
is requested it must be held prior to a rating decision of incompetency. 
Failure or refusal of the beneficiary after proper notice to request or 
cooperate in such a hearing will not preclude a rating decision based on 
the evidence of record.

(Authority: 38 U.S.C. 501(a))

[36 FR 19020, Sept. 25, 1971, and 40 FR 1241, Jan. 7, 1975, as amended 
at 42 FR 2069, Jan. 10, 1977; 58 FR 37856, July 14, 1993; 60 FR 55792, 
Nov. 3, 1995; 66 FR 48560, Sept. 21, 2001; 67 FR 46868, July 17, 2002; 
68 FR 34542, June 10, 2003; 83 FR 32738, July 13, 2018]



Sec.  3.354  Determinations of insanity.

    (a) Definition of insanity. An insane person is one who, while not 
mentally defective or constitutionally psychopathic, except when a 
psychosis has been engrafted upon such basic condition, exhibits, due to 
disease, a more or less prolonged deviation from his normal method of 
behavior; or who interferes with the peace of society; or who has so 
departed (become antisocial) from the accepted standards of the 
community to which by birth and education he belongs as to lack the 
adaptability to make further adjustment to

[[Page 300]]

the social customs of the community in which he resides.
    (b) Insanity causing discharge. When a rating agency is concerned 
with determining whether a veteran was insane at the time he committed 
an offense leading to his court-martial, discharge or resignation (38 
U.S.C. 5303(b)), it will base its decision on all the evidence 
procurable relating to the period involved, and apply the definition in 
paragraph (a) of this section.

[26 FR 1589, Feb. 24, 1961]



Sec.  3.355  Testamentary capacity for insurance purposes.

    When cases are referred to a rating agency involving the 
testamentary capacity of the insured to execute designations or changes 
of beneficiary, or designations or changes of option, the following 
considerations will apply:
    (a) Testamentary capacity is that degree of mental capacity 
necessary to enable a person to perform a testamentary act. This, in 
general, requires that the testator reasonably comprehend the nature and 
significance of his act, that is, the subject and extent of his 
disposition, recognition of the object of his bounty, and appreciation 
of the consequence of his act, uninfluenced by any material delusion as 
to the property or persons involved.
    (b) Due consideration should be given to all facts of record, with 
emphasis being placed on those facts bearing upon the mental condition 
of the testator (insured) at the time or nearest the time he executed 
the designation or change. In this connection, consideration should be 
given to lay as well as medical evidence.
    (c) Lack of testamentary capacity should not be confused with 
insanity or mental incompetence. An insane person might have a lucid 
interval during which he would possess testamentary capacity. On the 
other hand, a sane person might suffer a temporary mental aberration 
during which he would not possess testamentary capacity. There is a 
general but rebuttable presumption that every testator possesses 
testamentary capacity. Therefore, reasonable doubts should be resolved 
in favor of testamentary capacity.

[26 FR 1590, Feb. 24, 1961]



Sec.  3.356  Conditions which determine permanent incapacity for 
self-support.

    (a) Basic determinations. A child must be shown to be permanently 
incapable of self-support by reason of mental or physical defect at the 
date of attaining the age of 18 years.
    (b) Rating criteria. Rating determinations will be made solely on 
the basis of whether the child is permanently incapable of self-support 
through his own efforts by reason of physical or mental defects. The 
question of permanent incapacity for self-support is one of fact for 
determination by the rating agency on competent evidence of record in 
the individual case. Rating criteria applicable to disabled veterans are 
not controlling. Principal factors for consideration are:
    (1) The fact that a claimant is earning his or her own support is 
prima facie evidence that he or she is not incapable of self-support. 
Incapacity for self-support will not be considered to exist when the 
child by his or her own efforts is provided with sufficient income for 
his or her reasonable support.
    (2) A child shown by proper evidence to have been permanently 
incapable of self-support prior to the date of attaining the age of 18 
years, may be so held at a later date even though there may have been a 
short intervening period or periods when his or her condition was such 
that he or she was employed, provided the cause of incapacity is the 
same as that upon which the original determination was made and there 
were no intervening diseases or injuries that could be considered as 
major factors. Employment which was only casual, intermittent, tryout, 
unsuccessful, or terminated after a short period by reason of 
disability, should not be considered as rebutting permanent incapability 
of self-support otherwise established.
    (3) It should be borne in mind that employment of a child prior or 
subsequent to the delimiting age may or may not be a normal situation, 
depending on the educational progress of the child, the economic 
situation of the family, indulgent attitude of parents, and the like. In 
those cases where the extent and nature of disability raises some doubt 
as to whether they would

[[Page 301]]

render the average person incapable of self-support, factors other than 
employment are for consideration. In such cases there should be 
considered whether the daily activities of the child in the home and 
community are equivalent to the activities of employment of any nature 
within the physical or mental capacity of the child which would provide 
sufficient income for reasonable support. Lack of employment of the 
child either prior to the delimiting age or thereafter should not be 
considered as a major factor in the determination to be made, unless it 
is shown that it was due to physical or mental defect and not to mere 
disinclination to work or indulgence of relatives or friends.
    (4) The capacity of a child for self-support is not determinable 
upon employment afforded solely upon sympathetic or charitable 
considerations and which involved no actual or substantial rendition of 
services.

    Cross Reference: Basic pension and eligibility determinations. See 
Sec.  3.314.

[26 FR 1590, Feb. 24, 1961, as amended at 38 FR 871, Jan. 5, 1973]



Sec.  3.357  Civil service preference ratings.

    For the purpose of certifying civil service disability preference 
only, a service-connected disability may be assigned an evaluation of 
``less than ten percent.'' Any directly or presumptively service-
connected disease or injury which exhibits some extent of actual 
impairment may be held to exist at the level of less than ten percent. 
For disabilities incurred in combat, however, no actual impairment is 
required.

[58 FR 52018, Oct. 6, 1993]



Sec.  3.358  Compensation for disability or death from hospitalization, 
medical or surgical treatment, examinations or vocational rehabilitation
training (Sec. 3.800).

    (a) General. This section applies to claims received by VA before 
October 1, 1997. If it is determined that there is additional disability 
resulting from a disease or injury or aggravation of an existing disease 
or injury suffered as a result of hospitalization, medical or surgical 
treatment, examination, or vocational rehabilitation training, 
compensation will be payable for such additional disability. For claims 
received by VA on or after October 1, 1997, see Sec.  3.361.
    (b) Additional disability. In determining that additional disability 
exists, the following considerations will govern:
    (1) The veteran's physical condition immediately prior to the 
disease or injury on which the claim for compensation is based will be 
compared with the subsequent physical condition resulting from the 
disease or injury, each body part involved being considered separately.
    (i) As applied to examinations, the physical condition prior to the 
disease or injury will be the condition at time of beginning the 
physical examination as a result of which the disease or injury was 
sustained.
    (ii) As applied to medical or surgical treatment, the physical 
condition prior to the disease or injury will be the condition which the 
specific medical or surgical treatment was designed to relieve.
    (2) Compensation will not be payable under this section for the 
continuance or natural progress of a disease or injury for which the 
hospitalization, medical or surgical treatment, or examination was 
furnished, unless VA's failure to exercise reasonable skill and care in 
the diagnosis or treatment of the disease or injury caused additional 
disability or death that probably would have been prevented by proper 
diagnosis or treatment. Compensation will not be payable under this 
section for the continuance or natural progress of a disease or injury 
for which vocational rehabilitation training was provided.
    (c) Cause. In determining whether such additional disability 
resulted from a disease or an injury or an aggravation of an existing 
disease or injury suffered as a result of training, hospitalization, 
medical or surgical treatment, or examination, the following 
considerations will govern:
    (1) It will be necessary to show that the additional disability is 
actually the result of such disease or injury or an aggravation of an 
existing disease or injury and not merely coincidental therewith.

[[Page 302]]

    (2) The mere fact that aggravation occurred will not suffice to make 
the additional disability compensable in the absence of proof that it 
resulted from disease or injury or an aggravation of an existing disease 
or injury suffered as the result of training, hospitalization, medical 
or surgical treatment, or examination.
    (3) Compensation is not payable for the necessary consequences of 
medical or surgical treatment or examination properly administered with 
the express or implied consent of the veteran, or, in appropriate cases, 
the veteran's representative. ``Necessary consequences'' are those which 
are certain to result from, or were intended to result from, the 
examination or medical or surgical treatment administered. Consequences 
otherwise certain or intended to result from a treatment will not be 
considered uncertain or unintended solely because it had not been 
determined at the time consent was given whether that treatment would in 
fact be administered.
    (4) When the proximate cause of the injury suffered was the 
veteran's willful misconduct or failure to follow instructions, it will 
bar him (or her) from receipt of compensation hereunder except in the 
case of incompetent veterans.
    (5) Compensation for disability resulting from the pursuit of 
vocational rehabilitation is not payable unless there is established a 
direct (proximate) causal connection between the injury or aggravation 
of an existing injury and some essential activity or function which is 
within the scope of the vocational rehabilitation course, not 
necessarily limited to activities or functions specifically designated 
by the Department of Veterans Affairs in the individual case, since 
ordinarily it is not to be expected that each and every different 
function and act of a veteran pursuant to his or her course of training 
will be particularly specified in the outline of the course or training 
program. For example, a disability resulting from the use of an item of 
mechanical or other equipment is within the purview of the statute if 
training in its use is implicit within the prescribed program or course 
outlined or if its use is implicit in the performance of some task or 
operation the trainee must learn to perform, although such use may not 
be especially mentioned in the training program. In determining whether 
the element of direct or proximate causation is present, it remains 
necessary for a distinction to be made between an injury arising out of 
an act performed in pursuance of the course of training, that is, a 
required ``learning activity'', and one arising out of an activity which 
is incident to, related to, or coexistent with the pursuit of the 
program of training. For a case to fall within the statute there must 
have been sustained an injury which, but for the performance of a 
``learning activity'' in the prescribed course of training, would not 
have been sustained. A meticulous examination into all the circumstances 
is required, including a consideration of the time and place of the 
incident producing the injury.
    (6) Nursing home care furnished under section 1720 of title 38, 
United States Code is not hospitalization within the meaning of this 
section. Such a nursing home is an independent contractor and, 
accordingly, its agents and employees are not to be deemed agents and 
employees of the Department of Veterans Affairs. If additional 
disability results from medical or surgical treatment or examination 
through negligence or other wrongful acts or omissions on the part of 
such a nursing home, its employees, or its agents, entitlement does not 
exist under this section unless there was an act or omission on the part 
of the Department of Veterans Affairs independently giving rise to such 
entitlement and such acts on the part of both proximately caused the 
additional disability.

(Authority: 38 U.S.C. 1151, 1720)

[26 FR 1590, Feb. 24, 1961, as amended at 36 FR 7659, Apr. 23, 1971; 39 
FR 34531, Sept. 26, 1974; 43 FR 51015, Nov. 2, 1978; 60 FR 14223, Mar. 
16, 1995; 61 FR 25788, May 23, 1996; 64 FR 1131, Jan. 8, 1999; 69 FR 
46433, Aug. 3, 2004]

[[Page 303]]



Sec.  3.359  Determination of service connection for former members of
the Armed Forces of Czechoslovakia or Poland.

    Rating boards will determine whether or not the condition for which 
treatment is claimed by former members of the Armed Forces of 
Czechoslovakia or Poland under 38 U.S.C. 109(c) is service connected. 
This determination will be made using the same criteria that applies to 
determinations of service connection based on service in the Armed 
Forces of the United States.

[43 FR 4424, Feb. 2, 1978]



Sec.  3.360  Service-connected health-care eligibility of certain persons
administratively discharged under other than honorable condition.

    (a) General. The health-care and related benefits authorized by 
chapter 17 of title 38 U.S.C. shall be provided to certain former 
service persons with administrative discharges under other than 
honorable conditions for any disability incurred or aggravated during 
active military, naval, or air service in line of duty.
    (b) Discharge categorization. With certain exceptions such benefits 
shall be furnished for any disability incurred or aggravated during a 
period of service terminated by a discharge under other than honorable 
conditions. Specifically, they may not be furnished for any disability 
incurred or aggravated during a period of service terminated by a bad 
conduct discharge or when one of the bars listed in Sec.  3.12(c) 
applies.
    (c) Eligibility criteria. In making determinations of health-care 
eligibility the same criteria will be used as is now applicable to 
determinations of service incurrence and in line of duty when there is 
no character of discharge bar.

[43 FR 15154, Apr. 11, 1978]



Sec.  3.361  Benefits under 38 U.S.C. 1151(a) for additional disability
or death due to hospital care, medical or surgical treatment, examination,
training and rehabilitation services, or compensated work therapy program.

    (a) Claims subject to this section--(1) General. Except as provided 
in paragraph (2), this section applies to claims received by VA on or 
after October 1, 1997. This includes original claims and claims to 
reopen or otherwise readjudicate a previous claim for benefits under 38 
U.S.C. 1151 or its predecessors. The effective date of benefits is 
subject to the provisions of Sec.  3.400(i). For claims received by VA 
before October 1, 1997, see Sec.  3.358.
    (2) Compensated Work Therapy. With respect to claims alleging 
disability or death due to compensated work therapy, this section 
applies to claims that were pending before VA on November 1, 2000, or 
that were received by VA after that date. The effective date of benefits 
is subject to the provisions of Sec. Sec.  3.114(a) and 3.400(i), and 
shall not be earlier than November 1, 2000.
    (b) Determining whether a veteran has an additional disability. To 
determine whether a veteran has an additional disability, VA compares 
the veteran's condition immediately before the beginning of the hospital 
care, medical or surgical treatment, examination, training and 
rehabilitation services, or compensated work therapy (CWT) program upon 
which the claim is based to the veteran's condition after such care, 
treatment, examination, services, or program has stopped. VA considers 
each involved body part or system separately.
    (c) Establishing the cause of additional disability or death. Claims 
based on additional disability or death due to hospital care, medical or 
surgical treatment, or examination must meet the causation requirements 
of this paragraph and paragraph (d)(1) or (d)(2) of this section. Claims 
based on additional disability or death due to training and 
rehabilitation services or compensated work therapy program must meet 
the causation requirements of paragraph (d)(3) of this section.
    (1) Actual causation required. To establish causation, the evidence 
must show that the hospital care, medical or surgical treatment, or 
examination resulted in the veteran's additional disability or death. 
Merely showing that a veteran received care, treatment, or examination 
and that the veteran has an additional disability or died does not 
establish cause.
    (2) Continuance or natural progress of a disease or injury. Hospital 
care, medical or surgical treatment, or examination

[[Page 304]]

cannot cause the continuance or natural progress of a disease or injury 
for which the care, treatment, or examination was furnished unless VA's 
failure to timely diagnose and properly treat the disease or injury 
proximately caused the continuance or natural progress. The provision of 
training and rehabilitation services or CWT program cannot cause the 
continuance or natural progress of a disease or injury for which the 
services were provided.
    (3) Veteran's failure to follow medical instructions. Additional 
disability or death caused by a veteran's failure to follow properly 
given medical instructions is not caused by hospital care, medical or 
surgical treatment, or examination.
    (d) Establishing the proximate cause of additional disability or 
death. The proximate cause of disability or death is the action or event 
that directly caused the disability or death, as distinguished from a 
remote contributing cause.
    (1) Care, treatment, or examination. To establish that carelessness, 
negligence, lack of proper skill, error in judgment, or similar instance 
of fault on VA's part in furnishing hospital care, medical or surgical 
treatment, or examination proximately caused a veteran's additional 
disability or death, it must be shown that the hospital care, medical or 
surgical treatment, or examination caused the veteran's additional 
disability or death (as explained in paragraph (c) of this section); and
    (i) VA failed to exercise the degree of care that would be expected 
of a reasonable health care provider; or
    (ii) VA furnished the hospital care, medical or surgical treatment, 
or examination without the veteran's or, in appropriate cases, the 
veteran's representative's informed consent. To determine whether there 
was informed consent, VA will consider whether the health care providers 
substantially complied with the requirements of Sec.  17.32 of this 
chapter. Minor deviations from the requirements of Sec.  17.32 of this 
chapter that are immaterial under the circumstances of a case will not 
defeat a finding of informed consent. Consent may be express (i.e., 
given orally or in writing) or implied under the circumstances specified 
in Sec.  17.32(b) of this chapter, as in emergency situations.
    (2) Events not reasonably foreseeable. Whether the proximate cause 
of a veteran's additional disability or death was an event not 
reasonably foreseeable is in each claim to be determined based on what a 
reasonable health care provider would have foreseen. The event need not 
be completely unforeseeable or unimaginable but must be one that a 
reasonable health care provider would not have considered to be an 
ordinary risk of the treatment provided. In determining whether an event 
was reasonably foreseeable, VA will consider whether the risk of that 
event was the type of risk that a reasonable health care provider would 
have disclosed in connection with the informed consent procedures of 
Sec.  17.32 of this chapter.
    (3) Training and rehabilitation services or compensated work therapy 
program. To establish that the provision of training and rehabilitation 
services or a CWT program proximately caused a veteran's additional 
disability or death, it must be shown that the veteran's participation 
in an essential activity or function of the training, services, or CWT 
program provided or authorized by VA proximately caused the disability 
or death. The veteran must have been participating in such training, 
services, or CWT program provided or authorized by VA as part of an 
approved rehabilitation program under 38 U.S.C. chapter 31 or as part of 
a CWT program under 38 U.S.C. 1718. It need not be shown that VA 
approved that specific activity or function, as long as the activity or 
function is generally accepted as being a necessary component of the 
training, services, or CWT program that VA provided or authorized.
    (e) Department employees and facilities. (1) A Department employee 
is an individual--
    (i) Who is appointed by the Department in the civil service under 
title 38, United States Code, or title 5, United States Code, as an 
employee as defined in 5 U.S.C. 2105;
    (ii) Who is engaged in furnishing hospital care, medical or surgical 
treatment, or examinations under authority of law; and

[[Page 305]]

    (iii) Whose day-to-day activities are subject to supervision by the 
Secretary of Veterans Affairs.
    (2) A Department facility is a facility over which the Secretary of 
Veterans Affairs has direct jurisdiction.
    (f) Activities that are not hospital care, medical or surgical 
treatment, or examination furnished by a Department employee or in a 
Department facility. The following are not hospital care, medical or 
surgical treatment, or examination furnished by a Department employee or 
in a Department facility within the meaning of 38 U.S.C. 1151(a):
    (1) Hospital care or medical services furnished under a contract 
made under 38 U.S.C. 1703.
    (2) Nursing home care furnished under 38 U.S.C. 1720.
    (3) Hospital care or medical services, including examination, 
provided under 38 U.S.C. 8153 in a facility over which the Secretary 
does not have direct jurisdiction.
    (g) Benefits payable under 38 U.S.C. 1151 for a veteran's death. (1) 
Death before January 1, 1957. The benefit payable under 38 U.S.C. 
1151(a) to an eligible survivor for a veteran's death occurring before 
January 1, 1957, is death compensation. See Sec. Sec.  3.5(b)(2) and 
3.702 for the right to elect dependency and indemnity compensation.
    (2) Death after December 31, 1956. The benefit payable under 38 
U.S.C. 1151(a) to an eligible survivor for a veteran's death occurring 
after December 31, 1956, is dependency and indemnity compensation.

(Authority: 38 U.S.C. 1151)

[69 FR 46433, Aug. 3, 2004]



Sec.  3.362  Offsets under 38 U.S.C. 1151(b) of benefits awarded under
38 U.S.C. 1151(a).

    (a) Claims subject to this section. This section applies to claims 
received by VA on or after October 1, 1997. This includes original 
claims and claims to reopen or otherwise readjudicate a previous claim 
for benefits under 38 U.S.C. 1151 or its predecessors.
    (b) Offset of veterans' awards of compensation. If a veteran's 
disability is the basis of a judgment under 28 U.S.C. 1346(b) awarded, 
or a settlement or compromise under 28 U.S.C. 2672 or 2677 entered, on 
or after December 1, 1962, the amount to be offset under 38 U.S.C. 
1151(b) from any compensation awarded under 38 U.S.C. 1151(a) is the 
entire amount of the veteran's share of the judgment, settlement, or 
compromise, including the veteran's proportional share of attorney fees.
    (c) Offset of survivors' awards of dependency and indemnity 
compensation. If a veteran's death is the basis of a judgment under 28 
U.S.C. 1346(b) awarded, or a settlement or compromise under 28 U.S.C. 
2672 or 2677 entered, on or after December 1, 1962, the amount to be 
offset under 38 U.S.C. 1151(b) from any dependency and indemnity 
compensation awarded under 38 U.S.C. 1151(a) to a survivor is only the 
amount of the judgment, settlement, or compromise representing damages 
for the veteran's death the survivor receives in an individual capacity 
or as distribution from the decedent veteran's estate of sums included 
in the judgment, settlement, or compromise to compensate for harm 
suffered by the survivor, plus the survivor's proportional share of 
attorney fees.
    (d) Offset of structured settlements. This paragraph applies if a 
veteran's disability or death is the basis of a structured settlement or 
structured compromise under 28 U.S.C. 2672 or 2677 entered on or after 
December 1, 1962.
    (1) The amount to be offset. The amount to be offset under 38 U.S.C. 
1151(b) from benefits awarded under 38 U.S.C. 1151(a) is the veteran's 
or survivor's proportional share of the cost to the United States of the 
settlement or compromise, including the veteran's or survivor's 
proportional share of attorney fees.
    (2) When the offset begins. The offset of benefits awarded under 38 
U.S.C. 1151(a) begins the first month after the structured settlement or 
structured compromise has become final that such benefits would 
otherwise be paid.
    (e) Offset of award of benefits under 38 U.S.C. chapter 21 or 38 
U.S.C. chapter 39. (1) If a judgment, settlement, or compromise covered 
in paragraphs (b) through (d) of this section becomes final on or after 
December 10, 2004, and includes an amount that is specifically 
designated for a purpose for which benefits are provided under 38 U.S.C. 
chapter 21 (38 CFR 3.809 and 3.809a) or 38

[[Page 306]]

U.S.C. chapter 39 (38 CFR 3.808), and if VA awards 38 U.S.C. chapter 21 
or 38 U.S.C. chapter 39 benefits after the date on which the judgment, 
settlement, or compromise becomes final, the amount of the award will be 
reduced by the amount received under the judgment, settlement, or 
compromise for the same purpose.
    (2) If the amount described in paragraph (e)(1) of this section is 
greater than the amount of an award under 38 U.S.C. chapter 21 or 38 
U.S.C. chapter 39, the excess amount received under the judgment, 
settlement, or compromise will be offset against benefits otherwise 
payable under 38 U.S.C. chapter 11.

[69 FR 46434, Aug. 3, 2004, as amended at 71 FR 44918, Aug. 8, 2006; 75 
FR 57861, Sept. 23, 2010]



Sec.  3.363  Bar to benefits under 38 U.S.C. 1151.

    (a) Claims subject to this section. This section applies to claims 
received by VA on or after October 1, 1997. This includes original 
claims and claims to reopen or otherwise readjudicate a previous claim 
for benefits under 38 U.S.C. 1151 or its predecessors.
    (b) Administrative award, compromises, or settlements, or judgments 
that bar benefits under 38 U.S.C. 1151. If a veteran's disability or 
death was the basis of an administrative award under 28 U.S.C. 1346(b) 
made, or a settlement or compromise under 28 U.S.C. 2672 or 2677 
finalized, before December 1, 1962, VA may not award benefits under 38 
U.S.C. 1151 for any period after such award, settlement, or compromise 
was made or became final. If a veteran's disability or death was the 
basis of a judgment that became final before December 1, 1962, VA may 
award benefits under 38 U.S.C. 1151 for the disability or death unless 
the terms of the judgment provide otherwise.

(Authority: 38 U.S.C. 1151)

[69 FR 46434, Aug. 3, 2004]

           Rating Considerations Relative to Specific Diseases



Sec.  3.370  Pulmonary tuberculosis shown by X-ray in active service.

    (a) Active disease. X-ray evidence alone may be adequate for grant 
of direct service connection for pulmonary tuberculosis. When under 
consideration, all available service department films and subsequent 
films will be secured and read by specialists at designated stations who 
should have a current examination report and X-ray. Resulting 
interpretations of service films will be accorded the same consideration 
for service-connection purposes as if clinically established, however, a 
compensable rating will not be assigned prior to establishment of an 
active condition by approved methods.
    (b) Inactive disease. Where the veteran was examined at time of 
entrance into active service but X-ray was not made, or if made, is not 
available and there was no notation or other evidence of active or 
inactive reinfection type pulmonary tuberculosis existing prior to such 
entrance, it will be assumed that the condition occurred during service 
and direct service connection will be in order for inactive pulmonary 
tuberculosis shown by X-ray evidence during service in the manner 
prescribed in paragraph (a) of this section, unless lesions are first 
shown so soon after entry on active service as to compel the conclusion, 
on the basis of sound medical principles, that they existed prior to 
entry on active service.
    (c) Primary lesions. Healed primary type tuberculosis shown at the 
time of entrance into active service will not be taken as evidence to 
rebut direct or presumptive service connection for active reinfection 
type pulmonary tuberculosis.

[26 FR 1591, Feb. 24, 1961, as amended at 43 FR 45347, Oct. 2, 1978]



Sec.  3.371  Presumptive service connection for tuberculous disease;
wartime and service on or after January 1, 1947.

    (a) Pulmonary tuberculosis. (1) Evidence of activity on comparative 
study of X-ray films showing pulmonary tuberculosis within the 3-year 
presumptive period provided by Sec.  3.307(a)(3) will

[[Page 307]]

be taken as establishing service connection for active pulmonary 
tuberculosis subsequently diagnosed by approved methods but service 
connection and evaluation may be assigned only from the date of such 
diagnosis or other evidence of clinical activity.
    (2) A notation of inactive tuberculosis of the reinfection type at 
induction or enlistment definitely prevents the grant of service 
connection under Sec.  3.307 for active tuberculosis, regardless of the 
fact that it was shown within the appropriate presumptive period.
    (b) Pleurisy with effusion without obvious cause. Pleurisy with 
effusion with evidence of diagnostic studies ruling out obvious 
nontuberculous causes will qualify as active tuberculosis. The 
requirements for presumptive service connection will be the same as 
those for tuberculous pleurisy.
    (c) Tuberculous pleurisy and endobronchial tuberculosis. Tuberculous 
pleurisy and endobronchial tuberculosis fall within the category of 
pulmonary tuberculosis for the purpose of service connection on a 
presumptive basis. Either will be held incurred in service when 
initially manifested within 36 months after the veteran's separation 
from service as determined under Sec.  3.307(a)(2).
    (d) Miliary tuberculosis. Service connection for miliary 
tuberculosis involving the lungs is to be determined in the same manner 
as for other active pulmonary tuberculosis.

[26 FR 1591, Feb. 24, 1961, as amended at 27 FR 6387, July 6, 1962; 31 
FR 4681, Mar. 19, 1966; 39 FR 34532, Sept. 26, 1974; 43 FR 45347, Oct. 
2, 1978; 54 FR 34981, Aug. 23, 1989]



Sec.  3.372  Initial grant following inactivity of tuberculosis.

    When service connection is granted initially on an original or 
supplemental claim for pulmonary or nonpulmonary tuberculosis and there 
is satisfactory evidence that the condition was active previously but is 
now inactive (arrested), it will be presumed that the disease continued 
to be active for 1 year after the last date of established activity, 
provided there is no evidence to establish activity or inactivity in the 
intervening period. For a veteran entitled to receive compensation on 
August 19, 1968, the beginning date of graduated ratings will commence 
at the end of the 1-year period. For a veteran who was not receiving or 
entitled to receive compensation on August 19, 1968, ratings will be 
assigned in accordance with the Schedule for Rating Disabilities (part 4 
of this chapter). This section is not applicable to running award cases.

[33 FR 16275, Nov. 6, 1968, as amended at 84 FR 170, Jan. 18, 2019]



Sec.  3.373  [Reserved]



Sec.  3.374  Effect of diagnosis of active tuberculosis.

    (a) Service diagnosis. Service department diagnosis of active 
pulmonary tuberculosis will be accepted unless a board of medical 
examiners, Clinic Director or Chief, Outpatient Service certifies, after 
considering all the evidence, including the favoring or opposing 
tuberculosis and activity, that such diagnosis was incorrect. Doubtful 
cases may be referred to the Chief Medical Director in Central Office.
    (b) Department of Veterans Affairs diagnosis. Diagnosis of active 
pulmonary tuberculosis by the medical authorities of the Department of 
Veterans Affairs as the result of examination, observation, or treatment 
will be accepted for rating purposes. Reference to the Clinic Director 
or Chief, Outpatient Service, will be in order in questionable cases 
and, if necessary, to the Chief Medical Director in Central Office.
    (c) Private physician's diagnosis. Diagnosis of active pulmonary 
tuberculosis by private physicians on the basis of their examination, 
observation or treatment will not be accepted to show the disease was 
initially manifested after discharge from active service unless 
confirmed by acceptable clinical, X-ray or laboratory studies, or by 
findings of active tuberculosis based upon acceptable hospital 
observation or treatment.

[26 FR 1591, Feb. 24, 1961, as amended at 27 FR 6387, July 6, 1962; 33 
FR 16275, Nov. 6, 1968; 43 FR 45348, Oct. 2, 1978]



Sec.  3.375  Determination of inactivity (complete arrest) in tuberculosis.

    (a) Pulmonary tuberculosis. A veteran shown to have had pulmonary 
tuberculosis will be held to have reached a

[[Page 308]]

condition of ``complete arrest'' when a diagnosis of inactive is made.
    (b) Nonpulmonary disease. Determination of complete arrest of 
nonpulmonary tuberculosis requires absence of evidence of activity for 6 
months. If there are two or more foci of such tuberculosis, one of which 
is active, the condition will not be considered to be inactive until the 
tuberculous process has reached arrest in its entirety.
    (c) Arrest following surgery. Where there has been surgical excision 
of the lesion or organ, the date of complete arrest will be the date of 
discharge from the hospital, or 6 months from the date of excision, 
whichever is later.

[33 FR 16275, Nov. 6, 1968, as amended at 43 FR 45348, Oct. 2, 1978]



Sec. Sec.  3.376-3.377  [Reserved]



Sec.  3.378  Changes from activity in pulmonary tuberculosis pension 
cases.

    A permanent and total disability rating in effect during 
hospitalization will not be discontinued before hospital discharge on 
the basis of a change in classification from active. At hospital 
discharge, the permanent and total rating will be discontinued unless 
(a) the medical evidence does not support a finding of complete arrest 
(Sec.  3.375), or (b) where complete arrest is shown but the medical 
authorities recommend that employment not be resumed or be resumed only 
for short hours (not more than 4 hours a day for a 5-day week). If 
either of the two aforementioned conditions is met, discontinuance will 
be deferred pending examination in 6 months. Although complete arrest 
may be established upon that examination, the permanent and total rating 
may be extended for a further period of 6 months provided the veteran's 
employment is limited to short hours as recommended by the medical 
authorities (not more than 4 hours a day for a 5-day week). Similar 
extensions may be granted under the same conditions at the end of 12 and 
18 months periods. At the expiration of 24 months after hospitalization, 
the case will be considered under Sec.  3.321(b) if continued short 
hours of employment is recommended or if other evidence warrants 
submission.

[43 FR 45348, Oct. 2, 1978]



Sec.  3.379  Anterior poliomyelitis.

    If the first manifestations of acute anterior poliomyelitis present 
themselves in a veteran within 35 days of termination of active military 
service, it is probable that the infection occurred during service. If 
they first appear after this period, it is probable that the infection 
was incurred after service.

[26 FR 1592, Feb. 24, 1961]



Sec.  3.380  Diseases of allergic etiology.

    Diseases of allergic etiology, including bronchial asthma and 
urticaria, may not be disposed of routinely for compensation purposes as 
constitutional or developmental abnormalities. Service connection must 
be determined on the evidence as to existence prior to enlistment and, 
if so existent, a comparative study must be made of its severity at 
enlistment and subsequently. Increase in the degree of disability during 
service may not be disposed of routinely as natural progress nor as due 
to the inherent nature of the disease. Seasonal and other acute allergic 
manifestations subsiding on the absence of or removal of the allergen 
are generally to be regarded as acute diseases, healing without 
residuals. The determination as to service incurrence or aggravation 
must be on the whole evidentiary showing.

[26 FR 1592, Feb. 24, 1961]



Sec.  3.381  Service connection of dental conditions for treatment purposes.

    (a) The Veterans Benefits Administration (VBA) will adjudicate a 
claim for service connection of a dental condition for treatment 
purposes after the Veterans Health Administration determines a veteran 
meets the basic eligibility requirements of Sec.  17.161 of this chapter 
and requests VBA make a determination on questions that include, but are 
not limited to, any of the following:
    (1) Former Prisoner of War status;
    (2) Whether the veteran has a compensable or noncompensable service-
connected dental condition or disability;
    (3) Whether the dental condition or disability is a result of combat 
wounds;

[[Page 309]]

    (4) Whether the dental condition or disability is a result of 
service trauma; or
    (5) Whether the veteran is totally disabled due to a service-
connected disability.
    (b) Treatable carious teeth, replaceable missing teeth, dental or 
alveolar abscesses, and periodontal disease are not compensable 
disabilities, but may nevertheless be service connected solely for the 
purpose of establishing eligibility for outpatient dental treatment as 
provided for in Sec.  17.161 of this chapter. These conditions and other 
dental conditions or disabilities that are noncompensably rated under 
Sec.  4.150 of this chapter may be service connected for purposes of 
Class II or Class II (a) dental treatment under Sec.  17.161 of this 
chapter.
    (c) The rating activity will consider each defective or missing 
tooth and each disease of the teeth and periodontal tissues separately 
to determine whether the condition was incurred or aggravated in line of 
duty during active service
    (d) In determining service connection, the condition of teeth and 
periodontal tissues at the time of entry into active duty will be 
considered. Treatment during service, including filling or extraction of 
a tooth, or placement of a prosthesis, will not be considered evidence 
of aggravation of a condition that was noted at entry, unless additional 
pathology developed after 180 days or more of active service.
    (e) The following principles apply to dental conditions noted at 
entry and treated during service:
    (1) Teeth noted as normal at entry will be service-connected if they 
were filled or extracted after 180 days or more of active service.
    (2) Teeth noted as filled at entry will be service-connected if they 
were extracted, or if the existing filling was replaced, after 180 days 
or more of active service.
    (3) Teeth noted as carious but restorable at entry will not be 
service-connected on the basis that they were filled during service. 
However, new caries that developed 180 days or more after such a tooth 
was filled will be service-connected.
    (4) Teeth noted as carious but restorable at entry, whether or not 
filled, will be service-connected if extraction was required after 180 
days or more of active service.
    (5) Teeth noted at entry as non-restorable will not be service-
connected, regardless of treatment during service.
    (6) Teeth noted as missing at entry will not be service connected, 
regardless of treatment during service.
    (f) The following will not be considered service-connected for 
treatment purposes:
    (1) Calculus;
    (2) Acute periodontal disease;
    (3) Third molars, unless disease or pathology of the tooth developed 
after 180 days or more of active service, or was due to combat or in-
service trauma; and
    (4) Impacted or malposed teeth, and other developmental defects, 
unless disease or pathology of these teeth developed after 180 days or 
more of active service.
    (g) Teeth extracted because of chronic periodontal disease will be 
service-connected only if they were extracted after 180 days or more of 
active service.

(Authority: 38 U.S.C. 1712)

[64 FR 30393, June 8, 1999, as amended at 77 FR 4470, Jan. 30, 2012]



Sec.  3.382  [Reserved]



Sec.  3.383  Special consideration for paired organs and extremities.

    (a) Entitlement criteria. Compensation is payable for the 
combinations of service-connected and nonservice-connected disabilities 
specified in paragraphs (a)(1) through (a)(5) of this section as if both 
disabilities were service-connected, provided the nonservice-connected 
disability is not the result of the veteran's own willful misconduct.
    (1) Impairment of vision in one eye as a result of service-connected 
disability and impairment of vision in the other eye as a result of non-
service-connected disability and
    (i) The impairment of vision in each eye is rated at a visual acuity 
of 20/200 or less; or
    (ii) The peripheral field of vision for each eye is 20 degrees or 
less.

[[Page 310]]

    (2) Loss or loss of use of one kidney as a result of service-
connected disability and involvement of the other kidney as a result of 
nonservice-connected disability.
    (3) Hearing impairment in one ear compensable to a degree of 10 
percent or more as a result of service-connected disability and hearing 
impairment as a result of nonservice-connected disability that meets the 
provisions of Sec.  3.385 in the other ear.
    (4) Loss or loss of use of one hand or one foot as a result of 
service-connected disability and loss or loss of use of the other hand 
or foot as a result of nonservice-connected disability.
    (5) Permanent service-connected disability of one lung, rated 50 
percent or more disabling, in combination with a nonservice-connected 
disability of the other lung.
    (b) Effect of judgment or settlement. (1) If a veteran receives any 
money or property of value pursuant to an award in a judicial proceeding 
based upon, or a settlement or compromise of, any cause of action for 
damages for the nonservice-connected disability which established 
entitlement under this section, the increased compensation payable by 
reason of this section shall not be paid for any month following the 
month in which any such money or property is received until such time as 
the total amount of such increased compensation that would otherwise 
have been payable equals the total of the amount of any such money 
received and the fair market value of any such property received. The 
provisions of this paragraph do not apply, however, to any portion of 
such increased compensation payable for any period preceding the end of 
the month in which such money or property of value was received.
    (2) With respect to the disability combinations specified in 
paragraphs (a)(1), (a)(2), (a)(3) and (a)(5) of this section, the 
provisions of this paragraph apply only to awards of increased 
compensation made on or after October 28, 1986.
    (c) Social security and workers' compensation. Benefits received 
under social security or workers' compensation are not subject to 
recoupment under paragraph (b) of this section even though such benefits 
may have been awarded pursuant to a judicial proceeding.
    (d) Veteran's duty to report. Any person entitled to increased 
compensation under this section shall promptly report to VA the receipt 
of any money or property received pursuant to a judicial proceeding 
based upon, or a settlement or compromise of, any cause of action or 
other right of recovery for damages for the nonservice-connected loss or 
loss of use of the impaired extremity upon which entitlement under this 
section is based. The amount to be reported is the total of the amount 
of money received and the fair market value of property received. 
Expenses incident to recovery, such as attorneys' fees, may not be 
deducted from the amount to be reported.

(Authority: 38 U.S.C. 501(a), 1160)

    Cross References: Sec.  3.385 Disability due to impaired hearing; 
Sec.  4.85 Evaluation of hearing impairment.

[53 FR 23236, June 21, 1988, as amended at 69 FR 48149, Aug. 9, 2004; 74 
FR 11483, Mar. 18, 2009]



Sec.  3.384  Psychosis.

    For purposes of this part, the term ``psychosis'' means any of the 
following disorders listed in the American Psychiatric Association's 
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 
(DSM-5) (see Sec.  4.125 for availability information):
    (a) Brief Psychotic Disorder;
    (b) Delusional Disorder;
    (c) Psychotic Disorder Due to Another Medical Condition;
    (d) Other Specified Schizophrenia Spectrum and Other Psychotic 
Disorder;
    (e) Schizoaffective Disorder;
    (f) Schizophrenia;
    (g) Schizophreniform Disorder; and
    (h) Substance/Medication-Induced Psychotic Disorder.

(Authority: 38 U.S.C. 501(a), 1101, 1112(a) and (b))

[79 FR 45099, Aug. 4, 2014]



Sec.  3.385  Disability due to impaired hearing.

    For the purposes of applying the laws administered by VA, impaired 
hearing will be considered to be a disability

[[Page 311]]

when the auditory threshold in any of the frequencies 500, 1000, 2000, 
3000, 4000 Hertz is 40 decibels or greater; or when the auditory 
thresholds for at least three of the frequencies 500, 1000, 2000, 3000, 
or 4000 Hertz are 26 decibels or greater; or when speech recognition 
scores using the Maryland CNC Test are less than 94 percent.

[59 FR 60560, Nov. 25, 1994]

                             Effective Dates



Sec.  3.400  General.

    Except as otherwise provided, the effective date of an evaluation 
and award of pension, compensation, or dependency and indemnity 
compensation based on an initial claim or supplemental claim will be the 
date of receipt of the claim or the date entitlement arose, whichever is 
later. For effective date provisions regarding revision of a decision 
based on a supplemental claim or higher-level review, see Sec.  3.2500.


(Authority: 38 U.S.C. 5110(a))

    (a) Unless specifically provided. On basis of facts found.
    (b) Disability benefits--(1) Disability pension (Sec.  3.3). An 
award of disability pension may not be effective prior to the date 
entitlement arose.
    (i) Claims received prior to October 1, 1984. Date of receipt of 
claim or date on which the veteran became permanently and totally 
disabled, if claim is filed within one year from such date, whichever is 
to the advantage of the veteran.
    (ii) Claims received on or after October 1, 1984. (A) Except as 
provided in paragraph (b)(1)(ii)(B) of this section, date of receipt of 
claim.
    (B) If, within one year from the date on which the veteran became 
permanently and totally disabled, the veteran files a claim for a 
retroactive award and establishes that a physical or mental disability, 
which was not the result of the veteran's own willful misconduct, was so 
incapacitating that it prevented him or her from filing a disability 
pension claim for at least the first 30 days immediately following the 
date on which the veteran became permanently and totally disabled, the 
disability pension award may be effective from the date of receipt of 
claim or the date on which the veteran became permanently and totally 
disabled, whichever is to the advantage of the veteran. While rating 
board judgment must be applied to the facts and circumstances of each 
case, extensive hospitalization will generally qualify as sufficiently 
incapacitating to have prevented the filing of a claim. For the purposes 
of this subparagraph, the presumptive provisions of Sec.  3.342(a) do 
not apply.
    (2) Disability compensation--(i) Direct service connection (Sec.  
3.4(b)). Day following separation from active service or date 
entitlement arose if claim is received within 1 year after separation 
from service; otherwise, date of receipt of claim, or date entitlement 
arose, whichever is later. Separation from service means separation 
under conditions other than dishonorable from continuous active service 
which extended from the date the disability was incurred or aggravated.
    (ii) Presumptive service connection (Sec. Sec.  3.307, 3.308, 
3.309). Date entitlement arose, if claim is received within 1 year after 
separation from active duty; otherwise date of receipt of claim, or date 
entitlement arose, whichever is later. Where the requirements for 
service connection are met during service, the effective date will be 
the day following separation from service if there was continuous active 
service following the period of service on which the presumption is 
based and a claim is received within 1 year after separation from active 
duty.
    (c) Death benefits--(1) Death in service (38 U.S.C. 5110(j), Pub. L. 
87-825) (Sec. Sec.  3.4(c), 3.5(b)). First day of the month fixed by the 
Secretary concerned as the date of actual or presumed death, if claim is 
received with 1 year after the date the initial report of actual death 
or finding of presumed death was made; however benefits based on a 
report of actual death are not payable for any period for which the 
claimant has received, or is entitled to receive an allowance, 
allotment, or service pay of the veteran.
    (2) Service-connected death after separation from service (38 U.S.C. 
5110(d), Pub. L. 87-825) (Sec. Sec.  3.4(c), 3.5(b)). First day of the 
month in which the veteran's death occurred if claim is received within 
1 year after the date of

[[Page 312]]

death; otherwise, date of receipt of claim.
    (3) Nonservice-connected death after separation from service. (i) 
For awards based on claims received prior to October 1, 1984, or on or 
after December 10, 2004, first day of the month in which the veteran's 
death occurred if claim is received within one year after the date of 
death; otherwise, date of receipt of claim.
    (ii) For awards based on claims received between October 1, 1984, 
and December 9, 2004, first day of the month in which the veteran's 
death occurred if claim is received within 45 days after the date of 
death; otherwise, date of receipt of claim.


(Authority: 38 U.S.C. 5110(d))

    (4) Dependency and indemnity compensation--(i) Deaths prior to 
January 1, 1957 (Sec.  3.702). Date of receipt of election.
    (ii) Child (38 U.S.C. 5110(e), Pub. L. 87-835). First day of the 
month in which entitlement arose if claim is received within 1 year 
after the date of entitlement; otherwise, date of receipt of claim.
    (iii) Deaths on or after May 1, 1957 (in-service waiver cases) 
(Sec. Sec.  3.5(b)(3) and 3.702). Date of receipt of election. (See 
Sec.  3.114(a)).
    (d) [Reserved]
    (e) Apportionment (Sec. Sec.  3.450 through 3.461, 3.551). On 
original claims, in accordance with the facts found. On other than 
original claims from the first day of the month following the month in 
which:
    (1) Claim is received for apportionment of a veteran's award, except 
that where payments to him (her) have been interrupted, apportionment 
will be effective the day following date of last payment if a claim for 
apportionment is received within 1 year after that date;
    (2) Notice is received that a child included in the surviving 
spouse's award is not in the surviving spouse's custody, except that 
where payments to the surviving spouse have been interrupted, 
apportionment will be effective the day following date of last payment 
if such notice is received within 1 year after that date.
    (f) Federal employees' compensation cases (Sec.  3.708). Date 
authorized by applicable law, subject to any payments made by the Office 
of Workers' Compensation Programs under the Federal Employees' 
Compensation Act over the same period of time.
    (g) Correction of military records (38 U.S.C. 5110(i); Pub. L. 87-
825). Where entitlement is established because of the correction, change 
or modification of a military record, or of a discharge or dismissal, by 
a Board established under 10 U.S.C. 1552 or 1553, or because of other 
corrective action by competent military naval, or air authority, the 
award will be effective from the latest of these dates:
    (1) Date application for change, correction, or modification was 
filed with the service department, in either an original or a disallowed 
claim;
    (2) Date of receipt of claim if claim was disallowed; or
    (3) One year prior to date of reopening of disallowed claim.
    (h) Difference of opinion (Sec.  3.105). (1) As to decisions not 
finally adjudicated (see Sec.  3.160(d)) prior to timely receipt of an 
application for higher-level review, or prior to readjudication on VA 
initiative, the date from which benefits would have been payable if the 
former decision had been favorable.
    (2) As to decisions which have been finally adjudicated (see Sec.  
3.160(d)), and notwithstanding other provisions of this section, the 
date entitlement arose, but not earlier than the date of receipt of the 
supplemental claim.
    (3) As to decisions which have been finally adjudicated (see 
3.160(d)) and readjudication is undertaken solely on VA initiative, the 
date of Central Office approval authorizing a favorable decision or the 
date of the favorable Board of Veterans' Appeals decision.
    (4) Where the initial determination for the purpose of death 
benefits is favorable, the commencing date will be determined without 
regard to the fact that the action may reverse, on a difference of 
opinion, an unfavorable decision for disability purposes by an 
adjudicative agency other than the Board of Veterans Appeals, which was 
in effect at the date of the veteran's death.
    (i) Disability or death due to hospitalization, etc. (38 U.S.C. 
5110(c), (d); Public Law 87-825; Sec. Sec.  3.358, 3.361, and

[[Page 313]]

3.800.) (1) Disability. Date injury or aggravation was suffered if claim 
is received within 1 year after that date; otherwise, date of receipt of 
claim.
    (2) Death. First day of month in which the veteran's death occurred 
if a claim is received within 1 year following the date of death; 
otherwise, date of receipt of claim.
    (j) Election of Department of Veterans Affairs benefits (Sec.  3.700 
series). (1) Unless otherwise provided, the date of receipt of election, 
subject to prior payments.
    (2) July 1, 1960, as to pension payable under Pub. L. 86-211, where 
pension is payable for June 30, 1960, under the law in effect on that 
date, including an award approved after that date, if the election is 
filed within (generally) 120 days from date of notice of the award. The 
award will be subject to prior payments over the same period of time.
    (3) January 1, 1965, as to pension payable under Pub. L. 86-211 (73 
Stat. 432) as amended by Pub. L. 88-664 if there was basic eligibility 
for pension on June 30, 1960, under the law in effect on that date and 
an election if filed prior to May 1, 1965.
    (4) January 1, 1965, as to pension payable under Pub. L. 86-211 (73 
Stat. 432) as amended by Pub. L. 88-664 if there was basic eligibility 
on that date for pension on the basis of service in the Indian wars or 
Spanish-American War and an election is filed prior to May 1, 1965.
    (5) January 1, 1969, as to pension payable under Pub. L. 86-211 (73 
Stat. 432), as amended by Pub. L. 90-275 (82 Stat. 64), if there was 
basic eligibility for pension on June 30, 1960, under the law in effect 
on that date and an election is filed prior to May 1, 1969.
    (6) August 1, 1972, as to pension payable under Pub. L. (73 Stat. 
432) as amended by Pub. L. 92-328 (86 Stat. 393) if there was basic 
eligibility on that date based on death of a veteran of the Spanish-
American War and an election is filed prior to December 1, 1972.
    (k) Error (Sec.  3.105). Date from which benefits would have been 
payable if the corrected decision had been made on the date of the 
reversed decision.
    (l) Foreign residence. (See Sec.  3.653).
    (m) Forfeiture (Sec. Sec.  3.901, 3.902). Day following date of last 
payment on award to payee who forfeited.
    (n) Guardian. Day following date of last payment to prior payee or 
fiduciary.

    Note: Award to guardian shall include amounts withheld for possible 
apportionments as well as money in Personal Funds of Patients.

    (o) Increases (38 U.S.C. 5110(a) and 5110(b)(2), Pub. L. 94-71, 89 
Stat. 395; Sec. Sec.  3.109, 3.156, 3.157--(1) General. Except as 
provided in paragraph (o)(2) of this section and Sec.  3.401(b), date of 
receipt of claim or date entitlement arose, whichever is later. A 
retroactive increase or additional benefit will not be awarded after 
basic entitlement has been terminated, such as by severance of service 
connection.
    (2) Disability compensation. Earliest date as of which it is 
factually ascertainable based on all evidence of record that an increase 
in disability had occurred if a complete claim or intent to file a claim 
is received within 1 year from such date, otherwise, date of receipt of 
claim. When medical records indicate an increase in a disability, 
receipt of such medical records may be used to establish effective 
date(s) for retroactive benefits based on facts found of an increase in 
a disability only if a complete claim or intent to file a claim for an 
increase is received within 1 year of the date of the report of 
examination, hospitalization, or medical treatment. The provisions of 
this paragraph apply only when such reports relate to examination or 
treatment of a disability for which service-connection has previously 
been established.


(Authority: 38 U.S.C. 501, 5101)

    (p) Liberalizing laws and Department of Veterans Affairs issues. See 
Sec.  3.114.
    (q) New and material evidence (Sec.  3.156) other than service 
department records--(1) Received within appeal period or prior to 
appellate decision. The effective date will be as though the former 
decision had not been rendered. See Sec. Sec.  20.1103, 20.1104 and 
20.1304(b)(1) of this chapter.
    (2) Received after final disallowance. Date of receipt of new claim 
or date entitlement arose, whichever is later.
    (r) Reopened claims. (Sec. Sec.  3.109, 3.156, 3.157, 3.160(e)) Date 
of receipt of claim or date entitlement arose, whichever is

[[Page 314]]

later, except as provided in Sec.  20.1304(b)(1) of this chapter.


(Authority: 38 U.S.C. 501)

    (s) Renouncement (Sec.  3.106). Except as provided in Sec.  
3.106(c), date of receipt of new claim.
    (t) Whereabouts now known. (See Sec.  3.158(c).)
    (u) Void, annulled or terminated marriage of a child (38 U.S.C. 5110 
(a), (k), (l); Pub. L. 93-527, 88 Stat. 1702; Sec.  3.55)--(1) Void. 
Date the parties ceased to cohabit or date of receipt of claim, 
whichever is later.
    (2) Annulled. Date the decree of annulment became final if claim is 
filed within 1 year after that date; otherwise date of receipt of claim.
    (3) Death. Date of death if claim is filed within 1 year after that 
date; otherwise date of receipt of claim. Benefits are not payable 
unless the provisions of Sec.  3.55(b) of this part are met.
    (4) Divorce. Date the decree became final if claim is filed within 1 
year of that date; otherwise date of receipt of claim. Benefits are not 
payable unless the provisions of Sec.  3.55(b) of this part are met.
    (v) Termination of remarriage of surviving spouse (38 U.S.C. 
5110(a), (k); 38 U.S.C. 103(d) and 3010(l) effective January 1, 1971; 
Sec.  3.55)--(1) Void. Date the parties ceased to cohabit or date of 
receipt of claim, whichever is the later.
    (2) Annulled. Date the decree of annulment became final if claim is 
filed within 1 year after that date; otherwise date of receipt of claim.
    (3) Death. Date of death if claim is filed within 1 year after that 
date; otherwise date of receipt of claim. Benefits are not payable 
unless the provisions of Sec.  3.55(a) of this part are met.
    (4) Divorce. Date the decree became final if claim is filed within 1 
year after that date; otherwise date of receipt of claim. Benefits are 
not payable unless the provisions of Sec.  3.55(a) of this part are met.
    (w) Termination of relationship or conduct resulting in restriction 
on payment of benefits (38 U.S.C. 5110(m), effective January 1, 1971; 
Sec. Sec.  3.50(b)(2) and 3.55). Date of receipt of application filed 
after termination of relationship and after December 31, 1970. Benefits 
are not payable unless the provisions of Sec.  3.55(a), as applicable, 
are met.
    (x) Effective date of determination of incompetency (Sec.  3.353). 
Date of rating of incompetency. (Not applicable to an incompetency 
determination made for insurance purposes under 38 U.S.C. 1922).
    (y) Effective date of determination restoring competency (Sec.  
3.353). Date shown by evidence of record that competency was regained.
    (z) Claims based on service in the Women's Air Forces Service Pilots 
(WASP), or on service in a similarly situated group (Pub. L. 95-202). 
(1) Original claim: Date of receipt of claim or date entitlement arose, 
whichever is later, or as otherwise provided under this section (e.g., 
paragraph (b)(1) of this section) except that no benefits shall be 
awarded for any period prior to November 23, 1977.
    (2) Reopened claims received prior to the effective date provided in 
Sec.  19.2(a) of this chapter: Latest of the following dates:
    (i) November 23, 1977.
    (ii) Date entitlement arose.
    (iii) One year prior to date of receipt of reopened claim.
    (3) Supplemental claims received more than one year after notice of 
decision: Latest of the following dates:
    (i) Date entitlement arose.
    (ii) One year prior to date of receipt of a supplemental claim.

[26 FR 1593, Feb. 24, 1961]

    Editorial Note: For Federal Register citations affecting Sec.  
3.400, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  3.401  Veterans.

    Awards of pension or compensation payable to or for a veteran will 
be effective as follows:
    (a) Aid and attendance and housebound benefits. (1) Except as 
provided in Sec.  3.400(o)(2), the date of receipt of claim or date 
entitlement arose, whichever is later. However, when an award of pension 
or compensation based on an original or supplemental claim is effective 
for a period prior to the date of receipt of the claim, any additional 
pension or compensation payable by reason of need for aid and attendance 
or housebound status shall also be awarded for

[[Page 315]]

any part of the award's retroactive period for which entitlement to the 
additional benefit is established.


(Authority: 38 U.S.C. 501; 5110(b)(1), (3))

    (2) Date of departure from hospital, institution, or domiciliary.


(Authority: 38 U.S.C. 501)

    (3) Spouse, additional compensation for aid and attendance: Date of 
receipt of claim or date entitlement arose, whichever is later. However, 
when an award of disability compensation based on an original or 
supplemental claim is effective for a period prior to date of receipt of 
the claim additional disability compensation payable to a veteran by 
reason of the veteran's spouse's need for aid and attendance shall also 
be awarded for any part of the award's retroactive period for which the 
spouse's entitlement to aid and attendance is established.


(Authority: 38 U.S.C. 501; 5110(b)(1), (2))

    (b) Dependent, additional compensation or pension for. Latest of the 
following dates:
    (1) Date of claim. This term means the following, listed in their 
order of applicability:
    (i) Date of veteran's marriage, or birth of his or her child, or, 
adoption of a child, if the evidence of the event is received within 1 
year of the event; otherwise.
    (ii) Date notice is received of the dependent's existence, if 
evidence is received within 1 year of the Department of Veterans Affairs 
request.
    (2) Date dependency arises.
    (3) Effective date of the qualifying disability rating provided 
evidence of dependency is received within 1 year of notification of such 
rating action.


(Authority: 38 U.S.C. 5110(f))

    (4) Date of commencement of veteran's award. (Other increases, see 
Sec.  3.400(o). For school attendance see Sec.  3.667.)


(Authority: 38 U.S.C. 5110 (f), (n))

    (c) Divorce of veteran and spouse. See Sec.  3.501(d).
    (d) [Reserved]
    (e) Retirement pay (Sec.  3.750)--(1) Election. Date of entitlement 
if timely filed. Subject to prior payments of retirement pay.
    (2) Waiver. Day following date of discontinuance or reduction of 
retirement pay.
    (3) Reelection. Day the reelection is received by the Department of 
Veterans Affairs.
    (f) Service pension (Sec.  3.3(a)). Date of receipt of claim.
    (g) Tuberculosis, special compensation for arrested. As of the date 
the graduated evaluation of the disability or compensation for that 
degree of disablement combined with other service-connected disabilities 
would provide compensation payable at a rate less than $67. See Sec.  
3.350(g).
    (h) Temporary increase ``General Policy in Rating,'' 1945 Schedule 
for Rating Disabilities--(1) Section 4.29 of this chapter. Date of 
entrance into hospital, after 21 days of continuous hospitalization for 
treatment.
    (2) Section 4.30 of this chapter. Date of entrance into hospital, 
after discharge from hospitalization (regular or release to non-bed 
care).
    (i) Increased disability pension based on attainment of age 78. 
First day of the month during which veteran attains age 78.

[26 FR 1594, Feb. 24, 1961, as amended at 27 FR 11889, Dec. 1, 1962; 36 
FR 4599, Mar. 10, 1971; 39 FR 17222, Mar. 14, 1974; 41 FR 36493, Aug. 
30, 1976; 41 FR 55874, Dec. 23, 1976; 41 FR 56804, Dec. 30, 1976; 45 FR 
34886, May 23, 1980; 54 FR 34981, Aug. 23, 1989; 62 FR 5529, Feb. 6, 
1997; 83 FR 32738, July 13, 2018; 84 FR 170, Jan. 18, 2019]



Sec.  3.402  Surviving spouse.

    Awards of pension, compensation, or dependency and indemnity 
compensation to or for a surviving spouse will be effective as follows:
    (a) Additional allowance of dependency and indemnity compensation 
for children Sec.  3.5(e). Commencing date of surviving spouse's award. 
See Sec.  3.400(c).
    (b) Legal surviving spouse entitled. See Sec.  3.657.
    (c) Aid and attendance and housebound benefits. (1) Date of receipt 
of claim or date entitlement arose whichever is later. However, when an 
award of dependency and indemnity compensation (DIC) or pension based on 
an original

[[Page 316]]

or supplemental claim is effective for a period prior to date of receipt 
of the claim, any additional DIC or pension payable to the surviving 
spouse by reason of need for aid and attendance or housebound status 
shall also be awarded for any part of the award's retroactive period for 
which entitlement to the additional benefit is established.


(Authority: 38 U.S.C. 501; 5110(d))

    (2) Date of departure from hospital, institutional or domiciliary 
care at Department of Veterans Affairs expense. This is applicable only 
to aid and attendance benefits. Housebound benefits may be awarded 
during hospitalization at Department of Veterans Affairs expense.

(Authority: 38 U.S.C. 501)

[45 FR 34887, May 23, 1980, as amended at 84 FR 170, Jan. 18, 2019]



Sec.  3.403  Children.

    (a) Awards of pension, compensation, or dependency and indemnity 
compensation to or for a child, or to or for a veteran or surviving 
spouse on behalf of such child, will be effective as follows:
    (1) Permanently incapable of selfsupport (Sec.  3.57(a)(3)). In 
original claims, date fixed by Sec. Sec.  3.400(b) or (c) or 3.401(b). 
In claims for continuation of payments, 18th birthday if the condition 
is claimed prior to or within 1 year after that date; otherwise from 
date of receipt of claim.
    (2)Majority (Sec.  13.100). Direct payment to child if competent, 
from date of majority or, date of last payment, whichever is the earlier 
date.
    (3) Posthumous child. Date of child's birth if proof of birth is 
received within 1 year of that date, or if a claim or an intent to file 
a claim as set forth in Sec.  3.155(b), is received within 1 year after 
the veteran's death; otherwise, date of claim.


(Authority: 38 U.S.C. 5110(n))

    (4) School attendance. (See Sec.  3.667.)
    (5) Adopted child. Date of adoption either interlocutory or final or 
date of adoptive placement agreement, but not earlier than the date from 
which benefits are otherwise payable.
    (b) Monetary allowance under 38 U.S.C. 1805 for an individual 
suffering from spina bifida who is a child of a Vietnam veteran. Except 
as provided in Sec.  3.814(e), an award of the monetary allowance under 
38 U.S.C. 1805 to or for an individual suffering from spina bifida who 
is a child of a Vietnam veteran will be effective either date of birth 
if claim is received within one year of that date, or the later of the 
date of claim or the date entitlement arose, but not earlier than 
October 1, 1997.


(Authority: 38 U.S.C. 1805, 1832, 5110)

    (c) Monetary allowance under 38 U.S.C. 1815 for an individual with 
covered birth defects who is a child of a woman Vietnam veteran. Except 
as provided in Sec.  3.114(a) or Sec.  3.815(i), an award of the 
monetary allowance under 38 U.S.C. 1815 to or for an individual with one 
or more covered birth defects who is a child of a woman Vietnam veteran 
will be effective as of the date VA received the claim (or the date of 
birth if the claim is received within one year of that date), the date 
entitlement arose, or December 1, 2001, whichever is latest.


(Authority: 38 U.S.C. 1815, 1832, 1834, 5110)

    (d) Monetary allowance under 38 U.S.C. 1821 for an individual 
suffering from spina bifida who is a child of a veteran with covered 
service in Korea. Except as provided in Sec.  3.814(e), an award of the 
monetary allowance under 38 U.S.C. 1821 based on the existence of an 
individual suffering from spina bifida who is a child of a veteran with 
covered service in Korea will be effective from either the date of birth 
if claim is received within 1 year of that date, or the later of the 
date of claim or date entitlement arose, but not earlier than December 
16, 2003.


(Authority: 38 U.S.C. 1821, 1832, 5110)

[26 FR 1594, Feb. 24, 1961, as amended at 27 FR 11889, Dec. 1, 1962; 36 
FR 4599, Mar. 10, 1971; 38 FR 872, Jan. 5, 1973; 39 FR 20204, June 7, 
1974; 41 FR 36493, Aug. 30, 1976; 45 FR 34887, May 23, 1980; 62 FR 
51279, Sept. 30, 1997; 67 FR 49587, July 31, 2002; 76 FR 4248, Jan. 25, 
2011; 79 FR 57697, Sept. 25, 2014; 83 FR 32738, July 13, 2018]

[[Page 317]]



Sec.  3.404  Parents.

    Awards of additional amounts of compensation and dependency and 
indemnity compensation based on a parent's need for aid and attendance 
will be effective the date of receipt of claim or date entitlement 
arose, whichever is later. However, when an award of dependency and 
indemnity compensation based on an original or supplemental claim is 
effective for a period prior to date of receipt of claim, any additional 
dependency and indemnity compensation payable by reason of need for aid 
and attendance may also be awarded for any part of the award's 
retroactive period for which entitlement to aid and attendance is 
established. When the parent is provided hospital, institutional or 
domiciliary care at Department of Veterans Affairs expense, the 
effective date will be the date of departure therefrom.

(Authority: 38 U.S.C. 501; 5110(d))

[45 FR 34887, May 23, 1980, as amended at 84 FR 171, Jan. 18, 2019]



Sec.  3.405  Filipino veterans and their survivors; benefits at the
full-dollar rate.

    Public Laws 106-377 and 108-183, which provide disability 
compensation and dependency and indemnity compensation at full-dollar 
rates to certain Filipino veterans and their survivors, are considered 
liberalizing laws. As such, the provisions of 38 CFR 3.114(a) apply when 
determining the effective date of an award. If the requirements of Sec.  
3.114(a) are not satisfied, then the effective date of an award of 
benefits at the full-dollar rate under Sec.  3.42 will be determined as 
follows:
    (a) Initial entitlement to full-dollar rate. The latest of the 
following:
    (1) Date entitlement arose;
    (2) Date on which the veteran or survivor first met the residency 
and citizenship or permanent resident alien status requirements in Sec.  
3.42, if VA receives evidence of this within one year of that date; or
    (3) Effective date of service connection, provided VA receives 
evidence that the veteran or survivor meets the residency and 
citizenship or permanent resident alien status requirements in Sec.  
3.42 within one year of the date of notification of the decision 
establishing service connection.
    (b) Resumption of full-dollar rate. (1) Date the veteran or survivor 
returned to the United States after an absence of more than 60 
consecutive days; or
    (2) First day of the calendar year following the year in which the 
veteran or survivor was absent from the United States for a total of 183 
days or more, or the first day after that date that the veteran or 
survivor returns to the United States.

[71 FR 8221, Feb. 16, 2006]

                             Apportionments



Sec.  3.450  General.

    (a)(1) All or any part of the pension, compensation, or emergency 
officers' retirement pay payable on account of any veteran may be 
apportioned.
    (i) On behalf of his or her spouse, children, or dependent parents 
if the veteran is incompetent and is being furnished hospital treatment, 
institutional, or domiciliary care by the United States, or any 
political subdivision thereof.
    (ii) If the veteran is not residing with his or her spouse, or if 
the veteran's children are not residing with the veteran and the veteran 
is not reasonably discharging his or her responsibility for the spouse's 
or children's support.
    (2) Where any of the children of a deceased veteran are not living 
with the veteran's surviving spouse, the pension, compensation, or 
dependency and indemnity compensation otherwise payable to the surviving 
spouse may be apportioned.


(Authority: 38 U.S.C. 5307)

    (b) Except as provided in Sec.  3.458(e), no apportionment of 
disability or death benefits will be made or changed solely because a 
child has entered active duty with the air, military, or naval services 
of the United States.
    (c) No apportionment will be made where the veteran, the veteran's 
spouse (when paid ``as wife'' or ``as husband''), surviving spouse, or 
fiduciary is providing for dependents. The additional benefits for such 
dependents will be paid to the veteran, spouse, surviving spouse, or 
fiduciary.

[[Page 318]]

    (d) Any amounts payable for children under Sec. Sec.  3.459, 3.460 
and 3.461 will be equally divided among the children.
    (e) The amount payable for a child in custody of and residing with 
the surviving spouse shall be paid to the surviving spouse. Amounts 
payable to a surviving spouse for a child in the surviving spouse's 
custody but residing with someone else may be apportioned if the 
surviving spouse is not reasonably contributing to the child's support.
    (f) Prior to release of any amounts the relationship of the claimant 
and the dependency of a parent will be fully developed, and the 
necessary evidence secured.
    (g) The provisions of Sec.  3.460 are applicable where the surviving 
spouse is entitled to a higher rate of pension under the circumstances 
described in that section.

[26 FR 1594, Feb. 24, 1961, as amended at 26 FR 7266, Aug. 11, 1961; 27 
FR 6974, July 24, 1962; 32 FR 13226, Sept. 19, 1967; 37 FR 6678, Apr. 1, 
1972; 44 FR 45939, Aug. 6, 1979]



Sec.  3.451  Special apportionments.

    Without regard to any other provision regarding apportionment where 
hardship is shown to exist, pension, compensation, emergency officers' 
retirement pay, or dependency and indemnity compensation may be 
specially apportioned between the veteran and his or her dependents or 
the surviving spouse and children on the basis of the facts in the 
individual case as long as it does not cause undue hardship to the other 
persons in interest, except as to those cases covered by Sec.  3.458(b) 
and (c). In determining the basis for special apportionment, 
consideration will be given such factors as: Amount of Department of 
Veterans Affairs benefits payable; other resources and income of the 
veteran and those dependents in whose behalf apportionment is claimed; 
and special needs of the veteran, his or her dependents, and the 
apportionment claimants. The amount apportioned should generally be 
consistent with the total number of dependents involved. Ordinarily, 
apportionment of more than 50 percent of the veteran's benefits would 
constitute undue hardship on him or her while apportionment of less than 
20 percent of his or her benefits would not provide a reasonable amount 
for any apportionee.

[44 FR 45940, Aug. 6, 1979]



Sec.  3.452  Situations when benefits may be apportioned.

    Veterans benefits may be apportioned:
    (a) If the veteran is not residing with his or her spouse or his or 
her children and a claim for apportionment is filed for or on behalf of 
the spouse or children.
    (b) Pending the appointment of a guardian or other fiduciary.
    (c)(1) Where an incompetent veteran without a fiduciary is receiving 
institutional care by the United States or a political subdivision, his 
or her benefit may be apportioned for a spouse or child, or, except as 
provided in paragraph (c)(2), for a dependent parent, unless such 
benefit is paid to a spouse (``as wife'' or ``as husband'') for the use 
of the veteran and his or her dependents.
    (2) Where a married veteran is receiving section 306 or improved 
pension and the amount payable is reduced under Sec.  3.551(c) because 
of hospitalization, an apportionment may be paid to the veteran's spouse 
as provided in Sec.  3.454(b).


(Authority: 38 U.S.C. 501(a); 5307; 5503(a))

    (d) Where additional compensation is payable on behalf of a parent 
and the veteran or his or her guardian neglects or refuses to contribute 
such an amount to the support of the parent the additional compensation 
will be paid to the parent upon receipt of a claim.

    Cross References: Disappearance of veteran. See Sec.  3.656. 
Reduction because of hospitalization. See Sec.  3.551. Penal 
institutions. See Sec.  3.666.

[26 FR 7266, Aug. 11, 1961, as amended at 27 FR 6974, July 24, 1962; 40 
FR 21724, May 19, 1975; 44 FR 45940, Aug. 6, 1979; 66 FR 48560, Sept. 
21, 2001; 68 FR 34542, June 10, 2003; 83 FR 32738, July 13, 2018]

[[Page 319]]



Sec.  3.453  Veterans compensation or service pension or retirement pay.

    Rates of apportionment of disability compensation, service pension 
or retirement pay will be determined under Sec.  3.451.

[26 FR 7266, Aug. 11, 1961]



Sec.  3.454  Veterans disability pension.

    Apportionment of disability pension will be as follows:
    (a) Where a veteran with spouse, or child is incompetent and without 
legal fiduciary and is maintained in an institution by the United States 
or any political subdivision thereof, $25 monthly will be paid as an 
institutional award to the Director of a Department of Veterans Affairs 
medical center or chief officer of a non-Department of Veterans Affairs 
institution for the use of the veteran, and the balance will be paid to 
the dependent or dependents. If the veteran has no spouse, or child but 
has a dependent parent, apportionment will be in accordance with Sec.  
3.451.
    (b)(1) Where the amount of section 306 pension payable to a married 
veteran under 38 U.S.C. 1521(b), as in effect on December 31, 1978, is 
reduced to $50 monthly under Sec.  3.551(c), an apportionment may be 
made to such veteran's spouse upon an affirmative showing of hardship. 
The amount of the apportionment generally will be the difference between 
$50 and the total amount of pension payable on December 31, 1978.


(Authority: 38 U.S.C. 5503(a))

    (2) Where the amount of improved pension payable to a married 
veteran under 38 U.S.C. 1521(b) is reduced to $60 monthly under Sec.  
3.551(d) or (e)(2), an apportionment may be made to such veteran's 
spouse upon an affirmative showing of hardship. The amount of the 
apportionment generally will be the difference between $50 and the rate 
payable if pension was being paid under 38 U.S.C. 1521(c) including the 
additional amount payable under 38 U.S.C. 1521(e) if the veteran is so 
entitled.


(Authority: 38 U.S.C. 5503(a))

    (3) Where the amount of improved pension payable to a married 
veteran under 38 U.S.C. 1521(b) is reduced to $90 monthly under Sec.  
3.551(e)(1) an apportionment may be made to such veteran's spouse upon 
an affirmative showing of hardship. The amount of the apportionment 
generally will be the difference between $90 and the rate payable if 
pension was being paid under 38 U.S.C. 1521(c) including the additional 
amount payable under 38 U.S.C. 1521(e) if the veteran is so entitled.


(Authority: 38 U.S.C. 5503(a))

[40 FR 36329, Aug. 20, 1975, as amended at 44 FR 45940, Aug. 6, 1979; 56 
FR 65850, 65851, Dec. 19, 1991; 57 FR 7847, Mar. 4, 1992; 68 FR 34542, 
June 10, 2003]



Sec.  3.458  Veteran's benefits not apportionable.

    Veteran's benefits will not be apportioned:
    (a) Where the total benefit payable to the disabled person does not 
permit payment of a reasonable amount to any apportionee.
    (b) Where the spouse of the disabled person has been found guilty of 
conjugal infidelity by a court having proper jurisdiction.
    (c) For purported or legal spouse of the veteran if it has been 
determined that he or she has lived with another person and held herself 
or himself out openly to the public to be the spouse of such other 
person, except where such relationship was entered into in good faith 
with a reasonable basis (for example trickery on the part of the 
veteran) for the spouse believing that the marriage to the veteran was 
legally terminated. No apportionment to the spouse will thereafter be 
made unless there has been a reconciliation and later estrangement.
    (d) Where the child of the disabled person has been legally adopted 
by another person.
    (e) Where a child enters the active military, air, or naval service, 
any additional amount will be paid to the veteran unless such child is 
included in an existing apportionment to an estranged spouse. No 
adjustment in the apportioned award will be made based on the child's 
entry into service.
    (f)(1) For the spouse, child, father or mother of a disabled 
veteran, where

[[Page 320]]

forfeiture was declared prior to September 2, 1959, if the dependent is 
determined by the Department of Veterans Affairs to have been guilty of 
mutiny, treason, sabotage, or rendering assistance to an enemy of the 
United States or its allies.
    (2) For any dependent of a disabled veteran, or surviving spouse 
where forfeiture of benefits by a person primarily entitled was declared 
after September 1, 1959, by reason of fraud, treasonable acts, or 
subversive activities.


(Authority: 38 U.S.C. 6103(b); 6104(c); 6105(a))

    (g) Until the estranged spouse of a veteran files claim for an 
apportioned share. If there are any children of the veteran not in his 
or her custody an apportionment will not be authorized unless and until 
a claim for an apportioned share is filed in their behalf.

    Cross References: Child. See Sec.  3.57. Child adopted out of 
family. See Sec.  3.58.

[26 FR 7266, Aug. 11, 1961, as amended at 40 FR 21724, May 19, 1975; 44 
FR 45940, Aug. 6, 1979; 80 FR 48451, Aug. 13, 2015]



Sec.  3.459  Death compensation.

    (a) Death compensation will be apportioned if the child or children 
of the deceased veteran are not in the custody of the surviving spouse.
    (b) The surviving spouse may not be paid less than $65 monthly plus 
the amount of an aid and attendance allowance where applicable.

[40 FR 21725, May 19, 1975, as amended at 44 FR 45940, Aug. 6, 1979]



Sec.  3.460  Death pension.

    Death pension will be apportioned if the child or children of the 
deceased veteran are not in the custody of the surviving spouse. Where 
the surviving spouse's rate is in excess of $70 monthly because of 
having been the spouse of the veteran during service or because of need 
for regular aid and attendance, the additional amount will be added to 
the surviving spouse's share.
    (a) Civil, Indian and Spanish-American wars. Where pension is 
payable under 38 U.S.C. 1532, 1534, or 1536 apportionment will be based 
on the facts in the individual case in accordance with Sec.  3.451.
    (b) Section 306 and old-law death pension. Appointment of benefits 
provided under these pension programs will be at rates approved by the 
Under Secretary for Benefits except when the facts and circumstances in 
a case warrant special apportionment under Sec.  3.451.


(Authority: 38 U.S.C. 5307)

    (c) Improved death pension. Apportionment of the benefits provided 
under this program shall be made under the special apportionment 
provision of Sec.  3.451.

(Authority: 38 U.S.C. 5307)

[41 FR 21324, May 25, 1976, as amended at 43 FR 14018, Apr. 4, 1978; 44 
FR 45940, Aug. 6, 1979; 61 FR 20727, May 8, 1996]



Sec.  3.461  Dependency and indemnity compensation.

    (a) Conditions under which apportionment may be made. The surviving 
spouse's award of dependency and indemnity compensation will be 
apportioned where there is a child or children under 18 years of age and 
not in the custody of the surviving spouse. The surviving spouse's award 
of dependency and indemnity compensation will not be apportioned under 
this condition for a child over the age of 18 years.
    (b) Rates payable. (1) The share for each of the chidren under 18 
years of age, including those in the surviving spouse's custody as well 
as those who are not in such custody, will be at rates approved by the 
Under Secretary for Benefits except when the facts and circumstances in 
a case warrant special apportionment under Sec.  3.451. The share for 
the surviving spouse will be the difference between the children's share 
and the total amount payable. In the application of this rule, however, 
the surviving spouse's share will not be reduced to an amount less than 
50 percent of that to which the surviving spouse would otherwise be 
entitled.
    (2) The additional amount of aid and attendance, where applicable, 
will be added to the surviving spouse's share and not otherwise included 
in the computation.
    (3) Where the surviving spouse has elected to receive dependency and 
indemnity compensation instead of death compensation, the share of 
dependency

[[Page 321]]

and indemnity compensation for a child or children under 18 years of age 
will be whichever is the greater:
    (i) The apportioned share computed under paragraph (b)(1) of this 
section; or
    (ii) The share which would have been payable as death compensation 
but not in excess of the total dependency and indemnity compensation.

[43 FR 14018, Apr. 4, 1978, as amended at 61 FR 20727, May 8, 1996]

                     Reductions and Discontinuances



Sec.  3.500  General.

    The effective date of a rating which results in the reduction or 
discontinuance of an award will be in accordance with the facts found 
except as provided in Sec.  3.105. The effective date of reduction or 
discontinuance of an award of pension, compensation, or dependency and 
indemnity compensation for a payee or dependent will be the earliest of 
the dates stated in these paragraphs unless otherwise provided. Where an 
award is reduced, the reduced rate will be effective the day following 
the date of discontinuance of the greater benefit.


(Authority: 38 U.S.C. 5112(b))

    (a) Except as otherwise provided (38 U.S.C. 5112(a)). In accordance 
with the facts found.
    (b) Error; payee's or administrative (38 U.S.C. 5112(b), (9), (10)). 
(1) Effective date of award or day preceding act, whichever is later, 
but not prior to the date entitlement ceased, on an erroneous award 
based on an act of commission or omission by a payee or with the payee's 
knowledge.
    (2) Except as provided in paragraph (r) of this section, and Sec.  
3.501 (e) and (g), date of last payment on an erroneous award based 
solely on administrative error or error in judgment.
    (c) Annual income. See Sec.  3.660.
    (d) Apportionment (Sec. Sec.  3.450 series; Sec.  3.556). (1) Except 
as otherwise provided, date of last payment when reason for 
apportionment no longer exists.
    (2) Where pension was apportioned under Sec.  3.551(c), day 
preceding date of veteran's release from hospital, unless overpayment 
would result; date of last payment if necessary to avoid overpayment.
    (e) Federal employees' compensation (Sec.  3.708). The day preceding 
the date the award of benefits under the Federal Employees' Compensation 
Act became effective. If children on rolls and surviving spouse has 
primary title, award to children discontinued same date as surviving 
spouse's award.


(Authority: 5 U.S.C. 8116)

    (f) Contested claims Sec.  3.402(b) and Sec.  subpart F of part 20 
of this chapter). Date of last payment.
    (g) Death (38 U.S.C. 5112 (a), (b))--(1) Payee (includes 
apportionee). Last day of month before death.
    (2) Dependent of payee (includes apportionee):
    (i) Death prior to October 1, 1982: last day of the calendar year in 
which death occurred.
    (ii) Death on or after October 1, 1982: last day of the month in 
which death occurred, except that section 306 and old-law pension 
reductions or terminations will continue to be effective the last day of 
the calendar year in which death occurred.
    (3) Veteran receiving retirement pay. Date of death.
    (h) Dependency of parent (38 U.S.C. 5112; Pub. L. 90-275; Sec. Sec.  
3.4(a), (b)(2), 3.250, 3.551(b) and 3.660). See Sec.  3.660.
    (i) Election of Department of Veterans Affairs benefits (Sec.  3.700 
series). Day preceding beginning date of award under other law.
    (j) Foreign residence (38 U.S.C. 5308(a)). See Sec.  3.653.
    (k) Fraud (38 U.S.C. 6103(a), (d); Sec. Sec.  3.669 and 3.901). 
Beginning date of award or day preceding date of fraudulent act, 
whichever is later.
    (l)-(m) [Reserved]
    (n) Marriage (or remarriage) (38 U.S.C. 101(3), 5112 (b))--(1) Payee 
(includes apportionee). Last day of month before marriage.
    (2) Dependent of payee (includes apportionee):
    (i) Marriage prior to October 1, 1982: last day of the calendar year 
in which marriage occurred.
    (ii) Marriage on or after October 1, 1982: last day of the month in 
which marriage occurred, except that section 306 and old-law pension 
reductions or

[[Page 322]]

terminations will continue to be effective the last day of the calendar 
year in which marriage occurred.
    (3) Conduct of surviving spouse. Last day of month before inception 
of relationship.


(Authority: 38 U.S.C. 101(4), 501)

    (o) Penal institutions. See Sec.  3.666.
    (p) Philippines (38 U.S.C. 107(a)(3); Sec.  3.40). Date of last 
payment when recognition of service withdrawn.
    (q) Renouncement (Sec.  3.106). Last day of the month in which the 
renouncement is received.
    (r) Service connection (38 U.S.C. 5112(b)(6); Sec.  3.105). Last day 
of month following 60 days after notice to payee. Applies to reduced 
evaluation, and severance of service connection.
    (s) Treasonable acts or subversive activities (38 U.S.C. 6104 and 
6105; Sec. Sec.  3.902, 3.903). (1) Treasonable acts. Date of the 
forfeiture decision or date of last payment, whichever is earlier.
    (2) Subversive activities. Beginning date of award or day preceding 
date of commission of subversive activities for which convicted, 
whichever is later.
    (t) Whereabouts unknown (Sec. Sec.  3.158, 3.656). Date of last 
payment.
    (u) Change in law or Department of Veterans Affairs issue, or 
interpretation. See Sec.  3.114.
    (v) Failure to furnish evidence of continued eligibility. See Sec.  
3.652 (a) and (b).
    (w) Failure to furnish Social Security number. Last day of the month 
during which the 60 day period following the date of VA request expires.
    (x) Radiation Exposure Compensation Act of 1990 (Sec.  3.715). 
(Compensation or dependency and indemnity compensation only.) Last day 
of the month preceding the month in which payment under the Radiation 
Exposure Compensation Act of 1990 is issued.
    (y) Compensation for certain disabilities due to undiagnosed 
illnesses (Sec. Sec.  3.105; 3.317). Last day of the month in which the 
60-day period following notice to the payee of the final rating action 
expires. This applies to both reduced evaluations and severance of 
service connection.


(Authority: Pub. L. 103-446; 38 U.S.C. 501(a))

(Authority: 38 U.S.C. 8301)

    Cross Reference: Failure to return questionnaire. See Sec.  
3.661(b).

[26 FR 1596, Feb. 24, 1961]

    Editorial Note: For Federal Register citations affecting Sec.  
3.500, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  3.501  Veterans.

    The effective date of discontinuance of pension or compensation to 
or for a veteran will be the earliest of the dates stated in this 
section. Where an award is reduced, the reduced rate will be payable the 
day following the date of discontinuance of the greater benefit.
    (a) Active service pay (38 U.S.C. 5112(b)(3); Pub. L. 87-825; Sec.  
3.700(a)). Day preceding entrance on active duty. See Sec.  3.654.
    (b) Aid and attendance--(1) Section 3.552(b)(1). Last day of 
calendar month following month in which veteran is hospitalized at 
Department of Veterans Affairs expense.
    (2) Section 3.552(b)(2). Last day of calendar month following month 
in which veteran hospitalized at United States Government expense.
    (3) Aid and attendance for spouse. End of month in which award 
action is taken if need for aid and attendance has ceased.
    (c) Disappearance of veteran. See Sec.  3.656.
    (d) Divorce or annulment (38 U.S.C. 5112(b)(2)):
    (1) Divorce or annulment prior to October 1, 1982: last day of the 
calendar year in which divorce or annulment occurred.
    (2) Divorce or annulment on or after October 1, 1982: last day of 
the month in which divorce or annulment occurred, except that section 
306 and old-law pension reductions or terminations will continue to be 
effective the last day of the calendar year in which divorce or 
annulment occurred.
    (e) Employability regained (38 U.S.C. 5112(b) (5), (6); Pub. L. 87-
825; Sec.  3.105)--(1) Pension. Last day of month in which 
discontinuance is approved.
    (2) Compensation. Last day of month following 60 days after notice 
to payee.
    (f) Employment questionnaire, failure to return. Reduce award to the 
amount payable for the schedular evaluation

[[Page 323]]

shown in the current rating as of the day following the date of last 
payment.
    (g) Evaluation reduced (38 U.S.C. 5112(b) (5), (6); Pub. L. 87-825; 
Sec.  3.105)--(1) Pension. Last day of month in which reduction or 
discontinuance is approved.
    (2) Compensation. Last day of month following 60 days after notice 
to payee.
    (h) Examination; failure to report. See Sec.  3.655.
    (i) Hospitalization--(1) Section 3.551(b). Last day of the sixth 
calendar month following admission if veteran without dependents.
    (2) Section 3.551(c). (i) Last day of the second calendar month 
following admission to domiciliary care if veteran without spouse or 
child or, though married, is receiving pension at the rate provided for 
a veteran without dependents. (ii) Last day of the third calendar month 
following admission for hospital or nursing home care if veteran without 
spouse or child or, though married, is receiving pension at the rate 
provided for a veteran without dependents. (iii) Upon readmission to 
hospital, domiciliary, or nursing home care within 6 months of a period 
for which pension was reduced under Sec.  3.551(c)(1), the last day of 
the month of such readmission.
    (3) Section 3.552(b) Upon readmission to hospital care within 6 
months of a period of hospital care for which pension was affected by 
the provisions of Sec.  3.552(b)(1) and (2) or Sec.  3.552(k) and 
discharge or release was against medical advice or was the result of 
disciplinary action, the day preceding the date of such readmission.
    (4) Section 3.551(d) (i) Last day of the second calendar month 
following admission to domiciliary care if veteran without spouse or 
child or, though married, is receiving pension at the rate for a veteran 
without dependents.
    (ii) Last day of the third calendar month following admission for 
hospitalization or nursing home care if veteran without spouse or child 
or, though married, is receiving pension at the rate for a veteran 
without dependents.
    (iii) Upon readmission to hospital, domiciliary, or nursing home 
care within 6 months of a period for which pension was reduced under 
Sec.  3.551(d)(1) or (2), the last day of the month of such readmission.
    (5) Section 3.551(e) (i) Last day of the third calendar month 
following admission to domiciliary or nursing home care if veteran 
without spouse or child or, though married, is receiving pension at the 
rate for a veteran without dependents. (ii) Upon readmission to 
domiciliary or nursing home care within 6 months of a period of 
domiciliary or nursing home care for which pension was reduced under 
Sec.  3.551(e)(1), the last day of the month of such readmission.
    (6) Section 3.551(h). (i) Last day of the calendar month in which 
Medicaid payments begin, last day of the month following 60 days after 
issuance of a prereduction notice required under Sec.  3.103(b)(2), or 
the earliest date on which payment may be reduced without creating an 
overpayment, whichever date is later; or
    (ii) If the veteran willfully conceals information necessary to make 
the reduction, the last day of the month in which that willful 
concealment occurred.


(Authority: 38 U.S.C. 5503)

    (j) [Reserved]
    (k) Lump-sum readjustment pay. See Sec.  3.700(a)(2).
    (l) Retirement pay (38 U.S.C. 5112(b)(3); Pub. L. 87-825; Sec.  
3.750). Day before effective date of retirement pay.
    (m) Temporary increase (38 U.S.C. 5112(b)(8); Sec.  4.29 of this 
chapter). Last day of month in which hospitalization or treatment 
terminated, whichever is earlier, where temporary increase in 
compensation was authorized because of hospitalization for treatment.

(Authority: 38 U.S.C. 5505)

[26 FR 1596, Feb. 24, 1961, as amended at 27 FR 11889, Dec. 1, 1962; 29 
FR 12368, Aug. 28, 1964; 29 FR 16329, Dec. 5, 1964; 35 FR 2828, Feb. 11, 
1970; 37 FR 6679, Apr. 1, 1972; 38 FR 34115, Dec. 11, 1973; 41 FR 55874, 
Dec. 23, 1976; 44 FR 45941, Aug. 6, 1979; 48 FR 34473, July 29, 1983; 53 
FR 23236, June 21, 1988; 56 FR 25045, June 3, 1991; 56 FR 65849, 65853, 
Dec. 19, 1991; 66 FR 48560, Sept. 21, 2001; 68 FR 34542, June 10, 2003; 
83 FR 32738, July 13, 2018]



Sec.  3.502  Surviving spouses.

    The effective date of discontinuance of pension, compensation, or 
dependency and indemnity compensation to

[[Page 324]]

or for a surviving spouse will be the earliest of the dates stated in 
this section. Where an award is reduced, the reduced rate will be 
payable the day following the date of discontinuance of the greater 
benefit.


(Authority: 38 U.S.C. 501)

    (a) Additional allowance of dependency and indemnity compensation 
for children (38 U.S.C. 5112(b) Sec.  3.5(e)(3). (1) If marriage 
occurred prior to October 1, 1982, the day preceding child's 18th 
birthday or last day of calendar year in which child's marriage occurred 
(see Sec.  3.500(n) (2) and (3)), whichever is earlier.
    (2) If marriage occurred on or after October 1, 1982, the day 
preceding child's 18th birthday or last day of the month in which 
marriage occurred (see Sec.  3.500(n) (2) and (3)) whichever is earlier.
    (b) Pay grade; dependency and indemnity compensation (38 U.S.C. 
1311(a), 5112(b)(10); Pub. L. 91-96, 83 Stat. 144). Date of last payment 
when rate is reduced because of new certification of pay grade.
    (c) Legal surviving spouse entitled. Date of last payment on award 
to another person as surviving spouse. See Sec.  3.657.


(Authority: 38 U.S.C. 501)

    (d) Marriage. See Sec.  3.500(n).
    (e) Aid and attendance (Sec.  3.351(a)). (1) Date of last payment, 
if need for aid and attendance has ceased.
    (2) If hospitalized at Department of Veterans Affairs expense as a 
veteran, the date specified in Sec.  3.552(b) (1) or (3).
    (f) Medicaid-covered nursing home care (Sec.  3.551(i)). (1) Last 
day of the calendar month in which Medicaid payments begin, last day of 
the month following 60 days after issuance of a prereduction notice 
required under Sec.  3.103(b)(2), or the earliest date on which payment 
may be reduced without creating an overpayment, whichever date is later; 
or
    (2) If the surviving spouse willfully conceals information necessary 
to make the reduction, the last day of the month in which that willful 
concealment occurred.

(Authority: 38 U.S.C. 5503)

[26 FR 1596, Feb. 24, 1961, as amended at 27 FR 11890, Dec. 1, 1962; 33 
FR 2995, Feb. 15, 1968; 35 FR 2828, Feb. 11, 1970; 37 FR 6679, Apr. 1, 
1972; 41 FR 55874, Dec. 23, 1976; 48 FR 34473, July 29, 1983; 53 FR 
23237, June 21, 1988; 58 FR 32445, June 10, 1993]



Sec.  3.503  Children.

    (a) The effective date of discontinuance of pension, compensation, 
or dependency and indemnity compensation to or for a child, or to or for 
a veteran or surviving spouse on behalf of such child, will be the 
earliest of the dates stated in this section. Where an award is reduced, 
the reduced rate will be payable the day following the date of 
discontinuance of the greater benefit.


(Authority: 38 U.S.C. 501)

    (1) Age 18 (or 23) (38 U.S.C. 5112(a); Sec.  3.57). Day before 18th 
(or 23d birthday).
    (2) Enters service. Date of last payment of apportioned disability 
benefits for child not in custody of estranged spouse. Full rate payable 
to veteran. No change where payments are being made for the child to the 
veteran, his (her) estranged spouse, his (her) surviving spouse, or to 
the fiduciary of a child not in the surviving spouse's custody.


(Authority: 38 U.S.C. 501)

    (3) Permanently incapable of selfsupport (38 U.S.C. 5112(a), (b)(6); 
Pub. L. 87-825; Sec. Sec.  3.57, 3.950)--(i) Pension. Date of last 
payment.
    (ii) Compensation or dependency and indemnity compensation. Last day 
of month following 60 days after notice to payee.
    (4) Marriage. See Sec.  3.500(n).
    (5) School attendance. See Sec.  3.667.
    (6) Stepchild no longer member of veteran's household (Sec.  3.57). 
Last day child was a member of household.
    (7) Two parent cases (Sec.  3.703). Day preceding beginning date of 
award based on service of the other parent.
    (8) Dependents' educational assistance (Sec. Sec.  3.707, 3.807, and 
Sec.  21.3023 of this chapter). Day preceding beginning date of 
educational assistance allowance.

[[Page 325]]

    (9) Surviving spouse becomes entitled. Date of last payment. See 
Sec.  3.657.


(Authority: 38 U.S.C. 501)

    (10) Interlocutory adoption decree or adoptive placement agreement. 
Date child left custody of adopting parent during the interlocutory 
period or during adoptive placement agreement, or date of rescission of 
the decree or date of termination of the adoptive placement agreement, 
whichever first occurs.
    (b) Monetary allowance under 38 U.S.C. chapter 18 for certain 
individuals who are children of Vietnam veterans or children of veterans 
with covered service in Korea. The effective date of discontinuance of 
the monthly allowance under 38 U.S.C. chapter 18 will be the last day of 
the month before the month in which the death of the individual 
occurred.
    (c) Medicaid-covered nursing home care (Sec.  3.551(i)). (1) Last 
day of the calendar month in which Medicaid payments begin, last day of 
the month following 60 days after issuance of a prereduction notice 
required under Sec.  3.103(b)(2), or the earliest date on which payment 
may be reduced without creating an overpayment, whichever date is later; 
or
    (2) If the child or the child's custodian willfully conceals 
information necessary to make the reduction, the last day of the month 
in which that willful concealment occurred.

(Authority: 38 U.S.C. 501, 1832, 5112(b))

[26 FR 1597, Feb. 24, 1961, as amended at 27 FR 11890, Dec. 1, 1962; 30 
FR 14983, Dec. 3, 1965; 34 FR 839, Jan. 18, 1969; 38 FR 872, Jan. 5, 
1973; 41 FR 55875, Dec. 23, 1976; 53 FR 23237, June 21, 1988; 62 FR 
51279, Sept. 30, 1997; 67 FR 49587, July 31, 2002; 76 FR 4248, Jan. 25, 
2011; 83 FR 47275, Sept. 18, 2018]



Sec.  3.504  Parents; aid and attendance.

    The effective date of discontinuance of an increased award because 
of the parent's need for aid and attendance will be the day of last 
payment if need for aid and attendance has ceased. If hospitalized at 
Department of Veterans Affairs expense as a veteran the date will be 
specified in Sec.  3.552(b) (1) or (3).

(Authority: Pub. L. 92-197, 85 Stat. 660)

[37 FR 6679, Apr. 1, 1972]



Sec.  3.505  Filipino veterans and their survivors; benefits at the
full-dollar rate.

    The effective date of discontinuance of compensation or dependency 
and indemnity compensation for a Filipino veteran or his or her survivor 
under Sec.  3.42 will be the earliest of the dates stated in this 
section. Where an award is reduced, the reduced rate will be payable the 
day following the date of discontinuance of the greater benefit.
    (a) If a veteran or survivor receiving benefits at the full-dollar 
rate under Sec.  3.42 is physically absent from the U.S. for a total of 
183 days or more during any calendar year, VA will reduce benefits to 
the rate of $0.50 for each dollar authorized under the law, effective on 
the 183rd day of absence from the U.S.
    (b) If a veteran or survivor receiving benefits at the full-dollar 
rate under Sec.  3.42 is physically absent from the U.S. for more than 
60 consecutive days, VA will reduce benefits to the rate of $0.50 for 
each dollar authorized under the law, effective on the 61st day of the 
absence.
    (c) If a veteran or survivor receiving benefits at the full-dollar 
rate under Sec.  3.42 loses either U.S. citizenship or status as an 
alien lawfully admitted for permanent residence in the U.S., VA will 
reduce benefits to the rate of $0.50 for each dollar authorized under 
the law, effective on the day he or she no longer satisfies one of these 
criteria.
    (d) If mail to a veteran or survivor receiving benefits at the full-
dollar rate under Sec.  3.42 is returned to VA by the U.S. Postal 
Service, VA will make reasonable efforts to determine the correct 
mailing address. If VA is unable to determine the veteran's or 
survivor's correct address through reasonable efforts, VA will reduce 
benefits to the rate of $0.50 for each dollar authorized under law, 
effective the first day of the month that follows the month for which VA 
last paid benefits.

(Authority: 38 U.S.C. 107)

[71 FR 8221, Feb. 16, 2006]

[[Page 326]]

                       Hospitalization Adjustments



Sec.  3.551  Reduction because of hospitalization.

    (a) General. Pension is subject to reduction as specified below when 
a veteran who has neither spouse, child nor dependent parent is 
hospitalized, unless the veteran is hospitalized for Hansen's disease. 
The provisions of this section apply to initial periods of 
hospitalization and to readmissions following discharge from a prior 
period of hospitalization. If the veteran is hospitalized for 
observation and examination, the date treatment began is considered the 
date of admission. Special rules governing discontinuance of aid and 
attendance allowance are contained in Sec.  3.552. Except as otherwise 
indicated the terms ``hospitalized'' and ``hospitalization'' in 
Sec. Sec.  3.551 through 3.556 mean:
    (1) Hospital treatment in a Department of Veterans Affairs hospital 
or in any hospital at Department of Veterans Affairs expense.
    (2) Institutional, domiciliary or nursing home care in a Department 
of Veterans Affairs institution or domiciliary or at Department of 
Veterans Affairs expense.


(Authority: 38 U.S.C. 5503(a))

    (b) Old-law pension. (1) Old law pension in excess of $30 monthly 
for a veteran who has neither spouse, child nor dependent parent shall 
continue at the full monthly rate until the end of the sixth calendar 
month following the month of admission for hospitalization. The rate 
payable will be reduced effective the first of the seventh calendar 
month to $30 monthly or 50 percent of the amount otherwise payable, 
whichever is greater. The reduced rate will be effective the first day 
of the seventh calendar month following admission. Payment of the amount 
withheld may be made on termination of hospitalization, as provided in 
Sec.  3.556. (Sec. 306(b))
    (2) Readmission following regular discharge. Where a veteran has 
been given an approved discharge or release, readmission the next day to 
the same or any other VA institution begins a new period of 
hospitalization, unless the veteran was released for purposes of 
admission to another VA institution.
    (3) Readmission following irregular discharge. When a veteran whose 
award is subject to reduction under this paragraph has been discharged 
or released from a VA institution against medical advice or as a result 
of disciplinary action, reentry within 6 months from the date of 
previous admission constitutes a continuation of that period of 
hospitalization and the award will not be reduced prior to the first day 
of the seventh calendar month following the month of original admission, 
exclusive of authorized absences. Reentry 6 months or more after such 
discharge or release shall be considered a new admission.


(Authority: 38 U.S.C. 5503(a))

    (c) Section 306 pension. (1) Where any veteran having neither spouse 
nor child, or any veteran who is married or has a child and is receiving 
pension as a veteran without dependents, is being furnished hospital, 
nursing home or domiciliary care by the Department of Veterans Affairs, 
no pension in excess of $50 monthly shall be paid to or for the veteran 
for any period after the end of the second full calendar month following 
the month of admission for such care.


(Authority: 38 U.S.C. 5503(a))

    (2) No pension in excess of $50 monthly shall be paid to or for a 
veteran having neither spouse nor child, or to a veteran who is married 
or has a child and is receiving pension as a veteran without dependents, 
for any period after the month in which the veteran is readmitted within 
6 months of a period of care for which pension was reduced under 
paragraph (c) (1) of this section.


(Authority: 38 U.S.C. 5503(a))

    (3) Where section 306 pension is being paid to a married veteran at 
a rate for a veteran without dependents all or any part of the monthly 
amount of pension withheld in excess of $50 may be apportioned for a 
spouse as provided in Sec.  3.454(b).
    (d) Improved pension prior to February 1, 1990. (1) Where any 
veteran having neither spouse nor child, or any veteran who is married 
or has a child and

[[Page 327]]

is receiving pension as a veteran without dependents, is being furnished 
domiciliary care by VA, no pension in excess of $60 monthly shall be 
paid to or for the veteran for any period after the end of the second 
full calendar month following the month of admission for such care. (38 
U.S.C. 5503(a))
    (2) Where any veteran having neither spouse nor child, or any 
veteran who is married or has a child and is receiving pension as a 
veteran without dependents, is furnished hospital or nursing home care 
by VA, no pension in excess of $60 monthly shall be paid to or for the 
veteran for any period after the end of the third full calendar month 
following the month of admission for such care. (38 U.S.C. 5503(a))
    (3) No pension in excess of $60 monthly shall be paid to or for a 
veteran having neither spouse nor child, or to a veteran who is married 
or has a child and is receiving pension as a veteran without dependents, 
for any period after the month in which the veteran is readmitted within 
6 months of a period of care for which pension was reduced under 
paragraph (d)(1) or (2) of this section. (38 U.S.C. 5503(a))
    (4) Where improved pension is being paid to a married veteran at the 
rate prescribed by 38 U.S.C. 1521(b) all or any part of the rate payable 
under 38 U.S.C. 1521(c) may be apportioned for a spouse as provided in 
Sec.  3.454(b). (38 U.S.C. 5503(a))
    (5) The provisions of paragraphs (d) (1), (2), and (3) of this 
section are not applicable to any veteran who has a child, but is 
receiving pension as a veteran without a dependent because it is 
reasonable that some part of the child's estate be consumed for the 
child's maintenance under 38 U.S.C. 1522(b).
    (6) For the purpose of paragraphs (d) (1), (2), and (3) of this 
section, if a veteran is furnished hospital or nursing home care by VA 
and then is transferred to VA-furnished domiciliary care, the period of 
hospital or nursing home care shall be considered as domiciliary care. 
Similarly, if a veteran is furnished domiciliary care by VA and then is 
transferred to VA-furnished hospital or nursing home care, the period of 
domiciliary care shall be considered hospital or nursing home care.
    (e) Improved pension after January 31, 1990. (1) Where any veteran 
having neither spouse nor child, or any veteran who is married or has a 
child and is receiving pension as a veteran without dependents, is 
furnished domiciliary or nursing home care by VA, no pension in excess 
of $90 monthly shall be paid to or for the veteran for any period after 
the end of the third full calendar month following the month of 
admission for such care.


(Authority: 38 U.S.C. 5503(a))

    (2) No pension in excess of $90 monthly shall be paid to a veteran 
having neither spouse nor child, or to a veteran who is married or has a 
child and is receiving pension as a veteran without dependents, for any 
period after the month in which the veteran is readmitted within six 
months of a period of domiciliary or nursing home care for which pension 
was reduced under paragraph (e)(1) of this section.
    (3) Where improved pension is being paid to a married veteran at the 
rate prescribed by 38 U.S.C. 1521(b) all or any part of the rate payable 
under 38 U.S.C. 1521(c) may be apportioned for a spouse as provided in 
Sec.  3.454(b).


(Authority: 38 U.S.C. 5503(a))

    (4) For the purposes of paragraph (e)(1) of this section, if a 
veteran is furnished hospital care by VA and then is transferred to VA-
furnished nursing home or domiciliary care, the period of hospital care 
shall not be considered as nursing home or domiciliary care. Transfers 
from VA-furnished nursing home or domiciliary care to VA-furnished 
hospital care then back to nursing home or domiciliary care shall be 
considered as continuous nursing home or domiciliary care provided the 
period of hospitalization does not exceed six months. Similarly, if a 
veteran is transferred from domiciliary or nursing home to a VA hospital 
and dies while so hospitalized, the entire period of VA care shall be 
considered as domiciliary or nursing home care. Nursing home or 
domiciliary care shall be considered as terminated effective the date of 
transfer to a VA hospital if the veteran is completely discharged from

[[Page 328]]

VA care following the period of hospitalization or if the period of 
hospitalization exceeds six months.
    (5) Effective February 1, 1990, reductions of improved pension based 
on admissions or readmissions to VA hospitals or any hospital at VA 
expense shall no longer be made except when required under the 
provisions of 38 CFR 3.552.
    (6) The provisions of paragraphs (e) (1) and (2) of this section are 
not applicable to any veteran who has a child, but is receiving pension 
as a veteran without a dependent because it is reasonable that some part 
of the child's estate be consumed for the child's maintenance under 38 
U.S.C. 1522(b).
    (f) Computation of period. For purposes of computing periods of 
hospitalization in paragraph (c) of this section, authorized absences of 
96 hours or less will be included as periods of hospitalization, and 
those of over 96 hours excluded. Also, for purposes of that paragraph, 
periods of treatment or care of 60 total days will be considered two 
calendar months of hospitalization and periods of 90 total days 
considered three calendar months, exclusive of authorized absences in 
excess of 96 hours.
    (g) Proof of dependents. The veteran will be considered to have 
neither spouse, child nor dependent parent in the absence of 
satisfactory proof. Statements contained in the claims folder concerning 
the existence of such dependents will be considered a prima facie 
showing. If the necessary evidence is not received: (1) Within 60 days 
after the date of request where the award is subject to reduction under 
paragraph (b) of this section, or (2) prior to the effective date of 
reduction under paragraph (c) of this section, the veteran's award will 
be reduced on the basis of no dependents. The full rate may be 
authorized from the date of reduction if the necessary evidence is 
received within 1 year after the date of request.
    (h) Hospitalization--(1) General. The reduction required by 
paragraphs (d) and (e), except as they refer to domiciliary care, shall 
not be made for up to three additional calendar months after the last 
day of the third month referred to in paragraphs (d)(2) or (e)(1) of 
this section, or after the last day of the month referred to in 
paragraphs (d)(3) or (e)(2) of this section, under the following 
conditions:
    (i) The Chief Medical Director, or designee, certifies that the 
primary purpose for furnishing hospital or nursing home care during the 
additional period is to provide the veteran with a prescribed program of 
rehabilitation under chapter 17 of title 38, United States Code, 
designed to restore the veteran's ability to function within the 
veteran's family and community; and
    (ii) The veteran is admitted to a Department of Veterans Affairs 
hospital or nursing home after October 16, 1981.
    (2) Continued hospitalization for rehabilitation. The reduction 
required by paragraph (d) or (e) of this section shall not be made for 
periods after the expiration of the additional period provided by 
paragraph (h)(1) of this section under the following conditions:
    (i) The veteran remains hospitalized or in a nursing home after the 
expiration of the additional period provided by paragraph (h)(1) of this 
section; and
    (ii) The Chief Medical Director, or designee, certifies that the 
primary purpose for furnishing continued hospital or nursing home care 
after the additional period provided by paragraph (h)(1) of this section 
is to provide the veteran with a program of rehabilitation under chapter 
17 of title 38, United States Code, designed to restore the veteran's 
ability to function within the veteran's family and community.
    (3) Termination of hospitalization for rehabilitation. Pension in 
excess of $60 monthly or $90, if reduction is under paragraph (e)(1) 
payable to a veteran under this paragraph shall be reduced the end of 
the calendar month in which the primary purpose of hospitalization or 
nursing home care is no longer to provide the veteran with a program of 
rehabilitation under chapter 17 of title 38, United States Code designed 
to restore the veteran's ability to function within the veteran's family 
and community.


(Authority: 38 U.S.C. 5503(a))

    (i) Certain beneficiaries receiving Medicaid-covered nursing home 
care. This paragraph (i) applies to a veteran without a spouse or child, 
to a surviving

[[Page 329]]

spouse without a child, and to a surviving child. Effective November 5, 
1990, and terminating on the date provided in 38 U.S.C. 5503(d)(7), if 
such a beneficiary is receiving Medicaid-covered nursing home care, no 
pension or survivors pension in excess of $90 per month will be paid to 
or for the beneficiary for any period after the month in which the 
Medicaid payments begin. A beneficiary is not liable for any pension 
paid in excess of the $90 per month by reason of the Secretary's 
inability or failure to reduce payments, unless that inability or 
failure is the result of willful concealment, by the beneficiary, of 
information necessary to make that reduction.

(Authority: 38 U.S.C. 5503)

    Cross References: Time limits. See Sec.  3.109. Apportionment. See 
Sec.  3.400(e). Reductions and discontinuances; general. See Sec.  
3.500. Incompetents; resumption. See Sec.  3.558.

[27 FR 7677, Aug. 3, 1962]

    Editorial Note: For Federal Register citations affecting Sec.  
3.551, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  3.552  Adjustment of allowance for aid and attendance.

    (a)(1) When a veteran who is already entitled to the aid and 
attendance allowance is hospitalized, the additional compensation or 
increased pension for aid and attendance shall be discontinued as 
provided in paragraph (b) of this section except as to disabilities 
specified in paragraph (a)(2) of this section. (See paragraph (k) of 
this section for rules applicable to a veteran who establishes 
entitlement to the aid and attendance allowance on or after date of 
admission to hospitalization).
    (2) The allowance for aid and attendance will be continued during 
hospitalization where the disability is paraplegia involving paralysis 
of both lower extremities together with loss of anal and bladder 
sphincter control, or Hansen's disease, except where discontinuance is 
required by paragraph (b)(2) of this section. In addition, in pension 
cases only, the aid and attendance allowance will be continued where the 
pensionable disability is blindness (visual acuity \5/200\ or less) or 
concentric contraction of visual field to 5 degrees or less. Awards are, 
however, subject to the provisions of Sec.  3.551 (except where the 
disabling condition is Hansen's disease) .
    (3) Additional compensation for dependents under Sec.  3.4(b)(2) is 
payable during hospitalization in addition to the rates authorized by 
this section. The rates specified will also be increased by amounts 
authorized under 38 U.S.C. 1114(k) based on independently ratable 
disability, subject to the statutory ceiling on the total amount of 
compensation payable as set forth in Sec.  3.350(a).
    (b)(1) Where a veteran is admitted for hospitalization on or after 
October 1, 1964, the additional compensation or increased pension for 
aid and attendance will be discontinued effective the last day of the 
month following the month in which the veteran is admitted for 
hospitalization at the expense of the Department of Veterans Affairs.
    (2) When a veteran is hospitalized at the expense of the United 
States Government, the additional aid and attendance allowance 
authorized by 38 U.S.C. 1114(r)(1) or (2) or 38 U.S.C. 1114(t) will be 
discontinued effective the last day of the month following the month in 
which the veteran is admitted for hospitalization.
    (3) Where a veteran affected by the provisions of paragraph (b) (1) 
and (2) or paragraph (k) of this section is discharged or released from 
the hospital against medical advice or as the result of disciplinary 
action, and is readmitted to such hospitalization within 6 months after 
that date, the allowance, additional compensation, or increased pension 
will be discontinued effective the day preceding the date of 
readmission. A readmission 6 months or more after such discharge or 
release will be considered as a new admission.
    (c) Reduction will not be made where the same monthly rate of 
compensation would be payable without consideration of need for regular 
aid and attendance. This can only be determined after careful review of 
the current maximum entitlement without regard to any amount for aid and 
attendance.
    (d) Where entitlement by reason of need for regular aid and 
attendance is the basis of the monthly rate under 38 U.S.C. 1114(1) the 
award will be reduced

[[Page 330]]

to the rate payable under 38 U.S.C. 1114(s).
    (e) Where a veteran is in receipt of section 306 pension, the aid 
and attendance allowance shall be reduced to the housebound rate of $61 
monthly (or $76.25 if the veteran was age 78 or older on December 31, 
1978). Where a veteran is in receipt of old-law pension, the total 
amount payable shall be reduced to $100 monthly. Where a veteran is in 
receipt of improved pension, the applicable aid and attendance rate 
shall be reduced to the otherwise applicable rate under 38 U.S.C. 
1521(e). No reduction shall be made, however, for any case involving the 
disabilities specified in paragraph (a)(2) of this section.
    (f) Where entitlement to the rate in 38 U.S.C. 1114(o) is based in 
part on need for regular aid and attendance reduction because of being 
hospitalized will be to the rate payable for the other conditions shown.
    (g) Where a veteran entitled to one of the rates under 38 U.S.C. 
1114 (l), (m), or (n) by reason of anatomical losses or losses of use of 
extremities, blindness (visual acuity 5/200 or less or light perception 
only), or anatomical loss of both eyes is being paid compensation at the 
rate under 38 U.S.C. 1114(o) because of entitlement to another rate 
under section 1114(l) on account of need for aid and attendance, the 
compensation will be reduced while hospitalized to the following:
    (1) If entitlement is under section 1114(l) and in addition there is 
need for regular aid and attendance for another disability, the award 
during hospitalization will be at the rate under 38 U.S.C. 1114(m) since 
the disability requiring aid and attendance is 100 percent disabling.


(Authority: 38 U.S.C. 1114(p))

    (2) If entitlement is under section 1114(m), at the rate under 38 
U.S.C. 1114(n).
    (3) If entitlement is under section 1114(n), the rate under 38 
U.S.C. 1114(o) would be continued, since the disability previously 
causing the need for regular aid and attendance would then be totally 
disabling entitling the veteran to the maximum rate under 38 U.S.C. 
1114(p).
    (h) If, because of blindness, a veteran requires regular aid and 
attendance, but has better vision than ``light perception only'' the 
award under 38 U.S.C. 1114(m) will be reduced while hospitalized to the 
rate payable under 38 U.S.C. 1114(1).
    (i) If the disability meets the aid and attendance requirements of 
38 U.S.C. 1114(l) and the intermediate or next higher rate was assigned 
for disability independently ratable at 50 percent or 100 percent, the 
award based on such entitlement will be reduced because of 
hospitalization to the amount payable under 38 U.S.C. 1114(s).
    (j) The section 306 pension aid and attendance allowance authorized 
by Sec.  3.252(f) is subject to reduction for hospitalization under the 
provisions of this section in the same manner as the regular section 306 
pension aid and attendance allowance. The amount payable shall not be 
reduced to less than the housebound rate of $61 monthly (or $76.25 
monthly if the veteran was age 78 or older on December 31, 1978).
    (k)(1) This paragraph is applicable to hospitalized veterans who 
were not entitled to the aid and attendance allowance prior to hospital 
admission but who establish entitlement to it on or after the date of 
hospital admission.
    (2) If the effective date of entitlement to the aid and attendance 
allowance is on or after the date of admission to hospitalization, the 
aid and attendance allowance shall not be paid until the date of 
discharge or release from hospitalization, unless the aid and attendance 
allowance is based on a disability specified in paragraph (a)(2) of this 
section. If the aid and attendance allowance is based on a disability 
specified in paragraph (a)(2) of this section, the aid and attendance 
allowance shall be paid during hospitalization.
    (3) If the aid and attendance allowance is not payable to a veteran 
under paragraph (k)(2) of this section, the veteran shall receive the 
appropriate reduced rate under paragraphs (d)

[[Page 331]]

through (j) of this section while hospitalized.

(Authority: 38 U.S.C. 5503(c))

[28 FR 1588, Feb. 20, 1963, as amended at 30 FR 14983, Dec. 3, 1965; 32 
FR 13226, Sept. 19, 1967; 37 FR 19133, Sept. 19, 1972; 38 FR 34115, Dec. 
11, 1973; 41 FR 55875, Dec. 23, 1976; 44 FR 22721, Apr. 17, 1979; 44 FR 
45941, Aug. 6, 1979; 46 FR 31011, June 12, 1981; 46 FR 47541, Sept. 29, 
1981; 68 FR 34542, June 10, 2003; 83 FR 20737, May 8, 2018]



Sec. Sec.  3.553-3.555  [Reserved]



Sec.  3.556  Adjustment on discharge or release.

    (a) Temporary Absence--30 days. (1) Where a competent veteran whose 
award was reduced under Sec.  3.551(b) is placed on non-bed care status 
or other authorized absence of 30 days or more the full monthly rate, 
excluding any allowance for regular aid and attendance, will be restored 
effective the date of reduction. The full monthly rate for an 
incompetent veteran, or for a competent veteran whose pension was 
reduced under Sec.  3.551(c), will be restored effective the date of 
departure from the hospital unless it is determined that apportionment 
for a spouse should be continued. In all instances, any allowance for 
regular aid and attendance will be restored effective the date of 
departure from the hospital.
    (2) Upon the veteran's return to the hospital, an award which is 
subject to reduction under Sec.  3.551 (b) or (c) will again be reduced 
effective the date of the veteran's return to the hospital. In all 
instances, any allowance for regular aid and attendance will be 
discontinued, if in order, effective the date of the veteran's return to 
the hospital.
    (b) Temporary absence--less than 30 days. A temporary absence of 
less than 30 days, including the day of departure, will not require 
adjustment of the award. This applies to any approved absence. Any 
allowance for regular aid and attendance for such periods will be 
authorized after the veteran has been discharged from the hospital.
    (c) Adjustment based on need. Where an award of pension was reduced 
under Sec.  3.551(c), the full rate covering absences of less than 30 
days may be restored, subject to prior payments, prior to discharge from 
hospitalization at the request of the Director of the hospital, center 
or domiciliary, where this action is necessary to meet the veteran's 
financial needs, if the veteran has been hospitalized for more than 6 
months and the periods of absence exceed a total of 30 days.
    (d) Irregular discharge. When a competent veteran is given an 
irregular discharge, the full rate will be restored effective the date 
of release from the hospital. Payment of any amount withheld under Sec.  
3.551(b) will not be authorized until the expiration of 6 months after 
termination of hospitalization unless the prior release is changed to a 
regular release. However, amounts not paid under paragraph (c) of this 
section covering absence of less than 30 days where the award was 
reduced under Sec.  3.551(c) will be authorized immediately.
    (e) Regular discharge. When a veteran, either competent or 
incompetent, is given a regular discharge or release, the full rate, 
including any allowance for regular aid and attendance will be restored 
effective the date of release from the hospital, subject to prior 
payments. The award will be based on the most recent rating and, where 
the award was reduced under Sec.  3.551(b), will include, in the case of 
a competent veteran, any amounts withheld because of hospitalization. 
The amount withheld for an incompetent veteran will not be authorized 
until the expiration of 6 months following a rating of competency by VA. 
Any institutional award will be discontinued effective date of last 
payment, as provided in Sec.  3.501(j). Where an apportionment made 
under Sec.  3.551(c) is not continued, the apportionment will be 
discontinued effective the day preceding the date of the veteran's 
release from the hospital, or, if adjusted, effective the date of the 
veteran's release from the hospital, unless an overpayment would result. 
In the excepted cases, the awards to the veteran and apportionee will be 
adjusted as of date of last payment.


(Authority: 38 U.S.C. 5503)

    (f) Types of discharges. A discharge is considered regular if it is 
granted because of having received maximum

[[Page 332]]

hospital benefits. A discharge for disciplinary reasons or because of 
the patient's refusal to accept, neglect of or obstruction of treatment; 
refusal to accept transfer, or failure to return from authorized 
absence, is considered irregular.

[27 FR 7678, Aug. 3, 1962, as amended at 27 FR 8794, Sept. 1, 1962; 38 
FR 34115, Dec. 11, 1973; 39 FR 34532, Sept. 26, 1974; 40 FR 45169, Oct. 
1, 1975; 44 FR 22721, Apr. 17, 1979; 44 FR 45942, Aug. 6, 1979; 50 FR 
50616, Dec. 11, 1985]



Sec.  3.557  [Reserved]



Sec.  3.558  Resumption and payment of withheld benefits; incompetents
with estates that equaled or exceeded statutory limit.

    (a) Payments for the veteran will be resumed and apportionment 
awards discontinued under the applicable provisions of Sec.  3.556(a), 
(d), and (e) upon authorized absence from the hospital for 30 days or 
more or a regular or irregular discharge or release. Care and 
maintenance payments to an institution will not be made for any period 
the veteran is not receiving such care and maintenance.
    (b) Any amount not paid because of the provisions of former Sec.  
3.557(b) (as in effect prior to December 27, 2001), and any amount of 
compensation or retirement pay withheld pursuant to the provisions of 
Sec.  3.551(b) (and/or predecessor regulatory provisions) as it was 
constituted prior to August 1, 1972, and not previously paid because of 
the provisions of former Sec.  3.557(b) (as in effect prior to December 
27, 2001), will be awarded to the veteran if he or she is subsequently 
rated competent by VA for a period of not less than six months.

(Authority: 38 U.S.C. 5503)

[27 FR 7679, Aug. 3, 1962, as amended at 36 FR 25225, Dec. 30, 1971; 38 
FR 34116, Dec. 11, 1973; 40 FR 45170, Oct. 1, 1975; 41 FR 18412, May 4, 
1976; 50 FR 50617, Dec. 11, 1985; 58 FR 34224, June 24, 1993; 66 FR 
48560, Sept. 21, 2001; 68 FR 34542, June 10, 2003]



Sec.  3.559  [Reserved]

                       Adjustments and Resumptions



Sec.  3.650  Rate for additional dependent.

    (a) Running awards. Except as provided in paragraph (c) of this 
section where a claim is filed by an additional dependent who has 
apparent entitlement which, if established, would require reduction of 
pension, compensation or dependency and indemnity compensation being 
paid to another dependent, payments to the person or persons on the 
rolls will be reduced as follows:
    (1) Where benefits would be payable from a date prior to the date of 
filing claim, the reduction will be effective from the date of potential 
entitlement of the additional dependent.
    (2) Where benefits would be payable from the date of filing claim, 
the reduction will be effective the date of receipt of the claim by the 
additional dependent, or date of last payment, whichever is later.

If entitlement of the additional dependent is not established, benefits 
previously being paid will be resumed, if otherwise in order, commencing 
the day following the effective date of reduction.
    (b) New awards. If the additional dependent is found to be entitled, 
the full rate payable will be authorized effective the date of 
entitlement.
    (c) Retroactive DIC award to a school child--(1) General. If DIC 
(dependency and indemnity compensation) is being currently paid to a 
veteran's child or children under 38 U.S.C. 1313(a), and DIC is 
retroactively awarded to an additional child of the veteran based on 
school attendance, the full rate payable to the additional child shall 
be awarded the first of the month following the month in which the award 
to the additional child is approved. The rate payable under the current 
award shall be reduced effective the date the full rate is awarded to 
the additional child. The rate payable to the additional child for 
periods prior to the date the full rate is awarded shall be the 
difference between the rate payable for all the children and the rate 
that was payable before the additional child established entitlement.
    (2) Applicability. The provisions of paragraph (c)(1) of this 
section are applicable only when the following conditions are met:
    (i) The additional child was receiving DIC under 38 U.S.C. 1313(a) 
prior to attaining age 18; and

[[Page 333]]

    (ii) DIC for the additional child was discontinued on or after 
attainment of age 18; and
    (iii) After DIC has been discontinued, the additional child 
reestablishes entitlement to DIC under 38 U.S.C. 1313(a) based on 
attendance at an approved school and the effective date of entitlement 
is prior to the date the Department of Veterans Affairs receives the 
additional child's claim to reestablish entitlement.


(Authority: 38 U.S.C. 1313(b))

    (3) Effective date. This paragraph is applicable to DIC paid after 
September 30, 1981. If DIC is retroactively awarded for a period prior 
to October 1, 1981, payment for the period prior to October 1, 1981 
shall be made under paragraph (a) of this section and payment for the 
period after September 30, 1981, shall be made under this paragraph.

[29 FR 9564, July 15, 1964, as amended at 47 FR 24551, June 7, 1982]



Sec.  3.651  Change in status of dependents.

    Except as otherwise provided:
    (a) A payee who becomes entitled to pension, compensation, or 
dependency and indemnity compensation or to a greater rate because 
payment of that benefit to another payee has been reduced or 
discontinued will be awarded the benefit or increased benefit without 
the filing of a new claim.
    (b) The commencement or adjustment will be effective the day 
following the reduction or discontinuance of the award to the other 
payee if the necessary evidence is received in the Department of 
Veterans Affairs within 1 year from the date of request therefor; 
otherwise from the date of receipt of a new claim.
    (c) The rate for the persons entitled will be the rate that would 
have been payable if they had been the only original persons entitled.

[26 FR 1598, Feb. 24, 1961, as amended 27 FR 11890, Dec. 1, 1962; 30 FR 
133, Jan. 7, 1965]



Sec.  3.652  Periodic certification of continued eligibility.

    Except as otherwise provided:
    (a) Individuals to whom benefits are being paid are required to 
certify, when requested, that any or all of the eligibility factors 
which established entitlement to the benefit being paid continue to 
exist. The beneficiary will be advised at the time of the request that 
the certification must be furnished within 60 days from the date of the 
request therefor and that failure to do so will result in the reduction 
or termination of benefits.
    (1) If the certification is not received within 60 days from the 
date of the request, the eligibility factor(s) for which certification 
was requested will be considered to have ceased to exist as of the end 
of the month in which it was last shown by the evidence of record to 
have existed. For purposes of this paragraph, the effective date of 
reduction or termination of benefits will be in accordance with 
Sec. Sec.  3.500 through 3.504 as in effect on the date the eligibility 
factor(s) is considered to have ceased to exist. The claimant will be 
advised of the proposed reduction or termination of benefits and the 
date the proposed action will be effective. An additional 60 days from 
the date of notice of the proposed action will be provided for the 
claimant to respond.
    (2) If the certification is not received within the additional 60 
day period, the proposed reduction or termination of benefits will be 
put into effect.
    (b) When the required certification is received, benefits will be 
adjusted, if necessary, in accordance with the facts found.

(Authority: 38 U.S.C. 501)

    Cross References: Employment Questionnaire, failure to return. See 
Sec.  3.501(f). Income and Net Worth Questionnaires. See Sec.  3.661.

[52 FR 43063, Nov. 9, 1987]



Sec.  3.653  Foreign residence.

    (a) General. Pension, compensation, or dependency and indemnity 
compensation is not payable to an alien who is located in the territory 
of or under the control of an enemy of the United States or of its 
allies. The benefit may, however, be paid to the dependents of such 
alien, but not in excess of the amount which would be payable to the 
dependent if the alien were dead.


(Authority: 38 U.S.C. 5308)


[[Page 334]]


    (b) Retroactive payments. Any amount not paid to an alien under this 
section, together with any amounts placed to the alien's credit in the 
special deposit account in the Treasury or covered into the Treasury as 
miscellaneous receipts under 31 U.S.C. 123-128 will be paid to him or 
her on the filing of a new claim. Such claim should be supported with 
evidence that the alien has not been guilty of mutiny, treason, sabotage 
or rendering assistance to an enemy, as provided in Sec.  3.902(a).


(Authority: 38 U.S.C. 5309)

    (c) Treasury Department list. This paragraph is applicable to claims 
for benefits for aliens residing in countries identified on the list 
established by the Secretary of the Treasury as countries to which 
checks could not be delivered with reasonable assurance that the payee 
would actually receive and be able to negotiate a check for full value.
    (1) Evidence requests. Requests for evidence to establish either 
basic or continued entitlement will not be made where such evidence 
would be obtained from a country on the Treasury Department list unless 
the claimant requests that checks be sent to him or her in care of a 
U.S. Foreign Service post in a country which is not on the list.
    (2) Awards. Payments for a claimant residing in a country included 
in the Treasury Department list will not be authorized unless the 
claimant requests that checks be sent to him or her in care of a U.S. 
Foreign Service post in a country which is not on the list.
    (3) Retroactive payments. Where award action is authorized under 
paragraph (c)(2) of this section, or a new claim has been filed after a 
country has been removed from the Treasury Department list, all benefits 
to which the payee is otherwise entitled will be paid as provided in 
paragraph (b) of this section. There is no time limit for filing claim.
    (d) Germany and Japan. Where payments were discontinued before July 
1, 1954, because the payee was a citizen or subject of Germany or Japan, 
no payments will be made for any period prior to the date of filing a 
new claim.

(Authority: 38 U.S.C. 5309(b))

[26 FR 1599, Feb. 24, 1961, as amended at 31 FR 13172, Oct. 12, 1966; 47 
FR 24551, June 7, 1982]



Sec.  3.654  Active service pay.

    (a) General. Pension, compensation, or retirement pay will be 
discontinued under the circumstances stated in Sec.  3.700(a)(1) for any 
period for which the veteran received active service pay. For the 
purposes of this section, active service pay means pay received for 
active duty, active duty for training or inactive duty training.
    (b) Active duty. (1) Where the veteran returns to active duty 
status, the award will be discontinued effective the day preceding 
reentrance into active duty status. If the exact date is not known, 
payments will be discontinued effective date of last payment and as of 
the correct date when the date of reentrance has been ascertained from 
the service department.
    (2) Payments, if otherwise in order, will be resumed effective the 
day following release from active duty if claim for recommencement of 
payments is received within 1 year from the date of such release: 
otherwise payments will be resumed effective 1 year prior to the date of 
receipt of a new claim. Prior determinations of service connection will 
not be disturbed except as provided in Sec.  3.105. Compensation will be 
authorized based on the degree of disability found to exist at the time 
the award is resumed. Disability will be evaluated on the basis of all 
facts, including records from the service department relating to the 
most recent period of active service. If a disability is incurred or 
aggravated in the second period of service, compensation for that 
disability cannot be paid unless a claim therefor is filed.
    (c) Training duty. Prospective adjustment of awards may be made 
where the veteran waives his or her Department of Veterans Affairs 
benefit covering anticipated receipt of active service pay because of 
expected periods of active duty for training or inactive duty training. 
Where readjustment is in

[[Page 335]]

order because service pay was not received for expected training duty, 
retroactive payments may be authorized if a claim for readjustment is 
received within 1 year after the end of the fiscal year for which 
payments were waived.

[27 FR 11890, Dec. 1, 1962]



Sec.  3.655  Failure to report for Department of Veterans Affairs 
examination.

    (a) General. When entitlement or continued entitlement to a benefit 
cannot be established or confirmed without a current VA examination or 
reexamination and a claimant, without good cause, fails to report for 
such examination, or reexamination, action shall be taken in accordance 
with paragraph (b) or (c) of this section as appropriate. Examples of 
good cause include, but are not limited to, the illness or 
hospitalization of the claimant, death of an immediate family member, 
etc. For purposes of this section, the terms examination and 
reexamination include periods of hospital observation when required by 
VA.
    (b) Original or supplemental claim, or claim for increase. When a 
claimant fails to report for an examination scheduled in conjunction 
with an original compensation claim, the claim shall be rated based on 
the evidence of record. When the examination was scheduled in 
conjunction with any other original claim, a supplemental claim for a 
benefit which was previously disallowed, or a claim for increase, the 
claim shall be denied.
    (c) Running award. (1) When a claimant fails to report for a 
reexamination and the issue is continuing entitlement, VA shall issue a 
pretermination notice advising the payee that payment for the disability 
or disabilities for which the reexamination was scheduled will be 
discontinued or, if a minimum evaluation is established in part 4 of 
this title or there is an evaluation protected under Sec.  3.951(b) of 
this part, reduced to the lower evaluation. Such notice shall also 
include the prospective date of discontinuance or reduction, the reason 
therefor and a statement of the claimant's procedural and appellate 
rights. The claimant shall be allowed 60 days to indicate his or her 
willingness to report for a reexamination or to present evidence that 
payment for the disability or disabilities for which the reexamination 
was scheduled should not be discontinued or reduced.
    (2) If there is no response within 60 days, or if the evidence 
submitted does not establish continued entitlement, payment for such 
disability or disabilities shall be discontinued or reduced as of the 
date indicated in the pretermination notice or the date of last payment, 
whichever is later.
    (3) If notice is received that the claimant is willing to report for 
a reexamination before payment has been discontinued or reduced, action 
to adjust payment shall be deferred. The reexamination shall be 
rescheduled and the claimant notified that failure to report for the 
rescheduled examination shall be cause for immediate discontinuance or 
reduction of payment. When a claimant fails to report for such 
rescheduled examination, payment shall be reduced or discontinued as of 
the date of last payment and shall not be further adjusted until a VA 
examination has been conducted and the report reviewed.
    (4) If within 30 days of a pretermination notice issued under 
paragraph (c)(1) of this section the claimant requests a hearing, action 
to adjust payment shall be deferred as set forth in Sec.  3.105(i)(1) of 
this part. If a hearing is requested more than 30 days after such 
pretermination notice but before the proposed date of discontinuance or 
reduction, a hearing shall be scheduled, but payment shall nevertheless 
be discontinued or reduced as of the date proposed in the pretermination 
notice or date of last payment, whichever is later, unless information 
is presented which warrants a different determination. When the claimant 
has also expressed willingness to report for an examination, however, 
the provisions of paragraph (c)(3) of this section shall apply.

(Authority: 38 U.S.C. 501)

    Cross References: Procedural due process and appellate rights: See 
Sec.  3.103. Examinations: See Sec.  3.326. Reexaminations: See Sec.  
3.327.

[[Page 336]]

Resumption of rating when veteran subsequently reports for VA 
examination: See Sec.  3.330.

[55 FR 49521, Nov. 29, 1990; 58 FR 46865, Sept. 3, 1993; 80 FR 18117, 
Apr. 3, 2015; 84 FR 171, Jan. 18, 2019]



Sec.  3.656  Disappearance of veteran.

    (a) When any veteran has disappeared for 90 days or more and his or 
her whereabouts remain unknown to the members of his or her family and 
the Department of Veterans Affairs, disability compensation which he or 
she was receiving or entitled to receive may be paid to or for his or 
her spouse, children and parents, effective the day following the date 
of last payment to the veteran if a claim is received within 1 year 
after that date; otherwise from the date of receipt of a claim. The 
total amount payable will be the lesser of these amounts:
    (1) Dependency and indemnity compensation.
    (2) Amount of compensation payable to the veteran at the time of 
disappearance, subject to authorized insurance deductions.
    (b) Where a veteran's whereabouts become known to the Department of 
Veterans Affairs after an award to dependents has been made as provided 
in this section, the award to the dependents will be discontinued 
effective date of last payment, and appropriate action will be taken to 
adjust the veteran's award in accordance with the facts found.


(Authority: 38 U.S.C. 1158)

    (c) Awards to dependents will not be continued under this section in 
any case where the facts are such as to bring into effect the 
presumption of death under Sec.  3.212.
    (d) When any veteran has disappeared for 90 days or more and the 
veteran's whereabouts remain unknown to members of the veteran's family 
and the Department of Veterans Affairs, any improved pension, section 
306 or service pension which the veteran was receiving or entitled to 
receive may be paid to or for the spouse or children. The status of the 
veteran at the time of disappearance, with respect to permanent and 
total disability, income and net worth will be presumed to continue 
unchanged. Payment for the spouse or children will be effective the day 
following the date of last payment to the veteran if a claim is received 
within 1 year after that date; otherwise from date of receipt of a 
claim. The total amount payable will be the lesser of these amounts:
    (1) The service death pension rate if the veteran was receiving 
service pension or the improved death pension rate if the veteran was 
receiving section 306 or improved pension.
    (2) The amount of pension payable to the veteran at the time of 
disappearance.

(Authority: 38 U.S.C. 1507)

[26 FR 1599, Feb. 24, 1961, as amended at 27 FR 11891, Dec. 1, 1962; 30 
FR 6649, May 14, 1965; 40 FR 14313, Mar. 31, 1975; 44 FR 45942, Aug. 6, 
1979]



Sec.  3.657  Surviving spouse becomes entitled, or entitlement 
terminates.

    Where a surviving spouse establishes entitlement to pension, 
compensation, or dependency and indemnity compensation, an award to 
another person as surviving spouse, or for a child or children as if 
there were no surviving spouse will be discontinued or adjusted as 
provided in this section.
    (a) Surviving spouse's awards. For periods on or after December 1, 
1962, where a legal surviving spouse establishes entitlement after 
payments have been made to another person as surviving spouse, the full 
rate payable to the legal surviving spouse will be authorized effective 
the date of entitlement. Payments to the former payee will be 
discontinued as follows:
    (1) Where benefits are payable to the legal surviving spouse from a 
date prior to the date of filing claim, the award to the former payee 
will be terminated the day preceding the effective date of the award to 
the legal surviving spouse.
    (2) Where benefits are payable to the legal surviving spouse from 
the date of filing claim, the award to the former payee will be 
terminated effective the date of receipt of the claim or date of last 
payment, whichever is later.
    (b) Children's awards. (1) Where a surviving spouse establishes 
entitlement and:

[[Page 337]]

    (i) Payments were being made for a child or children at a lower 
monthly rate than that provided where there is a surviving spouse, the 
award to the surviving spouse will be effective the date provided by the 
applicable law, and will be the difference between the rate paid for the 
children and the rate payable for the surviving spouse and children. The 
full rate will be payable for the surviving spouse effective the day 
following the date of last payment for the children;
    (ii) Payments were being made for a child or children at the same or 
higher monthly rate than that provided where there is a surviving 
spouse, the award to the surviving spouse will be effective the day 
following the date of last payment on the awards on behalf of the 
children.
    (2) Where a surviving spouse has received benefits after entitlement 
was terminated and,
    (i) The child or children were entitled to a lower monthly rate, the 
award to the surviving spouse will be amended to authorize payment at 
the rate provided for the children as if there were no surviving spouse, 
covering the period from the date the surviving spouse's entitlement 
terminated to the date of last payment. The award for the child or 
children will be made effective the following day.
    (ii) The child or children were entitled to a higher monthly rate, 
the award to the surviving spouse will be discontinued effective date of 
last payment. The award to the children will be effective the day 
following the date the surviving spouse's entitlement terminated and 
will be the difference between the rate payable for the children and the 
rate paid on the surviving spouse's award. The full rate will be payable 
for the children effective the day following the date of last payment to 
the surviving spouse.

[39 FR 20204, June 7, 1974, as amended at 44 FR 45942, Aug. 6, 1979]



Sec.  3.658  Offsets; dependency and indemnity compensation.

    (a) When an award of dependency and indemnity compensation is made 
covering a period for which death compensation or benefits under the 
Federal Employee's Compensation Act, based on military service, have 
been paid to the same payee based on the same death, the award of 
dependency and indemnity compensation will be made subject to an offset 
of payments of death compensation or benefits under the Federal 
Employees' Compensation Act over the same period.
    (b) When an award of dependency and indemnity compensation is made 
covering a period for which death benefits have been paid to the same 
payee based on the death of another spouse the award will be made 
subject to an offset of payments of death pension or compensation, or 
dependency and indemnity compensation over the same period in the case 
of the other spouse.

(Authority: 38 U.S.C. 103(d)(2), 5304(b)(3))

[41 FR 17387, Apr. 26, 1976]



Sec.  3.659  Two parents in same parental line.

    The provisions of this section are applicable for periods commencing 
on or after January 1, 1957 in cases involving payments of death 
compensation or dependency and indemnity compensation, and in addition, 
for periods commencing on or after June 9, 1960, in cases involving 
payments of death pension based on death on or after that date.
    (a) If death pension, compensation or dependency and indemnity 
compensation is payable based on the service of one parent, an award of 
such benefits to or on account of a child will be made subject to any 
payments of these benefits made to or on account of that child over the 
same period of time based on the service of another parent in the same 
parental line.
    (b) Any reduction or discontinuance of an award to the child or to a 
surviving spouse will be effective the day preceding the commencing date 
of death pension, compensation, or dependency and indemnity compensation 
or, under the circumstances described in Sec.  3.707, the commencing 
date of dependents' educational assistance under 38 U.S.C. ch. 35, to or 
on account of the child based on the service of another parent in the 
same parental line. Any increase to a surviving spouse or another child 
will be effective the commencing date of the award to the child.

[[Page 338]]


    Cross Reference: Two-parent cases. See Sec.  3.503(a)(7). Two 
parents in same parental line. See Sec.  3.703.

[27 FR 4917, May 25, 1962, as amended at 29 FR 9564, July 15, 1964; 41 
FR 17387, Apr. 26, 1976]



Sec.  3.660  Dependency, income and estate.

    (a) Reduction or discontinuance--(1) General. A veteran, surviving 
spouse or child who is receiving pension, or a parent who is receiving 
compensation or dependency and indemnity compensation must notify the 
Department of Veterans Affairs of any material change or expected change 
in his or her income or other circumstances which would affect his or 
her entitlement to receive, or the rate of, the benefit being paid. Such 
notice must be furnished when the recipient acquires knowledge that he 
or she will begin to receive additional income or when his or her 
marital or dependency status changes. In pension claims subject to Sec.  
3.252(b) or Sec.  3.274 and in compensation claims subject to Sec.  
3.250(a)(2), notice must be furnished of any material increase in corpus 
of the estate or net worth.
    (2) Effective dates. Where reduction or discontinuance of a running 
award of section 306 pension or old-law pension is required because 
dependency of another person ceased due to marriage, annulment, divorce 
or death, or because of an increase in income, which increase could not 
reasonably have been anticipated based on the amount actually received 
from that source the year before, the reduction or discontinuance shall 
be made effective the end of the year in which the increase occurred. 
Where reduction or discontinuance of a running award of improved pension 
or dependency and indemnity compensation is required because of an 
increase in income, the reduction or discontinuance shall be made 
effective the end of the month in which the increase occurred. Where 
reduction or discontinuance of a running award of any benefit is 
required because of an increase in net worth or corpus of estate, 
because dependency of a parent ceased, or because dependency of another 
person ceased prior to October 1, 1982, due to marriage, annulment, 
divorce, or death, the award shall be reduced or discontinued effective 
the last day of the calendar year in which the increase occurred or 
dependency ceased. Except as noted in this subparagraph for section 306 
or old-law pension, where the dependency of another person ceased on or 
after October 1, 1982, due to marriage, annulment, divorce or death, the 
reduction or discontinuance shall be effective the last day of the month 
in which dependency ceased.


(Authority: 38 U.S.C. 5112(b))

    (3) Overpayments. Overpayments created by retroactive discontinuance 
of benefits will be subject to recovery if not waived. Where dependency 
and indemnity compensation was being paid to two parents living 
together, an overpayment will be established on the award to each 
parent.
    (b) Award or increase; income. Where pension or dependency and 
indemnity compensation was not paid for a particular 12-month 
annualization period because the claim was disallowed, an award was 
deferred under Sec.  3.260(b) or Sec.  3.271(f), payments were 
discontinued or made at a lower rate based on anticipated or actual 
income, benefits otherwise payable may be authorized commencing the 
first of a 12-month annualization period as provided in this paragraph. 
In all other cases, benefits may not be authorized for any period prior 
to the date of receipt of a new claim.
    (1) Anticipated income. Where payments were not made or were made at 
a lower rate because of anticipated income, pension or dependency and 
indemnity compensation may be awarded or increased in accordance with 
the facts found but not earlier than the beginning of the appropriate 
12-month annualization period if satisfactory evidence is received 
within the same or the next calendar year.


(Authority: 38 U.S.C. 5110(h))

    (2) Actual income. Where the claimant's actual income did not permit 
payment, or payment was made at a lower rate, for a given 12-month 
annualization period, pension or dependency and indemnity compensation 
may be awarded or increased, effective

[[Page 339]]

the beginning of the next 12-month annualization period, if satisfactory 
evidence is received within that period.
    (c) Increases; change in status. Where there is change in the 
payee's marital status or status of dependents which would permit 
payment at a higher rate and the change in status is by reason of the 
claimant's marriage or birth or adoption of a child, the effective date 
of the increase will be the date of the event if the required evidence 
is received within 1 year of the event. Where there is a change in 
dependency status for any reason other than marriage, or the birth or 
adoption of a child, which would permit payment at a higher rate, the 
increased rate will be effective the date of receipt of a claim or an 
intent to file a claim as set forth in Sec.  3.155(b) if the required 
evidence is received within 1 year of Department of Veterans Affairs 
request. The rate payable for each period will be determined, as 
provided in Sec. Sec.  3.260(f) or 3.273(c). (See Sec.  3.651 as to 
increase due to termination of payments to another payee. Also see Sec.  
3.667 as to increase based on school attendance.)
    (d) Corpus of estate; net worth. Where a claim has been finally 
disallowed or terminated because of the corpus of estate and net worth 
provisions of Sec.  3.263 and entitlement is established on the basis of 
a reduction in estate or net worth, or a change in circumstances such as 
health, acquisition of a dependent, or increased rate of depletion of 
the estate, benefits or increased benefits will not be paid for any 
period prior to the date of receipt of a new claim.

[30 FR 3354, Mar. 12, 1965, as amended at 44 FR 45942, Aug. 6, 1979; 48 
FR 34473, July 29, 1983; 57 FR 59300, Dec. 15, 1992; 79 FR 57697, Sept. 
25, 2014; 83 FR 47275, Sept. 18, 2018]



Sec.  3.661  Eligibility Verification Reports.

    (a) Determination and entitlement. (1) Where the report shows a 
change in income, net worth, marital status, status of dependents or 
change in circumstances affecting the application of the net worth 
provisions, the award will be adjusted in accordance with Sec.  
3.660(a)(2).
    (2) Where there is doubt as to the extent of anticipated income 
payment of pension or dependency and indemnity compensation will be 
authorized at the lowest appropriate rate or will be withheld, as 
provided in Sec.  3.260(b) or Sec.  3.271 (f).
    (b) Failure to return report--(1) Section 306 and old-law pension--
(i) Discontinuance. Discontinuance of old-law or section 306 pension 
shall be effective the last day of the calendar year for which income 
(and net worth in a section 306 pension case) was to be reported.
    (ii) Resumption of benefits. Payment of old-law or section 306 
pension may be resumed, if otherwise in order, from the date of last 
payment if evidence of entitlement is received within the calendar year 
following the calendar year for which income (and net worth in a section 
306 pension case) was to be reported; otherwise pension may not be paid 
for any period prior to the date of receipt of a new claim.
    (2) Improved pension and dependency and indemnity compensation--(i) 
Discontinuance. Discontinuance of dependency and indemnity compensation 
(DIC) or improved pension shall be effective the first day of the 12-
month annualization period for which income (and net worth in an 
improved pension case) was to be reported or the effective date of the 
award, whichever is the later date.
    (ii) Adjustment of overpayment. If evidence of entitlement to 
improved pension or DIC for any period for which payment of improved 
pension or DIC was discontinued for failure to file an Eligibility 
Verification Report is received at any time, payment of improved pension 
or DIC shall be awarded for the period of entitlement for which benefits 
were discontinued for failure to file an Eligibility Verification 
Report.
    (iii) Resumption of benefits. Payment of improved pension and DIC 
may be resumed, if otherwise in order, from the date of last payment if 
evidence of entitlement is received within the 12-month annualization 
period following the 12-month annualization period for which income (and 
net worth in an improved pension case) was to be reported; otherwise 
pension or DIC may

[[Page 340]]

not be paid for any period prior to receipt of a new claim.

(Authority: 38 U.S.C. 501)

[30 FR 3355, Mar. 12, 1965, as amended at 44 FR 45942, Aug. 6, 1979; 46 
FR 55098, Nov. 6, 1981; 57 FR 59300, Dec. 15, 1992]



Sec. Sec.  3.662-3.664  [Reserved]



Sec.  3.665  Incarcerated beneficiaries and fugitive felons--compensation.

    (a) General. Any person specified in paragraph (c) of this section 
who is incarcerated in a Federal, State or local penal institution in 
excess of 60 days for conviction of a felony will not be paid 
compensation or dependency and indemnity compensation (DIC) in excess of 
the amount specified in paragraph (d) of this section beginning on the 
61st day of incarceration. VA will inform a person whose benefits are 
subject to this reduction of the rights of the person's dependents to an 
apportionment while the person is incarcerated, and the conditions under 
which payments to the person may be resumed upon release from 
incarceration. In addition, VA will also notify the person's dependents 
of their right to an apportionment if the VA is aware of their existence 
and can obtain their addresses. However, no apportionment will be made 
if the veteran or the dependent is a fugitive felon as defined in 
paragraph (n) of this section.
    (b) Definitions. For the purposes of this section the term 
compensation includes disability compensation under 38 U.S.C. 1151. The 
term dependency and indemnity compensation (DIC) includes death 
compensation payable under 38 U.S.C. 1121 or 1141, death compensation 
and DIC payable under 38 U.S.C. 1151, and any benefit payable under 
chapter 13 of title 38, United States Code. The term release from 
incarceration includes participation in a work release or halfway house 
program, parole, and completion of sentence. For purposes of this 
section, a felony is any offense punishable by death or imprisonment for 
a term exceeding 1 year, unless specifically categorized as a 
misdemeanor under the law of the prosecuting jurisdiction.
    (c) Applicability. The provisions of paragraph (a) of this section 
are applicable to the following persons:
    (1) A person serving a period of incarceration for conviction of a 
felony committed after October 7, 1980.
    (2) A person serving a period of incarceration after September 30, 
1980 (regardless of when the felony was committed) when the following 
conditions are met:
    (i) The person was incarcerated on October 1, 1980; and
    (ii) An award of compensation or DIC is approved after September 30, 
1980.
    (3) A veteran who, on October 7, 1980, was incarcerated in a 
Federal, State, or local penal institution for a felony committed before 
that date, and who remains so incarcerated for a conviction of that 
felony as of December 27, 2001.
    (d) Amount payable during incarceration--(1) Veteran rated 20 
percent or more. A veteran to whom the provisions of paragraphs (a) and 
(c) of this section apply with a service-connected disability evaluation 
of 20 percent or more shall receive the rate of compensation payable 
under 38 U.S.C. 1114(a).
    (2) Veteran rated less than 20 percent. A veteran to whom the 
provisions of paragraphs (a) and (c) of this section apply with a 
service-connected disability evaluation of less than 20 percent (even 
though the rate for 38 U.S.C. 1114 (k) or (q) is paid) shall receive 
one-half the rate of compensation payable under 38 U.S.C. 1114(a).
    (3) Surviving spouse, parent or child. A surviving spouse, parent, 
or child, beneficiary to whom the provisions of paragraphs (a) and (c) 
of this section apply shall receive one-half the rate of compensation 
payable under 38 U.S.C. 1114(a).
    (e) Apportionment--(1) Compensation. All or part of the compensation 
not paid to an incarcerated veteran may be apportioned to the veteran's 
spouse, child or children and dependent parents on the basis of 
individual need. In determining individual need consideration shall be 
given to such factors as the apportionee claimant's income and living 
expenses, the amount of compensation available to be apportioned, the 
needs and living expenses of other apportionee claimants as well as any 
special needs, if any, of all apportionee claimants.

[[Page 341]]

    (2) DIC. All or part of the DIC not paid to an incarcerated 
surviving spouse or other children not in the surviving spouse's custody 
may be apportioned to another child or children. All or part of the DIC 
not paid to an incarcerated child may be apportioned to the surviving 
spouse or other children. These apportionments shall be made on the 
basis of individual need giving consideration to the factors set forth 
in paragraph (e)(1) of this section.
    (f) Effective dates. An apportionment under this section shall be 
effective the date of reduction of payments made to the incarcerated 
person, subject to payments to the incarcerated person over the same 
period, if a claim or intent to file a claim as set forth in Sec.  
3.155(b) is received within 1 year after notice to the incarcerated 
person as required by paragraph (a) of this section, and any necessary 
evidence is received within 1 year from the date of request by the 
Department of Veterans Affairs; otherwise, payments may not be made for 
any period prior to the date of receipt of a new claim or intent to file 
a claim as set forth in Sec.  3.155(b).
    (g) Incarcerated dependent. No apportionment may be made to or on 
behalf of any person who is incarcerated in a Federal, State, or local 
penal institution for conviction of a felony.
    (h) Notice to dependent for whom apportionment granted. A dependent 
for whom an apportionment is granted under this section shall be 
informed that the apportionment is subject to immediate discontinuance 
upon the incarcerated person's release or participation in a work 
release or halfway house program. A dependent shall also be informed 
that if the dependent and the incarcerated person do not live together 
when the incarcerated person is released (or participates in a work 
release or halfway house program) the dependent may submit a new claim 
for apportionment.
    (i) Resumption upon release--(1) No apportionment or family 
reunited. If there was no apportionment at the time of release from 
incarceration, or if the released person is reunited with all dependents 
for whom an apportionment was granted, the released person's award shall 
be resumed the date of release from incarceration if the Department of 
Veterans Affairs receives notice of release within 1 year following 
release; otherwise the award shall be resumed the date of receipt of 
notice of release. If there was an apportionment award during 
incarceration, it shall be discontinued date of last payment to the 
apportionee upon receipt of notice of release of the incarcerated 
person. Payment to the released person shall then be resumed at the full 
rate from date of last payment to the apportionee. Payment to the 
released person from date of release to date of last payment to the 
apportionee shall be made at the rate which is the difference between 
the released person's full rate and the sum of (i) the rate that was 
payable to the apportionee and (ii) the rate payable during 
incarceration.
    (2) Apportionment granted and family not reunited. If there was an 
apportionment granted during incarceration and the released person is 
not reunited with all dependents for whom an apportionment was granted, 
the released person's award shall be resumed as stated in paragraph 
(i)(1) of this section except that when the released person's award is 
resumed it shall not include any additional amount payable by reason of 
a dependent(s) not reunited with the released person. The award to this 
dependent(s) will then be reduced to the additional amount payable for 
the dependent(s).
    (3) Apportionment to a dependent parent. An apportionment made to a 
dependent parent under this section cannot be continued beyond the 
veteran's release from incarceration unless the veteran is incompetent 
and the provisions of Sec.  3.452(c) (1) and (2) are for application. 
When a competent veteran is released from incarceration an apportionment 
made to a dependent parent shall be discontinued and the veteran's award 
resumed as provided in paragraph (i)(1) of this section.
    (j) Increased compensation during incarceration--(1) General. The 
amount of any increased compensation awarded to an incarcerated veteran 
that results from other than a statutory rate increase may be subject to 
reduction due to incarceration. This applies to a veteran whose 
compensation is subject to reduction under paragraphs (a) and (c)

[[Page 342]]

of this section prior to approval of an award of increased compensation 
as well as to veteran whose compensation is not subject to reduction 
under paragraphs (a) and (c) of this section prior to approval of an 
award of increased compensation.
    (2) Veteran subject to reduction under paragraphs (a) and (c) of 
this section. If prior to approval of an award of increased compensation 
the veteran's compensation was reduced under the provisions of 
paragraphs (a) and (c) of this section, the amount of the increase shall 
be reduced as follows if the veteran remains incarcerated:
    (i) If the veteran's schedular evaluation is increased from 10 
percent to 20 percent or greater, the amount payable to the veteran 
shall be increased from one-half the rate payable under 38 U.S.C. 
1114(a) to the rate payable under section 1114(a).
    (ii) If the veteran's schedular evaluation was 20 percent or more, 
none of the increased compensation shall be paid to the veteran while 
the veteran remains incarcerated.
    (3) Veteran's compensation not subject to reduction under paragraphs 
(a) and (c) of this section prior to award of increased compensation. If 
prior to the approval of an award of increased compensation the veteran 
is incarcerated in a Federal, State, or local penal institution for 
conviction of a felony and the veteran's compensation was not reduced 
under the provisions of paragraphs (a) and (c) of this section, none of 
the increased compensation shall be paid to the veteran for periods 
after October 7, 1980, subject to the following conditions:
    (i) The veteran remains incarcerated after October 7, 1980 in a 
Federal, State, or local penal institution for conviction of a felony; 
and
    (ii) The award of increased compensation is approved after October 
7, 1980. If the effective date of the increase is prior to October 8, 
1980, the amount payable for periods prior to October 8, 1980, shall not 
be reduced.
    (4) Apportionments. The amount of any increased compensation reduced 
under this paragraph may be apportioned as provided in paragraph (e) of 
this section.
    (k) Retroactive awards. Whenever compensation or DIC is awarded to 
an incarcerated person any amounts due for periods prior to date of 
reduction under this section shall be paid to the incarcerated person.
    (l) DIC parents. If two parents are both entitled to DIC and were 
living together prior to the time of the DIC payable to one parent was 
reduced due to incarceration, they shall be considered as two parents 
not living together for the purpose of determining entitlement to DIC.
    (m) Conviction overturned on appeal. If a conviction is overturned 
on appeal, any compensation or DIC withheld under this section as a 
result of incarceration for such conviction (less the amount of any 
apportionment) shall be restored to the beneficiary.
    (n) Fugitive felons. (1) Compensation is not payable on behalf of a 
veteran for any period during which he or she is a fugitive felon. 
Compensation or DIC is not payable on behalf of a dependent of a veteran 
for any period during which the veteran or the dependent is a fugitive 
felon.
    (2) For purposes of this section, the term fugitive felon means a 
person who is a fugitive by reason of:
    (i) Fleeing to avoid prosecution, or custody or confinement after 
conviction, for an offense, or an attempt to commit an offense, which is 
a felony under the laws of the place from which the person flees; or
    (ii) Violating a condition of probation or parole imposed for 
commission of a felony under Federal or State law.
    (3) For purposes of paragraph (n) of this section, the term felony 
includes a high misdemeanor under the laws of a State which 
characterizes as high misdemeanors offenses that would be felony 
offenses under Federal law.
    (4) For purposes of paragraph (n) of this section, the term 
dependent means a spouse, surviving spouse, child, or dependent parent 
of a veteran.

(Authority: 38 U.S.C. 501(a), 5313, 5313B; Sec. 506, Pub. L. 107-103, 
115 Stat. 996-997)

[46 FR 47542, Sept. 29, 1981, as amended at 68 FR 34542, June 10, 2003; 
79 FR 57697, Sept. 25, 2014]

[[Page 343]]



Sec.  3.666  Incarcerated beneficiaries and fugitive felons--pension.

    If any individual to or for whom pension is being paid under a 
public or private law administered by the Department of Veterans Affairs 
is imprisoned in a Federal, State or local penal institution as the 
result of conviction of a felony or misdemeanor, such pension payments 
will be discontinued effective on the 61st day of imprisonment following 
conviction. The payee will be informed of his or her rights and the 
rights of dependents to payments while he or she is imprisoned as well 
as the conditions under which payments to him or to her may be resumed 
on his or her release from imprisonment. However, no apportionment will 
be made if the veteran or the dependent is a fugitive felon as defined 
in paragraph (e) of this section. Payments of pension authorized under 
this section will continue until notice is received by the Department of 
Veterans Affairs that the imprisonment has terminated.
    (a) Disability pension. Payment may be made to the spouse, child or 
children of a veteran disqualified under this section:
    (1) If the veteran continues to be eligible except for the 
provisions of this section, and
    (2) If the annual income of the spouse or child is such that death 
pension would be payable.
    (3) At the rate payable under the death pension law or the rate 
which the veteran was receiving at the time of imprisonment, whichever 
is less.
    (4) From the day following the date of discontinuance of payments to 
the veteran, subject to payments made to the veteran over the same 
period, if a claim or intent to file a claim as set forth in Sec.  
3.155(b) is received within 1 year after notice to the veteran as 
required by this section and any necessary evidence is received within 1 
year from the date of request; otherwise payments may not be made for 
any period prior to the date of receipt of a new claim or intent to file 
a claim as set forth in Sec.  3.155(b).
    (b) Death pension. Payment may be made to a child or children where 
a surviving spouse or child is disqualified under this section:
    (1) If surviving spouse is disqualified to child or children at the 
rate of death pension payable if there were no such surviving spouse; or
    (2) If a child is disqualified, to a surviving spouse or other child 
or children at the rate of death pension payable if there were no such 
child, and
    (3) From the day following the date of discontinuance of payments to 
the disqualified person, subject to payments made to that person over 
the same period if evidence of income is received within 1 year after 
date of request; otherwise payments may not be made for any period prior 
to the date of receipt of a claim or intent to file a claim as set forth 
in Sec.  3.155(b).
    (4) The income limitation applicable to eligible persons will be 
that which would apply if the imprisoned person did not exist.
    (c) Resumption of pension upon release from incarceration. Pension 
will be resumed as of the day of release if notice is received within 1 
year following release; otherwise resumption will be effective the date 
of receipt of such notice. Where an award or increased award was made to 
any other payee based upon the disqualification of the veteran, 
surviving spouse, or child while in prison, such award will be reduced 
or discontinued as of date of last payment and pension will be resumed 
to the released prisoner at a rate which will be the difference, if any, 
between the total pension payable and the amount which was paid to the 
other person or persons through the date of last payment and thereafter 
the full rate.
    (d) Veteran entitled to compensation. If an imprisoned veteran is 
entitled to a lesser rate of disability compensation, it shall be 
awarded as of the 61st day of imprisonment in lieu of the pension the 
veteran was receiving if the veteran has neither spouse nor child. If 
the veteran has a spouse or a child, compensation will be awarded only 
after the veteran has been furnished an explanation of the effect of 
electing compensation on the amount available for apportionment. If the 
veteran then requests compensation, it shall be awarded from the date 
veteran requests the Department of Veterans Affairs to take such action.

[[Page 344]]

    (e) Fugitive felons. (1) Pension is not payable on behalf of a 
veteran for any period during which he or she is a fugitive felon. 
Pension or death pension is not payable on behalf of a dependent of a 
veteran for any period during which the veteran or the dependent is a 
fugitive felon.
    (2) For purposes of this section, the term fugitive felon means a 
person who is a fugitive by reason of:
    (i) Fleeing to avoid prosecution, or custody or confinement after 
conviction for an offense, or an attempt to commit an offense, which is 
a felony under the laws of the place from which the person flees; or
    (ii) Violating a condition of probation or parole imposed for 
commission of a felony under Federal or State law.
    (3) For purposes of paragraph (e) of this section, the term felony 
includes a high misdemeanor under the laws of a State which 
characterizes as high misdemeanors offenses that would be felony 
offenses under Federal law.
    (4) For purposes of paragraph (e) of this section, the term 
dependent means a spouse, surviving spouse, child, or dependent parent 
of a veteran.

(Authority: 38 U.S.C. 501(a), 5313, 5313B)

[26 FR 1601, Feb. 24, 1961, as amended at 40 FR 6971, Feb. 18, 1975; 40 
FR 22254, May 22, 1975; 44 FR 45943, Aug. 6, 1979; 46 FR 47543, Sept. 
29, 1981; 62 FR 5529, Feb. 6, 1997; 68 FR 34543, June 10, 2003; 79 FR 
57697, Sept. 25, 2014]



Sec.  3.667  School attendance.

    (a) General. (1) Pension or compensation may be paid from a child's 
18th birthday based upon school attendance if the child was at that time 
pursing a course of instruction at an approved educational institution 
and a claim for such benefits is filed within 1 year from the child's 
18th birthday.
    (2) Pension or compensation based upon a course of instruction at an 
approved educational institution which was begun after a child's 18th 
birthday may be paid from the commencement of the course if a claim is 
filed within 1 year from that date.
    (3) An initial award of DIC (dependency and indemnity compensation) 
to a child in the child's own right is payable from the first day of the 
month in which the child attains age 18 if the child was pursuing a 
course of instruction at an approved educational institution on the 
child's 18th birthday, and if a claim for benefits is filed within 1 
year from the child's 18th birthday. In the case of a child who attains 
age 18 after September 30, 1981, if the child was, immediately before 
attaining age 18, counted under 38 U.S.C. 1311(b) for the purpose of 
determining the amount of DIC payable to the surviving spouse, the 
effective date of an award of DIC to the child shall be the date the 
child attains age 18 if a claim for DIC is filed within 1 year from that 
date.


(Authority: 38 U.S.C. 5110(e))

    (4) An initial award of dependency and indemnity compensation to a 
child in its own right based upon a course of instruction at an approved 
educational institution which was begun after the child's 18th birthday 
may be paid from the first day of the month in which the course 
commenced if a claim is filed within 1 year from that date.


(Authority: 38 U.S.C. 5110(e))

    (5) Where a child was receiving dependency and indemnity 
compensation in its own right prior to age 18, payments may be continued 
from the 18th birthday if the child was then attending an approved 
educational institution and evidence of such school attendance is 
received within 1 year from the 18th birthday. Where the child was 
receiving dependency and indemnity compensation in its own right prior 
to age 18 and was not attending an approved educational institution on 
the 18th birthday but commences attendance at an approved educational 
institution after the 18th birthday, payments may be resumed from the 
commencing date of the course if evidence of such school attendance is 
filed within 1 year from that date.
    (b) Vacation periods. A child is considered to be in school during a 
vacation or other holiday period if he or she was attending an approved 
educational institution at the end of the preceding school term and 
resumes attendance, either in the same or a different approved 
educational institution, at the beginning of the next term. If an award 
has been made covering a vacation period, and the child fails to 
commence or resume school attendance, benefits

[[Page 345]]

will be terminated the date of last payment or the last day of the month 
preceding the date of failure to pursue the course, whichever is the 
earlier.
    (c) Ending dates. Except as provided in paragraph (b) of this 
section, benefits may be authorized through the last day of the month in 
which a course was or will be completed.


(Authority: 38 U.S.C. 5112(b)(7))

    (d) Transfers to other schools. When benefits have been authorized 
based upon school attendance and it is shown that during a part or all 
of that period the child was pursuing a different course in the same 
approved educational institution or a course in a different approved 
educational institution, payments previously made will not be disturbed.
    (e) Accrued benefits only. When a claim for accrued benefits is 
filed by or on behalf of a veteran's child over 18 but under 23 years of 
age, who was pursuing a course of instruction at the time of the payee's 
death and payment of accrued benefits only is involved, evidence of 
school attendance need not be confirmed by the school. When the payee's 
death occurred during a school vacation period, the requirements will be 
considered to have been met if the child was carried on the school rolls 
on the last day of the regular school term immediately preceding the 
date of the payee's death.


(Authority: 38 U.S.C. 5112(b)(7))

    (f) Nonduplication. Pension, compensation or dependency and 
indemnity compensation may not be authorized:
    (1) After a child has elected to receive educational assistance 
under 38 U.S.C. chapter 35 (see Sec.  3.707 and Sec.  21.3023 of this 
chapter); or
    (2) Based on an educational program in a school where the child is 
wholly supported at the expense of the Federal Government, such as a 
service academy.

    Cross Reference: Dependents' educational assistance. See Sec.  
3.707.

[26 FR 1601, Feb. 24, 1961, as amended at 30 FR 14983, Dec. 3, 1965; 32 
FR 12114, Aug. 23, 1967; 34 FR 839, Jan. 18, 1969; 40 FR 22254, May 22, 
1975; 47 FR 24552, June 7, 1982; 65 FR 12116, Mar. 8, 2000]



Sec.  3.668  [Reserved]



Sec.  3.669  Forfeiture.

    (a) General. Upon receipt of notice from a Regional Counsel (or in 
cases under the jurisdiction of the Manila Regional Office, the Veterans 
Service Center Manager) that a case is being formally submitted for 
consideration of forfeiture of a payee's rights under Sec.  3.905 of 
this part or that the payee has been indicted for subversive activities, 
payments will be suspended effective date of last payment.
    (b) Fraud or treasonable act--(1) Fraud. If forfeiture of rights is 
not declared, payments shall be resumed from date of last payment, if 
otherwise in order. If it is determined that rights have been forfeited, 
benefits shall be discontinued effective the commencing date of the 
award or the day preceding the commission of the act resulting in the 
forfeiture, whichever is later.
    (2) Treasonable acts. If forfeiture of rights is not declared, 
payments shall be resumed from date of last payment, if otherwise in 
order. If it is determined that rights have been forfeited, benefits 
shall be discontinued the date of the forfeiture decision or date of 
last payment, whichever is earlier.
    (c) Subversive activities. If the payee is acquitted of the charge, 
payments will be resumed from date of last payment, if otherwise in 
order. If the payee is convicted, benefits will be discontinued 
effective the commencing date of the award or the day preceding the 
commission of the act resulting in the forfeiture, whichever is later.
    (d) Pardons. (1) Where the payee's offense has been pardoned by the 
President of the United States, the award will be resumed, if otherwise 
in order, effective the date of the pardon if claim is filed within 1 
year from that date; otherwise benefits may not be authorized for any 
period prior to the date of filing claim. The award will be subject to 
any existing overpayment.

[[Page 346]]

    (2) Payments to a dependent of the person whose benefits were 
declared forfeited before September 2, 1959, will be discontinued 
effective the day preceding the date of the pardon.

(Authority: 38 U.S.C. 501)

    Cross References: Fraud. See Sec.  3.901. Treasonable acts. See 
Sec.  3.902. Subversive activities. See Sec.  3.903.

[27 FR 8616, Aug. 29, 1962, as amended 28 FR 5618, June 7, 1963; 39 FR 
28630, Aug. 9, 1974; 46 FR 34801, July 6, 1981; 71 FR 52290, Sept. 5, 
2006]

                    Concurrent Benefits and Elections



Sec.  3.700  General.

    Not more than one award of pension, compensation, or emergency 
officers', regular or reserve retirement pay will be made concurrently 
to any person based on his or her own service except as provided in 
Sec.  3.803 relating to naval pension and Sec.  3.750(c) relating to 
waiver of retirement pay. Not more than one award of pension, 
compensation, or dependency and indemnity compensation may be made 
concurrently to a dependent on account of more than one period of 
service of a veteran.


(Authority: 38 U.S.C. 5304(a))

    (a) Veterans--(1) Active service pay. (i) Pension, compensation, or 
retirement pay on account of his or her own service will not be paid to 
any person for any period for which he or she receives active service 
pay.


(Authority: 38 U.S.C. 5304(c))

    (ii) Time spent by members of the ROTC in drills as part of their 
activities as members of the corps is not active service.
    (iii) Reservists may waive their pension, compensation, or 
retirement pay for periods of field training, instruction, other duty or 
drills. A waiver may include prospective periods and contain a right of 
recoupment for the days for which the reservists did not receive payment 
for duty by reason of failure to report for duty.
    (2) Lump-sum readjustment pay. (i) Where entitlement to disability 
compensation was established prior to September 15, 1981, a veteran who 
has received a lump-sum readjustment payment under former 10 U.S.C. 687 
(as in effect on September 14, 1981) may receive disability compensation 
for disability incurred in or aggravated by service prior to the date of 
receipt of lump-sum readjustment payment subject to deduction of an 
amount equal to 75 percent of the amount received as readjustment 
payment.


(Authority: 38 U.S.C. 501)

    (ii) Readjustment pay authorized under former 10 U.S.C. 3814(a) is 
not subject to recoupment through withholding of disability 
compensation, entitlement to which was established prior to September 
15, 1981.


(Authority: 38 U.S.C. 501)

    (iii) Where entitlement to disability compensation was established 
on or after September 15, 1981, a veteran who has received a lump-sum 
readjustment payment may receive disability compensation for disability 
incurred in or aggravated by service prior to the date of receipt of the 
lump-sum readjustment payment, subject to recoupment of the readjustment 
payment. Where payment of readjustment pay was made on or before 
September 30, 1996, VA will recoup from disability compensation an 
amount equal to the total amount of readjustment pay. Where payment of 
readjustment pay was made after September 30, 1996, VA will recoup from 
disability compensation an amount equal to the total amount of 
readjustment pay less the amount of Federal income tax withheld from 
such pay.


(Authority: 10 U.S.C. 1174(h)(2))

    (iv) The receipt of readjustment pay does not affect the payment of 
disability compensation based on a subsequent period of service. 
Compensation payable for service-connected disability incurred or 
aggravated in a subsequent period of service will not be reduced for the 
purpose of offsetting readjustment pay based on a prior period of 
service.


(Authority: 10 U.S.C. 1174(h)(2))

    (3) Severance pay. Where the disability or disabilities found to be 
service-connected are the same as those

[[Page 347]]

upon which disability severance pay is granted, or where entitlement to 
disability compensation was established on or after September 15, 1981, 
an award of compensation will be made subject to recoupment of the 
disability severance pay. Prior to the initial determination of the 
degree of disability recoupment will be at the full monthly compensation 
rate payable for the disability or disabilities for which severance pay 
was granted. Following initial determination of the degree of disability 
recoupment shall not be at a monthly rate in excess of the monthly 
compensation payable for that degree of disability. For this purpose the 
term ``initial determination of the degree of disability'' means the 
first regular schedular compensable rating in accordance with the 
provisions of subpart B, part 4 of this chapter and does not mean a 
rating based in whole or in part on a need for hospitalization or a 
period of convalescense. Where entitlement to disability compensation 
was established prior to September 15, 1981, compensation payable for 
service-connected disability other than the disability for which 
disability severance pay was granted will not be reduced for the purpose 
of recouping disability severance pay. Where entitlement to disability 
compensation was established on or after September 15, 1981, a veteran 
may receive disability compensation for disability incurred or 
aggravated by service prior to the date of receipt of the severance pay, 
but VA must recoup from that disability compensation an amount equal to 
the severance pay. Where payment of severance pay was made on or before 
September 30, 1996, VA will recoup from disability compensation an 
amount equal to the total amount of the severance pay. Where payment of 
severance pay was made after September 30, 1996, VA will recoup from 
disability compensation an amount equal to the total amount of the 
severance pay less the amount of Federal income tax withheld from such 
pay. For members of the Armed Forces who separated under Chapter 61 of 
title 10, United States Code, on or after January 28, 2008, no 
recoupment of severance pay will be made for disabilities incurred in 
line of duty in a combat zone or incurred during performance of duty in 
combat-related operations as designated by the Department of Defense.


(Authority: 10 U.S.C. 1174(h)(2) and 1212(d))

    (4) Improved pension. If a veteran is entitled to improved pension 
on the basis of the veteran's own service and is also entitled to 
pension under any pension program currently or previously in effect on 
the basis of any other person's service, the Department of Veterans 
Affairs shall pay the veteran only the greater benefit.


(Authority: 38 U.S.C. 1521(i))

    (5) Separation pay and special separation benefits. (i) Where 
entitlement to disability compensation was established on or after 
September 15, 1981, a veteran who has received separation pay may 
receive disability compensation for disability incurred in or aggravated 
by service prior to the date of receipt of separation pay subject to 
recoupment of the separation pay. Where payment of separation pay was 
made on or before September 30, 1996, VA will recoup from disability 
compensation an amount equal to the total amount of separation pay. 
Where payment of separation pay was made after September 30, 1996, VA 
will recoup from disability compensation an amount equal to the total 
amount of separation pay less the amount of Federal income tax withheld 
from such pay. The Federal income tax withholding amount is the flat 
withholding rate for Federal income tax withholding.
    (ii) The receipt of separation pay does not affect the payment of 
disability compensation based on a subsequent period of service. 
Compensation payable for service-connected disability incurred or 
aggravated in a subsequent period of service will not be reduced for the 
purpose of offsetting separation pay based on a prior period of service.
    (iii) Where payment of special separation benefits under 10 U.S.C. 
1174a was made on or after December 5, 1991, VA will recoup from 
disability compensation an amount equal to the total amount of special 
separation benefits less the amount of Federal income tax withheld from 
such pay. The Federal

[[Page 348]]

income tax withholding amount is the flat withholding rate for Federal 
income tax withholding.


(Authority: 10 U.S.C. 1174 and 1174a)

    (b) Dependents--(1) Surviving spouse. Subject to the provisions of 
paragraph (a)(4) of this section, the receipt of pension, compensation, 
or dependency and indemnity compensation by a surviving spouse because 
of the death of any veteran, or receipt of pension or compensation 
because of his or her own service, shall not bar the payment to the 
surviving spouse of pension, compensation, or dependency and indemnity 
compensation because of the death or disability of any other veteran; 
however, other than insurance, concurrent benefits under laws 
administered by the Department of Veterans Affairs may not be authorized 
to a surviving spouse by reason of the death of more than one veteran to 
whom the surviving spouse has been married. The surviving spouse may 
elect to receive benefits based on the death of one such spouse and the 
election places the right to benefits based on the deaths of other 
spouses in suspense. The suspension may be lifted at any time by another 
election based on the death of another spouse. Benefits payable in the 
elected case will be subject to prior payments for the same period based 
on the death of the other spouse where, under the provisions of Sec.  
3.400(c), there is entitlement in the elected case prior to date of 
receipt of the election.


(Authority: 38 U.S.C. 5304)

    (2) Children. Except as provided in Sec.  3.703 and paragraph (a)(4) 
of this section, the receipt of pension, compensation, or dependency and 
indemnity compensation by a child on account of the death of a veteran 
or the receipt by the child of pension or compensation on account of his 
or her own service will not bar the payment of pension, compensation, or 
dependency and indemnity compensation on account of the death or 
disability of any other veteran.
    (3) Parents. The receipt of compensation or dependency and indemnity 
compensation by a parent on account of the death of a veteran or receipt 
by him or her of pension or compensation on account of his or her own 
service, will not bar the payment of pension, compensation, or 
dependency and indemnity compensation on account of the death or 
disability of any other person.

(Authority: 38 U.S.C. 5304(b))

[26 FR 1601, Feb. 24, 1961, as amended at 29 FR 11359, Aug. 6, 1964; 29 
FR 15207, Nov. 11, 1964; 30 FR 11389, Sept. 8, 1965; 35 FR 10648, July 
1, 1970; 40 FR 59346, Dec. 23, 1975; 44 FR 45943, Aug. 6, 1979; 52 FR 
27340, July 21, 1987; 56 FR 1111, Jan. 11, 1991; 67 FR 60868, Sept. 27, 
2002; 74 FR 26957, June 5, 2009; 74 FR 36610, July 24, 2009]



Sec.  3.701  Elections of pension or compensation.

    (a) General. Except as otherwise provided, a person entitled to 
receive pension or compensation under more than one law or section of a 
law administered by the Department of Veterans Affairs may elect to 
receive whichever benefit, regardless of whether it is the greater or 
lesser benefit, even though the election reduces the benefits payable to 
his or her dependents. Such person may at any time elect or reelect the 
other benefit. An election by a veteran controls the rights of all 
dependents in that case. An election by a surviving spouse controls the 
claims of all children including children over 18 and children not in 
the custody of the surviving spouse. The election of improved pension by 
a surviving spouse, however, shall not prejudice the rights of any child 
receiving an apportionment on December 31, 1978. Termination of a 
marriage or marital relationship which had been the reason for 
terminating an award of section 306 or old-law pension does not restore 
to the surviving spouse the right to receive section 306 or old-law 
pension. The claimant's entitlement, if otherwise established, is under 
the current provisions of 38 U.S.C. 1541.


(Authority: 38 U.S.C. 501)

    (b) Form of election. An election must be in writing and must 
specify the benefit the person wishes to receive.
    (c) Change from one law to another. Except as otherwise provided, 
where payments of pension or compensation are being made to a person 
under one law, the right to receive benefits under

[[Page 349]]

another law being in suspension, and a higher rate of pension or 
compensation becomes payable under the other law, benefits at the higher 
rate will not be paid for any date prior to the date of receipt of an 
election.

[26 FR 1602, Feb. 24, 1961, as amended at 36 FR 12618, July 2, 1971; 44 
FR 45943, Aug. 6, 1979; 79 FR 57697, Sept. 25, 2014]



Sec.  3.702  Dependency and indemnity compensation.

    (a) Right to elect. A person who is eligible for death compensation 
and who has entitlement to dependency and indemnity compensation 
pursuant to the provisions of Sec.  3.5(b)(2) or (3) may receive 
dependency and indemnity compensation upon the filing of a claim. The 
claim of such a person for service-connected death benefits shall be 
considered a claim for dependency and indemnity compensation subject to 
confirmation by the claimant. The effective date of payment is 
controlled by the provisions of Sec.  3.400(c)(4).
    (b) Effect on child's entitlement. Where a surviving spouse is 
entitled to death compensation, the amount of which is based in part on 
the existence of a child who has attained the age of 18 years, and 
elects to receive dependency and indemnity compensation, the independent 
award of dependency and indemnity compensation to which the child is 
entitled will be awarded to or for the child without separate election 
by or for the child. Should such a surviving spouse not elect to receive 
dependency and indemnity compensation, the independent dependency and 
indemnity compensation to which a child who has attained 18 years of age 
is entitled, may be awarded upon application by or for the child. The 
effective date of award in these situations will be in accordance with 
Sec.  3.400(c)(4)(ii).
    (c) Limitation. A claim for dependency and indemnity compensation 
may not be filed or withdrawn after the death of the surviving spouse, 
child, or parent.
    (d) Finality of election. (1) Except as noted in paragraph (d)(2), 
an election to receive dependency and indemnity compensation is final 
and the claimant may not thereafter reelect death pension or 
compensation in that case. An election is final when the payee (or the 
payee's fiduciary) has negotiated one check for this benefit or when the 
payee dies after filing an election but prior to negotiation of a check.
    (2) Notwithstanding the provisions of paragraph (d)(1), effective 
November 2, 1994, a surviving spouse who is receiving dependency and 
indemnity compensation may elect to receive death pension instead of 
such compensation.


(Authority: 38 U.S.C. 1317)

    (e) Surviving spouse becomes entitled. A surviving spouse who 
becomes eligible to receive death compensation by reason of liberalizing 
provisions of any law may receive death compensation or elect dependency 
and indemnity compensation even though dependency and indemnity 
compensation has been paid to a child or children of the veteran.
    (f) Death pension rate. (1) Effective October 1, 1961, where the 
monthly rate of dependency and indemnity compensation payable to a 
surviving spouse who has children is less than the monthly rate of death 
pension which would be payable to such surviving spouse if the veteran's 
death had not been service connected, dependency and indemnity 
compensation shall be paid to such surviving spouse in an amount equal 
to the pension rate for any month (or part thereof) in which this rate 
is greater.
    (2) Effective June 22, 1966, where the monthly rate of dependency 
and indemnity compensation payable to a surviving spouse who has 
children is less than the monthly rate of death pension which would be 
payable for the children if the veteran's death had not been service 
connected and the surviving spouse were not entitled to such pension, 
dependency and indemnity compensation shall be payable to the surviving 
spouse in an amount equal to the monthly rate of death pension which 
would be payable to the children for any month (or part thereof) in 
which this rate is greater.

(Authority: 38 U.S.C. 1312(b))

    Cross Reference: Deaths prior to January 1, 1957. See Sec.  
3.400(c)(3)(i).

[35 FR 18661, Dec. 9, 1970, as amended at 39 FR 20205, June 7, 1974; 41 
FR 17387, Apr. 26, 1976; 44 FR 45943, Aug. 6, 1979; 60 FR 18356, Apr. 
11, 1995; 61 FR 20727, May 8, 1996; 62 FR 5529, Feb. 6, 1997]

[[Page 350]]



Sec.  3.703  Two parents in same parental line.

    (a) General. Death compensation or dependency and indemnity 
compensation is not payable for a child if dependency and indemnity 
compensation is paid to or for a child or to the surviving spouse on 
account of the child by reason of the death of another parent in the 
same parental line where both parents died before June 9, 1960. Where 
the death of one such parent occurred on or after June 9, 1960, 
gratuitous benefits may not be paid or furnished to or on account of any 
child by reason of the death of more than one parent in the same 
parental line.
    (b) Election. The child or his or her fiduciary may elect to receive 
benefits based on the service of either veteran. An election of pension, 
compensation or dependency and indemnity compensation based on the death 
of one parent places the right to such benefits based on the death of 
another parent in suspension. The suspension may be lifted at any time 
by making another election.
    (c) Other payees. Where a child has elected to receive pension, 
compensation, dependency and indemnity compensation or dependents' 
educational assistance under 38 U.S.C. ch. 35 based on the death of a 
veteran, he (or she) will be excluded from consideration in determining 
the eligibility or rate payable to a surviving spouse or another child 
or children in the case of another deceased veteran in the same parental 
line. See Sec.  3.659(b).

    Cross References: Two-parent cases. See Sec.  3.503(a)(7). Two 
parents in same parental line. See Sec.  3.659.

[27 FR 4993, May 29, 1962, as amended at 39 FR 20205, June 7, 1974]



Sec.  3.704  Elections within class of dependents.

    (a) Children. Where children are eligible to receive monthly 
benefits under more than one law in the same case, the election of 
benefits under one law by or on behalf of one child will not serve to 
increase the rate allowable for any other child under another law in 
that case. The rate payable for each child will not exceed the amount 
which would be paid if all children were receiving benefits under the 
same law. Where a child is no longer eligible to receive pension, 
compensation or dependency and indemnity compensation because of having 
elected dependents' educational assistance under 38 U.S.C. chapter 35, 
the child will be excluded from consideration in determining the rate 
payable for another child or children.
    (b) Parents. If there are two parents eligible for dependency and 
indemnity compensation and only one parent files claim for this benefit, 
the rate of dependency and indemnity compensation for that parent will 
not exceed the amount which would be paid to him or her if both parents 
had filed claim for dependency and indemnity compensation. The rate of 
death compensation for the other parent will not exceed the amount which 
would be paid if both parents were receiving this benefit.

[26 FR 1602, Feb. 24, 1961, as amended at 27 FR 4993, May 29, 1962; 34 
FR 839, Jan. 18, 1969; 39 FR 20205, June 7, 1974; 54 FR 34981, Aug. 23, 
1989]



Sec. Sec.  3.705-3.706  [Reserved]



Sec.  3.707  Dependents' educational assistance.

    (a) Child. The conditions applicable to the bar to payment of 
pension, compensation or dependency and indemnity compensation for a 
child concurrently with educational assistance allowance under 38 U.S.C. 
chapter 35 are set forth in Sec.  21.3023 of this chapter.
    (b) Spouse or surviving spouse. There is no bar to the payment of 
pension, compensation or dependency and indemnity compensation to a 
spouse concurrently with educational assistance allowance under 38 
U.S.C. ch. 35.

    Cross References: Discontinuance. See Sec.  3.503(a)(8). 
Certification. See Sec.  3.807.

[34 FR 840, Jan. 18, 1969, as amended at 41 FR 29120, July 15, 1976]



Sec.  3.708  Federal Employees' Compensation.

    (a) Military service--(1) Initial election. Where a person is 
entitled to compensation from the Office of Workers' Compensation 
Programs, under the Federal Employees' Compensation Act (FECA) based 
upon disability or death due to service in the Armed Forces and

[[Page 351]]

is also entitled based upon service in the Armed Forces to pension, 
compensation or dependency and indemnity compensation under the laws 
administered by the Department of Veterans Affairs, the claimant will 
elect which benefit he or she will receive. Pension compensation, or 
dependency and indemnity compensation may not be paid in such instances 
by the Department of Veterans Affairs concurrently with compensation 
from the Office of Workers' Compensation Programs. Benefits are not 
payable by the Office of Workers' Compensation Programs for disability 
or death incurred on or after January 1, 1957, based on military 
service.
    (2) Right of reelection. Persons receiving compensation from the 
Office of Workers' Compensation Programs based on death due to military 
service may elect to receive dependency and indemnity compensation at 
any time. Once payment of dependency and indemnity compensation has been 
granted, all further right to FECA benefits is extinguished and only 
dependency and indemnity compensation is payable thereafter.
    (3) Rights of children. Where primary title is vested in the 
surviving spouse, the claimant's election controls the rights of any of 
the veteran's children, regardless of whether they are in the claimant's 
custody and regardless of the fact that such children may not be 
eligible to receive benefits under laws administered by the Office of 
Workers' Compensation Programs. A child who is eligible for dependency 
and indemnity compensation or other benefits independent of the 
surviving spouse's entitlement may receive such benefits concurrently 
with payment of FECA benefits to the surviving spouse.
    (4) Entitlement based on 38 U.S.C. 1151. The provisions of this 
paragraph are applicable also in those cases in which disability or 
death occurs as a result of having submitted to an examination, medical 
or surgical treatment, hospitalization or hospital care, training, or 
compensated work therapy program. See Sec. Sec.  3.358 and 3.361.
    (b) Civilian employment--(1) Same disability or death. Where a 
person is entitled to compensation from the Office of Workers' 
Compensation Programs based upon civilian employment and is also 
entitled to compensation or dependency and indemnity compensation under 
laws administered by the Department of Veterans Affairs for the same 
disability or death, the claimant will elect which benefit he or she 
will receive. On or after September 13, 1960, an award cannot be 
approved for payment of compensation or dependency and indemnity 
compensation concurrently with compensation from the Office of Workers' 
Compensation Programs in such instances and an election to receive 
benefits from either agency is final. See Sec.  3.958. There is no right 
of reelection. (5 U.S.C. 8116(b)) A child who is eligible for dependency 
and indemnity compensation or other benefits independent of the 
surviving spouse's entitlement may receive such benefits concurrently 
with payment of FECA benefits to the surviving spouse.
    (2) Not the same disability or death. There is no prohibition 
against payment of benefits under the Federal Employees' Compensation 
Act concurrently with other benefits administered by the Department of 
Veterans Affairs when such benefits are not based on the same disability 
or death.

[39 FR 18099, May 23, 1974, as amended at 41 FR 29120, July 15, 1976; 44 
FR 45943, Aug. 6, 1979; 69 FR 46435, Aug. 3, 2004]



Sec.  3.710  Civil service annuitants.

    Department of Veterans Affairs benefits may be paid concurrently 
with civil service retirement benefits. However, payments will be 
considered income as provided in Sec.  3.262 (e) and (h).

[29 FR 15208, Nov. 11, 1964]



Sec.  3.711  Improved pension elections.

    Except as otherwise provided by this section and Sec.  3.712, a 
person entitled to receive section 306 or old-law pension on December 
31, 1978, may elect to receive improved pension under the provisions of 
38 U.S.C. 1521, 1541, or 1542 as in effect on January 1, 1979. Except as 
provided by Sec.  3.714, an election of improved pension is final when 
the payee (or the payee's fiduciary) negotiates one check for this 
benefit and there is no right to reelection. Any veteran eligible to 
make an election under this section who is married to a veteran

[[Page 352]]

who is also eligible to make such an election may not receive improved 
pension unless the veteran's spouse also elects to receive improved 
pension.

(Authority: Sec. 306(a)(1) of Pub. L. 95-588, 92 Stat. 2497)

[46 FR 11661, Feb. 10, 1981]



Sec.  3.712  Improved pension elections; surviving spouses of 
Spanish-American War veterans.

    (a) General. A surviving spouse of a Spanish-American War veteran 
eligible for pension under 38 U.S.C. 1536 may elect to receive improved 
pension under 38 U.S.C. 1541. Except as provided by Sec.  3.714, an 
election of improved pension is final when the payee (or the payee's 
fiduciary) negotiates one check for this benefit and there is no right 
of reelection.
    (b) Aid and attendance. A surviving spouse of a Spanish-American War 
veteran who is receiving or entitled to receive pension based on need 
for regular aid and attendance shall be paid whichever is the greater: 
The monthly rate authorized by 38 U.S.C. 1536 (a) and (b) and 1544 or 
the monthly rate authorized by 38 U.S.C. 1541 and 544, as 38 U.S.C. 1541 
and 1544 were in effect on December 31, 1978, based on the surviving 
spouse's current income and net worth. Pension under 38 U.S.C. 1541 and 
1544, as in effect on December 31, 1978, is not payable if the current 
size of the surviving spouse's net worth is a bar to payment under Sec.  
3.252(b) or if the surviving spouse's income exceeds the applicable 
limitation as in effect on December 31, 1978. Elections are not required 
for this purpose. The change in rate shall be effective the first day of 
the month in which the facts warrant such change.

(Authority: 38 U.S.C. 1536)

[44 FR 45943, Aug. 6, 1979, as amended at 46 FR 11661, Feb. 10, 1981; 61 
FR 67950, Dec. 26, 1996]



Sec.  3.713  Effective dates of improved pension elections.

    (a) General. Except as provided in paragraph (b) of this section an 
election to receive improved pension shall be effective the date of 
receipt of the election.
    (b) Persons entitled to pension on December 31, 1978. The effective 
date of an election to receive improved pension filed before October 1, 
1979, by a person entitled to receive either old-law pension or section 
306 pension on December 31, 1978, shall be January 1, 1979, or if to the 
beneficiary's advantage, at any date after January 1, 1979, and before 
October 1, 1979. The amount of improved pension payable from the 
effective date of the election shall be reduced by the amount of old-law 
pension or section 306 pension paid to the beneficiary for such period.

(Authority: Sec. 306(d) of Pub. L. 95-588, 92 Stat. 2497).

[44 FR 45944, Aug. 6, 1979]



Sec.  3.714  Improved pension elections--public assistance beneficiaries.

    (a) Definitions. The following definitions are applicable to this 
section.
    (1) Pensioner. This means a person who was entitled to section 306 
or old-law pension, or a dependent of such a person for the purposes of 
chapter 15 of title 38, United States Code as in effect on December 31, 
1978.
    (2) Public assistance. This means payments under the following 
titles of the Social Security Act:
    (i) Title I (Grants to States for Old Age Assistance and Medical 
Assistance to the Aged).
    (ii) Title X (Grants to States for Aid to the Blind).
    (iii) Title XIV (Grants to States for Aid to the Permanently and 
Totally Disabled).
    (iv) Part A of title IV (Aid to Families with Dependent Children).
    (v) Title XVI (Supplemental Security Income for the Aged, Blind and 
Disabled).
    (3) Medicaid. This means a State plan for medical assistance under 
title XIX of the Social Security Act.
    (4) Informed election. The term ``informed election'' means an 
election of improved pension (or a reaffirmation of a previous election 
of improved pension) after the Department of Veterans Affairs has 
complied with the requirements of paragraph (e) of this section.
    (b) General. In some States only a person in receipt of public 
assistance is eligible for medicaid. When this is the

[[Page 353]]

case the following applies effective January 1, 1979:
    (1) A pensioner may not be required to elect improved pension to 
receive, or to continue to receive, public assistance; or
    (2) A pensioner may not be denied (or suffer a reduction in the 
amount of) public assistance by reason of failure or refusal to elect 
improved pension.
    (c) Public assistance deemed to continue. Public assistance (or a 
supplementary payment under Pub. L. 93-233, sec. 13(c)) payable to a 
pensioner may have been terminated because the pensioner's income 
increased as a result of electing improved pension. In this instance 
public assistance (or a supplementary payment under Pub. L. 93-233, sec. 
13(c)) shall be deemed to have remained payable to a pensioner for each 
month after December 1978 when the following conditons are met:
    (1) The pensioner was in receipt of pension for the month of 
December 1978; and
    (2) The pensioner was in receipt of public assistance (or a 
supplementary payment under Pub. L. 93-233, sec. 13(c)) prior to June 
17, 1980, and for the month of December 1978, and
    (3) The pensioner's public assistance payments (or a supplementary 
payment under Pub. L. 93-233, sec. 13(c)) were discontinued because of 
an increase in income resulting from an election of improved pension.
    (d) End of the deemed period of entitlement to public assistance. 
The deemed period of entitlement to public assistance (or a 
supplementary payment under Pub. L. 93-233, sec. 13(c)) ends the first 
calendar month that begins more than 10 days after a pensioner makes an 
informed election of improved pension. (If the pensioner is unable to 
make an informed election the informed election may be made by a member 
of the pensioner's family.) A pensioner who fails to disaffirm a 
previously made election of improved pension within the time limits set 
forth in paragraph (e) of this section shall be deemed to have 
reaffirmed the previous election. This will also end the deemed period 
of entitlement to public assistance.
    (e) Notice of right to make informed election or disaffirm election 
previously made. The Department of Veterans Affairs shall send a written 
notice to each pensioner to whom paragraph (b) of this section applies 
and who is eligible to elect or who has elected improved pension. The 
notice shall be in clear and understandable language. It shall include 
the following:
    (1) A description of the consequences to the pensioner (and the 
pensioner's family if applicable) of losing medicaid eligibility because 
of an increase in income resulting from electing improved pension; and
    (2) A description of the provisions of paragraph (b) of this 
section; and
    (3) In the case of a pensioner who has previously elected improved 
pension, a form for the purpose of enabling the pensioner to disaffirm 
the previous election of improved pensions; and
    (4) The following provisons of Pub. L. 96-272, sec. 310(b)(2)(B):
    (i) That a pensioner has 90 days from the date the notice is mailed 
to the pensioner to disaffirm a previous election by completing the 
disaffirmation form and mailing it to the Department of Veterans 
Affairs.
    (ii) That a pensioner who disaffirms a previous election shall 
receive, beginning the calendar month after the calendar month in which 
the Department of Veterans Affairs receives the disaffirmation, the 
amount of pension payable if improved pension had not been elected.
    (iii) That a pensioner who disaffirms a previous election may again 
elect improved pension but without a right to disaffirm the subsequent 
election.
    (iv) That a pensioner who disaffirms an election of improved pension 
shall not be indebted to the United States for the period in which the 
pensioner received improved pension.


(Authority: Pub. L. 96-272, sec. 310; 94 Stat. 500)

    (f) Notification to the Social Security Administration. The 
Department of Veterans Affairs shall promptly furnish the Social 
Security Administration the following information:
    (1) The name and identifying information of each pensioner who 
disaffirms his or her election of improved pension.

[[Page 354]]

    (2) The name and identifying information of each pensioner who fails 
to disaffirm and election of improved pension within the 90-day period 
described in paragraph (e)(4)(i) of this section.
    (3) The name and identifying information of each pensioner who after 
disaffirming his or her election of improved pension, subsequently 
reelected improved pension.

(Authority: 38 U.S.C. 501)

[46 FR 11661, Feb. 10, 1981, as amended at 71 FR 44919, Aug. 8, 2006]



Sec.  3.715  Radiation Exposure Compensation Act of 1990, as amended.

    (a) Compensation. (1) A radiation-exposed veteran, as defined in 38 
CFR 3.309(d)(3), who receives a payment under the Radiation Exposure 
Compensation Act of 1990, as amended (42 U.S.C. 2210 note) (RECA), will 
not be denied compensation to which the veteran is entitled under 38 CFR 
3.309(d) for months beginning after March 26, 2002.
    (2) A veteran who is not a ``radiation-exposed veteran,'' as defined 
in 38 CFR 3.309(d)(3), is not entitled to VA compensation for disability 
caused by a disease that is attributable to exposure to radiation for 
which the veteran has received a payment under RECA.
    (b) Dependency and indemnity compensation. A person who receives a 
payment under RECA based upon a veteran's death will not be denied 
dependency and indemnity compensation to which the person is entitled 
under 38 CFR 3.5 and 3.22 for months beginning after March 26, 2002.
    (c) Offset of RECA payment against VA benefits. Notwithstanding 
paragraph (a) or (b) of this section, the amount of a RECA payment will 
be deducted from the amount of compensation payable pursuant to Sec.  
3.309(d) or the amount of dependency and indemnity compensation payable.


(Authority: 38 U.S.C. 1112(c)(4), 1310(c); 42 U.S.C. 2210 note)

[71 FR 44919, Aug. 8, 2006]

                               Retirement



Sec.  3.750  Entitlement to concurrent receipt of military retired pay 
and disability compensation.

    (a) Definition of military retired pay. For the purposes of this 
part, military retired pay is payment received by a veteran that is 
classified as retired pay by the Service Department, including retainer 
pay, based on the recipient's service as a member of the Armed Forces or 
as a commissioned officer of the Public Health Service, the Coast and 
Geodetic Survey, the Environmental Science Services Administration, or 
the National Oceanic and Atmospheric Administration.
    (b) Payment of both military retired pay and disability compensation 
or improved pension--(1) Compensation. Subject to paragraphs (b)(2) and 
(b)(3) of this section, a veteran who is entitled to military retired 
pay and disability compensation for a service-connected disability rated 
50 percent or more, or a combination of service-connected disabilities 
rated 50 percent or more, under the schedule for rating disabilities (38 
CFR part 4, subpart B), is entitled to receive both payments subject to 
the phase-in period described in paragraph (c) of this section.
    (2) Chapter 61 disability retirees retiring with 20 or more years of 
service. Disability retired pay payable under 10 U.S.C. Chapter 61 to a 
veteran with 20 or more years of creditable service may be paid 
concurrently with disability compensation to a qualifying veteran 
subject to the following:
    (i) Any waiver required during the phase-in period under paragraph 
(c)(1)(ii) of this section; and
    (ii) If the veteran's disability retired pay exceeds the amount of 
retired pay the veteran would have received had the veteran retired 
based on length of service, the veteran must waive that excess amount of 
disability retired pay in order to receive VA disability compensation.
    (3) Chapter 61 disability retirees retiring with less than 20 years 
of service. Veterans who receive disability retired pay under 10 U.S.C. 
Chapter 61 with less than 20 years of creditable service are not 
eligible for concurrent receipt.

[[Page 355]]

    (4) Improved Pension. A veteran may receive improved pension and 
military retired pay at the same time without having to waive military 
retired pay. However, in determining entitlement to improved pension, VA 
will treat military retired pay in the same manner as countable income 
from other sources.
    (c) Waiver--(1) When a waiver is necessary. (i) A waiver of military 
retired pay is necessary in order to receive disability compensation 
when a veteran is eligible for both military retired pay and disability 
compensation but is not eligible under paragraphs (b)(1) or (b)(2) of 
this section to receive both benefits at the same time.
    (ii) Except as provided in paragraph (c)(2) of this section, all 
veterans who are eligible to receive both military retired pay and 
disability compensation at the same time under paragraphs (b)(1) or 
(b)(2) of this section must file a waiver in order to receive the 
maximum allowable amount of disability compensation during the phase-in 
period. The phase-in period ends on December 31, 2013. After the phase-
in period, veterans retired under 10 U.S.C. chapter 61 who are eligible 
for concurrent receipt must still file a waiver under the circumstances 
described in paragraph (b)(2)(ii) of this section.


(Authority: 10 U.S.C. 1414, 38 U.S.C. 5304, 5305)

    (2) When a waiver is not necessary. Unless paragraph (b)(2)(ii) of 
this section applies, veterans who are entitled to receive disability 
compensation based on a VA determination of individual unemployability 
as well as veterans rated 100-percent disabled under the VA schedule for 
rating disabilities need not file waivers of military retired pay. The 
phase-in period does not apply to this group of veterans.
    (3) How to file a waiver of military retired pay. A veteran may 
request a waiver of military retired pay in any written, signed 
statement, including a VA form, which reflects a desire to waive all or 
some military retired pay. The statement must be submitted to VA or to 
the Federal agency that pays the veteran's military retired pay. VA will 
treat as a waiver an application for VA compensation filed by a veteran 
who is entitled to military retired pay.
    (d) Elections and the right to reelect either benefit. (1) A veteran 
who has filed a waiver of military retired pay under this section has 
elected to receive disability compensation. A veteran may reelect 
between benefits covered by this section at any time by submitting a 
written, signed statement to VA or to the Federal agency that pays the 
veteran's military retired pay.
    (2) An election filed within 1 year from the date of notification of 
Department of Veterans Affairs entitlement will be considered as 
``timely filed'' for effective date purposes. See Sec.  3.401(e)(1). If 
the veteran is incompetent, the 1-year period will begin on the date 
that notification is sent to the next friend or fiduciary. In initial 
determinations, elections may be applied retroactively if the claimant 
was not advised of his or her right of election and its effect.

(Authority: 38 U.S.C. 5304(a), 5305)

[71 FR 67061, Nov. 20, 2006, as amended at 74 FR 11647, Mar. 19, 2009]



Sec.  3.751  Statutory awards; retired service personnel.

    Retired Regular and Reserve officers and enlisted personnel are not 
entitled to statutory awards of disability compensation from the 
Department of Veterans Affairs in addition to their retirement pay. 
However, under Sec.  3.750(c), eligible persons may waive an amount 
equal to the basic disability compensation and any statutory award 
otherwise payable by the Department of Veterans Affairs.

[41 FR 53797, Dec. 9, 1976]



Sec.  3.752  [Reserved]



Sec.  3.753  Public Health Service.

    Disability compensation may be paid concurrently with retirement pay 
to an officer of the commissioned corps of the Public Health Service, 
who was receiving disability compensation on December 31, 1956, as 
follows:
    (a) An officer who incurred a disability before July 29, 1945, but 
retired for nondisability purposes prior to such date.
    (b) An officer who incurred a disability before July 29, 1945, but 
retired

[[Page 356]]

for nondisability purposes between July 4, 1952, and December 31, 1956.
    (c) An officer who incurred a disability between July 29, 1945, and 
July 3, 1952, but retired for nondisability purposes between July 4, 
1952, and December 31, 1956.

[26 FR 1604, Feb. 24, 1961]



Sec.  3.754  Emergency officers' retirement pay.

    A retired emergency officer of World War I has basic eligibility to 
retirement pay by the Department of Veterans Affairs under Pub. L. 87-
875 (sec. 11(b), Pub. L. 85-857) from date of filing application 
therefor after October 24, 1962, if the following requirements are met:
    (a) Emergency officers' retirement pay would have been granted under 
Pub. L. 506, 70th Congress (Act of May 24, 1928) if application therefor 
had been filed before May 25, 1929.
    (b) Such retirement pay would have continued to be payable under 
section 10 of Pub. L. 2, 73d Congress, or under section 1 of Pub. L. 
743, 76th Congress.
    (c) The monthly rate of retirement pay at any time between May 24, 
1928 and May 24, 1929, inclusive, would have been lower than the monthly 
rate of disability compensation payable to the retired emergency 
officer.

    Cross Reference: Emergency officers' retirement pay. See Sec.  
3.953(b).

[28 FR 72, Jan. 3, 1963]

                            Special Benefits



Sec.  3.800  Disability or death due to hospitalization, etc.

    This section applies to claims received by VA before October 1, 
1997. For claims received by VA on or after October 1, 1997, see 
Sec. Sec.  3.362 and 3.363.
    (a) Where disease, injury, death or the aggravation of an existing 
disease or injury occurs as a result of having submitted to an 
examination, medical or surgical treatment, hospitalization or the 
pursuit of a course of vocational rehabilitation under any law 
administered by the Department of Veterans Affairs and not the result of 
his (or her) own willful misconduct, disability or death compensation, 
or dependency and indemnity compensation will be awarded for such 
disease, injury, aggravation, or death as if such condition were service 
connected. The commencing date of benefits is subject to the provisions 
of Sec.  3.400(i).


(Authority: 38 U.S.C. 1151)

    (1) Benefits under paragraph (a) of this section will be in lieu of 
any benefits the veteran may be entitled to receive under the Federal 
Employees' Compensation Act inasmuch as concurrent payments are 
prohibited. (See Sec.  3.708.)
    (2) Where any person is awarded a judgment on or after December 1, 
1962, against the United States in a civil action brought pursuant to 28 
U.S.C. 1346(b), or enters into a settlement or compromise on or after 
December 1, 1962, under 28 U.S.C. 2672 or 2677, by reason of a 
disability, aggravation or death within the purview of this section, no 
compensation or dependency and indemnity compensation shall be paid to 
such person for any month beginning after the date such judgment, 
settlement, or compromise on account of such disability, aggravation, or 
death becomes final until the total amount of benefits which would be 
paid except for this provision equals the total amount included in such 
judgment, settlement, or compromise. The provisions of this paragraph do 
not apply, however, to any portion of such compensation or dependency 
and indemnity compensation payable for any period preceding the end of 
the month in which such judgment, settlement or compromise becomes 
final.


(Authority: 38 U.S.C. 501)

    (3) If an administrative award was made or a settlement or 
compromise became final before December 1, 1962, compensation or 
dependency and indemnity compensation may not be authorized for any 
period after such award settlement, or compromise whether before or 
after December 1, 1962. There is no bar to payment of compensation or 
dependency and indemnity compensation and no set-off because of a 
judgment which became final before December 1, 1962, unless specified in 
the terms of the judgment.
    (4) Offset of award of benefits under 38 U.S.C. chapter 21 or 38 
U.S.C. chapter 39.

[[Page 357]]

(i) If a judgment, settlement, or compromise covered by paragraph (a)(2) 
of this section becomes final on or after December 10, 2004, and 
includes an amount that is specifically designated for a purpose for 
which benefits are provided under 38 U.S.C. chapter 21 (38 CFR 3.809 and 
3.809a) or 38 U.S.C. chapter 39 (38 CFR 3.808), and if VA awards 38 
U.S.C. chapter 21 or 38 U.S.C. chapter 39 benefits after the date on 
which the judgment, settlement, or compromise becomes final, the amount 
of the award will be reduced by the amount received under the judgment, 
settlement, or compromise for the same purpose.
    (ii) If the amount described in paragraph (a)(4)(i) of this section 
is greater than the amount of an award under 38 U.S.C. chapter 21 or 38 
U.S.C. chapter 39, the excess amount received under the judgment, 
settlement, or compromise will be offset against benefits otherwise 
payable under 38 U.S.C. chapter 11.


(Authority: 38 U.S.C. 1151(b)(2))

    (b)(1) If death occurred prior to January 1, 1957, the benefit 
payable will be death compensation. See Sec. Sec.  3.5(b)(2) and 3.702 
as to right of election to dependency and indemnity compensation.
    (2) If death occurs on or after January 1, 1957, the benefit payable 
will be dependency and indemnity compensation.

    Cross References: Claims; injury due to hospital treatment, etc. See 
Sec.  3.154. Effective dates; disability or death due to 
hospitalization, etc. See Sec.  3.400(i).

[26 FR 1604, Feb. 24, 1961, as amended at 27 FR 11892, Dec. 1, 1962; 29 
FR 16252, Dec. 4, 1964; 39 FR 34532, Sept. 26, 1974; 53 FR 23237, June 
21, 1988; 64 FR 1132, Jan. 8, 1999; 69 FR 46435, Aug. 3, 2004; 71 FR 
44919, Aug. 8, 2006; 75 FR 57861, Sept. 23, 2010]



Sec.  3.801  Special acts.

    (a) General. A special act is one authorizing the payment of 
benefits to a particular person or persons. If a beneficiary in a 
special act has no claim before the Department of Veterans Affairs, a 
formal application must be filed before benefits may be awarded.
    (b) Limitations. Where the rate, commencement, and duration are 
fixed by a special act, they are not subject to be varied by the 
provisions and limitations of the public laws, but where not fixed, the 
rate and continuance of the benefit is subject to variance in accordance 
with the public laws.
    (c) Provisions of act. (1) When pension or compensation is granted 
by a special act, which fixes the rate and commencement, the rate 
thereunder cannot be increased nor can any other pension or compensation 
be paid in the absence of the payee's election, unless the special act 
expressly states that the benefit granted thereby is in addition to the 
benefit which the person is entitled to receive under any public law.
    (2) If a special act corrects the nature of separation from military 
service and does not grant pension or compensation directly, the 
claimant acquires a status so that he or she may apply for and be 
allowed benefits. The claimant, then, is placed in the same position he 
or she would have been if originally released under conditions other 
than dishonorable.
    (d) Service. A special act of Congress, reciting that a person is 
considered to have been mustered into the service on a named date and 
honorably discharged on a subsequently named date, is sufficient 
regardless of whether the service department has any record of such 
service.
    (e) Hospitalization. Pension payable under special acts is subject 
to reduction pursuant to Sec.  3.551.

(Authority: 38 U.S.C. 501(a), 5503)

[26 FR 1605, Feb. 24, 1961, as amended at 39 FR 34532, Sept. 26, 1974; 
68 FR 34543, June 10, 2003]



Sec.  3.802  Medal of Honor.

    (a) The Secretary of the Department of the Army, the Department of 
the Navy, the Department of the Air Force, or the Department of 
Transportation will determine the eligibility of applicants to be 
entered on the Medal of Honor Roll and will deliver to the Secretary of 
the Department of Veterans Affairs a certified copy of each certificate 
issued in which the right of the person named in the certificate to the 
special pension is set forth. The special

[[Page 358]]

pension will be authorized on the basis of such certification.


(Authority: 38 U.S.C. 1560, 1561)

    (b) An award of special pension at the monthly rate specified in 38 
U.S.C. 1562 will be made as of the date of filing of the application 
with the Secretary concerned. The special pension will be paid in 
addition to all other payments under laws of the United States. However, 
a person awarded more than one Medal of Honor may not receive more than 
one special pension.


(Authority: 38 U.S.C. 1562)

    (c) VA will pay to each person who is receiving or who in the future 
receives Medal of Honor pension a retroactive lump sum payment equal to 
the total amount of Medal of Honor pension that person would have 
received during the period beginning the first day of the month after 
the date of the event for which the veteran earned the Medal of Honor 
and ending on the last day of the month preceding the month in which 
pension was awarded under paragraph (b) of this section. VA will 
calculate the lump sum payment using the monthly Medal of Honor pension 
rates in effect from the first day of the month after the date of the 
event for which the veteran earned the Medal of Honor, to the last day 
of the month preceding the month in which the individual was initially 
awarded the Medal of Honor pension. VA will not make a retroactive lump 
sum payment under this section before October 1, 2003.


(Authority: 38 U.S.C. 1562(f))

[26 FR 1605, Feb. 24, 1961, as amended at 32 FR 6840, May 4, 1967; 44 FR 
22721, Apr. 17, 1979; 52 FR 34909, Sept. 16, 1987; 68 FR 55467, Sept. 
26, 2003]



Sec.  3.803  Naval pension.

    (a) Payment of naval pension will be authorized on the basis of a 
certification by the Secretary of the Navy.


(Authority: 10 U.S.C. 6160)

    (b) Awards of naval pension in effect prior to July 14, 1943, or 
renewed or continued may be paid concurrently with Department of 
Veterans Affairs pension or compensation; however, naval pension 
allowance under 10 U.S.C. 6160 may not exceed one-fourth of the rate of 
disability pension or compensation otherwise payable, exclusive of 
additional allowances for dependents or specific disabilities.
    (c) New awards of naval pension may not be made concurrently with 
Department of Veterans Affairs pension or compensation.


(Authority: 38 U.S.C. 5304(a))

    (d) Naval pension remaining unpaid at the date of the veteran's 
death is not payable by the Department of Veterans Affairs as an accrued 
benefit.

[26 FR 1605, Feb. 24, 1961, as amended at 28 FR 2857, Mar. 22, 1963; 44 
FR 22721, Apr. 17, 1979]



Sec.  3.804  Special allowance under 38 U.S.C. 1312.

    (a) The provisions of this section are applicable to the payment of 
a special allowance by the Department of Veterans Affairs to the 
surviving dependents of a veteran who served after September 15, 1940, 
and who died on or after January 1, 1957, as a result of such service 
and who was not a fully and currently insured individual under title II 
of the Social Security Act.
    (b) The special allowance is not payable: (1) Where the veteran's 
death resulted from Department of Veterans Affairs hospitalization, 
treatment, examination, or training;
    (2) Where the veteran's death was due to service rendered with the 
Commonwealth Army of the Philippines while such forces were in the 
service of the Armed Forces pursuant to the military order of the 
President dated July 26, 1941, or was due to service in the Philippine 
Scouts under section 14, Pub. L. 190, 79th Congress.
    (c) A claim for dependency and indemnity compensation on a form 
prescribed will be accepted as a claim for the special allowance where 
it is determined that this benefit is payable or where a specific 
inquiry concerning entitlement to the special allowance is received.
    (d) Payment of this allowance will be authorized on the basis of a 
certification from the Social Security Administration. Award actions 
subsequent to the original award, including

[[Page 359]]

adjustment and discontinuance, will be made in accordance with new 
certifications from the Social Security Administration.
    (e)(1) The special allowance will be payable only if the death 
occurred: (i) While on active duty, active duty for training, or 
inactive duty training as a member of a uniformed service (line of duty 
is not a factor); or
    (ii) As the result of a disease or injury which was incurred or 
aggravated in line of duty while on active duty or active duty for 
training, or an injury which was incurred or aggravated in line of duty 
while on inactive duty training, as a member of a uniformed service 
after September 15, 1940, if the veteran was discharged or released from 
the period of such duty, under conditions other than dishonorable.
    (2) Where the veteran died after separation from service: (i) 
Discharge from service must have been under conditions other than 
dishonorable as outlined in Sec.  3.12.
    (ii) Line of duty and service connection will be determined as 
outlined in Sec.  3.1(k) and (m) and the Sec.  3.300 series.

[26 FR 1605, Feb. 24, 1961]



Sec.  3.805  Loan guaranty for surviving spouses; certification.

    A certification of loan guaranty benefits may be extended to 
surviving spouses based on an application filed on or after January 1, 
1959, if:
    (a) The veteran served in the Armed Forces of the United States 
(Allied Nations are not included) at any time on or after September 16, 
1940; and
    (b) The veteran died in service; or
    (c) The veteran died after separation from service and such 
separation was under conditions other than dishonorable provided the 
veteran's death was the result of injury or disease incurred in or 
aggravated by service in line of duty rendered on or after September 16, 
1940, regardless of the date of entrance into such service (cases where 
compensation is payable because of death resulting from hospitalization, 
treatment, examination, or training are not included); and
    (d) The surviving spouse meets the requirements of the term 
``surviving spouse'' as outlined in Sec.  3.50; and
    (e) The veteran's surviving spouse is unmarried; and
    (f) The applicant is not an eligible veteran.

    Cross References: Wife, widow or spouse. See Sec.  3.50(b). 
Terminated marital relationships. See Sec.  3.55.

[26 FR 1605, Feb. 24, 1961, as amended at 31 FR 4347, Mar. 12, 1966; 37 
FR 24662, Nov. 18, 1972; 40 FR 54245, Nov. 21, 1975, 41 FR 49636, Nov. 
10, 1976; 44 FR 22721, Apr. 17, 1979; 62 FR 5529, Feb. 6, 1997]



Sec.  3.806  Death gratuity; certification.

    (a) Where a veteran dies on or after January 1, 1957, and during the 
120-day period which begins on the day following the date of his or her 
discharge or release from active duty, active duty for training, or 
inactive training duty, the Department of Veterans Affairs will certify 
that fact to the Secretary concerned if the Department of Veterans 
Affairs determines on the basis of a claim filed with it that:
    (1) Death resulted from:
    (i) Disease or injury incurred or aggravated while on such active 
duty or active duty for training; or
    (ii) Injury incurred or aggravated while on such inactive duty 
training; and
    (2) The deceased person was discharged or released from such service 
under conditions other than dishonorable.
    (b) In all cases, other than listed in paragraph (a) of this 
section, the certification will be furnished at the request of the 
Secretary concerned.
    (c) For the purposes of this section, line of duty is not a factor. 
The standards, criteria, and procedures for determining incurrence or 
aggravation of a disease or injury under paragraph (a) of this section 
are those applicable under disability and death compensation laws 
administered by the Department of Veterans Affairs.

(Authority: 38 U.S.C. 1323)

[26 FR 1605, Feb. 24, 1961, as amended at 40 FR 54245, Nov. 21, 1975]



Sec.  3.807  Dependents' educational assistance; certification.

    For the purposes of dependents' educational assistance under 38 
U.S.C. chapter 35 (see Sec.  21.3020), the child,

[[Page 360]]

spouse or surviving spouse of a veteran or serviceperson will have basic 
eligibility if the following conditions are met:
    (a) General. Basic eligibility exists if the veteran:
    (1) Was discharged from service under conditions other than 
dishonorable, or died in service; and
    (2) Has a permanent total service-connected disability; or
    (3) A permanent total service-connected disability was in existence 
at the date of the veteran's death; or
    (4) Died as a result of a service-connected disability; or (if a 
serviceperson)
    (5) Is on active duty as a member of the Armed Forces and
    (i) Now is, and, for a period of more than 90 days, has been listed 
by the Secretary concerned as missing in action, captured in line of 
duty by a hostile force, or forcibly detained or interned in line of 
duty by a foreign Government or power; or
    (ii) Has been determined by VA to have a total disability permanent 
in nature incurred or aggravated in the line of duty during active 
military, naval, or air service; is hospitalized or receiving outpatient 
medical care, services, or treatment for such disability; is likely to 
be discharged or released from such service for such disability; and the 
pursuit of a course of education by such individual's spouse or child 
for which benefits under 38 U.S.C. chapter 35 are sought occurred after 
December 22, 2006.
    (b) Service. Service-connected disability or death must have been 
the result of active military, naval, or air service on or after April 
21, 1898. (Pub. L. 89-358) Effective September 30, 1966, educational 
assistance for a child (but not for a spouse or surviving spouse) may be 
authorized based on service in the Philippine Commonwealth Army or as a 
Philippine Scout as defined in Sec.  3.40(b), (c), or (d) of this part.


(Authority: 38 U.S.C. 3565)

    (c) Service connection. For purpose of this section, the term 
``service-connected disability'' encompasses combinations of 
disabilities of paired organs or extremities treated as if service-
connected under the provisions of Sec.  3.383(a) of this part. The 
standards and criteria for determining service connection, either direct 
or presumptive, are those applicable to the period of service during 
which the disability was incurred or aggravated (38 U.S.C. 3501(a)). 
Cases where eligibility for service-connected benefits is established 
under Sec.  3.358, 3.361, or 3.800 are not included.
    (d) Relationship--(1) ``Child'' means the son or daughter of a 
veteran who meets the requirements of Sec.  3.57, except as to age and 
marital status.
    (2) ``Spouse'' means a person whose marriage to the veteran meets 
the requirements of Sec.  3.50(a) of this part.
    (3) ``Surviving spouse'' means a person whose marriage to the 
veteran meets the requirements of Sec. Sec.  3.50(b) or 3.52 of this 
part.

(Authority: 38 U.S.C. 1160, 3501)

    Cross References: Discontinuance. See Sec.  3.503(a)(8) Election; 
concurrent benefits. See Sec.  3.707 Nonduplication. See Sec.  21.3023 
of this chapter.

[29 FR 9537, July 14, 1964, as amended at 31 FR 4347, Mar. 12, 1966; 34 
FR 840, Jan. 18, 1969; 38 FR 8658, Apr. 5, 1973; 40 FR 54245, Nov. 21, 
1975; 53 FR 46607, Nov. 18, 1988; 59 FR 62585, Dec. 6, 1994; 69 FR 
46435, Aug. 3, 2004; 73 FR 1076, Jan. 7, 2008]



Sec.  3.808  Automobiles or other conveyances and adaptive equipment;
certification.

    (a) Entitlement. A certificate of eligibility for financial 
assistance in the purchase of one automobile or other conveyance in an 
amount not exceeding the amount specified in 38 U.S.C. 3902 (including 
all State, local, and other taxes where such are applicable and included 
in the purchase price) and of basic entitlement to necessary adaptive 
equipment will be provided to--
    (1) A veteran who is entitled to compensation under chapter 11 of 
title 38, United States Code, for a disability described in paragraph 
(b) of this section; or
    (2) A member of the Armed Forces serving on active duty who has a 
disability described in paragraph (b) of this section that is the result 
of an injury or disability incurred or disease contracted in or 
aggravated by active military, naval, or air service.

[[Page 361]]

    (b) Disability. One of the following must exist:
    (1) Loss or permanent loss of use of one or both feet;
    (2) Loss or permanent loss of use of one or both hands;
    (3) Permanent impairment of vision of both eyes: Central visual 
acuity of 20/200 or less in the better eye, with corrective glasses, or 
central visual acuity of more than 20/200 if there is a field defect in 
which the peripheral field has contracted to such an extent that the 
widest diameter of visual field subtends an angular distance no greater 
than 20[deg] in the better eye.
    (4) Severe burn injury: Deep partial thickness or full thickness 
burns resulting in scar formation that cause contractures and limit 
motion of one or more extremities or the trunk and preclude effective 
operation of an automobile.
    (5) Amyotrophic lateral sclerosis.
    (6) For adaptive equipment eligibility only, ankylosis of one or 
both knees or one or both hips.


(Authority: 38 U.S.C. 3901, 3902)

    (c) Claim for conveyance and certification for adaptive equipment. A 
specific application for financial assistance in purchasing a conveyance 
is required which must contain a certification by the claimant that the 
conveyance will be operated only by persons properly licensed. The 
application will also be considered as an application for the adaptive 
equipment to insure that the claimant will be able to operate the 
conveyance in a manner consistent with safety and to satisfy the 
applicable standards of licensure of the proper licensing authorities. 
Simultaneously with the certification provided pursuant to the 
introductory text of this section, a claimant for financial assistance 
in the purchase of an automobile will be furnished a certificate of 
eligibility for financial assistance in the purchase of such adaptive 
equipment as may be appropriate to the claimant's losses unless the need 
for such equipment is contraindicated by a physical or legal inability 
to operate the vehicle. There is no time limitation in which to apply. 
An application by a claimant on active duty will be deemed to have been 
filed with VA on the date it is shown to have been placed in the hands 
of military authority for transmittal.
    (d) Additional eligibility criteria for adaptive equipment. 
Claimants for adaptive equipment must also satisfy the additional 
eligibility criteria of Sec. Sec.  17.156, 17.157, and 17.158 of this 
chapter.
    (e) Definition. The term adaptive equipment, means generally, that 
equipment which must be part of or added to a conveyance manufactured 
for sale to the general public to make it safe for use by the claimant 
and to assist him or her in meeting the applicable standards of 
licensure of the proper licensing authority.
    (1) With regard to automobiles and similar vehicles the term 
includes a basic automatic transmission as to a claimant who has lost or 
lost the use of a limb. In addition, the term includes, but is not 
limited to, power steering, power brakes, power window lifts and power 
seats. The term also includes air-conditioning equipment when such 
equipment is necessary to the health and safety of the veteran and to 
the safety of others, and special equipment necessary to assist the 
eligible person into or out of the automobile or other conveyance, 
regardless of whether the automobile or other conveyance is to be 
operated by the eligible person or is to be operated for such person by 
another person; and any modification of the interior space of the 
automobile or other conveyance if needed because of the physical 
condition of such person in order for such person to enter or operate 
the vehicle.
    (2) With regard to automobiles and similar vehicles the term 
includes such items of equipment as the Chief Medical Director may, by 
directive, specify as ordinarily necessary for any of the classes of 
losses specified in paragraph (b) of this section and for any 
combination of such losses. Such specifications of equipment may include 
a limit on the financial assistance to be provided based on judgment and 
experience.

[[Page 362]]

    (3) The term also includes other equipment which the Chief Medical 
Director or designee may deem necessary in an individual case.


(Authority: 38 U.S.C. 501(a), 1151(c)(2), 3902))


[36 FR 7588, Apr. 22, 1971, as amended at 38 FR 14370, June 1, 1973; 40 
FR 37037, Aug. 25, 1975; 43 FR 4423, Feb. 2, 1978; 47 FR 24552, June 7, 
1982; 53 FR 46607, Nov. 18, 1988; 66 FR 44528, Aug. 24, 2001; 71 FR 
44919, Aug. 8, 2006; 78 FR 57487, Sept. 19, 2013; 80 FR 10003, Feb. 25, 
2015]



Sec.  3.809  Specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i).

    In order for a certificate of eligibility for assistance in 
acquiring specially adapted housing under 38 U.S.C. 2101(a)(2)(A)(i) or 
2101A(a) to be extended to a veteran or a member of the Armed Forces 
serving on active duty, the following requirements must be met:
    (a) General. A member of the Armed Forces serving on active duty 
must have a disability rated as permanent and total that was incurred or 
aggravated in line of duty in active military, naval, or air service. A 
veteran must be entitled to compensation under chapter 11 of title 38, 
United States Code, for a disability rated as permanent and total.
    (b) Disability. The disability must be due to:
    (1) The loss or loss of use of both lower extremities, such as to 
preclude locomotion without the aid of braces, crutches, canes, or a 
wheelchair,
    (2) Blindness in both eyes, having only light perception, plus the 
anatomical loss or loss of use of one lower extremity,
    (3) The loss or loss of use of one lower extremity together with 
residuals of organic disease or injury which so affect the functions of 
balance or propulsion as to preclude locomotion without the aid of 
braces, crutches, canes, or a wheelchair,
    (4) The loss or loss of use of one lower extremity together with the 
loss or loss of use of one upper extremity which so affect the functions 
of balance or propulsion as to preclude locomotion without the aid of 
braces, crutches, canes, or a wheelchair,
    (5) The loss or loss of use of both upper extremities such as to 
preclude use of the arms at or above the elbow, or
    (6) Full thickness or subdermal burns that have resulted in 
contractures with limitation of motion of two or more extremities or of 
at least one extremity and the trunk.
    (c) Preclude locomotion. This term means the necessity for regular 
and constant use of a wheelchair, braces, crutches or canes as a normal 
mode of locomotion although occasional locomotion by other methods may 
be possible.
    (d) Amyotrophic lateral sclerosis. VA considers Sec.  3.809(b) 
satisfied if the veteran or member of the Armed Forces serving on active 
duty has service-connected amyotrophic lateral sclerosis rated 100 
percent disabling under 38 CFR 4.124a, diagnostic code 8017.

(Authority: 38 U.S.C. 501(a), 1151(c)(1), 2101, 2101A)

    Cross Reference: Assistance to certain disabled veterans in 
acquiring specially adapted housing. See Sec. Sec.  36.4400 through 
36.4410 of this chapter.

[78 FR 72576, Dec. 3, 2013]



Sec.  3.809a  Special home adaptation grants under 38 U.S.C. 2101(b).

    A certificate of eligibility for assistance in acquiring necessary 
special home adaptations, or, on or after October 28, 1986, for 
assistance in acquiring a residence already adapted with necessary 
special features, under 38 U.S.C. 2101(b) or 2101A(a) may be issued to a 
veteran who served after April 20, 1898, or to a member of the Armed 
Forces serving on active duty who is eligible for the benefit under this 
section on or after December 16, 2003, if the following requirements are 
met:
    (a) The member of the Armed Forces serving on active duty or veteran 
is not entitled to a certificate of eligibility for assistance in 
acquiring specially adapted housing under Sec.  3.809 nor had the member 
of the Armed Forces serving on active duty or veteran previously 
received assistance in acquiring specially adapted housing under 38 
U.S.C. 2101(a). A member of the Armed Forces serving on active duty or 
veteran who first establishes entitlement

[[Page 363]]

under this section and who later becomes eligible for a certificate of 
eligibility under Sec.  3.809 may be issued a certificate of eligibility 
under Sec.  3.809.
    (b) A member of the Armed Forces serving on active duty must have a 
disability that was incurred or aggravated in line of duty in active 
military, naval, or air service and meets the requirements described in 
either paragraph (b)(1) or (b)(2) of this section. A veteran must be 
entitled to compensation under chapter 11 of title 38, United States 
Code, for a disability that meets the requirements described in either 
paragraph (b)(1) or (b)(2) of this section.
    (1) VA has rated the disability as permanently and totally disabling 
and it:
    (i) Includes the anatomical loss or loss of use of both hands;
    (ii) Is due to deep partial thickness burns that have resulted in 
contracture(s) with limitation of motion of two or more extremities or 
of at least one extremity and the trunk;
    (iii) Is due to full thickness or subdermal burns that have resulted 
in contracture(s) with limitation of motion of one or more extremities 
or the trunk; or
    (iv) Is due to residuals of an inhalation injury (including, but not 
limited to, pulmonary fibrosis, asthma, and chronic obstructive 
pulmonary disease).
    (2) The disability is due to blindness in both eyes, having central 
visual acuity of 20/200 or less in the better eye with the use of a 
standard correcting lens. For the purposes of this paragraph, an eye 
with a limitation in the fields of vision such that the widest diameter 
of the visual field subtends an angle no greater than 20 degrees shall 
be considered as having a central visual acuity of 20/200 or less. The 
disability discussed in this paragraph need not be rated as permanently 
and totally disabling.

(Authority: 38 U.S.C. 1151(c)(1), 2101, 2101A, 2104)

    Cross Reference: Assistance to certain disabled veterans in 
acquiring specially adapted housing. See Sec. Sec.  36.4400 through 
36.4410 of this chapter.

[46 FR 47543, Sept. 29, 1981, as amended at 53 FR 23237, June 21, 1988; 
75 FR 57861, Sept. 23, 2010; 79 FR 54609, Sept. 12, 2014]



Sec.  3.810  Clothing allowance.

    (a) Except as provided in paragraph (d) of this section, a veteran 
who has a service-connected disability, or a disability compensable 
under 38 U.S.C. 1151 as if it were service connected, is entitled, upon 
application therefore, to an annual clothing allowance, which is payable 
in a lump sum, as specified in this paragraph.
    (1) One clothing allowance. A veteran is entitled to one annual 
clothing allowance if--
    (i) A VA examination or a hospital or examination report from a 
facility specified in Sec.  3.326(b) establishes that the veteran, 
because of a service-connected disability or disabilities due to loss or 
loss of use of a hand or foot compensable at a rate specified in Sec.  
3.350(a), (b), (c), (d), or (f), wears or uses one qualifying prosthetic 
or orthopedic appliance (including, but not limited to, a wheelchair) 
which tends to wear or tear clothing; or
    (ii) The Under Secretary for Health or a designee certifies that--
    (A) A veteran, because of a service-connected disability or 
disabilities, wears or uses one qualifying prosthetic or orthopedic 
appliance (including, but not limited to, a wheelchair) which tends to 
wear or tear clothing; or
    (B) A veteran uses medication prescribed by a physician for one skin 
condition, which is due to a service-connected disability, that causes 
irreparable damage to the veteran's outergarments.
    (2) More than one clothing allowance; multiple types of garments 
affected. A veteran is entitled to an annual clothing allowance for each 
prosthetic or orthopedic appliance (including, but not limited to, a 
wheelchair) or medication used by the veteran if each appliance or 
medication--
    (i) Satisfies the requirements of paragraph (a)(1) of this section; 
and
    (ii) Affects a distinct type of article of clothing or outergarment.

[[Page 364]]

    (3) Two clothing allowances; single type of garment affected. A 
veteran is entitled to two annual clothing allowances if a veteran uses 
more than one prosthetic or orthopedic appliance, (including, but not 
limited to, a wheelchair), medication for more than one skin condition, 
or an appliance and a medication, and the appliance(s) or 
medication(s)--
    (i) Each satisfy the requirements of paragraph (a)(1) of this 
section; and
    (ii) Together tend to wear or tear a single type of article of 
clothing or irreparably damage a type of outergarment at an increased 
rate of damage to the clothing or outergarment due to a second appliance 
or medication.
    (b) Effective August 1, 1972, the initial lump sum clothing 
allowance is due and payable for veterans meeting the eligibility 
requirements of paragraph (a) of this section as of that date. 
Subsequent annual payments for those meeting the eligibility 
requirements of paragraphs (a) of this section will become due on the 
anniversary date thereafter, both as to initial claims and recurring 
payments under previously established entitlement.
    (c)(1) Except as provided in paragraph (c)(2) of this section, the 
application for clothing allowance must be filed within 1 year of the 
anniversary date (August 1) for which entitlement is initially 
established, otherwise, the application will be acceptable only to 
effect payment of the clothing allowance becoming due on any succeeding 
anniversary date for which entitlement is established, provided the 
application is filed within 1 year of such date. The 1-year period for 
filing application will include the anniversary date and terminate on 
July 31 of the following year.
    (2) Where the initial determination of service connection for the 
qualifying disability is made subsequent to an anniversary date for 
which entitlement is established, the application for clothing allowance 
may be filed within 1 year from the date of notification to the veteran 
of such determination.


(Authority: 38 U.S.C. 1162)

    (d) If a veteran is incarcerated in a Federal, State, or local penal 
institution for a period of more than 60 days and is furnished clothing 
without charge by the institution, VA shall reduce the amount of the 
annual clothing allowance by 1/365th of the amount otherwise payable for 
each day the veteran was incarcerated during the 12-month period 
preceding the anniversary date for which entitlement is established. No 
reduction shall be made for the first 60 days of incarceration.

(Authority: 38 U.S.C. 5313A)

[37 FR 19134, Sept. 19, 1972, as amended at 39 FR 2362, Jan. 21, 1974; 
49 FR 28242, July 11, 1984; 56 FR 5756, Feb. 13, 1991; 62 FR 35422, July 
1, 1997; 76 FR 70885, Nov. 16, 2011; 77 FR 34218, June 11, 2012]



Sec.  3.811  Minimum income annuity and gratuitous annuity.

    (a) Eligibility for minimum income annuity. The minimum income 
annuity authorized by Public Law 92-425 as amended is payable to a 
person:
    (1) Whom the Department of Defense or the Department of 
Transportation has determined meets the eligibility criteria of section 
4(a) of Pub. L. 92-425 as amended other than section 4(a)(1) and (2); 
and
    (2) Who is eligible for pension under subchapter III of chapter 15 
of title 38, United States Code, or section 306 of the Veterans' and 
Survivors' Pension Improvement Act of 1978; and
    (3) Whose annual income, as determined in establishing pension 
eligibility, is less than the maximum annual rate of pension in effect 
under 38 U.S.C. 1541(b).
    (b) Computation of the minimum income annuity payment--(1) Annual 
income. VA will determine a beneficiary's annual income for minimum 
income annuity purposes under the provisions of Sec. Sec.  3.271 and 
3.272 of this part for beneficiaries receiving improved pension, or 
under Sec. Sec.  3.260 through 3.262 of this part for beneficiaries 
receiving old law or section 306 pensions, except that the amount of the 
minimum income annuity will be excluded from the calculation.
    (2) VA will determine the minimum income annuity payment for 
beneficiaries entitled to improved pension by subtracting the annual 
income for minimum income annuity purposes

[[Page 365]]

from the maximum annual pension rate under 38 U.S.C. 1541(b).
    (3) VA will determine the minimum income annuity payment for 
beneficiaries receiving old law and section 306 pensions by reducing the 
maximum annual pension rate under 38 U.S.C. 1541(b) by the amount of the 
Retired Servicemen's Family Protection Plan benefit, if any, that the 
beneficiary receives and subtracting from that amount the annual income 
for minimum income annuity purposes.
    (4) VA will recompute the monthly minimum income annuity payment 
whenever there is a change to the maximum annual rate of pension in 
effect under 38 U.S.C. 1541(b), and whenever there is a change in the 
beneficiary's income.
    (c) An individual otherwise eligible for pension under subchapter 
III of chapter 15 of title 38, United States Code, or section 306 of the 
Veterans' and Survivors' Pension Improvement Act of 1978 shall be 
considered eligible for pension for purposes of determining eligibility 
for the minimum income annuity even though as a result of adding the 
amount of the minimum income annuity authorized under Public Law 92-425 
as amended to any other countable income, no amount of pension is due.
    (d) If the Department of Defense or the Department of Transportation 
determines that a minimum income annuitant also is entitled to the 
gratuitous annuity authorized by Pub. L. 100-456 as amended, which is 
payable to certain surviving spouses of servicemembers who died before 
November 1, 1953, and were entitled to retired or retainer pay on the 
date of death, VA will combine the payment of the gratuitous annuity 
with the minimum income annuity payment.
    (e) Termination. Other than as provided in paragraph (c) of this 
section, if a beneficiary receiving the minimum income annuity becomes 
ineligible for pension, VA will terminate the minimum income annuity 
effective the same date.

(Authority: Sec. 4, Pub. L. 92-425, 86 Stat. 706, 712, as amended (10 
U.S.C. 1448 note))

[63 FR 412, Jan. 6, 1998, as amended at 63 FR 62943, Nov. 10, 1998]



Sec.  3.812  Special allowance payable under section 156 of Pub. L. 97-377.

    The provisions of this section apply to the payment of a special 
allowance to certain surviving spouses and children of individuals who 
died on active duty prior to August 13, 1981, or who died as a result of 
a service-connected disability which was incurred or aggravated prior to 
August 13, 1981. This special allowance is a replacement for certain 
social security benefits which were either reduced or terminated by 
provisions of the Omnibus Budget Reconciliation Act of 1981.
    (a) Eligibility requirements. (1) A determination must first be made 
that the person on whose earnings record the claim is based either died 
on active duty prior to August 13, 1981, or died as a result of a 
service-connected disability which was incurred or aggravated prior to 
August 13, 1981. For purposes of this determination, character of 
discharge is not a factor for consideration, and death on active duty 
subsequent to August 12, 1981, is qualifying provided that the death 
resulted from a service-connected disability which was incurred or 
aggravated prior to August 13, 1981.
    (2) Once a favorable determination has been made under paragraph 
(a)(1) of this section, determinations as to the age, relationship and 
school attendance requirements contained in paragraphs (a)(1) and (b)(1) 
of section 156 of Pub. L. 97-377 will be made. In making these 
eligibility determinations VA shall apply the provisions of the Social 
Security Act, and any regulations promulgated pursuant thereto, as in 
effect during the claimant's period of eligibility. Unless otherwise 
provided in this section, when issues are raised concerning eligibility 
or entitlement to this special allowance which cannot be appropriately 
resolved under the provisions of the Social Security Act, or the 
regulations promulgated pursuant thereto, the provisions of title 38, 
Code of Federal Regulations, are for application.
    (b) Computation of payment rate--(1) Basic entitlement rate. A basic 
entitlement rate will be computed for each eligible claimant in 
accordance with the provisions of subparagraphs (a)(2) and (b)(2) of 
section 156 of Pub. L. 97-377

[[Page 366]]

using data to be provided by the Social Security Administration. This 
basic entitlement rate will then be used to compute the monthly payment 
rate as described in paragraphs (b)(2) to (b)(6) of this section.
    (2) Original or reopened awards to surviving spouses. The monthly 
payment rate shall be equal to the basic entitlement rate increased by 
the overall average percentage (rounded to the nearest tenth of a 
percent) of each legislative increase in dependency and indemnity 
compensation rates under 38 U.S.C. 1311 which became effective 
concurrently with or subsequent to the effective date of the earliest 
adjustment under section 215(i) of the Social Security Act that was 
disregarded in computing the basic entitlement rate.
    (3) Original and reopened awards to children. The monthly payment 
rate shall be equal to the basic entitlement rate increased by the 
overall average percentage (rounded to the nearest tenth of a percent) 
of each legislative increase in the rates of educational assistance 
allowance under 38 U.S.C. 3531(b) which became effective concurrently 
with or subsequent to the effective date of the earliest adjustment 
under section 215(i) of the Social Security Act that was disregarded in 
computing the basic entitlement rate.
    (4) Subsequent legislative increases in rates. The monthly rate of 
special allowance payable to a surviving spouse shall be increased by 
the same overall average percentage increase (rounded to the nearest 
tenth of a percent) and on the same effective date as any legislative 
increase in the rates payable under 38 U.S.C. 1311. The monthly rate of 
special allowance payable to a child shall be increased by the same 
overall average percentage increase (rounded to the nearest tenth of a 
percent) and on the same effective date as any legislative increase in 
the rates payable under 38 U.S.C. 3531(b).
    (5) Amendment of awards. Prompt action shall be taken to amend any 
award of this special allowance to conform with evidence indicating a 
change in basic eligibility, any basic entitlement rate, or any 
effective date previously determined. It is the claimant's 
responsibility to promptly notify VA of any change in their status or 
employment which affects eligibility or entitlement.
    (6) Rounding of monthly rates. Any monthly rate computed under the 
provisions of this paragraph, if not a multiple of $1, shall be rounded 
to the next lower multiple of $1.
    (c) Claimants not entitled to this special allowance. The following 
are not entitled to this special allowance for the reasons indicated.
    (1) Claimants eligible for death benefits under 38 U.S.C. 1151. The 
deaths in such cases are not service-connected.
    (2) Claimants eligible for death benefits under 38 U.S.C. 1318. The 
deaths in such cases are not service connected.
    (3) Claimants whose claims are based on an individual's service in:
    (i) The Commonwealth Army of the Philippines while such forces were 
in the service of the Armed Forces pursuant to the military order of the 
President dated July 26, 1941, including recognized guerrilla forces 
(see 38 U.S.C. 107).
    (ii) The Philippine Scouts under section 14, Pub. L. 190, 79th 
Congress (see 38 U.S.C. 107).
    (iii) The commissioned corps of the Public Health Service 
(specifically excluded by section 156 of Pub. L. 97-377), or
    (iv) The National Oceanic and Atmospheric Administration 
(specifically excluded by section 156 of Pub. L. 97-377).
    (d) Appellate jurisdiction. VA shall have appellate jurisdiction of 
all determinations made in connection with this special allowance.
    (e) Claims. Claimants must file or submit a complete claim on a 
paper or electronic form prescribed by the Secretary in order for VA to 
pay this special allowance. When VA receives an intent to file a claim 
or inquiries as to eligibility, VA will follow the procedures outlined 
in Sec.  3.155. Otherwise, the date of receipt of the complete claim 
will be accepted as the date of claim for this special allowance. See 
Sec. Sec.  3.150, 3.151, 3.155, 3.400.
    (f) Retroactivity and effective dates. There is no time limit for 
filing a claim for this special allowance. Upon the filing of a complete 
claim, benefits shall be payable for all periods of eligibility 
beginning on or after the first

[[Page 367]]

day of the month in which the claimant first became eligible for this 
special allowance, except that no payment may be made for any period 
prior to January 1, 1983.

(Authority: Sec. 156, Pub. L. 97-377, 96 Stat. 1830, 1920 (1982))

[49 FR 21709, May 23, 1984, as amended at 54 FR 26030, June 21, 1989; 60 
FR 20643, Apr. 27, 1995; 79 FR 57697, Sept. 25, 2014]



Sec.  3.813  Interim benefits for disability or death due to chloracne 
or porphyria cutanea tarda.

    (a) Disability benefits. Except as provided in paragraph (c) of this 
section, a veteran who served in the active military, naval or air 
service in the Republic of Vietnam during the Vietnam era, and who 
suffers from chloracne or porphyria cutanea tarda which became manifest 
within one year after the date of the veteran's most recent departure 
from the Republic of Vietnam during such service, shall be paid interim 
disability benefits under this section in the same manner and to the 
same extent that compensation would be payable if such disabilities were 
service-connected.
    (b) Death benefits. Except as provided in paragraph (c) of this 
section, if a veteran described in paragraph (a) of this section dies as 
a result of chloracne or porphyria cutanea tarda, the veteran's 
survivors shall be paid interim death benefits under this section based 
upon the same elgibility requirements and at the same rates that 
dependency and indemnity compensation would be payable if the death were 
service-connected.
    (c) Exceptions. Benefits under this section are not payable for any 
month for which compensation or dependency and indemnity compensation is 
payable for the same disability or death, nor are benefits payable under 
this section (1) when there is affirmative evidence that the disease was 
not incurred by the veteran during service in the Republic of Vietnam 
during the Vietnam era, (2) when there is affirmative evidence to 
establish that an intercurrent injury or disease, which is a recognized 
cause of the disease for which benefits are being claimed, was suffered 
by the veteran between the date of the veteran's most recent departure 
from the Republic of Vietnam during active military, naval or air 
service and the onset of the claimed disease, or (3) if it is 
determined, based on evidence in the veteran's service records and other 
records provided by the Secretary of Defense, that the veteran was not 
exposed to dioxin during active military, naval or air service in the 
Republic of Vietnam during the Vietnam era.
    (d) Similarity to service-connected benefits. For purposes of all 
laws administered by VA (except chapters 11 and 13 of title 38 U.S.C.), 
a disease establishing eligibility for disability or death benefits 
under this section shall be treated as if it were service-connected, and 
the receipt of disability or death benefits shall be treated as if such 
benefits were compensation or dependency and indemnity compensation, 
respectively.
    (e) Effective dates. Benefits under this section may not be paid for 
any period prior to October 1, 1984, nor for any period after September 
30, 1986.

(Authority: Pub. L. 98-542)

[50 FR 34460, Aug. 26, 1985]



Sec.  3.814  Monetary allowance under 38 U.S.C. chapter 18 for an individual
suffering from spina bifida whose biological father or mother is or was
a Vietnam veteran or a veteran with covered service in Korea.

    (a) Monthly monetary allowance. VA will pay a monthly monetary 
allowance under subchapter I of 38 U.S.C. chapter 18, based upon the 
level of disability determined under the provisions of paragraph (d) of 
this section, to or for a person who VA has determined is an individual 
suffering from spina bifida whose biological mother or father is or was 
a Vietnam veteran or a veteran with covered service in Korea. Receipt of 
this allowance will not affect the right of the individual or any 
related person to receive any other benefit to which he or she may be 
entitled under any law administered by VA. An individual suffering from 
spina bifida is entitled to only one monthly allowance under this 
section, even if the individual's biological father and mother are or 
were both Vietnam veterans or veterans with covered service in Korea.
    (b) [Reserved]

[[Page 368]]

    (c) Definitions--(1) Vietnam veteran. For the purposes of this 
section, the term ``Vietnam veteran'' means a person who performed 
active military, naval, or air service in the Republic of Vietnam during 
the period beginning on January 9, 1962, and ending on May 7, 1975, 
without regard to the characterization of the person's service. Service 
in the Republic of Vietnam includes service in the waters offshore and 
service in other locations if the conditions of service involved duty or 
visitation in the Republic of Vietnam.
    (2) Covered service in Korea. For the purposes of this section, the 
term ``veteran with covered service in Korea'' means a person who served 
in the active military, naval, or air service in or near the Korean DMZ 
between September 1, 1967, and August 31, 1971, and who is determined by 
VA, in consultation with the Department of Defense, to have been exposed 
to an herbicide agent during such service. Exposure to an herbicide 
agent will be conceded if the veteran served between April 1, 1968, and 
August 31, 1971, in a unit that, as determined by the Department of 
Defense, operated in or near the Korean DMZ in an area in which 
herbicides are known to have been applied during that period, unless 
there is affirmative evidence to establish that the veteran was not 
exposed to any such agent during that service.
    (3) Individual. For the purposes of this section, the term 
``individual'' means a person, regardless of age or marital status, 
whose biological father or mother is or was a Vietnam veteran and who 
was conceived after the date on which the veteran first served in the 
Republic of Vietnam during the Vietnam era, or whose biological father 
or mother is or was a veteran with covered service in Korea and who was 
conceived after the date on which the veteran first had covered service 
in Korea as defined in this section. Notwithstanding the provisions of 
Sec.  3.204(a)(1), VA will require the types of evidence specified in 
Sec. Sec.  3.209 and 3.210 sufficient to establish in the judgment of 
the Secretary that a person is the biological son or daughter of a 
Vietnam veteran or a veteran with covered service in Korea.
    (4) Spina bifida. For the purposes of this section, the term ``spina 
bifida'' means any form and manifestation of spina bifida except spina 
bifida occulta.
    (d) Disability evaluations. (1) Except as otherwise specified in 
this paragraph, VA will determine the level of payment as follows:
    (i) Level I. The individual walks without braces or other external 
support as his or her primary means of mobility in the community, has no 
sensory or motor impairment of the upper extremities, has an IQ of 90 or 
higher, and is continent of urine and feces without the use of 
medication or other means to control incontinence.
    (ii) Level II. Provided that none of the disabilities is severe 
enough to warrant payment at Level III, and the individual: walks with 
braces or other external support as his or her primary means of mobility 
in the community; or, has sensory or motor impairment of the upper 
extremities, but is able to grasp pen, feed self, and perform self care; 
or, has an IQ of at least 70 but less than 90; or, requires medication 
or other means to control the effects of urinary bladder impairment and 
no more than two times per week is unable to remain dry for at least 
three hours at a time during waking hours; or, requires bowel management 
techniques or other treatment to control the effects of bowel impairment 
but does not have fecal leakage severe or frequent enough to require 
wearing of absorbent materials at least four days a week; or, has a 
colostomy that does not require wearing a bag.
    (iii) Level III. The individual uses a wheelchair as his or her 
primary means of mobility in the community; or, has sensory or motor 
impairment of the upper extremities severe enough to prevent grasping a 
pen, feeding self, and performing self care; or, has an IQ of 69 or 
less; or, despite the use of medication or other means to control the 
effects of urinary bladder impairment, at least three times per week is 
unable to remain dry for three hours at a time during waking hours; or, 
despite bowel management techniques or other treatment to control the 
effects of bowel impairment, has fecal leakage severe or frequent enough 
to require wearing of absorbent materials at least four

[[Page 369]]

days a week; or, regularly requires manual evacuation or digital 
stimulation to empty the bowel; or, has a colostomy that requires 
wearing a bag.
    (2) If an individual who would otherwise be paid at Level I or II 
has one or more disabilities, such as blindness, uncontrolled seizures, 
or renal failure that result either from spina bifida, or from treatment 
procedures for spina bifida, the Director of the Compensation Service 
may increase the monthly payment to the level that, in his or her 
judgment, best represents the extent to which the disabilities resulting 
from spina bifida limit the individual's ability to engage in ordinary 
day-to-day activities, including activities outside the home. A Level II 
or Level III payment will be awarded depending on whether the effects of 
a disability are of equivalent severity to the effects specified under 
Level II or Level III.
    (3) VA may accept statements from private physicians, or examination 
reports from government or private institutions, for the purpose of 
rating spina bifida claims without further examination, provided the 
statements or reports are adequate for assessing the level of disability 
due to spina bifida under the provisions of paragraph (d)(1) of this 
section. In the absence of adequate medical information, VA will 
schedule an examination for the purpose of assessing the level of 
disability.
    (4) VA will pay an individual eligible for a monetary allowance due 
to spina bifida at Level I unless or until it receives medical evidence 
supporting a higher payment. When required to reassess the level of 
disability under paragraph (d)(5) or (d)(6) of this section, VA will pay 
an individual eligible for this monetary allowance at Level I in the 
absence of evidence adequate to support a higher level of disability or 
if the individual fails to report, without good cause, for a scheduled 
examination. Examples of good cause include, but are not limited to, the 
illness or hospitalization of the claimant, death of an immediate family 
member, etc.
    (5) VA will pay individuals under the age of one year at Level I 
unless a pediatric neurologist or a pediatric neurosurgeon certifies 
that, in his or her medical judgment, there is a neurological deficit 
that will prevent the individual from ambulating, grasping a pen, 
feeding himself or herself, performing self care, or from achieving 
urinary or fecal continence. If any of those deficits are present, VA 
will pay the individual at Level III. In either case, VA will reassess 
the level of disability when the individual reaches the age of one year.
    (6) VA will reassess the level of payment whenever it receives 
medical evidence indicating that a change is warranted. For individuals 
between the ages of one and twenty-one, however, it must reassess the 
level of payment at least every five years.
    (e) Effective dates. Except as otherwise provided, VA will award the 
monetary allowance for an individual suffering from spina bifida based 
on an initial claim or supplemental claim as of the date VA received the 
claim (or the date of birth if the claim is received within 1 year of 
that date) or the date entitlement arose, whichever is later.
    (1) VA will increase benefits as of the earliest date the evidence 
establishes that the level of severity increased, but only if the 
beneficiary applies for an increase within one year of that date.
    (2) If a claimant reopens a previously disallowed claim based on 
corrected military records, VA will award the benefit from the latest of 
the following dates: the date the veteran or beneficiary applied for a 
correction of the military records; the date the disallowed claim was 
filed; or, the date one year before the date of receipt of the reopened 
claim.
    (f) Reductions and discontinuances. VA will generally reduce or 
discontinue awards according to the facts found except as provided in 
Sec. Sec.  3.105 and 3.114(b).
    (1) If benefits were paid erroneously because of beneficiary error, 
VA will reduce or discontinue benefits as of the effective date of the 
erroneous award.
    (2) If benefits were paid erroneously because of administrative 
error, VA will reduce or discontinue benefits as of the date of last 
payment.

(Authority: 38 U.S.C. 501, 1805, 1811, 1812, 1821, 1831, 1832, 1833, 
1834, 5101, 5110, 5111, 5112)

[[Page 370]]


    Cross Reference: 38 CFR 3.307(a)(6)(iv).

[62 FR 51279, Sept. 30, 1997, as amended at 65 FR 35282, June 2, 2000; 
66 FR 13436, Mar. 6, 2001; 67 FR 49587, July 31, 2002; 76 FR 4249, Jan. 
25, 2011; 79 FR 2100, Jan. 13, 2014; 84 FR 171, Jan. 18, 2019]



Sec.  3.815  Monetary allowance under 38 U.S.C. chapter 18 for an 
individual with disability from covered birth defects whose biological
mother is or was a Vietnam veteran; identification of covered birth defects.

    (a) Monthly monetary allowance--(1) General. VA will pay a monthly 
monetary allowance under subchapter II of 38 U.S.C. chapter 18 to or for 
an individual whose biological mother is or was a Vietnam veteran and 
who VA has determined to have disability resulting from one or more 
covered birth defects. Except as provided in paragraph (a)(3) of this 
section, the amount of the monetary allowance paid will be based upon 
the level of such disability suffered by the individual, as determined 
in accordance with the provisions of paragraph (e) of this section.
    (2) Affirmative evidence of cause other than mother's service during 
Vietnam era. No monetary allowance will be provided under this section 
based on a particular birth defect of an individual in any case where 
affirmative evidence establishes that the birth defect results from a 
cause other than the active military, naval, or air service of the 
individual's mother during the Vietnam era and, in determining the level 
of disability for an individual with more than one birth defect, the 
particular defect resulting from other causes will be excluded from 
consideration. This will not prevent VA from paying a monetary allowance 
under this section for other birth defects.
    (3) Nonduplication; spina bifida. In the case of an individual whose 
only covered birth defect is spina bifida, a monetary allowance will be 
paid under Sec.  3.814, and not under this section, nor will the 
individual be evaluated for disability under this section. In the case 
of an individual who has spina bifida and one or more additional covered 
birth defects, a monetary allowance will be paid under this section and 
the amount of the monetary allowance will be not less than the amount 
the individual would receive if his or her only covered birth defect 
were spina bifida. If, but for the individual's one or more additional 
covered birth defects, the monetary allowance payable to or for the 
individual would be based on an evaluation at Level I, II, or III, 
respectively, under Sec.  3.814(d), the evaluation of the individual's 
level of disability under paragraph (e) of this section will be not less 
than Level II, III, or IV, respectively.
    (b) No effect on other VA benefits. Receipt of a monetary allowance 
under 38 U.S.C. chapter 18 will not affect the right of the individual, 
or the right of any person based on the individual's relationship to 
that person, to receive any other benefit to which the individual, or 
that person, may be entitled under any law administered by VA.
    (c) Definitions--(1) Vietnam veteran. For the purposes of this 
section, the term Vietnam veteran means a person who performed active 
military, naval, or air service in the Republic of Vietnam during the 
period beginning on February 28, 1961, and ending on May 7, 1975, 
without regard to the characterization of the person's service. Service 
in the Republic of Vietnam includes service in the waters offshore and 
service in other locations if the conditions of service involved duty or 
visitation in the Republic of Vietnam.
    (2) Individual. For the purposes of this section, the term 
individual means a person, regardless of age or marital status, whose 
biological mother is or was a Vietnam veteran and who was conceived 
after the date on which the veteran first entered the Republic of 
Vietnam during the period beginning on February 28, 1961, and ending on 
May 7, 1975. Notwithstanding the provisions of Sec.  3.204(a)(1), VA 
will require the types of evidence specified in Sec. Sec.  3.209 and 
3.210 sufficient to establish that a person is the biological son or 
daughter of a Vietnam veteran.
    (3) Covered birth defect. For the purposes of this section, the term 
covered birth defect means any birth defect identified by VA as a birth 
defect that is associated with the service of women Vietnam veterans in 
the Republic of Vietnam during the period beginning on February 28, 
1961, and ending on May 7, 1975, and that has resulted, or may result, 
in permanent physical or

[[Page 371]]

mental disability. However, the term covered birth defect does not 
include a condition due to a:
    (i) Familial disorder;
    (ii) Birth-related injury; or
    (iii) Fetal or neonatal infirmity with well-established causes.
    (d) Identification of covered birth defects. All birth defects that 
are not excluded under the provisions of this paragraph are covered 
birth defects.
    (1) Covered birth defects include, but are not limited to, the 
following (however, if a birth defect is determined to be familial in a 
particular family, it will not be a covered birth defect):
    (i) Achondroplasia;
    (ii) Cleft lip and cleft palate;
    (iii) Congenital heart disease;
    (iv) Congenital talipes equinovarus (clubfoot);
    (v) Esophageal and intestinal atresia;
    (vi) Hallerman-Streiff syndrome;
    (vii) Hip dysplasia;
    (viii) Hirschprung's disease (congenital megacolon);
    (ix) Hydrocephalus due to aqueductal stenosis;
    (x) Hypospadias;
    (xi) Imperforate anus;
    (xii) Neural tube defects (including spina bifida, encephalocele, 
and anencephaly);
    (xiii) Poland syndrome;
    (xiv) Pyloric stenosis;
    (xv) Syndactyly (fused digits);
    (xvi) Tracheoesophageal fistula;
    (xvii) Undescended testicle; and
    (xviii) Williams syndrome.
    (2) Birth defects that are familial disorders, including hereditary 
genetic conditions, are not covered birth defects. Familial disorders 
include, but are not limited to, the following, unless the birth defect 
is not familial in a particular family:
    (i) Albinism;
    (ii) Alpha-antitrypsin deficiency;
    (iii) Crouzon syndrome;
    (iv) Cystic fibrosis;
    (v) Duchenne's muscular dystrophy;
    (vi) Galactosemia;
    (vii) Hemophilia;
    (viii) Huntington's disease;
    (ix) Hurler syndrome;
    (x) Kartagener's syndrome (Primary Ciliary Dyskinesia);
    (xi) Marfan syndrome;
    (xii) Neurofibromatosis;
    (xiii) Osteogenesis imperfecta;
    (xiv) Pectus excavatum;
    (xv) Phenylketonuria;
    (xvi) Sickle cell disease;
    (xvii) Tay-Sachs disease;
    (xviii) Thalassemia; and
    (xix) Wilson's disease.
    (3) Conditions that are congenital malignant neoplasms are not 
covered birth defects. These include, but are not limited to, the 
following:
    (i) Medulloblastoma;
    (ii) Neuroblastoma;
    (iii) Retinoblastoma;
    (iv) Teratoma; and
    (v) Wilm's tumor.
    (4) Conditions that are chromosomal disorders are not covered birth 
defects. These include, but are not limited to, the following:
    (i) Down syndrome and other Trisomies;
    (ii) Fragile X syndrome;
    (iii) Klinefelter's syndrome; and
    (iv) Turner's syndrome.
    (5) Conditions that are due to birth-related injury are not covered 
birth defects. These include, but are not limited to, the following:
    (i) Brain damage due to anoxia during or around time of birth;
    (ii) Cerebral palsy due to birth trauma, (iii) Facial nerve palsy or 
other peripheral nerve injury;
    (iv) Fractured clavicle; and
    (v) Horner's syndrome due to forceful manipulation during birth.
    (6) Conditions that are due to a fetal or neonatal infirmity with 
well-established causes or that are miscellaneous pediatric conditions 
are not covered birth defects. These include, but are not limited to, 
the following:
    (i) Asthma and other allergies;
    (ii) Effects of maternal infection during pregnancy, including but 
not limited to, maternal rubella, toxoplasmosis, or syphilis;
    (iii) Fetal alcohol syndrome or fetal effects of maternal drug use;
    (iv) Hyaline membrane disease;
    (v) Maternal-infant blood incompatibility;
    (vi) Neonatal infections;
    (vii) Neonatal jaundice;
    (viii) Post-infancy deafness/hearing impairment (onset after the age 
of one year);
    (ix) Prematurity; and

[[Page 372]]

    (x) Refractive disorders of the eye.
    (7) Conditions that are developmental disorders are not covered 
birth defects. These include, but are not limited to, the following:
    (i) Attention deficit disorder;
    (ii) Autism;
    (iii) Epilepsy diagnosed after infancy (after the age of one year);
    (iv) Learning disorders; and
    (v) Mental retardation (unless part of a syndrome that is a covered 
birth defect).
    (8) Conditions that do not result in permanent physical or mental 
disability are not covered birth defects. These include, but are not 
limited to:
    (i) Conditions rendered non-disabling through treatment;
    (ii) Congenital heart problems surgically corrected or resolved 
without disabling residuals;
    (iii) Heart murmurs unassociated with a diagnosed cardiac 
abnormality;
    (iv) Hemangiomas that have resolved with or without treatment; and
    (v) Scars (other than of the head, face, or neck) as the only 
residual of corrective surgery for birth defects.
    (e) Disability evaluations. Whenever VA determines, upon receipt of 
competent medical evidence, that an individual has one or more covered 
birth defects, VA will determine the level of disability currently 
resulting, in combination, from the covered birth defects and associated 
disabilities. No monetary allowance will be payable under this section 
if VA determines under this paragraph that an individual has no current 
disability resulting from the covered birth defects, unless VA 
determines that the provisions of paragraph (a)(3) of this section are 
for application. Except as otherwise provided in paragraph (a)(3) of 
this section, VA will determine the level of disability as follows:
    (1) Levels of disability.
    (i) Level 0. The individual has no current disability resulting from 
covered birth defects.
    (ii) Level I. The individual meets one or more of the following 
criteria:
    (A) The individual has residual physical or mental effects that only 
occasionally or intermittently limit or prevent some daily activities; 
or
    (B) The individual has disfigurement or scarring of the head, face, 
or neck without gross distortion or gross asymmetry of any facial 
feature (nose, chin, forehead, eyes (including eyelids), ears 
(auricles), cheeks, or lips).
    (iii) Level II. The individual meets one or more of the following 
criteria:
    (A) The individual has residual physical or mental effects that 
frequently or constantly limit or prevent some daily activities, but the 
individual is able to work or attend school, carry out most household 
chores, travel, and provide age-appropriate self-care, such as eating, 
dressing, grooming, and carrying out personal hygiene, and 
communication, behavior, social interaction, and intellectual 
functioning are appropriate for age; or
    (B) The individual has disfigurement or scarring of the head, face, 
or neck with either gross distortion or gross asymmetry of one facial 
feature or one paired set of facial features (nose, chin, forehead, eyes 
(including eyelids), ears (auricles), cheeks, or lips).
    (iv) Level III. The individual meets one or more of the following 
criteria:
    (A) The individual has residual physical or mental effects that 
frequently or constantly limit or prevent most daily activities, but the 
individual is able to provide age-appropriate self-care, such as eating, 
dressing, grooming, and carrying out personal hygiene;
    (B) The individual is unable to work or attend school, travel, or 
carry out household chores, or does so intermittently and with 
difficulty;
    (C) The individual's communication, behavior, social interaction, 
and intellectual functioning are not entirely appropriate for age; or
    (D) The individual has disfigurement or scarring of the head, face, 
or neck with either gross distortion or gross asymmetry of two facial 
features or two paired sets of facial features (nose, chin, forehead, 
eyes (including eyelids), ears (auricles), cheeks, or lips).
    (v) Level IV. The individual meets one or more of the following 
criteria:
    (A) The individual has residual physical or mental effects that 
prevent age-appropriate self-care, such as eating, dressing, grooming, 
and carrying out personal hygiene;

[[Page 373]]

    (B) The individual's communication, behavior, social interaction, 
and intellectual functioning are grossly inappropriate for age; or
    (C) The individual has disfigurement or scarring of the head, face, 
or neck with either gross distortion or gross asymmetry of three facial 
features or three paired sets of facial features (nose, chin, forehead, 
eyes (including eyelids), ears (auricles), cheeks, or lips).
    (2) Assessing limitation of daily activities. Physical or mental 
effects on the following functions are to be considered in assessing 
limitation of daily activities:
    (i) Mobility (ability to stand and walk, including balance and 
coordination);
    (ii) Manual dexterity;
    (iii) Stamina;
    (iv) Speech;
    (v) Hearing;
    (vi) Vision (other than correctable refraction errors);
    (vii) Memory;
    (viii) Ability to concentrate;
    (ix) Appropriateness of behavior; and
    (x) Urinary and fecal continence.
    (f) Information for determining whether individuals have covered 
birth defects and rating disability levels. (1) VA may accept statements 
from private physicians, or examination reports from government or 
private institutions, for the purposes of determining whether an 
individual has a covered birth defect and for rating claims for covered 
birth defects. If they are adequate for such purposes, VA may make the 
determination and rating without further examination. In the absence of 
adequate information, VA may schedule examinations for the purpose of 
determining whether an individual has a covered birth defect and/or 
assessing the level of disability.
    (2) Except in accordance with paragraph (a)(3) of this section, VA 
will not pay a monthly monetary allowance unless or until VA is able to 
obtain medical evidence adequate to determine that an individual has a 
covered birth defect and adequate to assess the level of disability due 
to covered birth defects.
    (g) Redeterminations. VA will reassess a determination under this 
section whenever it receives evidence indicating that a change is 
warranted.
    (h) Referrals. If a regional office is unclear in any case as to 
whether a condition is a covered birth defect, it may refer the issue to 
the Director of the Compensation Service for determination.
    (i) Effective dates. Except as provided in Sec.  3.114(a) or 
paragraph (i)(1) or (2) of this section, VA will award the monetary 
allowance under subchapter II of 38 U.S.C. chapter 18, for an individual 
with disability resulting from one or more covered birth defects, based 
on an initial claim or supplemental claim, as of the date VA received 
the claim (or the date of birth if the claim is received within one year 
of that date), the date entitlement arose, or December 1, 2001, 
whichever is latest. Subject to the condition that no benefits may be 
paid for any period prior to December 1, 2001:
    (1) VA will increase benefits as of the earliest date the evidence 
establishes that the level of severity increased, but only if the 
beneficiary applies for an increase within one year of that date.
    (2) If a claimant reopens a previously disallowed claim based on 
corrected military records, VA will award the benefit from the latest of 
the following dates: the date the veteran or beneficiary applied for a 
correction of the military records; the date the disallowed claim was 
filed; or, the date one year before the date of receipt of the reopened 
claim.
    (j) Reductions and discontinuances. VA will generally reduce or 
discontinue awards under subchapter II of 38 U.S.C. chapter 18 according 
to the facts found except as provided in Sec. Sec.  3.105 and 3.114(b).
    (1) If benefits were paid erroneously because of beneficiary error, 
VA will reduce or discontinue benefits as of the effective date of the 
erroneous award.
    (2) If benefits were paid erroneously because of administrative 
error, VA will reduce or discontinue benefits as of the date of last 
payment.

(Authority: 38 U.S.C. 501, 1811, 1812, 1813, 1814, 1815, 1816, 1831, 
1832, 1833, 1834, 5101, 5110, 5111, 5112)

[67 FR 49588, July 31, 2002, as amended at 76 FR 4249, Jan. 25, 2011; 79 
FR 2100, Jan. 13, 2014; 84 FR 171, Jan. 18, 2019]

[[Page 374]]



Sec.  3.816  Awards under the Nehmer Court Orders for disability or
death caused by a condition presumptively associated with herbicide 
exposure.

    (a) Purpose. This section states effective-date rules required by 
orders of a United States district court in the class-action case of 
Nehmer v. United States Department of Veterans Affairs, No. CV-86-6160 
TEH (N.D. Cal.).
    (b) Definitions. For purposes of this section--
    (1) Nehmer class member means:
    (i) A Vietnam veteran who has a covered herbicide disease; or
    (ii) A surviving spouse, child, or parent of a deceased Vietnam 
veteran who died from a covered herbicide disease.
    (2) Covered herbicide disease means a disease for which the 
Secretary of Veterans Affairs has established a presumption of service 
connection pursuant to the Agent Orange Act of 1991, Public Law 102-4, 
other than chloracne, as provided in Sec.  3.309(e).
    (c) Effective date of disability compensation. If a Nehmer class 
member is entitled to disability compensation for a covered herbicide 
disease, the effective date of the award will be as follows:
    (1) If VA denied compensation for the same covered herbicide disease 
in a decision issued between September 25, 1985 and May 3, 1989, the 
effective date of the award will be the later of the date VA received 
the claim on which the prior denial was based or the date the disability 
arose, except as otherwise provided in paragraph (c)(3) of this section. 
A prior decision will be construed as having denied compensation for the 
same disease if the prior decision denied compensation for a disease 
that reasonably may be construed as the same covered herbicide disease 
for which compensation has been awarded. Minor differences in the 
terminology used in the prior decision will not preclude a finding, 
based on the record at the time of the prior decision, that the prior 
decision denied compensation for the same covered herbicide disease.
    (2) If the class member's claim for disability compensation for the 
covered herbicide disease was either pending before VA on May 3, 1989, 
or was received by VA between that date and the effective date of the 
statute or regulation establishing a presumption of service connection 
for the covered disease, the effective date of the award will be the 
later of the date such claim was received by VA or the date the 
disability arose, except as otherwise provided in paragraph (c)(3) of 
this section. A claim will be considered a claim for compensation for a 
particular covered herbicide disease if:
    (i) The claimant's application and other supporting statements and 
submissions may reasonably be viewed, under the standards ordinarily 
governing compensation claims, as indicating an intent to apply for 
compensation for the covered herbicide disability; or
    (ii) VA issued a decision on the claim, between May 3, 1989 and the 
effective date of the statute or regulation establishing a presumption 
of service connection for the covered disease, in which VA denied 
compensation for a disease that reasonably may be construed as the same 
covered herbicide disease for which compensation has been awarded.
    (3) If the class member's claim referred to in paragraph (c)(1) or 
(c)(2) of this section was received within one year from the date of the 
class member's separation from service, the effective date of the award 
shall be the day following the date of the class member's separation 
from active service.
    (4) If the requirements of paragraph (c)(1) or (c)(2) of this 
section are not met, the effective date of the award shall be determined 
in accordance with Sec. Sec.  3.114 and 3.400.
    (d) Effective date of dependency and indemnity compensation (DIC). 
If a Nehmer class member is entitled to DIC for a death due to a covered 
herbicide disease, the effective date of the award will be as follows:
    (1) If VA denied DIC for the death in a decision issued between 
September 25, 1985 and May 3, 1989, the effective date of the award will 
be the later of the date VA received the claim on which such prior 
denial was based or the date the death occurred, except as otherwise 
provided in paragraph (d)(3) of this section.
    (2) If the class member's claim for DIC for the death was either 
pending

[[Page 375]]

before VA on May 3, 1989, or was received by VA between that date and 
the effective date of the statute or regulation establishing a 
presumption of service connection for the covered herbicide disease that 
caused the death, the effective date of the award will be the later of 
the date such claim was received by VA or the date the death occurred, 
except as otherwise provided in paragraph (d)(3) of this section. In 
accordance with Sec.  3.152(b)(1), a claim by a surviving spouse or 
child for death pension will be considered a claim for DIC. In all other 
cases, a claim will be considered a claim for DIC if the claimant's 
application and other supporting statements and submissions may 
reasonably be viewed, under the standards ordinarily governing DIC 
claims, as indicating an intent to apply for DIC.
    (3) If the class member's claim referred to in paragraph (d)(1) or 
(d)(2) of this section was received within one year from the date of the 
veteran's death, the effective date of the award shall be the first day 
of the month in which the death occurred.
    (4) If the requirements of paragraph (d)(1) or (d)(2) of this 
section are not met, the effective date of the award shall be determined 
in accordance with Sec. Sec.  3.114 and 3.400.
    (e) Effect of other provisions affecting retroactive entitlement--
(1) General. If the requirements specified in paragraphs (c)(1) or 
(c)(2) or (d)(1) or (d)(2) of this section are satisfied, the effective 
date shall be assigned as specified in those paragraphs, without regard 
to the provisions in 38 U.S.C. 5110(g) or Sec.  3.114 prohibiting 
payment for periods prior to the effective date of the statute or 
regulation establishing a presumption of service connection for a 
covered herbicide disease. However, the provisions of this section will 
not apply if payment to a Nehmer class member based on a claim described 
in paragraph (c) or (d) of this section is otherwise prohibited by 
statute or regulation, as, for example, where a class member did not 
qualify as a surviving spouse at the time of the prior claim or denial.
    (2) Claims Based on Service in the Republic of Vietnam Prior to 
August 5, 1964. If a claim referred to in paragraph (c) or (d) of this 
section was denied by VA prior to January 1, 1997, and the veteran's 
service in the Republic of Vietnam ended before August 5, 1964, the 
effective-date rules of this regulation do not apply. The effective date 
of benefits in such cases shall be determined in accordance with 38 
U.S.C. 5110. If a claim referred to in paragraph (c) or (d) of this 
section was pending before VA on January 1, 1997, or was received by VA 
after that date, and the veteran's service in the Republic of Vietnam 
ended before August 5, 1964, the effective date shall be the later of 
the date provided by paragraph (c) or (d) of this section or January 1, 
1997.


(Authority: Public Law 104-275, sec. 505)

    (f) Payment of Benefits to Survivors or Estates of Deceased 
Beneficiaries--(1) General. If a Nehmer class member entitled to 
retroactive benefits pursuant to paragraphs (c)(1) through (c)(3) or 
(d)(1) through (d)(3) of this section dies prior to receiving payment of 
any such benefits, VA shall pay such unpaid retroactive benefits to the 
first individual or entity listed below that is in existence at the time 
of payment:
    (i) The class member's spouse, regardless of current marital status.

    Note to paragraph (f)(1)(i): For purposes of this paragraph, a 
spouse is the person who was legally married to the class member at the 
time of the class member's death.

    (ii) The class member's child(ren), regardless of age or marital 
status (if more than one child exists, payment will be made in equal 
shares, accompanied by an explanation of the division).

    Note to paragraph (f)(1)(ii): For purposes of this paragraph, the 
term ``child'' includes natural and adopted children, and also includes 
any stepchildren who were members of the class member's household at the 
time of the class member's death.

    (iii) The class member's parent(s), regardless of dependency (if 
both parents are alive, payment will be made in equal shares, 
accompanied by an explanation of the division).

    Note to paragraph (f)(1)(iii): For purposes of this paragraph, the 
term ``parent'' includes natural and adoptive parents, but in the event 
of successive parents, the persons who last stood as parents in relation 
to the class member will be considered the parents.


[[Page 376]]


    (iv) The class member's estate.
    (2) Inapplicability of certain accrued benefit requirements. The 
provisions of 38 U.S.C. 5121(c) and Sec.  3.1000(c) requiring survivors 
to file claims for accrued benefits do not apply to payments under this 
section. When a Nehmer class member dies prior to receiving retroactive 
payments under this section, VA will pay the amount to an identified 
payee in accordance with paragraph (f)(1) of this section without 
requiring an application from the payee. Prior to releasing such 
payment, however, VA may ask the payee to provide further information as 
specified in paragraph (f)(3) of this section.
    (3) Identifying payees. VA shall make reasonable efforts to identify 
the appropriate payee(s) under paragraph (f)(1) of this section based on 
information in the veteran's claims file. If further information is 
needed to determine whether any appropriate payee exists or whether 
there are any persons having equal or higher precedence than a known 
prospective payee, VA will request such information from a survivor or 
authorized representative if the claims file provides sufficient contact 
information. Before releasing payment to an identified payee, VA will 
ask the payee to state whether there are any other survivors of the 
class member who may have equal or greater entitlement to payment under 
this section, unless the circumstances clearly indicate that such a 
request is unnecessary. If, following such efforts, VA releases the full 
amount of unpaid benefits to a payee, VA may not thereafter pay any 
portion of such benefits to any other individual, unless VA is able to 
recover the payment previously released.
    (4) Bar to accrued benefit claims. Payment of benefits pursuant to 
paragraph (f)(1) of this section shall bar a later claim by any 
individual for payment of all or any part of such benefits as accrued 
benefits under 38 U.S.C. 5121 and Sec.  3.1000.
    (g) Awards covered by this section. This section applies only to 
awards of disability compensation or DIC for disability or death caused 
by a disease listed in paragraph (b)(2) of this section.

(Authority: 38 U.S.C. 501)

[68 FR 50970, Aug. 25, 2003, as amended at 73 FR 61736, Oct. 17, 2008; 
78 FR 54766, Sept. 6, 2013]

                               Forfeiture



Sec.  3.900  General.

    (a) Forfeiture of benefits based on one period of service does not 
affect entitlement to benefits based on a period of service beginning 
after the offense causing the prior forfeiture.
    (b)(1) Except as provided in paragraph (b)(2) of this section, any 
offense committed prior to January 1, 1959, may cause a forfeiture and 
any forfeiture in effect prior to January 1, 1959, will continue to be a 
bar on and after January 1, 1959.


(Authority: Section 3, Pub. L. 85-857)

    (2) Effective September 2, 1959, forfeiture of benefits may not be 
declared except under the circumstances set forth in Sec.  3.901(d), 
Sec.  3.902(d), or Sec.  3.903. Forfeitures declared before September 2, 
1959, will continue to be a bar on and after that date.


(Authority: 38 U.S.C. 6103(d) and 6105)

    (c) Pension or compensation payments are not subject to forfeiture 
because of violation of hospital rules.
    (d) When the person primarily entitled has forfeited his or her 
rights by reason of fraud or a treasonable act determination as to the 
rights of any dependents of record to benefits under Sec.  3.901(c) or 
Sec.  3.902(c) may be made upon receipt of an application.

(Authority: 38 U.S.C. 6103(b) and 38 U.S.C. 6104(b))

[26 FR 1607, Feb. 24, 1961, as amended at 27 FR 8590, Aug. 28, 1962; 53 
FR 17934, May 19, 1988]



Sec.  3.901  Fraud.

    (a) Definition. An act committed when a person knowingly makes or 
causes to be made or conspires, combines, aids, or assists in, agrees 
to, arranges for, or in any way procures the making or presentation of a 
false or fraudulent affidavit, declaration, certificate, statement, 
voucher, or paper,

[[Page 377]]

concerning any claim for benefits under any of the laws administered by 
the Department of Veterans Affairs (except laws relating to insurance 
benefits).
    (b) Effect on claim. For the purposes of paragraph (d) of this 
section, any person who commits fraud forfeits all rights to benefits 
under all laws administered by the Department of Veterans Affairs other 
than laws relating to insurance benefits.
    (c) Forfeiture before September 2, 1959. Where forfeiture for fraud 
was declared before September 2, 1959, in the case of a veteran entitled 
to disability compensation, the compensation payable except for the 
forfeiture may be paid to the veteran's spouse, children and parents 
provided the decision to apportion was authorized prior to September 2, 
1959. The total amount payable will be the lesser of these amounts:


(Authority: 38 U.S.C. 6103)

    (1) Service-connected death benefit payable.
    (2) Amount of compensation payable but for the forfeiture.

No benefits are payable to any person who participated in the fraud 
causing the forfeiture.
    (d) Forfeiture after September 1, 1959. After September 1, 1959, 
forfeiture by reason of fraud may be declared only
    (1) Where the person was not residing or domiciled in a State as 
defined in Sec.  3.1(i) at the time of commission of the fraudulent act; 
or
    (2) Where the person ceased to be a resident of or domiciled in a 
State as defined in Sec.  3.1(i) before expiration of the period during 
which criminal prosecution could be instituted; or
    (3) The fraudulent act was committed in the Philippine Islands.


Where the veteran's rights have been forfeited, no part of his or her 
benefit may be paid to his or her dependents.


(Authority: 38 U.S.C. 6103)

    (e) Remission of forfeitures imposed prior to September 2, 1959. 
Where it is determined that a forfeiture for fraud which was imposed 
prior to September 2, 1959, would not be imposed under the law and 
regulation in effect on and after September 2, 1959, the forfeiture 
shall be remitted effective June 30, 1972. Benefits to which a person 
becomes eligible by virtue of the remission, upon application therefor, 
shall be awarded effective as provided by Sec.  3.114.

(Authority: 38 U.S.C. 6103)

[27 FR 8590, Aug. 28, 1962, as amended at 37 FR 19134, Sept. 19, 1972; 
53 FR 17934, May 19, 1988]



Sec.  3.902  Treasonable acts.

    (a) Definition. An act of mutiny, treason, sabotage or rendering 
assistance to an enemy of the United States or of its allies.
    (b) Effect on claim. For the purposes of paragraph (d) of this 
section, any person determined by the Department of Veterans Affairs to 
be guilty of a treasonable act forfeits all gratuitous benefits under 
laws administered by the Department of Veterans Affairs which he or she 
may be receiving or would have been entitled to receive in the future.
    (c) Forfeiture before September 2, 1959. Where forfeiture for 
treasonable acts was declared before September 2, 1959, the Secretary 
may pay any part of benefits so forfeited to the dependents of the 
person provided the decision to apportion was authorized prior to 
September 2, 1959, except that the amount may not be in excess of that 
which the dependent would be entitled to as a death benefit.


(Authority: 38 U.S.C. 6104(c))

    (1) Compensation. Whenever a veteran entitled to disability 
compensation has forfeited his or her right, any part of the 
compensation payable except for the forfeiture may be paid to the 
veteran's spouse, children and parents. The total amount payable will be 
the lesser of these amounts:
    (i) Service-connected death benefit payable.
    (ii) Amount of compensation payable but for the forfeiture.

No benefits are payable to any person participating in the treasonable 
act causing the forfeiture.
    (2) Pension. Whenever a veteran entitled to pension has forfeited 
his or her right, any part of the pension payable except for the 
forfeiture provision may

[[Page 378]]

be paid to the veteran's spouse and children. The total amount payable 
will be the lesser of these amounts:
    (i) Nonservice-connected death benefit payable.
    (ii) Amount of pension being paid the veteran at the time of 
forfeiture.

No benefits are payable to any person who participated in the 
treasonable act causing the forfeiture.
    (d) Forfeiture after September 1, 1959. After September 1, 1959, 
forfeiture by reason of a treasonable act may be declared only
    (1) Where the person was not residing or domiciled in a State as 
defined in Sec.  3.1(i) at the time of commission of the act; or
    (2) Where the person ceased to be a resident of or domiciled in a 
State as defined in Sec.  3.1(i) before expiration of the period during 
which criminal prosecution could be instituted; or
    (3) The treasonable act was committed in the Philippine Islands.

No part of the benefits forfeited by the person primarily entitled shall 
be paid to any dependent.


(Authority: 38 U.S.C. 6104)

    (e) Children. A treasonable act committed by a child or children, 
regardless of age, who are in the surviving spouse's custody and 
included in an award to such person will not affect the award to the 
surviving spouse.

[27 FR 8590, Aug. 28, 1962; 53 FR 17934, May 19, 1988]



Sec.  3.903  Subversive activities.

    (a) Definition. Any offense for which punishment is prescribed: (1) 
In title 18 U.S.C., sections 792, 793, 794, 798, 2381 through 2385, 2387 
through 2390, and chapter 105;
    (2) In title 18 U.S.C., sections 175, 229, 831, 1091, 2332a, and 
2332b, for claims filed on or after December 17, 2003.
    (3) In the Uniform Code of Military Justice, Articles 94, 104 and 
106 (10 U.S.C. 894, 904, and 906);
    (4) In the following sections of the Atomic Energy Act of 1954: 
Sections 222 through 226 (42 U.S.C. 2272-2276); and
    (5) In section 4 of the Internal Security Act of 1950 (50 U.S.C. 
783).
    (b) Effect on claim. (1) Any person who is convicted after September 
1, 1959, of subversive activities shall from and after the date of 
commission of such offense have no right to gratuitous benefits 
(including the right to burial in a national cemetery) under laws 
administered by the Department of Veterans Affairs based on periods of 
military, naval, or air service commencing before the date of the 
commission of such offense and no other person shall be entitled to such 
benefits on account of such person.
    (2) The Attorney General will notify the Department of Veterans 
Affairs in each case in which a person is indicted or convicted of an 
offense listed in paragraphs (a)(1), (3), and (4) of this section. The 
Secretary of Defense or the Secretary of the Treasury, as may be 
appropriate, will notify the Department of Veterans Affairs in each case 
in which a person is convicted of an offense listed in paragraph (a)(2) 
of this section.
    (c) Presidential pardon. Where any person whose right to benefits 
has been so terminated is granted a pardon of the offense by the 
President of the United States, the right to such benefits shall be 
restored as of the date of such pardon, if otherwise eligible.

(Authority: 38 U.S.C. 6105)

[27 FR 8591, Aug. 28, 1962, as amended at 38 FR 4511, Feb. 15, 1973; 38 
FR 30106, Nov. 1, 1973; 53 FR 17934, May 19, 1988; 71 FR 44919, Aug. 8, 
2006]



Sec.  3.904  Effect of forfeiture after veteran's death.

    (a) Fraud. Whenever a veteran has forfeited his or her right by 
reason of fraud, his or her surviving dependents upon proper application 
may be paid pension, compensation, or dependency and indemnity 
compensation, if otherwise eligible. No benefits are payable to any 
person who participated in the fraud causing the forfeiture.


(Authority: 38 U.S.C. 6103(c))

    (b) Treasonable acts. Death benefits may be paid as provided in 
paragraph (a) of this section where forfeiture by reason of a 
treasonable act was declared before September 2, 1959, and such benefits 
were authorized prior to that date. Otherwise, no award of gratuitous 
benefits (including the right to

[[Page 379]]

burial in a national cemetery) may be made to any person based on any 
period of service commencing before the date of commission of the 
offense which resulted in the forfeiture.


(Authority: 38 U.S.C. 6104(c))

    (c) Subversive activities. Where the veteran was convicted of 
subversive activities after September 1, 1959, no award of gratuitous 
benefits (including the right to burial in a national cemetery) may be 
made to any person based on any period of service commencing before the 
date of commission of the offense which resulted in the forfeiture 
unless the veteran had been granted a pardon of the offense by the 
President of the United States. If pardoned, the veteran's surviving 
dependents upon proper application may be paid pension, compensation or 
dependency and indemnity compensation, if otherwise eligible, and the 
right to burial in a national cemetery is restored.

(Authority: 38 U.S.C. 6105(a))

[27 FR 8591, Aug. 28, 1962, as amended at 38 FR 30106, Nov. 1, 1973; 39 
FR 13970, Apr. 19, 1974; 53 FR 16924, May 19, 1988]



Sec.  3.905  Declaration of forfeiture or remission of forfeiture.

    (a) Jurisdiction. At the regional office level, except in VA 
Regional Office, Manila, Philippines, the Regional Counsel is authorized 
to determine whether the evidence warrants formal consideration as to 
forfeiture. In the Manila Regional Office the Veterans Service Center 
Manager is authorized to make this determination. Submissions may also 
be made by the director of a service, the Chairman, Board of Veterans 
Appeals, and the General Counsel. Jurisdiction to determine whether the 
claimant or payee has forfeited the right to gratuitous benefits or to 
remit a prior forfeiture is vested in the Director, Compensation 
Service, and the Director, Pension and Fiduciary Service, and personnel 
to whom authority has been delegated under the provisions of Sec.  
3.100(c).
    (b) Fraud or treasonable acts. Forfeiture of benefits under Sec.  
3.901 or Sec.  3.902 will not be declared until the person has been 
notified by the Regional Counsel or, in VA Regional Office, Manila, 
Philippines, the Veterans Service Center Manager, of the right to 
present a defense. Such notice shall consist of a written statement sent 
to the person's latest address of record setting forth the following:
    (1) The specific charges against the person;
    (2) A detailed statement of the evidence supporting the charges, 
subject to regulatory limitations on disclosure of information;
    (3) Citation and discussion of the applicable statute;
    (4) The right to submit a statement or evidence within 60 days, 
either to rebut the charges or to explain the person's position;
    (5) The right to a hearing within 60 days, with representation by 
counsel of the person's own choosing, that fees for the representation 
are limited in accordance with 38 U.S.C. 5904(c) and that no expenses 
incurred by a claimant, counsel or witness will be paid by VA.
    (c) Subversive activities. Automatic forfeiture of benefits under 
Sec.  3.903 will be effectuated by an official authorized to declare a 
forfeiture as provided in paragraph (a) of this section.
    (d) Finality of decisions. A decision of forfeiture is subject to 
the provisions of Sec.  3.104(a) and Sec. Sec.  20.1103 and 20.1104 of 
this chapter. The officials authorized to file administrative appeals 
and the time limit for filing such appeals are set forth in Sec.  19.51 
of this chapter.
    (e) Remission of forfeiture. In event of remission of forfeiture 
under Sec.  3.901(e), any amounts paid as an apportionment(s) during 
periods of the previously forfeited beneficiary's reentitlement will be 
offset.

    Cross References: Effective dates; forfeiture. See Sec.  3.400(m). 
Reductions and discontinuances; fraud. See Sec.  3.500(k). Reductions 
and discontinuances; treasonable acts or subversive activities. See 
Sec.  3.500(s). Adjustments and resumptions. See Sec.  3.669. Burial 
benefits. See Sec.  3.1609.

[28 FR 2234, Mar. 7, 1963, as amended at 29 FR 7547, June 12, 1964; 37 
FR 19134, Sept. 19, 1972; 39 FR 13970, Apr. 19, 1974; 53 FR 17934, May 
19, 1988; 58 FR 32443, June 10, 1993; 79 FR 2100, Jan. 13, 2014]

[[Page 380]]

                               Protection



Sec.  3.950  Helpless children; Spanish-American and prior wars.

    Marriage is not a bar to the payment of pension or compensation to a 
helpless child under an award approved prior to April 1, 1944. The 
presumption, arising from the fact of marriage, that helplessness has 
ceased may be overcome by positive proof of continuing helplessness. As 
to awards approved on or after April 1, 1944, pension or compensation 
may not be paid to a helpless child who has married.

[26 FR 1608, Feb. 24, 1961]



Sec.  3.951  Preservation of disability ratings.

    (a) A readjustment to the Schedule for Rating Disabilities shall not 
be grounds for reduction of a disability rating in effect on the date of 
the readjustment unless medical evidence establishes that the disability 
to be evaluated has actually improved.


(Authority: 38 U.S.C. 1155)

    (b) A disability which has been continuously rated at or above any 
evaluation of disability for 20 or more years for compensation purposes 
under laws administered by the Department of Veterans Affairs will not 
be reduced to less than such evaluation except upon a showing that such 
rating was based on fraud. Likewise, a rating of permanent total 
disability for pension purposes which has been in force for 20 or more 
years will not be reduced except upon a showing that the rating was 
based on fraud. The 20-year period will be computed from the effective 
date of the evaluation to the effective date of reduction of evaluation.

(Authority: 38 U.S.C. 110)

[34 FR 11970, July 16, 1969, as amended at 57 FR 10426, Mar. 26, 1992]



Sec.  3.952  Protected ratings.

    Ratings under the Schedule of Disability Ratings, 1925, which were 
the basis of compensation on April 1, 1946, are subject to modification 
only when a change in physical or mental condition would have required a 
reduction under the 1925 schedule, or an increased evaluation has been 
assigned under the Schedule for Rating Disabilities, 1945 (looseleaf 
edition), after which time all evaluations will be under the 1945 
schedule (loose-leaf edition) only. Such increased evaluations must be 
of an other than temporary nature (due to hospitalization, surgery, 
etc.). When a temporary evaluation is involved, the 1925 schedule 
evaluation will be restored after the period of increase has elapsed 
unless the permanent residuals would have required reduction under that 
schedule, or unless an increased evualation would be assignable under a 
1945 schedule (looseleaf edition) rating. In any instance where the 
changed condition represents an increased degree of disability under 
either rating schedule but the evaluation provided by the 1945 schedule 
(looseleaf edition) is less than the evaluation in effect under the 1925 
schedule on April 1, 1946, the 1925 schedule evaluation and award are 
protected.

[26 FR 12766, Dec. 30, 1961]



Sec.  3.953  Pub. L. 85-56 and Pub. L. 85-857.

    (a) In receipt of or entitled to receive benefits on December 31, 
1958. Any person receiving or entitled to receive benefits under any 
public law administered by the Department of Veterans Affairs on 
December 31, 1958, may, except where there was fraud, clear and 
unmistakable error of fact or law, or misrepresentation of material 
facts, continue to receive such benefits as long as the conditions 
warranting such payment under those laws continue. The greater benefit 
under the previous law or the corresponding section of title 38 U.S.C., 
will be paid in the absence of an election to receive the lesser 
benefit.


(Authority: Section 10, Pub. L. 85-857)

    (b) Emergency officers' retirement pay. Any person who was 
receiving, or entitled to receive, emergency officers' retirement pay, 
or other privileges or benefits as a retired emergency officer of World 
War I, on December 31, 1958, under the laws in effect on that day, will, 
except where there was fraud,

[[Page 381]]

clear and unmistakable error as to conclusion of fact or law, or 
misrepresentation of material facts, continue to receive, or be entitled 
to receive, emergency officers' retirement pay at the rate otherwise 
payable on December 31, 1958, and such other privileges and benefits, so 
long as the conditions warranting such pay, privileges, and benefits 
under those laws continue.


(Authority: Section 11, Pub. L. 85-857)

    (c) Service connection established under prior laws. In the absence 
of fraud, misrepresentation of material facts or clear and unmistakable 
error, all cases where compensation was payable on December 31, 1957, 
for disability service connected under prior laws, repealed by Pub. L. 
85-56, including those service connected under the second proviso of 
section 200 of the World War Veterans' Act, 1924, as amended, are 
protected by section 2316(b), Pub. L. 85-56 and section 10, Pub. L. 85-
857 as to both service connection and rate of compensation, so long as 
the conditions warranting such status and rate continue. Any disability 
so service connected may be evaluated under the Schedule for Rating 
Disabilities, 1945 (looseleaf edition) and benefits awarded on the basis 
thereof, as well as special monthly compensation under 38 U.S.C. 1114, 
provided such action results in compensation payable at a rate equal to 
or higher than that payable on December 31, 1957. Where a changed 
physical condition warrants reevaluation of service-connected 
disabilities, compensation will be awarded under the provisions of 38 
U.S.C. 1114.

[26 FR 1608, Feb. 24, 1961, as amended at 26 FR 8561, Sept. 13, 1961; 26 
FR 12766, Dec. 30, 1961]



Sec. Sec.  3.955-3.956  [Reserved]



Sec.  3.957  Service connection.

    Service connection for any disability or death granted or continued 
under title 38 U.S.C., which has been in effect for 10 or more years 
will not be severed except upon a showing that the original grant was 
based on fraud or it is clearly shown from military records that the 
person concerned did not have the requisite service or character of 
discharge. The 10-year period will be computed from the effective date 
of the Department of Veterans Affairs finding of service connection to 
the effective date of the rating decision severing service connection, 
after compliance with Sec.  3.105(d). The protection afforded in this 
section extends to claims for dependency and indemnity compensation or 
death compensation.

(Authority: 38 U.S.C. 1159)

[33 FR 15286, Oct. 15, 1968]



Sec.  3.958  Federal employees' compensation cases.

    Any award approved prior to September 13, 1960, authorizing 
Department of Veterans Affairs benefits concurrently with an award of 
benefits under the Federal Employees' Compensation Act based on a 
finding that the same disability or death was due to civilian employment 
is not affected by the prohibition against concurrent awards contained 
in 5 U.S.C. 8116(b).

[41 FR 20408, May 18, 1976]



Sec.  3.959  Tuberculosis.

    Any veteran who, on August 19, 1968, was receiving or entitled to 
receive compensation for active or inactive (arrested) tuberculosis may 
receive compensation under 38 U.S.C. 1114(q) and 1156 as in effect 
before August 20, 1968.

(Authority: Pub. L. 90-493; 82 Stat. 809)

[33 FR 16275, Nov. 6, 1968]



Sec.  3.960  Section 306 and old-law pension protection.

    (a) General. Except as provided in paragraphs (b) and (c) of this 
section, any person eligible to elect improved pension under Sec.  3.711 
or 3.712 who is in receipt of section 306 or old-law pension on December 
31, 1978, shall in the absence of an election to receive improved 
pension, continue to receive such pension at the monthly rate payable on 
December 31, 1978.
    (b) Termination. Pension payable under paragraph (a) of this section 
shall be terminated for any one of the following reasons:
    (1) A veteran pensioner ceases to be permanently and totally 
disabled.

[[Page 382]]

    (2) A surviving spouse pensioner ceases to meet the definition of 
surviving spouse in 38 U.S.C. 101(3).
    (3) A child pensioner ceases to meet the definition of child in 38 
U.S.C. 101(4).
    (4) A section 306 pensioner's countable annual income, determined 
under Sec. Sec.  3.250 to 3.270, exceeds the applicable amount stated in 
Sec.  3.26(a).
    (5) An old-law pensioner's countable annual income determined under 
Sec. Sec.  3.250 to 3.270 exceeds the applicable amount stated in Sec.  
3.26(c).
    (6) A section 306 pensioner has a net worth of such size that it is 
reasonable that some part of it be consumed for the pensioner's 
maintenance. Evaluation of net worth shall be made under Sec.  3.263.
    (c) Reduction. The pension rate payable under paragraph (a) of this 
section shall be reduced by the amount of any additional pension payable 
by reason of a dependent upon the loss of such dependent. A veteran or 
surviving spouse who no longer has any dependents shall not continue to 
receive either section 306 pension or old-law pension if countable 
annual income exceeds the appropriate rate in Sec.  3.26(a), (b), or 
(c).
    (d) Finality of termination. Termination of section 306 pension or 
old-law pension for one of the reasons listed in paragraph (b) of this 
section precludes a person from thereafter establishing entitlement 
under any other pension program except the improved pension program.

(Authority: Sec. 306 of Pub. L. 95-588, 92 Stat. 2497)

[44 FR 45944, Aug. 6, 1979, as amended at 56 FR 28824, June 25, 1991]

                                 Accrued



Sec.  3.1000  Entitlement under 38 U.S.C. 5121 to benefits due and unpaid
upon death of a beneficiary.

    (a) Basic entitlement. Except as provided in Sec. Sec.  3.1001 and 
3.1008, where death occurred on or after December 1, 1962, periodic 
monetary benefits (other than insurance and servicemembers' indemnity) 
authorized under laws administered by the Department of Veterans 
Affairs, to which a payee was entitled at his or her death under 
existing ratings or decisions or those based on evidence in the file at 
date of death, and due and unpaid will, upon the death of such person, 
be paid as follows:


(Authority: 38 U.S.C. 5121(a)

    (1) Upon the death of a veteran to the living person first listed as 
follows:
    (i) His or her spouse;
    (ii) His or her children (in equal shares);
    (iii) His or her dependent parents (in equal shares) or the 
surviving parent.
    (2) Upon the death of a surviving spouse or remarried surviving 
spouse, to the veteran's children.
    (3) Upon the death of a child, to the surviving children of the 
veteran entitled to death pension, compensation, or dependency and 
indemnity compensation.
    (4) Upon the death of a child claiming benefits under chapter 18 of 
this title, to the surviving parents.
    (5) In all other cases, only so much of the accrued benefit may be 
paid as may be necessary to reimburse the person who bore the expense of 
last sickness or burial. (See Sec.  3.1002.)
    (b) Apportionments. (1) Upon the death of a person receiving an 
apportioned share of benefits payable to a veteran, all or any part of 
such unpaid amount is payable to the veteran or to any other dependent 
or dependents of the veteran.


(Authority: 38 U.S.C. 5121(a)(1))

    (2) Where at the date of death of the veteran an apportioned share 
is being paid to or has been withheld on behalf of another person, the 
apportioned amount remaining unpaid for periods prior to the last day of 
the month before the veteran's death is payable to the apportionee.
    (3) Where the accrued death pension, compensation or dependency and 
indemnity compensation was payable for a child as an apportioned share 
of the surviving spouse's benefit, payment will be made under the 
provisions of paragraph (a)(5) of this section, on the expenses of such 
deceased child's last sickness or burial.
    (c) Claims and evidence. Application for accrued benefits must be 
filed within 1 year after the date of death. A claim for death pension, 
compensation,

[[Page 383]]

or dependency and indemnity compensation, by an apportionee, surviving 
spouse, child or parent is deemed to include claim for any accrued 
benefits. (See Sec.  3.152(b)).
    (1) If an application for accrued benefits is incomplete because the 
claimant has not furnished information necessary to establish that he or 
she is within the category of eligible persons under the provisions of 
paragraphs (a)(1) through (a)(5) or paragraph (b) of this section and 
that circumstances exist which make the claimant the specific person 
entitled to payment of all or part of any benefits which may have 
accrued, VA shall notify the claimant:
    (i) Of the type of information required to complete the application;
    (ii) That VA will take no further action on the claim unless VA 
receives the required information; and
    (iii) That if VA does not receive the required information within 1 
year of the date of the original VA notification of information 
required, no benefits will be awarded on the basis of that application.
    (2) Failure to file timely claim, or a waiver of rights, by a 
preferred dependent will not serve to vest title in a person in a lower 
class or a claimant for reimbursement; neither will such failure or 
waiver by a person or persons in a joint class serve to increase the 
amount payable to another or others in the class.


(Authority: 38 U.S.C. 5121(c); 5112(b))

    (d) Definitions. (1) Spouse means the surviving spouse of the 
veteran, whose marriage meets the requirements of Sec.  3.1(j) or Sec.  
3.52. Where the marriage meets the requirements of Sec.  3.1(j) date of 
marriage and continuous cohabitation are not factors.
    (2) Child is as defined in Sec.  3.57 and includes an unmarried 
child who became permanently incapable of self-support prior to 
attaining 18 years of age as well as an unmarried child over the age of 
18 but not over 23 years of age, who was pursuing a course of 
instruction within the meaning of Sec.  3.57 at the time of the payee's 
death. However, upon the death of a child in receipt of death pension, 
compensation, or dependency and indemnity compensation, any accrued will 
be payable to the surviving child or children of the veteran entitled to 
death pension, compensation, or dependency and indemnity compensation. 
Upon the death of a child, another child who has elected dependents' 
educational assistance under 38 U.S.C. chapter 35 may receive accrued 
death pension, compensation, or dependency and indemnity compensation, 
payable on behalf of the deceased child for periods prior to the 
commencement of benefits under that chapter.
    (3) Dependent parent is as defined in Sec.  3.59: Provided, That the 
mother or father was dependent within the meaning of Sec.  3.250 at the 
date of the veteran's death.
    (4) Evidence in the file at date of death means evidence in VA's 
possession on or before the date of the beneficiary's death, even if 
such evidence was not physically located in the VA claims folder on or 
before the date of death, in support of a claim for VA benefits pending 
on the date of death.
    (5) Claim for VA benefits pending on the date of death means a claim 
filed with VA that had not been finally adjudicated by VA on or before 
the date of death. Such a claim includes a deceased beneficiary's claim 
to reopen a finally disallowed claim based upon new and material 
evidence or a deceased beneficiary's claim of clear and unmistakable 
error in a prior rating or decision. Any new and material evidence must 
have been in VA's possession on or before the date of the beneficiary's 
death.
    (e) Subsistence allowance. Subsistence allowance under the 
provisions of 38 U.S.C. ch. 31 remaining due and unpaid at the date of 
the veteran's death, is payable under the provisions of this section.
    (f) Dependents' educational assistance. Educational assistance 
allowance or special restorative training allowance under 38 U.S.C. ch. 
35, remaining due and unpaid at the date of death of an eligible 
surviving spouse or eligible child is payable to a child or children of 
the veteran (see paragraphs (a)(2), (a)(3) and (d)(2) of this section), 
or on the expenses of last sickness and burial (see paragraph (a)(5) of 
this section.) Benefits due and unpaid at the date of death of an 
eligible spouse are payable only on the expenses of last sickness

[[Page 384]]

and burial (see paragraph (a)(5) of this section).
    (g) Veterans educational assistance. Educational assistance 
allowance under 38 U.S.C chapters 30, 32, or 34, and 10 U.S.C. chapter 
1606 remaining due and unpaid at the date of the veteran's death is 
payable under the provisions of this section.


(Authority: 38 U.S.C. 5121)

    (h) Clothing allowance. Clothing allowance under 38 U.S.C. 1162 
remaining due and unpaid at the date of the veteran's death is payable 
under the provisions of this section.
    (i) Active service pay. Benefits awarded under this section do not 
include compensation or pension benefits for any period for which the 
veteran received active service pay.

(Authority: 38 U.S.C. 5304(c))

[26 FR 1608, Feb. 24, 1961, as amended at 27 FR 11892, Dec. 1, 1962; 30 
FR 11389, Sept. 8, 1965; 31 FR 4790, Mar. 22, 1966; 34 FR 840, Jan. 18, 
1969; 39 FR 15126, May 1, 1974; 56 FR 18733, Apr. 24, 1991; 56 FR 24239, 
May 29, 1991; 61 FR 67950, Dec. 26, 1996; 62 FR 5529, Feb. 6, 1997; 62 
FR 35423, July 1, 1997; 67 FR 65708, Oct. 28, 2002; 71 FR 78369, Dec. 
29, 2006; 80 FR 18117, Apr. 3, 2015]



Sec.  3.1001  Hospitalized competent veterans.

    The provisions of this section apply only to the payment of amounts 
actually withheld on a running award under Sec.  3.551(b) which are 
payable in a lump sum after the veteran's death.
    (a) Basic entitlement. Where an award of disability pension for a 
competent veteran without dependents was reduced because of hospital 
treatment or institutional or domiciliary care by the Department of 
Veterans Affairs and the veteran dies while receiving such treatment or 
care or before payment of amounts withheld, the lump sum is payable to 
the living person first listed as follows:
    (1) The veteran's spouse, as defined in Sec.  3.1000(d)(1);
    (2) The veteran's children (in equal shares), as defined in Sec.  
3.57 but without regard to their age or marital status;
    (3) The veteran's dependent parents (in equal shares), or the 
surviving dependent parent, as defined in Sec.  3.1000(d)(3);
    (4) In all other cases, only so much of the lump sum may be paid as 
may be necessary to reimburse a person who bore the expenses of last 
sickness or burial. (See Sec.  3.1002.)
    (b) Claim. Applications must be filed with the Department of 
Veterans Affairs within 5 years after the death of the veteran. If, 
however, any person otherwise entitled is under legal disability at the 
time of the veteran's death, the 5-year period will run from the date of 
termination or removal of the legal disability.
    (1) There is no time limit on the retroactive period of an award or 
for furnishing evidence.
    (2) Failure to file timely claim, or a waiver of rights, by a 
preferred dependent will not serve to vest title in a person in a lower 
class or a claimant for reimbursement; neither will such failure or 
waiver by a person or persons in a joint class serve to increase the 
amount payable to another or others in the class.
    (c) Lump sum withheld after discharge from institution. The 
provisions of paragraphs (a) and (b) of this section will apply in the 
event of the death of any veteran prior to receiving a lump sum which 
was withheld because treatment or care was terminated against medical 
advice or as the result of disciplinary action.

(Authority: 38 U.S.C. 5503)

[26 FR 1609, Feb. 24, 1961, as amended at 27 FR 5539, June 12, 1962; 27 
FR 8177, Aug. 16, 1962; 27 FR 11893, Dec. 1, 1962; 39 FR 15126, May 1, 
1974]



Sec.  3.1002  Political subdivisions of United States.

    No part of any accrued benefits will be used to reimburse any 
political subdivision of the United States for expenses incurred in the 
last sickness or burial of any beneficiary. (See Sec.  3.1(o)).

(Authority: 38 U.S.C. 5121(b) and 5502(d))

[39 FR 15126, May 1, 1974]



Sec.  3.1003  Returned and canceled checks.

    Where the payee of a check for benefits has died prior to 
negotiating the check, the check shall be returned to the issuing office 
and canceled.

[[Page 385]]

    (a) The amount represented by the returned check, or any amount 
recovered following improper negotiation of the check, shall be payable 
to the living person or persons in the order of precedence listed in 
Sec.  3.1000(a)(1) through (5), except that the total amount payable 
shall not include any payment for the month in which the payee died (see 
Sec.  3.500(g)), and payments to persons described in Sec.  3.1000(a)(5) 
shall be limited to the amount necessary to reimburse such persons for 
the expenses of last sickness and/or burial.
    (1) There is no limit on the retroactive period for which payment of 
the amount represented by the check may be made, and no time limit for 
filing a claim to obtain the proceeds of the check or for furnishing 
evidence to perfect a claim.
    (2) Nothing in this section will preclude payment to an otherwise 
entitled claimant having a lower order of precedence under Sec.  
3.1000(a)(1) through (5), if it is shown that the person or persons 
having a higher order of precedence are deceased at the time the claim 
is adjudicated.
    (b) Subject to the limitations in Sec.  3.500(g) of this part, any 
amount not paid in the manner provided in paragraph (a) of this section 
shall be paid to the estate of the deceased payee, provided that the 
estate, including the amount paid under this paragraph, will not will 
not revert to the state because there is no one eligible to inherit it.
    (c) The provisions of this section do not apply to checks for lump 
sums representing amounts withheld under Sec.  3.551(b) or Sec.  3.557. 
These amounts are subject to the provisions of Sec. Sec.  3.1001 and 
3.1007, as applicable.

(Authority: 38 U.S.C. 501(a), 5122)

[59 FR 25329, May 16, 1994, as amended at 64 FR 54207, Oct. 6, 1999; 80 
FR 18117, Apr. 3, 2015]



Sec. Sec.  3.1004-3.1006  [Reserved]



Sec.  3.1007  Hospitalized incompetent veterans.

    Where an award of disability pension for an incompetent veteran 
without dependents was reduced under Sec.  3.551(b) because of 
hospitalization, institutional or domiciliary care by the Department of 
Veterans Affairs, or an award of disability pension, compensation or 
emergency officers' retirement pay was discontinued under former Sec.  
3.557(b) (as applicable prior to December 27, 2001) because the veteran 
was hospitalized by the United States or a political subdivision and had 
an estate which equaled or exceeded the statutory maximum, and the 
veteran dies before payment of amounts withheld or not paid by reason of 
such care, no part of such amount will be paid to any person. The 
provisions of this section are applicable to amounts withheld for 
periods prior to as well as subsequent to the rating of incompetency. 
The term dies before payment includes cases in which a check was issued 
and the veteran died before negotiating the check.

(Authority: 38 U.S.C. 5503)

[39 FR 30349, Aug. 22, 1974, as amended at 66 FR 48561, Sept. 21, 2001; 
68 FR 34543, June 10, 2003]



Sec.  3.1008  Accrued benefits payable to foreign beneficiaries.

    In case of death of the payee of any check in payment of periodic 
monetary benefits (other than insurance and servicemembers' indemnity) 
accruing under laws administered by the Department of Veterans Affairs, 
while the amount thereof remains in the special deposit account 
established by Pub. L. 828, 76th Congress, such amount will be payable 
under section 3 of that act. (31 U.S.C. 125) However, the accrued amount 
will be payable only if the person on whose behalf checks were issued 
and the person claiming the accrued amount have not been guilty of 
mutiny, treason, sabotage, or rendering assistance to an enemy of the 
United States or of its allies.

[26 FR 1609, Feb. 24, 1961]



Sec.  3.1009  Personal funds of patients.

    The provisions of this section are applicable to gratuitous benefits 
deposited by the Department of Veterans Affairs either before, on, or 
after December 1, 1959, in a personal funds of patients account for an 
incompetent veteran who was incompetent at the date of death. Where the 
veteran died after November 30, 1959:

[[Page 386]]

    (a) Eligible persons. Gratuitous benefits shall be paid to the 
living person first listed as follows:
    (1) His or her spouse, as defined in Sec.  3.1000(d)(1);
    (2) His or her children (in equal shares), as defined in Sec.  3.57 
but without regard to their age or marital status;
    (3) His or her dependent parents (in equal shares) as defined in 
Sec.  3.59 or the surviving parent, provided that the parent was 
dependent within the meaning of Sec.  3.250 at the date of the veteran's 
death.
    (4) In all other cases, only so much may be paid as may be necessary 
to reimburse a person who bore the expense of last sickness or burial. 
(See Sec.  3.1002.)


(Authority: 38 U.S.C. 5502(d))

    (b) Claim. Application must be filed with the Department of Veterans 
Affairs within 5 years after the death of the veteran. If, however, any 
person otherwise entitled is under legal disability at the time of the 
veteran's death, the 5-year period will run from the date of termination 
or removal of the legal disability.
    (1) There is no time limit for the submission of evidence.
    (2) Failure to file timely claim, or a waiver of rights, by a 
preferred dependent will not serve to vest title in a person in a lower 
class or a claimant for reimbursement; neither will such failure or 
waiver by a person or persons in a joint class serve to increase the 
amount payable to another or others in the class.

[27 FR 5539, June 12, 1962, as amended at 28 FR 10487, Sept. 28, 1963; 
39 FR 30349, Aug. 22, 1974]



Sec.  3.1010  Substitution under 38 U.S.C. 5121A following death of a
claimant.

    (a) Eligibility. If a claimant dies on or after October 10, 2008, a 
person eligible for accrued benefits under Sec.  3.1000(a) listed in 38 
CFR 3.1000(a)(1) through (5) may, in priority order, request to 
substitute for the deceased claimant in a claim for periodic monetary 
benefits (other than insurance and servicemembers' indemnity) under laws 
administered by the Secretary, or an appeal of a decision with respect 
to such a claim, that was pending before the agency of original 
jurisdiction or the Board of Veterans' Appeals when the claimant died. 
Upon VA's grant of a request to substitute, the substitute may continue 
the claim or appeal on behalf of the deceased claimant for purposes of 
processing the claim or appeal to completion. Any benefits ultimately 
awarded are payable to the substitute and other members of a joint 
class, if any, in equal shares.
    (b) Time and place for filing a request. A person may not substitute 
for a deceased claimant under this section unless the person files a 
request to substitute with the agency of original jurisdiction no later 
than one year after the claimant's death.
    (c) Request format. (1) A request to substitute must be submitted in 
writing. At a minimum, a request to substitute must indicate intent to 
substitute; include the deceased claimant's claim number, Social 
Security number, or appeal number; and include the names of the deceased 
claimant and the person requesting to substitute.
    (2) In lieu of a specific request to substitute, a claim for accrued 
benefits, survivors pension, or dependency and indemnity compensation by 
an eligible person listed in Sec.  3.1000(a)(1) through (5) is deemed to 
include a request to substitute if a claim for periodic monetary 
benefits (other than insurance and servicemembers' indemnity) under laws 
administered by the Secretary, or an appeal of a decision with respect 
to such a claim, was pending before the agency of original jurisdiction 
or the Board of Veterans' Appeals when the claimant died. A claimant for 
accrued benefits, survivors pension, or dependency and indemnity 
compensation may waive the right to substitute in writing over the 
claimant's signature.
    (d) Evidence of eligibility. A person filing a request to substitute 
must provide evidence of eligibility to substitute. Evidence of 
eligibility to substitute means evidence demonstrating that the person 
is among those listed in the categories of eligible persons in Sec.  
3.1000(a)(1) through (5) and first in priority order. If a person's 
request to substitute does not include evidence of

[[Page 387]]

eligibility when it is originally submitted and the person may be an 
eligible person, the Secretary will notify the person--
    (1) Of the evidence of eligibility required to complete the request 
to substitute;
    (2) That VA will take no further action on the request to substitute 
unless VA receives the evidence of eligibility; and
    (3) That VA must receive the evidence of eligibility no later than 
60 days after the date of notification or one year after the claimant's 
death, whichever is later, or VA will deny the request to substitute.
    (e) Decisions on substitution requests. Subject to the provisions of 
Sec.  20.1302 of this chapter, the agency of original jurisdiction will 
decide in the first instance all requests to substitute, including any 
request to substitute in an appeal pending before the Board of Veterans' 
Appeals.
    (1) Notification. The agency of original jurisdiction will provide 
written notification of the granting or denial of a request to 
substitute to the person who filed the request, together with notice in 
accordance with Sec.  3.103(b)(1).
    (2) Appeals. The denial of a request to substitute may be appealed 
to the Board of Veterans' Appeals pursuant to 38 U.S.C. 7104(a) and 
7105.
    (3) Joint class representative. (i) A joint class means a group of 
two or more persons eligible to substitute under the same priority group 
under Sec.  3.1000(a)(1) through (a)(5), e.g., two or more surviving 
children.
    (ii) In the case of a joint class of potential substitutes, only one 
person of the joint class may be a substitute at any one time. The first 
eligible person in the joint class to file a request to substitute will 
be the substitute representing the joint class.
    (f) Adjudications involving a substitute. The following provisions 
apply with respect to a claim or appeal in which a survivor has been 
substituted for the deceased claimant:
    (1) Notice under Sec.  3.159. VA will send notice under Sec.  
3.159(b), ``Department of Veterans Affairs assistance in developing 
claims,'' to the substitute only if the required notice was not sent to 
the deceased claimant or if the notice sent to the deceased claimant was 
inadequate.
    (2) Expansion of the claim not permitted. A substitute may not add 
an issue to or expand the claim. However, a substitute may raise new 
theories of entitlement in support of the claim.
    (3) Submission of evidence and other rights. A substitute has the 
same rights regarding hearings, representation, appeals, and the 
submission of evidence as would have applied to the claimant had the 
claimant not died. However, rights that may have applied to the claimant 
prior to death but which cannot practically apply to a substitute, such 
as the right to a medical examination, are not available to the 
substitute. The substitute must complete any action required by law or 
regulation within the time period remaining for the claimant to take 
such action on the date of his or her death. The time remaining to take 
such action will start to run on the date of the mailing of the decision 
granting the substitution request.
    (4) Board of Veterans' Appeals procedures. The rules and procedures 
governing appeals involving substitutes before the Board of Veterans' 
Appeals are found in parts 19 and 20 of this chapter.
    (g) Limitations on substitution. The following limitations apply 
with respect to substitution:
    (1) A claim or appeal must be pending. (i) A claim is considered to 
be pending if the claimant had filed the claim with an agency of 
original jurisdiction but dies before the agency of original 
jurisdiction makes a decision on the claim. A claim is also considered 
to be pending if, at the time of the claimant's death, the agency of 
original jurisdiction has made a decision on the claim, but the claimant 
has not filed a notice of disagreement, and the period allowed by law 
for filing a notice of disagreement has not expired.
    (ii) An appeal is considered to be pending if a claimant filed a 
notice of disagreement in response to a notification from an agency of 
original jurisdiction of its decision on a claim, but

[[Page 388]]

dies before the Board of Veterans' Appeals issues a final decision on 
the appeal. If the Board issued a final decision on an appeal prior to 
the claimant's death, the appeal is not pending before VA for purposes 
of this section, even if the 120-day period for appealing the Board's 
decision to the Court of Appeals for Veterans Claims has not yet 
expired.
    (2) Benefits awarded. Any benefits ultimately awarded are limited to 
any past-due benefits for the time period between the effective date of 
the award and what would have been the effective date of discontinuance 
of the award as a result of the claimant's death.
    (3) Benefits for last sickness and burial only. When substitution 
cannot be established under any of the categories listed in Sec.  
3.1000(a)(1) through (a)(4), only so much of any benefits ultimately 
awarded may be paid as may be necessary to reimburse the person who bore 
the expense of last sickness and burial. No part of any benefits 
ultimately awarded shall be used to reimburse any political subdivision 
of the United States for expenses incurred in the last sickness or 
burial of any claimant.
    (4) Substitution by subordinate members prohibited. Failure to 
timely file a request to substitute, or a waiver of the right to request 
substitution, by a person of a preferred category of eligible person 
will not serve to vest the right to request substitution in a person in 
a lower category or a person who bore the expense of last sickness and 
burial; neither will such failure or waiver by a person or persons in a 
joint class serve to increase the amount payable to other persons in the 
class.
    (5) Death of a substitute. If a substitute dies while a claim or 
appeal is pending before an agency of original jurisdiction, or an 
appeal of a decision on a claim is pending before the Board, another 
member of the same joint class or a member of the next preferred 
subordinate category listed in Sec.  3.1000(a)(1) through (5) may 
substitute for the deceased substitute but only if the person requesting 
the successive substitution files a request to substitute no later than 
one year after the date of the substitute's death (not the date of the 
claimant's death).

(Authority: 38 U.S.C. 5121, 5121A)


(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0740)

[79 FR 52982, Sept. 5, 2014]



                        Subpart B_Burial Benefits

    Source: 79 FR 32658, June 6, 2014, unless otherwise noted.

    Authority: 105 Stat. 386, 38 U.S.C. 501(a), 2302-2308, unless 
otherwise noted.

                        Burial Benefits: General



Sec.  3.1700  Types of VA burial benefits.

    (a) Burial benefits. VA provides the following types of burial 
benefits, which are discussed in Sec. Sec.  3.1700 through 3.1712:
    (1) Burial allowance based on service-connected death;
    (2) Burial allowance based on non-service-connected death;
    (3) Burial allowance for a veteran who died while hospitalized by 
VA;
    (4) Burial plot or interment allowance; and
    (5) Reimbursement for transportation of remains.
    (b) Definition. For purposes of this subpart, burial means all the 
legal methods of disposing of the remains of a deceased person, 
including, but not limited to, cremation, burial at sea, and medical 
school donation.
    (c) Cross references. (1) Other benefits and services related to the 
memorialization or interment of a deceased veteran and certain survivors 
include the following:
    (i) Burial in a national cemetery (see Sec. Sec.  38.600 and 38.617 
through 38.629 of this chapter);
    (ii) Presidential memorial certificates (see 38 U.S.C. 112);
    (iii) Burial flags (see Sec.  1.10 of this chapter); and
    (iv) Headstones or markers (see Sec. Sec.  38.630 through 38.633 of 
this chapter).
    (2) The provisions of Sec. Sec.  3.1702 through 3.1711 do not apply 
to any of the programs listed in paragraph (c)(1) of this section.

[[Page 389]]



Sec.  3.1701  Deceased veterans for whom VA may provide burial benefits.

    For purposes of providing burial benefits under subpart B of this 
part, the term ``veteran'' means the same as provided in 38 U.S.C. 
101(2). A veteran must be deceased, and burial benefits for that veteran 
must be authorized by a specific provision of law. For purposes of the 
non-service-connected burial allowance under 38 U.S.C. 2302, the term 
``veteran'' includes a person who died during a period deemed to be 
active military, naval, or air service under Sec. Sec.  3.6(b)(7), 
3.7(m) and 3.7(o).

(Authority: 38 U.S.C. 101(2), 2302, 2303, 2307, 2308)



Sec.  3.1702  Persons who may receive burial benefits; priority 
of payments.

    (a) Automatic payments to surviving spouses of eligible deceased 
veterans. (1) On or after July 7, 2014, VA may automatically pay a 
burial benefit to an eligible veteran's surviving spouse, whether or not 
previously established as a dependent spouse on the deceased veteran's 
compensation or pension award, when VA knows of or is informed of the 
existence of the surviving spouse, can establish the surviving spouse's 
relationship under Sec.  3.204 (when applicable), and is able to 
determine burial benefits eligibility based on evidence of record at the 
time VA updates its computer system to reflect the veteran's date of 
death.
    (2) VA may grant additional burial benefits, including the plot or 
interment allowance, reimbursement for transportation, and the service-
connected burial allowance under Sec.  3.1704, to the surviving spouse 
or any other eligible person in accordance with paragraph (b) of this 
section and based on a claim described in Sec.  3.1703.
    (b) Priority of payments--claims received on or after July 7, 2014. 
(1) Except for claims a State, or an agency or political subdivision of 
a State, files under Sec.  3.1707, Plot or interment allowance for 
burial in a State veterans cemetery or other cemetery, or Sec.  3.1708, 
Burial of a veteran whose remains are unclaimed, VA will pay, upon the 
death of a veteran, the first living person to file of those listed 
below:
    (i) His or her surviving spouse;
    (ii) The survivor of a legal union between the deceased veteran and 
the survivor that is not covered by paragraph (b)(1)(i) of this section. 
For purposes of this paragraph, legal union means a formal relationship 
between the decedent and the survivor that
    (A) Existed on the date of the veteran's death,
    (B) Was recognized under the law of the State in which the couple 
formalized the relationship, and
    (C) Was evidenced by the State's issuance of documentation 
memorializing the relationship;
    (iii) His or her children, regardless of age;
    (iv) His or her parents or the surviving parent; or
    (v) The executor or administrator of the estate of the deceased 
veteran. If no executor or administrator has been appointed, VA may pay 
burial benefits based on a claim filed by a person acting for such 
estate who will distribute the burial benefits to the person or persons 
entitled to such distribution under the laws of the veteran's last State 
of residence.
    (2) In the case of a veteran whose remains are unclaimed, VA will 
pay the person or entity that provided burial services and 
transportation subject to the limitations prescribed in Sec. Sec.  
3.1708 and 3.1709.
    (3) VA will pay burial benefits to a single representative of the 
categories in paragraph (b)(1) of this section. VA will not divide 
applicable burial benefits among claimants; it is the responsibility of 
the recipient to distribute benefits as may be required.
    (c) Priority of payments--claims received before July 7, 2014.
    (1) Claims for burial allowance may be executed by:
    (i) The funeral director, if entire bill or any balance is unpaid 
(if unpaid bill or the unpaid balance is less than the applicable 
statutory burial allowance, only the unpaid amount may be claimed by the 
funeral director); or
    (ii) The individual whose personal funds were used to pay burial, 
funeral, and transportation expenses; or
    (iii) The executor or administrator of the estate of the veteran or 
the estate of the person who paid the expenses of the veteran's burial 
or provided such

[[Page 390]]

services. If no executor or administrator has been appointed then by 
some person acting for such estate who will make distribution of the 
burial allowance to the person or persons entitled under the laws 
governing the distribution of interstate estates in the State of the 
decedent's personal domicile.
    (2) Claims for the plot or interment allowance (except for claims 
filed by a State or an agency or political subdivision thereof), under 
Sec.  3.1707 may be executed by:
    (i) The funeral director, if he or she provided the plot or 
interment services, or advanced funds to pay for them, and if the entire 
bill for such or any balance thereof is unpaid (if the unpaid bill or 
the unpaid balance is less than the statutory plot or interment 
allowance, only the unpaid amount may be claimed by the funeral 
director); or
    (ii) The person(s) whose personal funds were used to defray the cost 
of the plot or interment expenses; or
    (iii) The person or entity from whom the plot was purchased or who 
provided interment services if the bill for such is unpaid in whole or 
in part. An unpaid bill for a plot will take precedence in payment of 
the plot or interment allowance over an unpaid bill for other interment 
expenses or a claim for reimbursement for such expenses. Any remaining 
balance of the plot or interment allowance may then be applied to 
interment expenses; or
    (iv) The executor or administrator of the estate of the veteran or 
the estate of the person who bore the expense of the plot or interment 
expenses. If no executor or administrator has been appointed, claim for 
the plot or interment allowance may be filed as provided in paragraph 
(c)(1)(iii) of this section for the burial allowance.

(Authority: 38 U.S.C. 2302, 2303, 2307)

Cross Reference: Sec.  3.1(i) for the definition of ``State''.

[79 FR 32658, June 6, 2014, as amended at 83 FR 39888, Aug. 13, 2018]



Sec.  3.1703  Claims for burial benefits.

    (a) When claims must be filed--(1) General rule. Except as provided 
in paragraph (a)(2) of this section, VA must receive a claim for the 
non-service-connected burial allowance no later than 2 years after the 
burial of the veteran. There are no other time limitations to file 
claims for burial benefits under subpart B of this part.
    (2) Correction of character of discharge. If the non-service-
connected burial allowance was not payable at the time of the veteran's 
death or burial because of the character of the veteran's discharge from 
service, VA may pay the allowance if a competent authority corrects the 
deceased veteran's discharge to reflect a discharge under conditions 
other than dishonorable. Claims for the non-service-connected burial 
allowance must be filed no later than 2 years after the date that the 
discharge was corrected.
    (b) Supporting evidence--(1) General rule. In order to pay burial 
benefits, VA must receive all of the following:
    (i) A claim, except as provided in Sec.  3.1702(a);
    (ii) Proof of the veteran's death in accordance with Sec.  3.211, 
Death; and
    (iii) For persons listed under Sec.  3.1702(b), except as provided 
in Sec.  3.1702(a), a statement certifying that the claimant incurred 
burial, plot or interment, or transportation costs of the deceased 
veteran.
    (2) Reimbursement of transportation expenses. In order to pay 
transportation costs, VA must receive a receipt, preferably on 
letterhead, showing who paid the costs, the name of the deceased 
veteran, the specific transportation expenses incurred, and the dates of 
the services rendered.
    (3) Eligibility based on evidence of record. VA may establish 
eligibility for benefits in this subpart based upon evidence of service 
and disability that VA relied upon to grant disability compensation or 
pension during the veteran's lifetime, unless VA has some other evidence 
on the date that it receives notice of the veteran's death that creates 
doubt as to the correctness of that evidence.


(The information collection requirements in this section are approved by 
the Office of Management and Budget under control number 2900-0003.)

(Authority: 38 U.S.C. 2304, 5107(a))

[[Page 391]]

            Burial Benefits: Allowances & Expenses Paid by VA



Sec.  3.1704  Burial allowance based on service-connected death.

    (a) General rule. VA will pay the maximum burial allowance specified 
in 38 U.S.C. 2307 for the burial and funeral expenses of a veteran 
described in paragraph (b) of this section, unless VA has evidence on 
the date it receives notice of the veteran's death that the expenses 
incurred were less than that amount. Payment of the service-connected 
burial allowance is in lieu of other allowances authorized by subpart B 
of this part, except those allowances listed in paragraph (c) of this 
section.
    (b) Eligibility. A burial allowance is payable under this section 
for a veteran who died as a result of a service-connected disability or 
disabilities. VA will presume, unless it has evidence to the contrary on 
the date it receives notice of the veteran's death, that a veteran died 
as a result of a service-connected disability or disabilities if, at the 
date of death, the veteran was rated totally disabled for a service-
connected disability or disabilities, excluding a total disability 
rating based on individual unemployability.
    (c) Additional allowances available based on service-connected 
death. In addition to the service-connected burial allowance authorized 
by this section:
    (1) VA may reimburse for transportation expenses related to burial 
in a national cemetery under Sec.  3.1709, Transportation expenses for 
burial in a national cemetery; and
    (2) VA may pay the plot or interment allowance for burial in a State 
veterans cemetery under Sec.  3.1707(a), Plot or interment allowance.

(Authority: 38 U.S.C. 2303, 2307, 2308)

Cross Reference: Sec.  3.1(i), for the definition of ``State''.



Sec.  3.1705  Burial allowance based on non-service-connected death.

    (a) General rule. VA will pay the maximum burial allowance specified 
in 38 U.S.C. 2302 for the burial and funeral expenses of a veteran 
described in paragraph (b) of this section, unless VA has evidence on 
the date it receives notice of the veteran's death that the expenses 
incurred were less than that amount. Payment of the non-service-
connected burial allowance is subject to other applicable regulations in 
subpart B of this part.
    (b) Eligibility. A burial allowance is payable under this section 
for a veteran who, on the date of death:
    (1) Was receiving VA pension or disability compensation;
    (2) Would have been receiving disability compensation but for the 
receipt of military retired pay; or
    (3) Had pending any of the following claims:
    (i) An original claim for pension or disability compensation, and 
the evidence in the claims file on the date of death and any evidence 
received under paragraph (d) of this section is sufficient to grant 
pension or disability compensation effective before the date of death; 
or
    (ii) A claim to reopen a previously denied pension or disability 
compensation claim, based on new and material evidence, and the evidence 
in the claims file on the date of the veteran's death and any evidence 
received under paragraph (d) of this section is sufficient to reopen the 
claim and grant pension or disability compensation effective before the 
date of death; or
    (iii) A claim for which a person would be eligible to substitute for 
the deceased veteran under 38 U.S.C. 5121A, Substitution in case of 
death of claimant, and that claim, once processed to completion by the 
substitute, results in the grant of pension or disability compensation 
effective before the date of death.
    (c) Evidence in the claims file on the date of the veteran's death 
means evidence in VA's possession on or before the date of the deceased 
veteran's death, even if such evidence was not part of the VA claims 
file on or before the date of death.
    (d) Requesting additional evidence. If the veteran had either an 
original claim or a claim to reopen pending on the date of death and 
there is sufficient evidence in VA's possession to support an award of 
compensation or pension prior to the date of death, but VA determines 
that additional evidence is needed to confirm that the deceased would 
have been entitled prior to death, VA will request such evidence. If

[[Page 392]]

VA does not receive such evidence within 1 year after the date of the 
request, it will deny the claim.
    (e) Additional allowances available based on non-service-connected 
death. In addition to the non-service-connected burial allowance 
authorized by this section:
    (1) VA may reimburse for transportation expenses related to burial 
in a national cemetery under Sec.  3.1709, Transportation expenses for 
burial in a national cemetery, but only if eligibility under paragraphs 
(b) of this section is based on a pending claim for, or award of, 
disability compensation, or eligibility for disability compensation but 
for receipt of military retired pay, rather than a claim for, or award 
of, pension; and
    (2) VA may pay the plot or interment allowance for burial in a State 
veterans cemetery under Sec.  3.1707(a), Plot or interment allowance.

(Authority: 38 U.S.C. 2302, 2303, 2304, 2308)

Cross Reference: Sec.  3.1(i), for the definition of ``State''.



Sec.  3.1706  Burial allowance for a veteran who died while hospitalized 
by VA.

    (a) General rule. VA will pay up to the maximum burial allowance 
specified in 38 U.S.C. 2303(a) for the burial and funeral expenses of a 
veteran described in paragraph (b) of this section.
    (b) Eligibility. A burial allowance is payable under this section 
for a veteran whose death was not service-connected and who died while 
hospitalized by VA. For purposes of this allowance, a veteran was 
hospitalized by VA if the veteran:
    (1) Was properly admitted to a VA facility (as described in 38 
U.S.C. 1701(3)) for hospital, nursing home, or domiciliary care under 
the authority of 38 U.S.C. 1710 or 1711(a);
    (2) Was transferred or admitted to a non-VA facility (as described 
in 38 U.S.C. 1701(4)) for hospital care under the authority of 38 U.S.C. 
1703;
    (3) Was transferred or admitted to a nursing home for nursing home 
care at the expense of the U.S. under the authority of 38 U.S.C. 1720;
    (4) Was transferred or admitted to a State nursing home for nursing 
home care for which payment is authorized under the authority of 38 
U.S.C. 1741;
    (5) Was traveling under proper prior authorization, and at VA 
expense, to or from a specified place for purpose of examination, 
treatment, or care; or
    (6) Was hospitalized by VA pursuant to any of paragraphs (b)(1) 
through (4) of this section but was not at the facility at the time of 
death and was:
    (i) On authorized absence that did not exceed 96 hours at the time 
of death;
    (ii) On unauthorized absence for a period not in excess of 24 hours 
at the time of death; or
    (iii) Absent from the facility for a period not in excess of 24 
hours of combined authorized and unauthorized absence at the time of 
death.
    (c) Hospitalization in the Philippines. Hospitalization in the 
Philippines under 38 U.S.C. 1731, 1732, and 1733 does not meet the 
requirements of this section.
    (d) Additional allowances available based on death while 
hospitalized by VA. In addition to the burial allowance authorized by 
this section:
    (1) VA will reimburse for the expense of transporting the remains of 
a person described in paragraph (b) of this section to the place of 
burial subject to the limitations of Sec.  3.1709 and where the death 
occurs within a State and:
    (i) The place of burial is in the same State or any other State; or
    (ii) The place of burial is in Canada or Mexico. However, 
reimbursement for transportation of the remains for such burial is 
authorized only from the place of death within a State to the port of 
embarkation within a State, or to the border limits of the United 
States.
    (2) VA may pay the plot or interment allowance for burial in a 
veterans cemetery under Sec.  3.1707, Plot or interment allowance.

(Authority: 38 U.S.C. 2303(a), 2308)

Cross Reference: Sec.  3.1(z) for the definition of ``nursing home'', 
Sec.  3.1(i) for the definition of ``State''.



Sec.  3.1707  Plot or interment allowances for burial in a State veterans
cemetery or other cemetery.

    (a) General eligibility. For a veteran who was eligible for burial 
in a national cemetery under 38 U.S.C. 2402,

[[Page 393]]

but was not buried in a national cemetery or other cemetery under the 
jurisdiction of the U.S., VA will pay the allowances described below, 
provided all criteria are met.
    (b) Plot or interment allowance for burial in a State veterans 
cemetery. VA will pay the plot or interment allowance in the amount 
specified in 38 U.S.C. 2303(b)(1) (without regard to whether any other 
burial benefits were provided for that veteran) to a State, or an agency 
or political subdivision of a State, that provided a burial plot or 
interment for the veteran without charge if the State, or agency or 
political subdivision of the State:
    (1) Is claiming the plot or interment allowance for burial of the 
veteran in a cemetery, or section of a cemetery, owned by the State or 
agency or subdivision of the State;
    (2) Did not charge for the expense of the plot or interment; and
    (3) Uses the cemetery or section of a cemetery solely for the 
interment of:
    (i) Persons eligible for burial in a national cemetery; and
    (ii) In a claim based on a veteran's death after October 31, 2000, 
either:
    (A) Deceased members of a reserve component of the Armed Forces not 
otherwise eligible for interment in a national cemetery; or
    (B) Deceased former members of a reserve component of the Armed 
Forces not otherwise eligible for interment in a national cemetery who 
were discharged or released from service under conditions other than 
dishonorable.
    (c) Plot or interment allowance payable based on burial in other 
than a State veterans cemetery. Unless VA has evidence on the date it 
receives notice of the veteran's death that the expenses incurred were 
less, VA will pay the maximum plot or interment allowance specified in 
38 U.S.C. 2303(b)(2) to a claimant who incurred plot or interment 
expenses relating to the purchase of a burial plot for a deceased 
veteran if the veteran is buried in a cemetery other than a cemetery 
described in paragraphs (b)(1) and (b)(3) of this section and:
    (1) The veteran is eligible for a burial allowance under Sec.  
3.1705, Burial allowance based on non-service-connected death;
    (2) The veteran is eligible for a burial allowance under Sec.  
3.1706, Burial allowance for a veteran who died while hospitalized by 
VA;
    (3) The veteran was discharged from active service for a disability 
incurred or aggravated in line of duty (VA will accept the official 
service record of such discharge as proof of eligibility for the plot or 
interment allowance and VA will disregard any previous VA determination 
made in connection with a claim for monetary benefits that the 
disability was not incurred or aggravated in line of duty); or
    (4) The veteran, at the time of discharge from active service, had a 
disability, shown by official service records, which in medical judgment 
would have justified a discharge for disability.
    (d) Definitions. For purposes of subpart B of this part, plot or 
burial plot means the final disposal site of the remains, whether it is 
a grave, mausoleum vault, columbarium niche, or other similar place. 
Plot or interment expenses are those expenses associated with the final 
disposition of the remains and are not confined to the acts done within 
the burial grounds but may include the removal of remains for burial or 
interment.

(Authority: 38 U.S.C. 501(a), 2303(b))

Cross Reference: Sec.  3.1(i) for the definition of ``State''.



Sec.  3.1708  Burial of a veteran whose remains are unclaimed.

    (a) General. VA will pay the maximum burial allowance specified in 
38 U.S.C. 2302 for the burial and funeral expenses of a veteran 
described in paragraph (b) of this section, unless VA has evidence on 
the date it receives notice of the veteran's death that the expenses 
incurred were less than that amount.
    (b) Eligibility. A burial allowance is payable under this section 
for a veteran if the Secretary determines that:
    (1) There is no next of kin or other person claiming the remains of 
the deceased veteran; and
    (2) There are not sufficient resources available in the veteran's 
estate to cover the burial and funeral expenses.

[[Page 394]]

    (c) Additional allowance for transportation of unclaimed remains. VA 
may reimburse for transportation expenses related to burial in a 
national cemetery under Sec.  3.1709, Transportation expenses for burial 
in a national cemetery, for a veteran described in paragraph (b) of this 
section.
    (d) Burial. When VA determines that a veteran's remains are 
unclaimed, the Director of the VA regional office in the area in which 
the veteran died will immediately complete arrangements for burial in a 
national cemetery or, at his or her option, in a cemetery or cemetery 
section meeting the requirements of paragraph (b) of Sec.  3.1707, Plot 
or interment allowance.

(Authority: 38 U.S.C. 2302(a))

Cross Reference: Sec.  3.1(i) for the definition of ``State''.



Sec.  3.1709  Transportation expenses for burial in a national cemetery.

    (a) General. VA will reimburse the costs of transportation, subject 
to paragraph (d) of this section, of a veteran's remains for burial in a 
national cemetery for a veteran described in paragraph (b) of this 
section.
    (b) Eligibility. VA will reimburse for the expense incurred, subject 
to paragraph (d) of this section, to transport a veteran's remains for 
burial in a national cemetery if:
    (1) The veteran died as the result of a service-connected 
disability;
    (2) The veteran was receiving service-connected disability 
compensation on the date of death;
    (3) The veteran would have been receiving service-connected 
disability compensation on the date of death, but for the receipt of 
military retired pay or non-service-connected disability pension; or
    (4) The Secretary determines the veteran is eligible for a burial 
allowance under Sec.  3.1708.
    (c) Amount payable. The amount payable under this section will not 
exceed the cost of transporting the remains to the national cemetery 
closest to the veteran's last place of residence in which burial space 
is available, and is subject to the limitations set forth in paragraph 
(d) of this section.
    (d) Reimbursable transportation expenses. (1) VA will reimburse 
reasonable transportation expenses, including but not limited to the 
costs of shipment via common carrier (i.e., procuring permits for 
shipment, a shipping case, sealing of the shipping case, and applicable 
Federal taxes) and costs of transporting the remains to the place of 
burial.
    (2) A reasonable transportation expense is an expense that is usual 
and customary in the context of burial transportation, with a 
corresponding charge that is the usual and customary charge made to the 
general public for the same or similar services.

(Authority: 38 U.S.C. 2303, 2308)

                         Burial Benefits: Other



Sec.  3.1710  Escheat (payment of burial benefits to an estate with 
no heirs).

    VA will not pay burial benefits if the payment would escheat (that 
is, would be turned over to the State because there are no heirs to the 
estate of the person to whom such benefits would be paid).

(Authority: 38 U.S.C. 501(a))



Sec.  3.1711  Effect of contributions by government, public, or private 
organizations.

    (a) Contributions by government or employer. With respect to claims 
for a plot or interment allowance under Sec.  3.1707, if VA has evidence 
that the U.S., a State, any agency or political subdivision of the U.S. 
or of a State, or the employer of the deceased veteran has paid or 
contributed payment to the veteran's plot or interment expenses, VA will 
pay the claimant up to the lesser of:
    (1) The allowable statutory amount; or
    (2) The amount of the total plot or interment expenses minus the 
amount of expenses paid by any or all of the organizations described in 
this paragraph (a).
    (b) Burial expenses paid by other agencies of the U.S. (1) Burial 
allowance when Federal law or regulation also provides for payment. VA 
cannot pay the non-service-connected burial allowance when any Federal 
law or regulation also specifically provides for the payment of the 
deceased veteran's burial, funeral, or transportation expenses. However, 
VA will pay the non-service-

[[Page 395]]

connected burial allowance when a Federal law or regulation allows the 
payment of burial expenses using funds due, or accrued to the credit of, 
the deceased veteran (such as Social Security benefits), but the law or 
regulation does not specifically require such payment. In such cases, VA 
will pay the maximum amount specified in 38 U.S.C. 2302.
    (2) Payment by military service department. VA will not pay or will 
recoup the non-service-connected burial allowance for deaths occurring 
during active service or for other deaths for which the service 
department pays the burial, funeral, or transportation expenses.
    (3) When a veteran dies while hospitalized. When a veteran dies 
while hospitalized at the expense of the U.S. government (including, but 
not limited to, death in a VA facility) and benefits would be otherwise 
payable under 10 U.S.C. 1482 and a provision of this subpart B, only one 
of these benefits is payable. VA will attempt to locate a relative of 
the veteran or another person entitled to reimbursement under Sec.  
3.1702(b) and will ask that person to elect between these benefits.

(Authority: 38 U.S.C. 2302, 2303(b))



Sec.  3.1712  Effect of forfeiture on payment of burial benefits.

    (a) Forfeiture for fraud. VA will pay burial benefits, if otherwise 
in order, based on a deceased veteran who forfeited his or her right to 
receive benefits due to fraud under Sec.  3.901, Fraud. However, VA will 
not pay burial benefits to a claimant who participated in fraudulent 
activity that resulted in forfeiture under Sec.  3.901.
    (b) Forfeiture for treasonable acts or for subversive activity. VA 
will not pay burial benefits based on a period of service commencing 
before the date of commission of the offense if either the veteran or 
the claimant has forfeited the right to all benefits except insurance 
payments under Sec.  3.902, Forfeiture for treasonable acts, or Sec.  
3.903, Forfeiture for subversive activities, because of a treasonable 
act or subversive activities, unless the offense was pardoned by the 
President of the U.S.

(Authority: 38 U.S.C. 6103, 6104, 6105)

Cross Reference: Sec.  3.1(aa), for the definition of ``fraud.''



Sec.  3.1713  Eligibility based on status before 1958.

    When any person dies who had a status under any law in effect on 
December 31, 1957, that afforded entitlement to burial benefits, burial 
benefits will be paid, if otherwise in order, even though such status 
does not meet the service requirements of 38 U.S.C. chapter 23.

(Authority: 38 U.S.C. 2305)

Subpart C [Reserved]



  Subpart D_Universal Adjudication Rules That Apply to Benefit Claims 
                    Governed by Part 3 of This Title

    Authority: 38 U.S.C. 501(a), unless otherwise noted.

    Source: 66 FR 18195, Apr. 6, 2001, unless otherwise noted.

                                 General



Sec.  3.2100  Scope of Applicability.

    Unless otherwise specified, the provisions of this subpart apply 
only to claims governed by part 3 of this title.

(Authority: 38 U.S.C. 501(a))



Sec.  3.2130  Will VA accept a signature by mark or thumbprint?

    VA will accept signatures by mark or thumbprint if:
    (a) They are witnessed by two people who sign their names and give 
their addresses, or
    (b) They are witnessed by an accredited agent, attorney, or service 
organization representative, or
    (c) They are certified by a notary public or any other person having 
the authority to administer oaths for general purposes, or
    (d) They are certified by a VA employee who has been delegated 
authority by the Secretary under 38 CFR 2.3.

(Authority: 38 U.S.C. 5101).

[[Page 396]]



Sec.  3.2400  Applicability of modernized review system.

    (a) Applicability. The modernized review system defined in 38 CFR 
19.2(b) applies to all claims, requests for reopening of finally 
adjudicated claims, and requests for revision based on clear and 
unmistakable error:
    (1) For which VA issues notice of an initial decision on or after 
the effective date of the modernized review system as provided in 38 CFR 
19.2(a); or
    (2) Where a claimant has elected review of a legacy claim under the 
modernized review system as provided in paragraph (c) of this section.
    (b) Legacy claims. A legacy claim is a claim, or request for 
reopening or revision of a finally adjudicated claim, for which VA 
provided notice of a decision prior to the effective date of the 
modernized review system and the claimant has not elected to participate 
in the modernized review system as provided in paragraph (c) of this 
section.
    (c) Election into the modernized review system. For claims governed 
by this part, pursuant to election by a claimant, the modernized review 
system applies where:
    (1) Rapid appeals modernization program election. A claimant with a 
legacy appeal elects to opt-in to the modernized review system on or 
after November 1, 2017, as part of a program authorized by the Secretary 
pursuant to section 4 of Public Law 115-55; or
    (2) Election after receiving a statement of the case. A claimant 
with a legacy appeal elects to opt-in to the modernized review system, 
following issuance, on or after the effective date of the modernized 
system, of a VA Statement of the Case or Supplemental Statement of the 
Case, by filing for a review option under the new system in accordance 
with Sec.  3.2500 on a form prescribed by the Secretary within the time 
allowed for filing a substantive appeal under 38 CFR 19.52(b) and other 
applicable provisions in part 19 of this chapter.
    (d) Effect of election. Once an eligible claimant elects the 
modernized review system with respect to a particular claim, the 
provisions of 38 CFR parts 3, 19, and 20 applicable only to legacy 
claims and appeals no longer apply to that claim.

[84 FR 171, Jan. 18, 2019, as amended at 84 FR 4336, Feb. 15, 2019]



Sec.  3.2500  Review of decisions.

    (a) Reviews available. (1) Within one year from the date on which 
the agency of original jurisdiction issues a notice of a decision on a 
claim or issue as defined in Sec.  3.151(c), except as otherwise 
provided in paragraphs (c), (e), and (f) of this section, a claimant may 
elect one of the following administrative review options by timely 
filing the appropriate form prescribed by the Secretary:
    (i) A request for higher-level review under Sec.  3.2601 or
    (ii) An appeal to the Board under Sec.  20.202 of this chapter.
    (2) At any time after VA issues notice of a decision on an issue 
within a claim, a claimant may file a supplemental claim under Sec.  
3.2501.
    (b) Concurrent election prohibited. With regard to the adjudication 
of a claim or an issue as defined in Sec.  3.151(c), a claimant who has 
filed for review under one of the options available under paragraph (a) 
of this section may not, while that review is pending final 
adjudication, file for review under a different available option. While 
the adjudication of a specific benefit is pending on appeal before a 
federal court, a claimant may not file for administrative review of the 
claim under any of options listed in paragraph (a) of this section.
    (c) Continuously pursued issues. A claimant may continuously pursue 
a claim or an issue by timely and properly filing one of the following 
administrative review options, as specified (except as otherwise 
provided in paragraphs (c), (e), and (f) of this section), after any 
decision by the agency of original jurisdiction, Board of Veterans' 
Appeals, or by the U.S. Court of Appeals for Veterans Claims, provided 
that any appeal to the U.S. Court of Appeals for Veterans Claims is 
timely filed as determined by the court:
    (1) Following notice of a decision on an initial claim or a 
supplemental claim, the claimant may file a supplemental claim, request 
a higher-level

[[Page 397]]

review, or appeal to the Board of Veterans' Appeals.
    (2) Following notice of a decision on a higher-level review, the 
claimant may file a supplemental claim or appeal to the Board of 
Veterans' Appeals. (See appeal to the Board, 38 CFR 20.202).
    (3) Following notice of a decision on an appeal to the Board of 
Veterans' Appeals, the claimant may file a supplemental claim or file a 
notice of appeal to the Court of Appeals for Veterans Claims.
    (4) Following a decision on an appeal to the Court of Appeals for 
Veterans Claims, the claimant may file a supplemental claim.
    (d) Voluntary withdrawal. A claimant may withdraw a supplemental 
claim or a request for a higher-level review at any time before VA 
renders a decision on the issue. A claimant must submit in writing or 
through electronic submission in a manner prescribed by the Secretary 
any notice of withdrawal of an issue under the selected review option to 
the agency of original jurisdiction. The withdrawal will be effective 
the date VA receives it. A claimant may withdraw an appeal to the Board 
of Veteran's Appeals as prescribed in Sec.  20.205.
    (e) Changing review options while a review is pending adjudication--
(1) Within one year of prior decision notice. A claimant may change the 
review option selected by withdrawing the request as prescribed in Sec.  
3.2500(d) and filing the appropriate application for the requested 
review option within one year from the date on which VA issued notice of 
a decision on an issue.
    (2) More than one year after notice of a decision. A claimant may 
change the review option selected to a supplemental claim after 
expiration of one-year following the date on which VA issued a notice of 
decision on an issue by following the procedure specified in paragraph 
(e)(1) of this section. Where VA receives the supplemental claim 
application after expiration of the one-year period, continuous pursuit 
of the claim will be broken and VA will apply the effective date 
provisions under paragraph (h)(2) of this section, unless VA grants an 
extension of the one-year period for good cause shown under Sec.  
3.109(b) and the supplemental claim application is received within the 
extension period allowed.
    (f) Applicability. This section applies to claims and requests under 
the modernized review system as set forth in Sec.  3.2400, with the 
exception that a supplemental claim may not be filed in connection with 
a denial of a request to revise a final decision of the agency of 
original jurisdiction based on clear and unmistakable error.
    (g) Review of simultaneously contested claims. Notwithstanding other 
provisions of this part, a party to a simultaneously contested claim may 
only seek administrative review of a decision by the agency of original 
jurisdiction on such claim by filing an appeal to the Board as 
prescribed in Sec.  20.402 of this chapter within 60 days of the date VA 
issues notice of the decision on the claim. (See contested claims, 38 
CFR 20.402).
    (h) Effective dates--(1) Continuously pursued claims. Except as 
otherwise provided by other provisions of this part, including Sec.  
3.400, the effective date will be fixed in accordance with the date of 
receipt of the initial claim or date entitlement arose, whichever is 
later, if a claimant continuously pursues an issue by timely filing in 
succession any of the available review options as specified in paragraph 
(c) of this section within one year of the issuance of the decision (or 
the time period specified in paragraph (f) of this section, as 
applicable to simultaneously contested claims), provided that any appeal 
to the U.S. Court of Appeals for Veterans Claims must be accepted as 
timely by that court.
    (2) Supplemental claims received more than one year after notice of 
decision. Except as otherwise provided in this section, for supplemental 
claims received more than one year after the date on which the agency of 
original jurisdiction issues notice of a decision or the Board of 
Veterans' Appeals issued notice of a decision, the effective date will 
be fixed in accordance with the date entitlement arose, but will not be 
earlier than the date of receipt of the supplemental claim.

[84 FR 171, Jan. 18, 2019, as amended at 84 FR 4336, Feb. 15, 2019; 84 
FR 54033, Oct. 9, 2019]

[[Page 398]]



Sec.  3.2501  Supplemental claims.

    Except as otherwise provided, a claimant or his or her authorized 
representative, if any, who disagrees with a prior VA decision may file 
a supplemental claim (see Sec.  3.1(p)(2)) by submitting in writing or 
electronically a complete application (see Sec.  3.160(a)) on a form 
prescribed by the Secretary any time after the agency of original 
jurisdiction issues notice of a decision, regardless of whether the 
claim is pending (see Sec.  3.160(c)) or has become finally adjudicated 
(see Sec.  3.160(d)). If new and relevant evidence is presented or 
secured with respect to the supplemental claim, the agency of original 
jurisdiction will readjudicate the claim taking into consideration all 
of the evidence of record. If new and relevant evidence is not presented 
or secured, the agency of original jurisdiction will issue a decision 
finding that there was insufficient evidence to readjudicate the claim. 
In determining whether new and relevant evidence is presented or 
secured, VA will consider any VA treatment records reasonably identified 
by the claimant and any evidence received by VA after VA issued notice 
of a decision on the claim and while the evidentiary record was closed 
(see 3.103(c)).
    (a) New and relevant evidence. The new and relevant standard will 
not impose a higher evidentiary threshold than the previous new and 
material evidence standard under Sec.  3.156(a).
    (1) Definition. New evidence is evidence not previously part of the 
actual record before agency adjudicators. Relevant evidence is 
information that tends to prove or disprove a matter at issue in a 
claim. Relevant evidence includes evidence that raises a theory of 
entitlement that was not previously addressed.
    (2) Receipt prior to notice of a decision. New and relevant evidence 
received before VA issues its decision on a supplemental claim will be 
considered as having been filed in connection with the claim.
    (b) Evidentiary record. The evidentiary record for a supplemental 
claim includes all evidence received by VA before VA issues notice of a 
decision on the supplemental claim. For VA to readjudicate the claim, 
the evidentiary record must include new and relevant evidence that was 
not of record as of the date of notice of the prior decision.
    (c) Duty to assist. Upon receipt of a substantially complete 
supplemental claim, VA's duty to assist in the gathering of evidence 
under Sec.  3.159 of this part is triggered and includes any such 
assistance that may help secure new and relevant evidence as defined in 
paragraph (a) of this section to complete the supplemental claim 
application.
    (d) Date of filing. The filing date of a supplemental claim is 
determined according to Sec.  3.155, with the exception of the intent to 
file rule found in Sec.  3.155(b) which applies to initial claims.

(Authority: 38 U.S.C. 501, 5103A(h), 5108)

[83 FR 172, Jan. 18, 2019]



Sec.  3.2502  Return by higher-level adjudicator or remand by the 
Board of Veterans' Appeals.

    Upon receipt of a returned claim from a higher-level adjudicator or 
remand by the Board of Veterans' Appeals, the agency of original 
jurisdiction will expeditiously readjudicate the claim in accordance 
with 38 U.S.C. 5109B. The agency of original jurisdiction retains 
jurisdiction of the claim. In readjudicating the claim, the agency of 
original jurisidction will correct all identified duty to assist errors, 
complete a new decision and issue notice to the claimant and or his or 
her legal representative in accordance with 3.103(f). The effective date 
of any evaluation and award of pension, compensation or dependency and 
indemnity compensation will be determined in accordance with the date of 
receipt of the initial claim as prescribed under Sec.  3.2500(g).

[84 FR 172, Jan. 18, 2019]

                                Revisions



Sec.  3.2600  Legacy review of benefit claims decisions.

    This section applies only to legacy claims as defined in Sec.  
3.2400 in which a Notice of Disagreement is timely filed on or after 
June 1, 2001, under regulations applicable at the time of filing.

[[Page 399]]

    (a) A claimant who has filed a Notice of Disagreement submitted in 
accordance with the provisions of Sec.  20.201 of this chapter, and 
either Sec.  20.302(a) or Sec.  20.501(a) of this chapter, as 
applicable, with a decision of an agency of original jurisdiction on a 
benefit claim has a right to a review of that decision under this 
section. The review will be conducted by a Veterans Service Center 
Manager, Pension Management Center Manager, or Decision Review Officer, 
at VA's discretion. An individual who did not participate in the 
decision being reviewed will conduct this review. Only a decision that 
has not yet become final (by appellate decision or failure to timely 
appeal) may be reviewed. Review under this section will encompass only 
decisions with which the claimant has expressed disagreement in the 
Notice of Disagreement. The reviewer will consider all evidence of 
record and applicable law, and will give no deference to the decision 
being reviewed.
    (b) Unless the claimant has requested review under this section with 
his or her Notice of Disagreement, VA will, upon receipt of the Notice 
of Disagreement, notify the claimant in writing of his or her right to a 
review under this section. To obtain such a review, the claimant must 
request it not later than 60 days after the date VA mails the notice. 
This 60-day time limit may not be extended. If the claimant fails to 
request review under this section not later than 60 days after the date 
VA mails the notice, VA will proceed with the traditional appellate 
process by issuing a Statement of the Case. A claimant may not have more 
than one review under this section of the same decision.
    (c) The reviewer may conduct whatever development he or she 
considers necessary to resolve any disagreements in the Notice of 
Disagreement, consistent with applicable law. This may include an 
attempt to obtain additional evidence or the holding of an informal 
conference with the claimant. Upon the request of the claimant, the 
reviewer will conduct a hearing under the version of Sec.  3.103(c) of 
this chapter predating Public Law 115-55.
    (d) The reviewer may grant a benefit sought in the claim 
notwithstanding Sec.  3.105(b), but, except as provided in paragraph (e) 
of this section, may not revise the decision in a manner that is less 
advantageous to the claimant than the decision under review. A review 
decision made under this section will include a summary of the evidence, 
a citation to pertinent laws, a discussion of how those laws affect the 
decision, and a summary of the reasons for the decision.
    (e) Notwithstanding any other provisions of this section, the 
reviewer may reverse or revise (even if disadvantageous to the claimant) 
prior decisions of an agency of original jurisdiction (including the 
decision being reviewed or any prior decision that has become final due 
to failure to timely appeal) on the grounds of clear and unmistakable 
error (see Sec.  3.105(a)).
    (f) Review under this section does not limit the appeal rights of a 
claimant. Unless a claimant withdraws his or her Notice of Disagreement 
as a result of this review process, VA will proceed with the traditional 
appellate process by issuing a Statement of the Case.

(Authority: 38 U.S.C. 5109A and 7105(d))

[66 FR 21874, May 2, 2001, as amended at 67 FR 46868, July 17, 2002; 74 
FR 26959, June 5, 2009; 79 FR 57697, Sept. 25, 2014; 84 FR 172, Jan. 18, 
2019; 84 FR 4336, Feb. 15, 2019]



Sec.  3.2601  Higher-level review.

    (a) Applicability. This section applies to all claims under the 
modernized review system, with the exception of simultaneously contested 
claims.
    (b) Requirements for election. A claimant who is dissatisfied with a 
decision by the agency of original jurisdiction may file a request for 
higher-level review in accordance with Sec.  3.2500, by submitting a 
complete request for review on a form prescribed by the Secretary.
    (c) Complete request. A complete request for higher-level review is 
a submission of a request on a form prescribed by the Secretary, whether 
paper or electronic, that meets the following requirements:
    (1) A complete request must provide the name of the claimant and the 
relationship to the veteran, if applicable;
    (2) A complete request must be signed by the claimant or a person 
legally authorized to sign for the claimant; and

[[Page 400]]

    (3) A complete request must specify the date of the underlying 
decision for which review is requested and specify the issues for which 
review is requested.
    (d) Filing period. A complete request for higher-level review must 
be received by VA within one year of the date of VA's issuance of the 
notice of the decision. If VA receives an incomplete request form, VA 
will notify the claimant and the claimant's representative, if any, of 
the information necessary to complete the request form prescribed by the 
Secretary. If a complete request is submitted within 60 days of the date 
of the VA notification of such incomplete request or prior to the 
expiration of the one-year filing period, VA will consider it filed as 
of the date VA received the incomplete application form that did not 
meet the standards of a complete request.
    (e) Who may conduct a higher-level review. Higher-level review will 
be conducted by an experienced adjudicator who did not participate in 
the prior decision. Selection of a higher-level adjudicator to conduct a 
higher-level review is at VA's discretion. As a general rule, an 
adjudicator in an office other than the office that rendered the prior 
decision will conduct the higher-level review. An exception to this rule 
applies for claims requiring specialized processing, such as where there 
is only one office that handles adjudication of a particular type of 
entitlement. A claimant may request that the office that rendered the 
prior decision conduct the higher-level review, and VA will grant the 
request in the absence of good cause to deny such as when processing is 
centralized at one office within the agency of original jurisdiction or 
when the office that rendered the prior decision does not have higher-
level review personnel available to conduct the review.
    (f) Evidentiary record. The evidentiary record in a higher-level 
review is limited to the evidence of record as of the date the agency of 
original jurisdiction issued notice of the prior decision under review 
and the higher-level adjudicator may not consider additional evidence. 
The higher-level adjudicator may not order development of additional 
evidence that may be relevant to the claim under review, except as 
provided in paragraph (g) of this section.
    (g) Duty to assist errors. The higher-level adjudicator will ensure 
that VA complied with its statutory duty to assist (see Sec.  3.159) in 
gathering evidence applicable prior to issuance of the decision being 
reviewed. If the higher-level adjudicator both identifies a duty to 
assist error that existed at the time of VA's decision on the claim 
under review and cannot grant the maximum benefit for the claim, the 
higher-level adjudicator must return the claim for correction of the 
error and readjudication. Upon receipt, the agency of jurisdiction will 
expeditiously readjudicate the claim in accordance with 38 U.S.C. 5109B.
    (1) For disability evaluations, the maximum benefit means the 
highest schedular evaluation allowed by law and regulation for the issue 
under review.
    (2) For ancillary benefits, the maximum benefit means the granting 
of the benefit sought.
    (3) For pension benefits or dependents indemnity compensation, the 
maximum benefit means granting the highest benefit payable.
    (h) Informal conferences. A claimant or his or her representative 
may include a request for an informal conference with a request for 
higher-level review. For purposes of this section, informal conference 
means contact with a claimant's representative or, if not represented, 
with the claimant, telephonically, or as otherwise determined by VA, for 
the sole purpose of allowing the claimant or representative to identify 
any errors of law or fact in a prior decision based on the record at the 
time the decision was issued. If requested, VA will make reasonable 
efforts to contact the claimant and/or the authorized representative to 
conduct one informal conference during a higher-level review, but if 
such reasonable efforts are not successful, a decision may be issued in 
the absence of an informal conference. The higher-level adjudicator with 
determinative authority over the issue will conduct the informal 
conference, absent exceptional circumstances. VA will not receive any 
new evidence or introduction of facts

[[Page 401]]

not present at the time of the prior decision or apart of the 
evidentiary record in support of the higher-level review during the 
informal conference in accordance with paragraph (d) of this section. 
Any expenses incurred by the claimant in connection with the informal 
conference are the responsibility of the claimant.
    (i) De novo review. The higher-level adjudicator will consider only 
those decisions and claims for which the claimant has requested higher-
level review, and will conduct a de novo review giving no deference to 
the prior decision, except as provided in Sec.  3.104(c).
    (j) Difference of opinion. The higher-level adjudicator may grant a 
benefit sought in the claim under review based on a difference of 
opinion (see Sec.  3.105(b)). However, any finding favorable to the 
claimant is binding except as provided in Sec.  3.104(c) of this part. 
In addition, the higher-level adjudicator will not revise the outcome in 
a manner that is less advantageous to the claimant based solely on a 
difference of opinion. The higher-level adjudicator may reverse or 
revise (even if disadvantageous to the claimant) prior decisions by VA 
(including the decision being reviewed or any prior decision) on the 
grounds of clear and unmistakable error under Sec.  3.105(a)(1) or 
(a)(2), as applicable, depending on whether the prior decision is 
finally adjudicated.
    (k) Notice requirements. Notice of a decision made under this 
section will include all of the elements described in Sec.  3.103(f), a 
general statement indicating whether evidence submitted while the record 
was closed was not considered, and notice of the options available to 
have such evidence considered.

(Authority: 38 U.S.C. 5109A and 7105(d))

[84 FR 173, Jan. 18, 2019]



PART 4_SCHEDULE FOR RATING DISABILITIES--Table of Contents



                   Subpart A_General Policy in Rating

Sec.
4.1 Essentials of evaluative rating.
4.2 Interpretation of examination reports.
4.3 Resolution of reasonable doubt.
4.6 Evaluation of evidence.
4.7 Higher of two evaluations.
4.9 Congenital or developmental defects.
4.10 Functional impairment.
4.13 Effect of change of diagnosis.
4.14 Avoidance of pyramiding.
4.15 Total disability ratings.
4.16 Total disability ratings for compensation based on unemployability 
          of the individual.
4.17 Total disability ratings for pension based on unemployability and 
          age of the individual.
4.17a Misconduct etiology.
4.18 Unemployability.
4.19 Age in service-connected claims.
4.20 Analogous ratings.
4.21 Application of rating schedule.
4.22 Rating of disabilities aggravated by active service.
4.23 Attitude of rating officers.
4.24 Correspondence.
4.25 Combined ratings table.
4.26 Bilateral factor.
4.27 Use of diagnostic code numbers.
4.28 Prestabilization rating from date of discharge from service.
4.29 Ratings for service-connected disabilities requiring hospital 
          treatment or observation.
4.30 Convalescent ratings.
4.31 Zero percent evaluations.

                      Subpart B_Disability Ratings

                       The Musculoskeletal System

4.40 Functional loss.
4.41 History of injury.
4.42 Complete medical examination of injury cases.
4.43 Osteomyelitis.
4.44 The bones.
4.45 The joints.
4.46 Accurate measurement.
4.47-4.54 [Reserved]
4.55 Principles of combined ratings for muscle injuries.
4.56 Evaluation of muscle disabilities.
4.57 Static foot deformities.
4.58 Arthritis due to strain.
4.59 Painful motion.
4.60 [Reserved]
4.61 Examination.
4.62 Circulatory disturbances.
4.63 Loss of use of hand or foot.
4.64 Loss of use of both buttocks.
4.65 [Reserved]
4.66 Sacroiliac joint.
4.67 Pelvic bones.
4.68 Amputation rule.
4.69 Dominant hand.
4.70 Inadequate examinations.
4.71 Measurement of ankylosis and joint motion.
4.71a Schedule of ratings--musculoskeletal system.
4.72 [Reserved]
4.73 Schedule of ratings--muscle injuries.

[[Page 402]]

                       The Organs of Special Sense

4.75 General considerations for evaluating visual impairment.
4.76 Visual acuity.
4.76a Computation of average concentric contraction of visual fields.
4.77 Visual fields.
4.78 Muscle function.
4.79 Schedule of ratings--eye.
4.80-4.84 [Reserved]

                      Impairment of Auditory Acuity

4.85 Evaluation of hearing impairment.
4.86 Exceptional patterns of hearing impairment.
4.87 Schedule of ratings--ear.
4.87a Schedule of ratings--other sense organs.

   Infectious Diseases, Immune Disorders and Nutritional Deficiencies

4.88 [Reserved]
4.88a Chronic fatigue syndrome.
4.88b Schedule of ratings--infectious diseases, immune disorders and 
          nutritional deficiencies.
4.88c Ratings for inactive nonpulmonary tuberculosis initially entitled 
          after August 19, 1968.
4.89 Ratings for inactive nonpulmonary tuberculosis in effect on August 
          19, 1968.

                         The Respiratory System

4.96 Special provisions regarding evaluation of respiratory conditions.
4.97 Schedule of ratings--respiratory system.

                        The Cardiovascular System

4.100 Application of the evaluation criteria for diagnostic codes 7000-
          7007, 7011, and 7015-7020.
4.101-4.103 [Reserved]
4.104 Schedule of ratings--cardiovascular system.

                          The Digestive System

4.110 Ulcers.
4.111 Postgastrectomy syndromes.
4.112 Weight loss.
4.113 Coexisting abdominal conditions.
4.114 Schedule of ratings--digestive system.

                        The Genitourinary System

4.115 Nephritis.
4.115a Ratings of the genitourinary system--dysfunctions.
4.115b Ratings of the genitourinary system--diagnoses.

          Gynecological Conditions and Disorders of the Breast

4.116 Schedule of ratings--gynecological conditions and disorders of the 
          breast.

                  The Hematologic and Lymphatic Systems

4.117 Schedule of ratings--hemic and lymphatic systems.

                                The Skin

4.118 Schedule of ratings--skin.

                          The Endocrine System

4.119 Schedule of ratings--endocrine system.

            Neurological Conditions and Convulsive Disorders

4.120 Evaluations by comparison.
4.121 Identification of epilepsy.
4.122 Psychomotor epilepsy.
4.123 Neuritis, cranial or peripheral.
4.124 Neuralgia, cranial or peripheral.
4.124a Schedule of ratings--neurological conditions and convulsive 
          disorders.

                            Mental Disorders

4.125 Diagnosis of mental disorders.
4.126 Evaluation of disability from mental disorders.
4.127 Intellectual disability (intellectual developmental disorder) and 
          personality disorders.
4.128 Convalescence ratings following extended hospitalization.
4.129 Mental disorders due to traumatic stress.
4.130 Schedule of ratings--Mental disorders.

                       Dental and Oral Conditions

4.149 [Reserved]
4.150 Schedule of ratings--dental and oral conditions.

Appendix A to Part 4--Table of Amendments and Effective Dates Since 1946
Appendix B to Part 4--Numerical Index of Disabilities
Appendix C to Part 4--Alphabetical Index of Disabilities

    Authority: 38 U.S.C. 1155, unless otherwise noted.

    Source: 29 FR 6718, May 22, 1964, unless otherwise noted.



                   Subpart A_General Policy in Rating



Sec.  4.1  Essentials of evaluative rating.

    This rating schedule is primarily a guide in the evaluation of 
disability resulting from all types of diseases and injuries encountered 
as a result of or incident to military service. The percentage ratings 
represent as far as can practicably be determined the average impairment 
in earning capacity resulting from such diseases and injuries and

[[Page 403]]

their residual conditions in civil occupations. Generally, the degrees 
of disability specified are considered adequate to compensate for 
considerable loss of working time from exacerbations or illnesses 
proportionate to the severity of the several grades of disability. For 
the application of this schedule, accurate and fully descriptive medical 
examinations are required, with emphasis upon the limitation of activity 
imposed by the disabling condition. Over a period of many years, a 
veteran's disability claim may require reratings in accordance with 
changes in laws, medical knowledge and his or her physical or mental 
condition. It is thus essential, both in the examination and in the 
evaluation of disability, that each disability be viewed in relation to 
its history.

[41 FR 11292, Mar. 18, 1976]



Sec.  4.2  Interpretation of examination reports.

    Different examiners, at different times, will not describe the same 
disability in the same language. Features of the disability which must 
have persisted unchanged may be overlooked or a change for the better or 
worse may not be accurately appreciated or described. It is the 
responsibility of the rating specialist to interpret reports of 
examination in the light of the whole recorded history, reconciling the 
various reports into a consistent picture so that the current rating may 
accurately reflect the elements of disability present. Each disability 
must be considered from the point of view of the veteran working or 
seeking work. If a diagnosis is not supported by the findings on the 
examination report or if the report does not contain sufficient detail, 
it is incumbent upon the rating board to return the report as inadequate 
for evaluation purposes.

[41 FR 11292, Mar. 18, 1976]



Sec.  4.3  Resolution of reasonable doubt.

    It is the defined and consistently applied policy of the Department 
of Veterans Affairs to administer the law under a broad interpretation, 
consistent, however, with the facts shown in every case. When after 
careful consideration of all procurable and assembled data, a reasonable 
doubt arises regarding the degree of disability such doubt will be 
resolved in favor of the claimant. See Sec.  3.102 of this chapter.

[40 FR 42535, Sept. 15, 1975]



Sec.  4.6  Evaluation of evidence.

    The element of the weight to be accorded the character of the 
veteran's service is but one factor entering into the considerations of 
the rating boards in arriving at determinations of the evaluation of 
disability. Every element in any way affecting the probative value to be 
assigned to the evidence in each individual claim must be thoroughly and 
conscientiously studied by each member of the rating board in the light 
of the established policies of the Department of Veterans Affairs to the 
end that decisions will be equitable and just as contemplated by the 
requirements of the law.



Sec.  4.7  Higher of two evaluations.

    Where there is a question as to which of two evaluations shall be 
applied, the higher evaluation will be assigned if the disability 
picture more nearly approximates the criteria required for that rating. 
Otherwise, the lower rating will be assigned.



Sec.  4.9  Congenital or developmental defects.

    Mere congenital or developmental defects, absent, displaced or 
supernumerary parts, refractive error of the eye, personality disorder 
and mental deficiency are not diseases or injuries in the meaning of 
applicable legislation for disability compensation purposes.

[41 FR 11292, Mar. 18, 1976]



Sec.  4.10  Functional impairment.

    The basis of disability evaluations is the ability of the body as a 
whole, or of the psyche, or of a system or organ of the body to function 
under the ordinary conditions of daily life including employment. 
Whether the upper or lower extremities, the back or abdominal wall, the 
eyes or ears, or the cardiovascular, digestive, or other system, or 
psyche are affected, evaluations are based upon lack of usefulness, of 
these

[[Page 404]]

parts or systems, especially in self-support. This imposes upon the 
medical examiner the responsibility of furnishing, in addition to the 
etiological, anatomical, pathological, laboratory and prognostic data 
required for ordinary medical classification, full description of the 
effects of disability upon the person's ordinary activity. In this 
connection, it will be remembered that a person may be too disabled to 
engage in employment although he or she is up and about and fairly 
comfortable at home or upon limited activity.

[41 FR 11292, Mar. 18, 1976]



Sec.  4.13  Effect of change of diagnosis.

    The repercussion upon a current rating of service connection when 
change is made of a previously assigned diagnosis or etiology must be 
kept in mind. The aim should be the reconciliation and continuance of 
the diagnosis or etiology upon which service connection for the 
disability had been granted. The relevant principle enunciated in Sec.  
4.125, entitled ``Diagnosis of mental disorders,'' should have careful 
attention in this connection. When any change in evaluation is to be 
made, the rating agency should assure itself that there has been an 
actual change in the conditions, for better or worse, and not merely a 
difference in thoroughness of the examination or in use of descriptive 
terms. This will not, of course, preclude the correction of erroneous 
ratings, nor will it preclude assignment of a rating in conformity with 
Sec.  4.7.

[29 FR 6718, May 22, 1964, as amended at 61 FR 52700, Oct. 8, 1996]



Sec.  4.14  Avoidance of pyramiding.

    The evaluation of the same disability under various diagnoses is to 
be avoided. Disability from injuries to the muscles, nerves, and joints 
of an extremity may overlap to a great extent, so that special rules are 
included in the appropriate bodily system for their evaluation. Dyspnea, 
tachycardia, nervousness, fatigability, etc., may result from many 
causes; some may be service connected, others, not. Both the use of 
manifestations not resulting from service-connected disease or injury in 
establishing the service-connected evaluation, and the evaluation of the 
same manifestation under different diagnoses are to be avoided.



Sec.  4.15  Total disability ratings.

    The ability to overcome the handicap of disability varies widely 
among individuals. The rating, however, is based primarily upon the 
average impairment in earning capacity, that is, upon the economic or 
industrial handicap which must be overcome and not from individual 
success in overcoming it. However, full consideration must be given to 
unusual physical or mental effects in individual cases, to peculiar 
effects of occupational activities, to defects in physical or mental 
endowment preventing the usual amount of success in overcoming the 
handicap of disability and to the effect of combinations of disability. 
Total disability will be considered to exist when there is present any 
impairment of mind or body which is sufficient to render it impossible 
for the average person to follow a substantially gainful occupation; 
Provided, That permanent total disability shall be taken to exist when 
the impairment is reasonably certain to continue throughout the life of 
the disabled person. The following will be considered to be permanent 
total disability: the permanent loss of the use of both hands, or of 
both feet, or of one hand and one foot, or of the sight of both eyes, or 
becoming permanently helpless or permanently bedridden. Other total 
disability ratings are scheduled in the various bodily systems of this 
schedule.



Sec.  4.16  Total disability ratings for compensation based on
unemployability of the individual.

    (a) Total disability ratings for compensation may be assigned, where 
the schedular rating is less than total, when the disabled person is, in 
the judgment of the rating agency, unable to secure or follow a 
substantially gainful occupation as a result of service-connected 
disabilities: Provided That, if there is only one such disability, this 
disability shall be ratable at 60 percent or more, and that, if there 
are two or more disabilities, there shall be at least one disability 
ratable at 40

[[Page 405]]

percent or more, and sufficient additional disability to bring the 
combined rating to 70 percent or more. For the above purpose of one 60 
percent disability, or one 40 percent disability in combination, the 
following will be considered as one disability: (1) Disabilities of one 
or both upper extremities, or of one or both lower extremities, 
including the bilateral factor, if applicable, (2) disabilities 
resulting from common etiology or a single accident, (3) disabilities 
affecting a single body system, e.g. orthopedic, digestive, respiratory, 
cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred 
in action, or (5) multiple disabilities incurred as a prisoner of war. 
It is provided further that the existence or degree of nonservice-
connected disabilities or previous unemployability status will be 
disregarded where the percentages referred to in this paragraph for the 
service-connected disability or disabilities are met and in the judgment 
of the rating agency such service-connected disabilities render the 
veteran unemployable. Marginal employment shall not be considered 
substantially gainful employment. For purposes of this section, marginal 
employment generally shall be deemed to exist when a veteran's earned 
annual income does not exceed the amount established by the U.S. 
Department of Commerce, Bureau of the Census, as the poverty threshold 
for one person. Marginal employment may also be held to exist, on a 
facts found basis (includes but is not limited to employment in a 
protected environment such as a family business or sheltered workshop), 
when earned annual income exceeds the poverty threshold. Consideration 
shall be given in all claims to the nature of the employment and the 
reason for termination.


(Authority: 38 U.S.C. 501)

    (b) It is the established policy of the Department of Veterans 
Affairs that all veterans who are unable to secure and follow a 
substantially gainful occupation by reason of service-connected 
disabilities shall be rated totally disabled. Therefore, rating boards 
should submit to the Director, Compensation Service, for extra-schedular 
consideration all cases of veterans who are unemployable by reason of 
service-connected disabilities, but who fail to meet the percentage 
standards set forth in paragraph (a) of this section. The rating board 
will include a full statement as to the veteran's service-connected 
disabilities, employment history, educational and vocational attainment 
and all other factors having a bearing on the issue.

[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 
55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 
8, 1996; 79 FR 2100, Jan. 13, 2014]



Sec.  4.17  Total disability ratings for pension based on unemployability
and age of the individual.

    All veterans who are basically eligible and who are unable to secure 
and follow a substantially gainful occupation by reason of disabilities 
which are likely to be permanent shall be rated as permanently and 
totally disabled. For the purpose of pension, the permanence of the 
percentage requirements of Sec.  4.16 is a requisite. When the 
percentage requirements are met, and the disabilities involved are of a 
permanent nature, a rating of permanent and total disability will be 
assigned if the veteran is found to be unable to secure and follow 
substantially gainful employment by reason of such disability. Prior 
employment or unemployment status is immaterial if in the judgment of 
the rating board the veteran's disabilities render him or her 
unemployable. In making such determinations, the following guidelines 
will be used:
    (a) Marginal employment, for example, as a self-employed farmer or 
other person, while employed in his or her own business, or at odd jobs 
or while employed at less than half the usual remuneration will not be 
considered incompatible with a determination of unemployability, if the 
restriction, as to securing or retaining better employment, is due to 
disability.
    (b) Claims of all veterans who fail to meet the percentage standards 
but who meet the basic entitlement criteria and are unemployable, will 
be referred by the rating board to the Veterans Service Center Manager 
or the Pension

[[Page 406]]

Management Center Manager under Sec.  3.321(b)(2) of this chapter.

(Authority: 38 U.S.C. 1155; 38 U.S.C. 3102)

[43 FR 45348, Oct. 2, 1978, as amended at 56 FR 57985, Nov. 15, 1991; 71 
FR 28586, May 17, 2006; 74 FR 26959, June 5, 2009]



Sec.  4.17a  Misconduct etiology.

    A permanent and total disability rating under the provisions of 
Sec. Sec.  4.15, 4.16 and 4.17 will not be precluded by reason of the 
coexistence of misconduct disability when:
    (a) A veteran, regardless of employment status, also has innocently 
acquired 100 percent disability, or
    (b) Where unemployable, the veteran has other disabilities 
innocently acquired which meet the percentage requirements of Sec. Sec.  
4.16 and 4.17 and would render, in the judgment of the rating agency, 
the average person unable to secure or follow a substantially gainful 
occupation.

[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978]



Sec.  4.18  Unemployability.

    A veteran may be considered as unemployable upon termination of 
employment which was provided on account of disability, or in which 
special consideration was given on account of the same, when it is 
satisfactorily shown that he or she is unable to secure further 
employment. With amputations, sequelae of fractures and other residuals 
of traumatism shown to be of static character, a showing of continuous 
unemployability from date of incurrence, or the date the condition 
reached the stabilized level, is a general requirement in order to 
establish the fact that present unemployability is the result of the 
disability. However, consideration is to be given to the circumstances 
of employment in individual claims, and, if the employment was only 
occasional, intermittent, tryout or unsuccessful, or eventually 
terminated on account of the disability, present unemployability may be 
attributed to the static disability. Where unemployability for pension 
previously has been established on the basis of combined service-
connected and nonservice-connected disabilities and the service-
connected disability or disabilities have increased in severity, Sec.  
4.16 is for consideration.

[40 FR 42536, Sept. 15, 1975, as amended at 43 FR 45349, Oct. 2, 1978]



Sec.  4.19  Age in service-connected claims.

    Age may not be considered as a factor in evaluating service-
connected disability; and unemployability, in service-connected claims, 
associated with advancing age or intercurrent disability, may not be 
used as a basis for a total disability rating. Age, as such, is a factor 
only in evaluations of disability not resulting from service, i.e., for 
the purposes of pension.

[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978]



Sec.  4.20  Analogous ratings.

    When an unlisted condition is encountered it will be permissible to 
rate under a closely related disease or injury in which not only the 
functions affected, but the anatomical localization and symptomatology 
are closely analogous. Conjectural analogies will be avoided, as will 
the use of analogous ratings for conditions of doubtful diagnosis, or 
for those not fully supported by clinical and laboratory findings. Nor 
will ratings assigned to organic diseases and injuries be assigned by 
analogy to conditions of functional origin.



Sec.  4.21  Application of rating schedule.

    In view of the number of atypical instances it is not expected, 
especially with the more fully described grades of disabilities, that 
all cases will show all the findings specified. Findings sufficiently 
characteristic to identify the disease and the disability therefrom, and 
above all, coordination of rating with impairment of function will, 
however, be expected in all instances.

[41 FR 11293, Mar. 18, 1976]



Sec.  4.22  Rating of disabilities aggravated by active service.

    In cases involving aggravation by active service, the rating will 
reflect only the degree of disability over and above the degree existing 
at the time of entrance into the active service, whether the particular 
condition was noted at the time of entrance into the active service, or 
it is determined upon the

[[Page 407]]

evidence of record to have existed at that time. It is necessary 
therefore, in all cases of this character to deduct from the present 
degree of disability the degree, if ascertainable, of the disability 
existing at the time of entrance into active service, in terms of the 
rating schedule, except that if the disability is total (100 percent) no 
deduction will be made. The resulting difference will be recorded on the 
rating sheet. If the degree of disability at the time of entrance into 
the service is not ascertainable in terms of the schedule, no deduction 
will be made.



Sec.  4.23  Attitude of rating officers.

    It is to be remembered that the majority of applicants are disabled 
persons who are seeking benefits of law to which they believe themselves 
entitled. In the exercise of his or her functions, rating officers must 
not allow their personal feelings to intrude; an antagonistic, critical, 
or even abusive attitude on the part of a claimant should not in any 
instance influence the officers in the handling of the case. Fairness 
and courtesy must at all times be shown to applicants by all employees 
whose duties bring them in contact, directly or indirectly, with the 
Department's claimants.

[41 FR 11292, Mar. 18, 1976]



Sec.  4.24  Correspondence.

    All correspondence relative to the interpretation of the schedule 
for rating disabilities, requests for advisory opinions, questions 
regarding lack of clarity or application to individual cases involving 
unusual difficulties, will be addressed to the Director, Compensation 
Service. A clear statement will be made of the point or points upon 
which information is desired, and the complete case file will be 
simultaneously forwarded to Central Office. Rating agencies will assure 
themselves that the recent report of physical examination presents an 
adequate picture of the claimant's condition. Claims in regard to which 
the schedule evaluations are considered inadequate or excessive, and 
errors in the schedule will be similarly brought to attention.

[41 FR 11292, Mar. 18, 1976, as amended at 79 FR 2100, Jan. 13, 2014]



Sec.  4.25  Combined ratings table.

    Table I, Combined Ratings Table, results from the consideration of 
the efficiency of the individual as affected first by the most disabling 
condition, then by the less disabling condition, then by other less 
disabling conditions, if any, in the order of severity. Thus, a person 
having a 60 percent disability is considered 40 percent efficient. 
Proceeding from this 40 percent efficiency, the effect of a further 30 
percent disability is to leave only 70 percent of the efficiency 
remaining after consideration of the first disability, or 28 percent 
efficiency altogether. The individual is thus 72 percent disabled, as 
shown in table I opposite 60 percent and under 30 percent.
    (a) To use table I, the disabilities will first be arranged in the 
exact order of their severity, beginning with the greatest disability 
and then combined with use of table I as hereinafter indicated. For 
example, if there are two disabilities, the degree of one disability 
will be read in the left column and the degree of the other in the top 
row, whichever is appropriate. The figures appearing in the space where 
the column and row intersect will represent the combined value of the 
two. This combined value will then be converted to the nearest number 
divisible by 10, and combined values ending in 5 will be adjusted 
upward. Thus, with a 50 percent disability and a 30 percent disability, 
the combined value will be found to be 65 percent, but the 65 percent 
must be converted to 70 percent to represent the final degree of 
disability. Similarly, with a disability of 40 percent, and another 
disability of 20 percent, the combined value is found to be 52 percent, 
but the 52 percent must be converted to the nearest degree divisible by 
10, which is 50 percent. If there are more than two disabilities, the 
disabilities will also be arranged in the exact order of their severity 
and the combined value for the first two will be found as previously 
described for two disabilities. The combined value, exactly as found in 
table I, will be combined with the degree of the third disability (in 
order of severity). The combined value for the three disabilities will 
be found in the space where the column and row intersect, and if there

[[Page 408]]

are only three disabilities will be converted to the nearest degree 
divisible by 10, adjusting final 5's upward. Thus, if there are three 
disabilities ratable at 60 percent, 40 percent, and 20 percent, 
respectively, the combined value for the first two will be found 
opposite 60 and under 40 and is 76 percent. This 76 will be combined 
with 20 and the combined value for the three is 81 percent. This 
combined value will be converted to the nearest degree divisible by 10 
which is 80 percent. The same procedure will be employed when there are 
four or more disabilities. (See table I).
    (b) Except as otherwise provided in this schedule, the disabilities 
arising from a single disease entity, e.g., arthritis, multiple 
sclerosis, cerebrovascular accident, etc., are to be rated separately as 
are all other disabiling conditions, if any. All disabilities are then 
to be combined as described in paragraph (a) of this section. The 
conversion to the nearest degree divisible by 10 will be done only once 
per rating decision, will follow the combining of all disabilities, and 
will be the last procedure in determining the combined degree of 
disability.

                                         Table I--Combined Ratings Table
                                           [10 combined with 10 is 19]
----------------------------------------------------------------------------------------------------------------
                                            10      20      30      40      50      60      70      80      90
----------------------------------------------------------------------------------------------------------------
19......................................      27      35      43      51      60      68      76      84      92
20......................................      28      36      44      52      60      68      76      84      92
21......................................      29      37      45      53      61      68      76      84      92
22......................................      30      38      45      53      61      69      77      84      92
23......................................      31      38      46      54      62      69      77      85      92
24......................................      32      39      47      54      62      70      77      85      92
25......................................      33      40      48      55      63      70      78      85      93
26......................................      33      41      48      56      63      70      78      85      93
27......................................      34      42      49      56      64      71      78      85      93
28......................................      35      42      50      57      64      71      78      86      93
29......................................      36      43      50      57      65      72      79      86      93
30......................................      37      44      51      58      65      72      79      86      93
31......................................      38      45      52      59      66      72      79      86      93
32......................................      39      46      52      59      66      73      80      86      93
33......................................      40      46      53      60      67      73      80      87      93
34......................................      41      47      54      60      67      74      80      87      93
35......................................      42      48      55      61      68      74      81      87      94
36......................................      42      49      55      62      68      74      81      87      94
37......................................      43      50      56      62      69      75      81      87      94
38......................................      44      50      57      63      69      75      81      88      94
39......................................      45      51      57      63      70      76      82      88      94
40......................................      46      52      58      64      70      76      82      88      94
41......................................      47      53      59      65      71      76      82      88      94
42......................................      48      54      59      65      71      77      83      88      94
43......................................      49      54      60      66      72      77      83      89      94
44......................................      50      55      61      66      72      78      83      89      94
45......................................      51      56      62      67      73      78      84      89      95
46......................................      51      57      62      68      73      78      84      89      95
47......................................      52      58      63      68      74      79      84      89      95
48......................................      53      58      64      69      74      79      84      90      95
49......................................      54      59      64      69      75      80      85      90      95
50......................................      55      60      65      70      75      80      85      90      95
51......................................      56      61      66      71      76      80      85      90      95
52......................................      57      62      66      71      76      81      86      90      95
53......................................      58      62      67      72      77      81      86      91      95
54......................................      59      63      68      72      77      82      86      91      95
55......................................      60      64      69      73      78      82      87      91      96
56......................................      60      65      69      74      78      82      87      91      96
57......................................      61      66      70      74      79      83      87      91      96
58......................................      62      66      71      75      79      83      87      92      96
59......................................      63      67      71      75      80      84      88      92      96
60......................................      64      68      72      76      80      84      88      92      96
61......................................      65      69      73      77      81      84      88      92      96
62......................................      66      70      73      77      81      85      89      92      96
63......................................      67      70      74      78      82      85      89      93      96
64......................................      68      71      75      78      82      86      89      93      96
65......................................      69      72      76      79      83      86      90      93      97
66......................................      69      73      76      80      83      86      90      93      97
67......................................      70      74      77      80      84      87      90      93      97
68......................................      71      74      78      81      84      87      90      94      97
69......................................      72      75      78      81      85      88      91      94      97

[[Page 409]]

 
70......................................      73      76      79      82      85      88      91      94      97
71......................................      74      77      80      83      86      88      91      94      97
72......................................      75      78      80      83      86      89      92      94      97
73......................................      76      78      81      84      87      89      92      95      97
74......................................      77      79      82      84      87      90      92      95      97
75......................................      78      80      83      85      88      90      93      95      98
76......................................      78      81      83      86      88      90      93      95      98
77......................................      79      82      84      86      89      91      93      95      98
78......................................      80      82      85      87      89      91      93      96      98
79......................................      81      83      85      87      90      92      94      96      98
80......................................      82      84      86      88      90      92      94      96      98
81......................................      83      85      87      89      91      92      94      96      98
82......................................      84      86      87      89      91      93      95      96      98
83......................................      85      86      88      90      92      93      95      97      98
84......................................      86      87      89      90      92      94      95      97      98
85......................................      87      88      90      91      93      94      96      97      99
86......................................      87      89      90      92      93      94      96      97      99
87......................................      88      90      91      92      94      95      96      97      99
88......................................      89      90      92      93      94      95      96      98      99
89......................................      90      91      92      93      95      96      97      98      99
90......................................      91      92      93      94      95      96      97      98      99
91......................................      92      93      94      95      96      96      97      98      99
92......................................      93      94      94      95      96      97      98      98      99
93......................................      94      94      95      96      97      97      98      99      99
94......................................      95      95      96      96      97      98      98      99      99
----------------------------------------------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[41 FR 11293, Mar. 18, 1976, as amended at 54 FR 27161, June 28, 1989; 
54 FR 36029, Aug. 31, 1989; 83 FR 17756, Apr. 24, 2018]



Sec.  4.26  Bilateral factor.

    When a partial disability results from disease or injury of both 
arms, or of both legs, or of paired skeletal muscles, the ratings for 
the disabilities of the right and left sides will be combined as usual, 
and 10 percent of this value will be added (i.e., not combined) before 
proceeding with further combinations, or converting to degree of 
disability. The bilateral factor will be applied to such bilateral 
disabilities before other combinations are carried out and the rating 
for such disabilities including the bilateral factor in this section 
will be treated as 1 disability for the purpose of arranging in order of 
severity and for all further combinations. For example, with 
disabilities evaluated at 60 percent, 20 percent, 10 percent and 10 
percent (the two 10's representing bilateral disabilities), the order of 
severity would be 60, 21 and 20. The 60 and 21 combine to 68 percent and 
the 68 and 20 to 74 percent, converted to 70 percent as the final degree 
of disability.
    (a) The use of the terms ``arms'' and ``legs'' is not intended to 
distinguish between the arm, forearm and hand, or the thigh, leg, and 
foot, but relates to the upper extremities and lower extremities as a 
whole. Thus with a compensable disability of the right thigh, for 
example, amputation, and one of the left foot, for example, pes planus, 
the bilateral factor applies, and similarly whenever there are 
compensable disabilities affecting use of paired extremities regardless 
of location or specified type of impairment.
    (b) The correct procedure when applying the bilateral factor to 
disabilities affecting both upper extremities and both lower extremities 
is to combine the ratings of the disabilities affecting the 4 
extremities in the order of their individual severity and apply the 
bilateral factor by adding, not combining, 10 percent of the combined 
value thus attained.
    (c) The bilateral factor is not applicable unless there is partial 
disability of compensable degree in each of 2 paired extremities, or 
paired skeletal muscles.

[[Page 410]]



Sec.  4.27  Use of diagnostic code numbers.

    The diagnostic code numbers appearing opposite the listed ratable 
disabilities are arbitrary numbers for the purpose of showing the basis 
of the evaluation assigned and for statistical analysis in the 
Department of Veterans Affairs, and as will be observed, extend from 
5000 to a possible 9999. Great care will be exercised in the selection 
of the applicable code number and in its citation on the rating sheet. 
No other numbers than these listed or hereafter furnished are to be 
employed for rating purposes, with an exception as described in this 
section, as to unlisted conditions. When an unlisted disease, injury, or 
residual condition is encountered, requiring rating by analogy, the 
diagnostic code number will be ``built-up'' as follows: The first 2 
digits will be selected from that part of the schedule most closely 
identifying the part, or system, of the body involved; the last 2 digits 
will be ``99'' for all unlisted conditions. This procedure will 
facilitate a close check of new and unlisted conditions, rated by 
analogy. In the selection of code numbers, injuries will generally be 
represented by the number assigned to the residual condition on the 
basis of which the rating is determined. With diseases, preference is to 
be given to the number assigned to the disease itself; if the rating is 
determined on the basis of residual conditions, the number appropriate 
to the residual condition will be added, preceded by a hyphen. Thus, 
rheumatoid (atrophic) arthritis rated as ankylosis of the lumbar spine 
should be coded ``5002-5240.'' In this way, the exact source of each 
rating can be easily identified. In the citation of disabilities on 
rating sheets, the diagnostic terminology will be that of the medical 
examiner, with no attempt to translate the terms into schedule 
nomenclature. Residuals of diseases or therapeutic procedures will not 
be cited without reference to the basic disease.

[41 FR 11293, Mar. 18, 1976, as amended at 70 FR 75399, Dec. 20, 2005]



Sec.  4.28  Prestabilization rating from date of discharge from service.

    The following ratings may be assigned, in lieu of ratings prescribed 
elsewhere, under the conditions stated for disability from any disease 
or injury. The prestabilization rating is not to be assigned in any case 
in which a total rating is immediately assignable under the regular 
provisions of the schedule or on the basis of individual 
unemployability. The prestabilization 50-percent rating is not to be 
used in any case in which a rating of 50 percent or more is immediately 
assignable under the regular provisions.

------------------------------------------------------------------------
                                                                Rating
------------------------------------------------------------------------
Unstabilized condition with severe disability--
  Substantially gainful employment is not feasible or                100
   advisable................................................
Unhealed or incompletely healed wounds or injuries--
  Material impairment of employability likely...............          50
------------------------------------------------------------------------

    Note (1): Department of Veterans Affairs examination is not required 
prior to assignment of prestabilization ratings; however, the fact that 
examination was accomplished will not preclude assignment of these 
benefits. Prestabilization ratings are for assignment in the immediate 
postdischarge period. They will continue for a 12-month period following 
discharge from service. However, prestabilization ratings may be changed 
to a regular schedular total rating or one authorizing a greater benefit 
at any time. In each prestabilization rating an examination will be 
requested to be accomplished not earlier than 6 months nor more than 12 
months following discharge. In those prestabilization ratings in which 
following examination reduction in evaluation is found to be warranted, 
the higher evaluation will be continued to the end of the 12th month 
following discharge or to the end of the period provided under Sec.  
3.105(e) of this chapter, whichever is later. Special monthly 
compensation should be assigned concurrently in these cases whenever 
records are adequate to establish entitlement.
    Note (2): Diagnosis of disease, injury, or residuals will be cited, 
with diagnostic code number assigned from this rating schedule for 
conditions listed therein.

[35 FR 11906, July 24, 1970]



Sec.  4.29  Ratings for service-connected disabilities requiring hospital
treatment or observation.

    A total disability rating (100 percent) will be assigned without 
regard to other provisions of the rating schedule when it is established 
that a service-connected disability has required hospital treatment in a 
Department of

[[Page 411]]

Veterans Affairs or an approved hospital for a period in excess of 21 
days or hospital observation at Department of Veterans Affairs expense 
for a service-connected disability for a period in excess of 21 days.
    (a) Subject to the provisions of paragraphs (d), (e), and (f) of 
this section this increased rating will be effective the first day of 
continuous hospitalization and will be terminated effective the last day 
of the month of hospital discharge (regular discharge or release to non-
bed care) or effective the last day of the month of termination of 
treatment or observation for the service-connected disability. A 
temporary release which is approved by an attending Department of 
Veterans Affairs physician as part of the treatment plan will not be 
considered an absence.
    (1) An authorized absence in excess of 4 days which begins during 
the first 21 days of hospitalization will be regarded as the equivalent 
of hospital discharge effective the first day of such authorized 
absence. An authorized absence of 4 days or less which results in a 
total of more than 8 days of authorized absence during the first 21 days 
of hospitalization will be regarded as the equivalent of hospital 
discharge effective the ninth day of authorized absence.
    (2) Following a period of hospitalization in excess of 21 days, an 
authorized absence in excess of 14 days or a third consecutive 
authorized absence of 14 days will be regarded as the equivalent of 
hospital discharge and will interrupt hospitalization effective on the 
last day of the month in which either the authorized absence in excess 
of 14 days or the third 14 day period begins, except where there is a 
finding that convalescence is required as provided by paragraph (e) or 
(f) of this section. The termination of these total ratings will not be 
subject to Sec.  3.105(e) of this chapter.
    (b) Notwithstanding that hospital admission was for disability not 
connected with service, if during such hospitalization, hospital 
treatment for a service-connected disability is instituted and continued 
for a period in excess of 21 days, the increase to a total rating will 
be granted from the first day of such treatment. If service connection 
for the disability under treatment is granted after hospital admission, 
the rating will be from the first day of hospitalization if otherwise in 
order.
    (c) The assignment of a total disability rating on the basis of 
hospital treatment or observation will not preclude the assignment of a 
total disability rating otherwise in order under other provisions of the 
rating schedule, and consideration will be given to the propriety of 
such a rating in all instances and to the propriety of its continuance 
after discharge. Particular attention, with a view to proper rating 
under the rating schedule, is to be given to the claims of veterans 
discharged from hospital, regardless of length of hospitalization, with 
indications on the final summary of expected confinement to bed or 
house, or to inability to work with requirement of frequent care of 
physician or nurse at home.
    (d) On these total ratings Department of Veterans Affairs 
regulations governing effective dates for increased benefits will 
control.
    (e) The total hospital rating if convalescence is required may be 
continued for periods of 1, 2, or 3 months in addition to the period 
provided in paragraph (a) of this section.
    (f) Extension of periods of 1, 2 or 3 months beyond the initial 3 
months may be made upon approval of the Veterans Service Center Manager.
    (g) Meritorious claims of veterans who are discharged from the 
hospital with less than the required number of days but need post-
hospital care and a prolonged period of convalescence will be referred 
to the Director, Compensation Service, under Sec.  3.321(b)(1) of this 
chapter.

[29 FR 6718, May 22, 1964, as amended at 41 FR 11294, Mar. 18, 1976; 41 
FR 34256, Aug. 13, 1976; 54 FR 4281, Jan. 30, 1989; 54 FR 34981, Aug. 
23, 1989; 71 FR 28586, May 17, 2006; 79 FR 2100, Jan. 13, 2014]



Sec.  4.30  Convalescent ratings.

    A total disability rating (100 percent) will be assigned without 
regard to other provisions of the rating schedule when it is established 
by report at hospital discharge (regular discharge or release to non-bed 
care) or outpatient release that entitlement is warranted

[[Page 412]]

under paragraph (a) (1), (2) or (3) of this section effective the date 
of hospital admission or outpatient treatment and continuing for a 
period of 1, 2, or 3 months from the first day of the month following 
such hospital discharge or outpatient release. The termination of these 
total ratings will not be subject to Sec.  3.105(e) of this chapter. 
Such total rating will be followed by appropriate schedular evaluations. 
When the evidence is inadequate to assign a schedular evaluation, a 
physical examination will be scheduled and considered prior to the 
termination of a total rating under this section.
    (a) Total ratings will be assigned under this section if treatment 
of a service-connected disability resulted in:
    (1) Surgery necessitating at least one month of convalescence 
(Effective as to outpatient surgery March 1, 1989.)
    (2) Surgery with severe postoperative residuals such as incompletely 
healed surgical wounds, stumps of recent amputations, therapeutic 
immobilization of one major joint or more, application of a body cast, 
or the necessity for house confinement, or the necessity for continued 
use of a wheelchair or crutches (regular weight-bearing prohibited). 
(Effective as to outpatient surgery March 1, 1989.)
    (3) Immobilization by cast, without surgery, of one major joint or 
more. (Effective as to outpatient treatment March 10, 1976.)

A reduction in the total rating will not be subject to Sec.  3.105(e) of 
this chapter. The total rating will be followed by an open rating 
reflecting the appropriate schedular evaluation; where the evidence is 
inadequate to assign the schedular evaluation, a physcial examination 
will be scheduled prior to the end of the total rating period.
    (b) A total rating under this section will require full 
justification on the rating sheet and may be extended as follows:
    (1) Extensions of 1, 2 or 3 months beyond the initial 3 months may 
be made under paragraph (a) (1), (2) or (3) of this section.
    (2) Extensions of 1 or more months up to 6 months beyond the initial 
6 months period may be made under paragraph (a) (2) or (3) of this 
section upon approval of the Veterans Service Center Manager.

[41 FR 34256, Aug. 13, 1976, as amended at 54 FR 4281, Jan. 30, 1989; 71 
FR 28586, May 17, 2006]



Sec.  4.31  Zero percent evaluations.

    In every instance where the schedule does not provide a zero percent 
evaluation for a diagnostic code, a zero percent evaluation shall be 
assigned when the requirements for a compensable evaluation are not met.

[58 FR 52018, Oct. 6, 1993]



                      Subpart B_Disability Ratings

                       The Musculoskeletal System



Sec.  4.40  Functional loss.

    Disability of the musculoskeletal system is primarily the inability, 
due to damage or infection in parts of the system, to perform the normal 
working movements of the body with normal excursion, strength, speed, 
coordination and endurance. It is essential that the examination on 
which ratings are based adequately portray the anatomical damage, and 
the functional loss, with respect to all these elements. The functional 
loss may be due to absence of part, or all, of the necessary bones, 
joints and muscles, or associated structures, or to deformity, 
adhesions, defective innervation, or other pathology, or it may be due 
to pain, supported by adequate pathology and evidenced by the visible 
behavior of the claimant undertaking the motion. Weakness is as 
important as limitation of motion, and a part which becomes painful on 
use must be regarded as seriously disabled. A little used part of the 
musculoskeletal system may be expected to show evidence of disuse, 
either through atrophy, the condition of the skin, absence of normal 
callosity or the like.



Sec.  4.41  History of injury.

    In considering the residuals of injury, it is essential to trace the 
medical-industrial history of the disabled person from the original 
injury, considering

[[Page 413]]

the nature of the injury and the attendant circumstances, and the 
requirements for, and the effect of, treatment over past periods, and 
the course of the recovery to date. The duration of the initial, and any 
subsequent, period of total incapacity, especially periods reflecting 
delayed union, inflammation, swelling, drainage, or operative 
intervention, should be given close attention. This consideration, or 
the absence of clear cut evidence of injury, may result in classifying 
the disability as not of traumatic origin, either reflecting congenital 
or developmental etiology, or the effects of healed disease.



Sec.  4.42  Complete medical examination of injury cases.

    The importance of complete medical examination of injury cases at 
the time of first medical examination by the Department of Veterans 
Affairs cannot be overemphasized. When possible, this should include 
complete neurological and psychiatric examination, and other special 
examinations indicated by the physical condition, in addition to the 
required general and orthopedic or surgical examinations. When complete 
examinations are not conducted covering all systems of the body affected 
by disease or injury, it is impossible to visualize the nature and 
extent of the service connected disability. Incomplete examination is a 
common cause of incorrect diagnosis, especially in the neurological and 
psychiatric fields, and frequently leaves the Department of Veterans 
Affairs in doubt as to the presence or absence of disabling conditions 
at the time of the examination.



Sec.  4.43  Osteomyelitis.

    Chronic, or recurring, suppurative osteomyelitis, once clinically 
identified, including chronic inflammation of bone marrow, cortex, or 
periosteum, should be considered as a continuously disabling process, 
whether or not an actively discharging sinus or other obvious evidence 
of infection is manifest from time to time, and unless the focus is 
entirely removed by amputation will entitle to a permanent rating to be 
combined with other ratings for residual conditions, however, not 
exceeding amputation ratings at the site of election.



Sec.  4.44  The bones.

    The osseous abnormalities incident to trauma or disease, such as 
malunion with deformity throwing abnormal stress upon, and causing 
malalignment of joint surfaces, should be depicted from study and 
observation of all available data, beginning with inception of injury or 
disease, its nature, degree of prostration, treatment and duration of 
convalescence, and progress of recovery with development of permanent 
residuals. With shortening of a long bone, some degree of angulation is 
to be expected; the extent and direction should be brought out by X-ray 
and observation. The direction of angulation and extent of deformity 
should be carefully related to strain on the neighboring joints, 
especially those connected with weight-bearing.



Sec.  4.45  The joints.

    As regards the joints the factors of disability reside in reductions 
of their normal excursion of movements in different planes. Inquiry will 
be directed to these considerations:
    (a) Less movement than normal (due to ankylosis, limitation or 
blocking, adhesions, tendon-tie-up, contracted scars, etc.).
    (b) More movement than normal (from flail joint, resections, 
nonunion of fracture, relaxation of ligaments, etc.).
    (c) Weakened movement (due to muscle injury, disease or injury of 
peripheral nerves, divided or lengthened tendons, etc.).
    (d) Excess fatigability.
    (e) Incoordination, impaired ability to execute skilled movements 
smoothly.
    (f) Pain on movement, swelling, deformity or atrophy of disuse. 
Instability of station, disturbance of locomotion, interference with 
sitting, standing and weight-bearing are related considerations. For the 
purpose of rating disability from arthritis, the shoulder, elbow, wrist, 
hip, knee, and ankle are considered major joints; multiple involvements 
of the interphalangeal, metacarpal and carpal joints of

[[Page 414]]

the upper extremities, the interphalangeal, metatarsal and tarsal joints 
of the lower extremities, the cervical vertebrae, the dorsal vertebrae, 
and the lumbar vertebrae, are considered groups of minor joints, ratable 
on a parity with major joints. The lumbosacral articulation and both 
sacroiliac joints are considered to be a group of minor joints, ratable 
on disturbance of lumbar spine functions.



Sec.  4.46  Accurate measurement.

    Accurate measurement of the length of stumps, excursion of joints, 
dimensions and location of scars with respect to landmarks, should be 
insisted on. The use of a goniometer in the measurement of limitation of 
motion is indispensable in examinations conducted within the Department 
of Veterans Affairs. Muscle atrophy must also be accurately measured and 
reported.

[41 FR 11294, Mar. 18, 1976]



Sec. Sec.  4.47-4.54  [Reserved]



Sec.  4.55  Principles of combined ratings for muscle injuries.

    (a) A muscle injury rating will not be combined with a peripheral 
nerve paralysis rating of the same body part, unless the injuries affect 
entirely different functions.
    (b) For rating purposes, the skeletal muscles of the body are 
divided into 23 muscle groups in 5 anatomical regions: 6 muscle groups 
for the shoulder girdle and arm (diagnostic codes 5301 through 5306); 3 
muscle groups for the forearm and hand (diagnostic codes 5307 through 
5309); 3 muscle groups for the foot and leg (diagnostic codes 5310 
through 5312); 6 muscle groups for the pelvic girdle and thigh 
(diagnostic codes 5313 through 5318); and 5 muscle groups for the torso 
and neck (diagnostic codes 5319 through 5323).
    (c) There will be no rating assigned for muscle groups which act 
upon an ankylosed joint, with the following exceptions:
    (1) In the case of an ankylosed knee, if muscle group XIII is 
disabled, it will be rated, but at the next lower level than that which 
would otherwise be assigned.
    (2) In the case of an ankylosed shoulder, if muscle groups I and II 
are severely disabled, the evaluation of the shoulder joint under 
diagnostic code 5200 will be elevated to the level for unfavorable 
ankylosis, if not already assigned, but the muscle groups themselves 
will not be rated.
    (d) The combined evaluation of muscle groups acting upon a single 
unankylosed joint must be lower than the evaluation for unfavorable 
ankylosis of that joint, except in the case of muscle groups I and II 
acting upon the shoulder.
    (e) For compensable muscle group injuries which are in the same 
anatomical region but do not act on the same joint, the evaluation for 
the most severely injured muscle group will be increased by one level 
and used as the combined evaluation for the affected muscle groups.
    (f) For muscle group injuries in different anatomical regions which 
do not act upon ankylosed joints, each muscle group injury shall be 
separately rated and the ratings combined under the provisions of Sec.  
4.25.

(Authority: 38 U.S.C. 1155)

[62 FR 30237, June 3, 1997]



Sec.  4.56  Evaluation of muscle disabilities.

    (a) An open comminuted fracture with muscle or tendon damage will be 
rated as a severe injury of the muscle group involved unless, for 
locations such as in the wrist or over the tibia, evidence establishes 
that the muscle damage is minimal.
    (b) A through-and-through injury with muscle damage shall be 
evaluated as no less than a moderate injury for each group of muscles 
damaged.
    (c) For VA rating purposes, the cardinal signs and symptoms of 
muscle disability are loss of power, weakness, lowered threshold of 
fatigue, fatigue-pain, impairment of coordination and uncertainty of 
movement.
    (d) Under diagnostic codes 5301 through 5323, disabilities resulting 
from muscle injuries shall be classified as slight, moderate, moderately 
severe or severe as follows:
    (1) Slight disability of muscles--(i) Type of injury. Simple wound 
of muscle without debridement or infection.

[[Page 415]]

    (ii) History and complaint. Service department record of superficial 
wound with brief treatment and return to duty. Healing with good 
functional results. No cardinal signs or symptoms of muscle disability 
as defined in paragraph (c) of this section.
    (iii) Objective findings. Minimal scar. No evidence of fascial 
defect, atrophy, or impaired tonus. No impairment of function or 
metallic fragments retained in muscle tissue.
    (2) Moderate disability of muscles--(i) Type of injury. Through and 
through or deep penetrating wound of short track from a single bullet, 
small shell or shrapnel fragment, without explosive effect of high 
velocity missile, residuals of debridement, or prolonged infection.
    (ii) History and complaint. Service department record or other 
evidence of in-service treatment for the wound. Record of consistent 
complaint of one or more of the cardinal signs and symptoms of muscle 
disability as defined in paragraph (c) of this section, particularly 
lowered threshold of fatigue after average use, affecting the particular 
functions controlled by the injured muscles.
    (iii) Objective findings. Entrance and (if present) exit scars, 
small or linear, indicating short track of missile through muscle 
tissue. Some loss of deep fascia or muscle substance or impairment of 
muscle tonus and loss of power or lowered threshold of fatigue when 
compared to the sound side.
    (3) Moderately severe disability of muscles--(i) Type of injury. 
Through and through or deep penetrating wound by small high velocity 
missile or large low-velocity missile, with debridement, prolonged 
infection, or sloughing of soft parts, and intermuscular scarring.
    (ii) History and complaint. Service department record or other 
evidence showing hospitalization for a prolonged period for treatment of 
wound. Record of consistent complaint of cardinal signs and symptoms of 
muscle disability as defined in paragraph (c) of this section and, if 
present, evidence of inability to keep up with work requirements.
    (iii) Objective findings. Entrance and (if present) exit scars 
indicating track of missile through one or more muscle groups. 
Indications on palpation of loss of deep fascia, muscle substance, or 
normal firm resistance of muscles compared with sound side. Tests of 
strength and endurance compared with sound side demonstrate positive 
evidence of impairment.
    (4) Severe disability of muscles--(i) Type of injury. Through and 
through or deep penetrating wound due to high-velocity missile, or large 
or multiple low velocity missiles, or with shattering bone fracture or 
open comminuted fracture with extensive debridement, prolonged 
infection, or sloughing of soft parts, intermuscular binding and 
scarring.
    (ii) History and complaint. Service department record or other 
evidence showing hospitalization for a prolonged period for treatment of 
wound. Record of consistent complaint of cardinal signs and symptoms of 
muscle disability as defined in paragraph (c) of this section, worse 
than those shown for moderately severe muscle injuries, and, if present, 
evidence of inability to keep up with work requirements.
    (iii) Objective findings. Ragged, depressed and adherent scars 
indicating wide damage to muscle groups in missile track. Palpation 
shows loss of deep fascia or muscle substance, or soft flabby muscles in 
wound area. Muscles swell and harden abnormally in contraction. Tests of 
strength, endurance, or coordinated movements compared with the 
corresponding muscles of the uninjured side indicate severe impairment 
of function. If present, the following are also signs of severe muscle 
disability:
    (A) X-ray evidence of minute multiple scattered foreign bodies 
indicating intermuscular trauma and explosive effect of the missile.
    (B) Adhesion of scar to one of the long bones, scapula, pelvic 
bones, sacrum or vertebrae, with epithelial sealing over the bone rather 
than true skin covering in an area where bone is normally protected by 
muscle.
    (C) Diminished muscle excitability to pulsed electrical current in 
electrodiagnostic tests.
    (D) Visible or measurable atrophy.
    (E) Adaptive contraction of an opposing group of muscles.
    (F) Atrophy of muscle groups not in the track of the missile, 
particularly of

[[Page 416]]

the trapezius and serratus in wounds of the shoulder girdle.
    (G) Induration or atrophy of an entire muscle following simple 
piercing by a projectile.

(Authority: 38 U.S.C. 1155

[62 FR 30238, June 3, 1997]



Sec.  4.57  Static foot deformities.

    It is essential to make an initial distinction between bilateral 
flatfoot as a congenital or as an acquired condition. The congenital 
condition, with depression of the arch, but no evidence of abnormal 
callosities, areas of pressure, strain or demonstrable tenderness, is a 
congenital abnormality which is not compensable or pensionable. In the 
acquired condition, it is to be remembered that depression of the 
longitudinal arch, or the degree of depression, is not the essential 
feature. The attention should be given to anatomical changes, as 
compared to normal, in the relationship of the foot and leg, 
particularly to the inward rotation of the superior portion of the os 
calcis, medial deviation of the insertion of the Achilles tendon, the 
medial tilting of the upper border of the astragalus. This is an 
unfavorable mechanical relationship of the parts. A plumb line dropped 
from the middle of the patella falls inside of the normal point. The 
forepart of the foot is abducted, and the foot everted. The plantar 
surface of the foot is painful and shows demonstrable tenderness, and 
manipulation of the foot produces spasm of the Achilles tendon, peroneal 
spasm due to adhesion about the peroneal sheaths, and other evidence of 
pain and limited motion. The symptoms should be apparent without regard 
to exercise. In severe cases there is gaping of bones on the inner 
border of the foot, and rigid valgus position with loss of the power of 
inversion and adduction. Exercise with undeveloped or unbalanced 
musculature, producing chronic irritation, can be an aggravating factor. 
In the absence of trauma or other definite evidence of aggravation, 
service connection is not in order for pes cavus which is a typically 
congenital or juvenile disease.



Sec.  4.58  Arthritis due to strain.

    With service incurred lower extremity amputation or shortening, a 
disabling arthritis, developing in the same extremity, or in both lower 
extremities, with indications of earlier, or more severe, arthritis in 
the injured extremity, including also arthritis of the lumbosacral 
joints and lumbar spine, if associated with the leg amputation or 
shortening, will be considered as service incurred, provided, however, 
that arthritis affecting joints not directly subject to strain as a 
result of the service incurred amputation will not be granted service 
connection. This will generally require separate evaluation of the 
arthritis in the joints directly subject to strain. Amputation, or 
injury to an upper extremity, is not considered as a causative factor 
with subsequently developing arthritis, except in joints subject to 
direct strain or actually injured.



Sec.  4.59  Painful motion.

    With any form of arthritis, painful motion is an important factor of 
disability, the facial expression, wincing, etc., on pressure or 
manipulation, should be carefully noted and definitely related to 
affected joints. Muscle spasm will greatly assist the identification. 
Sciatic neuritis is not uncommonly caused by arthritis of the spine. The 
intent of the schedule is to recognize painful motion with joint or 
periarticular pathology as productive of disability. It is the intention 
to recognize actually painful, unstable, or malaligned joints, due to 
healed injury, as entitled to at least the minimum compensable rating 
for the joint. Crepitation either in the soft tissues such as the 
tendons or ligaments, or crepitation within the joint structures should 
be noted carefully as points of contact which are diseased. Flexion 
elicits such manifestations. The joints involved should be tested for 
pain on both active and passive motion, in weight-bearing and nonweight-
bearing and, if possible, with the range of the opposite undamaged 
joint.

[[Page 417]]



Sec.  4.60  [Reserved]



Sec.  4.61  Examination.

    With any form of arthritis (except traumatic arthritis) it is 
essential that the examination for rating purposes cover all major 
joints, with especial reference to Heberden's or Haygarth's nodes.



Sec.  4.62  Circulatory disturbances.

    The circulatory disturbances, especially of the lower extremity 
following injury in the popliteal space, must not be overlooked, and 
require rating generally as phlebitis.



Sec.  4.63  Loss of use of hand or foot.

    Loss of use of a hand or a foot, for the purpose of special monthly 
compensation, will be held to exist when no effective function remains 
other than that which would be equally well served by an amputation 
stump at the site of election below elbow or knee with use of a suitable 
prosthetic appliance. The determination will be made on the basis of the 
actual remaining function of the hand or foot, whether the acts of 
grasping, manipulation, etc., in the case of the hand, or of balance and 
propulsion, etc., in the case of the foot, could be accomplished equally 
well by an amputation stump with prosthesis.
    (a) Extremely unfavorable complete ankylosis of the knee, or 
complete ankylosis of 2 major joints of an extremity, or shortening of 
the lower extremity of 3\1/2\ inches (8.9 cms.) or more, will be taken 
as loss of use of the hand or foot involved.
    (b) Complete paralysis of the external popliteal nerve (common 
peroneal) and consequent, footdrop, accompanied by characteristic 
organic changes including trophic and circulatory disturbances and other 
concomitants confirmatory of complete paralysis of this nerve, will be 
taken as loss of use of the foot.

[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978]



Sec.  4.64  Loss of use of both buttocks.

    Loss of use of both buttocks shall be deemed to exist when there is 
severe damage to muscle Group XVII, bilateral (diagnostic code number 
5317) and additional disability rendering it impossible for the disabled 
person, without assistance, to rise from a seated position and from a 
stooped position (fingers to toes position) and to maintain postural 
stability (the pelvis upon head of femur). The assistance may be 
rendered by the person's own hands or arms, and, in the matter of 
postural stability, by a special appliance.



Sec.  4.65  [Reserved]



Sec.  4.66  Sacroiliac joint.

    The common cause of disability in this region is arthritis, to be 
identified in the usual manner. The lumbosacral and sacroiliac joints 
should be considered as one anatomical segment for rating purposes. X-
ray changes from arthritis in this location are decrease or obliteration 
of the joint space, with the appearance of increased bone density of the 
sacrum and ilium and sharpening of the margins of the joint. Disability 
is manifest from erector spinae spasm (not accounted for by other 
pathology), tenderness on deep palpation and percussion over these 
joints, loss of normal quickness of motion and resiliency, and postural 
defects often accompanied by limitation of flexion and extension of the 
hip. Traumatism is a rare cause of disability in this connection, except 
when superimposed upon congenital defect or upon an existent arthritis; 
to permit assumption of pure traumatic origin, objective evidence of 
damage to the joint, and history of trauma sufficiently severe to injure 
this extremely strong and practically immovable joint is required. There 
should be careful consideration of lumbosacral sprain, and the various 
symptoms of pain and paralysis attributable to disease affecting the 
lumbar vertebrae and the intervertebral disc.



Sec.  4.67  Pelvic bones.

    The variability of residuals following these fractures necessitates 
rating on specific residuals, faulty posture, limitation of motion, 
muscle injury, painful motion of the lumbar spine, manifest by muscle 
spasm, mild to moderate sciatic neuritis, peripheral nerve injury, or 
limitation of hip motion.

[[Page 418]]



Sec.  4.68  Amputation rule.

    The combined rating for disabilities of an extremity shall not 
exceed the rating for the amputation at the elective level, were 
amputation to be performed. For example, the combined evaluations for 
disabilities below the knee shall not exceed the 40 percent evaluation, 
diagnostic code 5165. This 40 percent rating may be further combined 
with evaluation for disabilities above the knee but not to exceed the 
above the knee amputation elective level. Painful neuroma of a stump 
after amputation shall be assigned the evaluation for the elective site 
of reamputation.



Sec.  4.69  Dominant hand.

    Handedness for the purpose of a dominant rating will be determined 
by the evidence of record, or by testing on VA examination. Only one 
hand shall be considered dominant. The injured hand, or the most 
severely injured hand, of an ambidextrous individual will be considered 
the dominant hand for rating purposes.

(Authority: 38 U.S.C. 1155)

[62 FR 30239, June 3, 1997]



Sec.  4.70  Inadequate examinations.

    If the report of examination is inadequate as a basis for the 
required consideration of service connection and evaluation, the rating 
agency may request a supplementary report from the examiner giving 
further details as to the limitations of the disabled person's ordinary 
activity imposed by the disease, injury, or residual condition, the 
prognosis for return to, or continuance of, useful work. When the best 
interests of the service will be advanced by personal conference with 
the examiner, such conference may be arranged through channels.



Sec.  4.71  Measurement of ankylosis and joint motion.

    Plates I and II provide a standardized description of ankylosis and 
joint motion measurement. The anatomical position is considered as 
0[deg], with two major exceptions: (a) Shoulder rotation--arm abducted 
to 90[deg], elbow flexed to 90[deg] with the position of the forearm 
reflecting the midpoint 0[deg] between internal and external rotation of 
the shoulder; and (b) supination and pronation--the arm next to the 
body, elbow flexed to 90[deg], and the forearm in midposition 0[deg] 
between supination and pronation. Motion of the thumb and fingers should 
be described by appropriate reference to the joints (See Plate III) 
whose movement is limited, with a statement as to how near, in 
centimeters, the tip of the thumb can approximate the fingers, or how 
near the tips of the fingers can approximate the proximal transverse 
crease of palm.

[[Page 419]]

[GRAPHIC] [TIFF OMITTED] TC04NO91.001


[[Page 420]]


[GRAPHIC] [TIFF OMITTED] TC04NO91.002


[29 FR 6718, May 22, 1964, as amended at 43 FR 45349, Oct. 2, 1978; 67 
FR 48785, July 26, 2002]



Sec.  4.71a  Schedule of ratings--musculoskeletal system.

                  Acute, Subacute, or Chronic Diseases
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5000 Osteomyelitis, acute, subacute, or chronic:
  Of the pelvis, vertebrae, or extending into major joints, or       100
   with multiple localization or with long history of
   intractability and debility, anemia, amyloid liver changes,
   or other continuous constitutional symptoms..................
  Frequent episodes, with constitutional symptoms...............      60
  With definite involucrum or sequestrum, with or without             30
   discharging sinus............................................
  With discharging sinus or other evidence of active infection        20
   within the past 5 years......................................
  Inactive, following repeated episodes, without evidence of          10
   active infection in past 5 years.............................
  Note (1): A rating of 10 percent, as an exception to the
   amputation rule, is to be assigned in any case of active
   osteomyelitis where the amputation rating for the affected
   part is no percent. This 10 percent rating and the other
   partial ratings of 30 percent or less are to be combined with
   ratings for ankylosis, limited motion, nonunion or malunion,
   shortening, etc., subject, of course, to the amputation rule.
   The 60 percent rating, as it is based on constitutional
   symptoms, is not subject to the amputation rule. A rating for
   osteomyelitis will not be applied following cure by removal
   or radical resection of the affected bone.

[[Page 421]]

 
  Note (2): The 20 percent rating on the basis of activity
   within the past 5 years is not assignable following the
   initial infection of active osteomyelitis with no subsequent
   reactivation. The prerequisite for this historical rating is
   an established recurrent osteomyelitis. To qualify for the 10
   percent rating, 2 or more episodes following the initial
   infection are required. This 20 percent rating or the 10
   percent rating, when applicable, will be assigned once only
   to cover disability at all sites of previously active
   infection with a future ending date in the case of the 20
   percent rating.
5001 Bones and joints, tuberculosis of, active or inactive:
    Active......................................................     100
    Inactive: See Sec.  Sec.   4.88c and 4.89...................
5002 Multi-joint arthritis (except post-traumatic and gout), 2
 or more joints, as an active process:
    With constitutional manifestations associated with active        100
     joint involvement, totally incapacitating..................
    Less than criteria for 100% but with weight loss and anemia       60
     productive of severe impairment of health or severely
     incapacitating exacerbations occurring 4 or more times a
     year or a lesser number over prolonged periods.............
    Symptom combinations productive of definite impairment of         40
     health objectively supported by examination findings or
     incapacitating exacerbations occurring 3 or more times a
     year.......................................................
    One or two exacerbations a year in a well-established             20
     diagnosis..................................................
    Note (1): Examples of conditions rated using this diagnostic
     code include, but are not limited to, rheumatoid arthritis,
     psoriatic arthritis, and spondyloarthropathies.
    Note (2): For chronic residuals, rate under diagnostic code
     5003.
    Note (3): The ratings for the active process will not be
     combined with the residual ratings for limitation of
     motion, ankylosis, or diagnostic code 5003. Instead, assign
     the higher evaluation.
5003 Degenerative arthritis, other than post-traumatic:
    Degenerative arthritis established by X-ray findings will be
     rated on the basis of limitation of motion under the
     appropriate diagnostic codes for the specific joint or
     joints involved (DC 5200 etc.). When however, the
     limitation of motion of the specific joint or joints
     involved is noncompensable under the appropriate diagnostic
     codes, a rating of 10 pct is for application for each such
     major joint or group of minor joints affected by limitation
     of motion, to be combined, not added under diagnostic code
     5003. Limitation of motion must be objectively confirmed by
     findings such as swelling, muscle spasm, or satisfactory
     evidence of painful motion. In the absence of limitation of
     motion, rate as below:
        With X-ray evidence of involvement of 2 or more major         20
         joints or 2 or more minor joint groups, with occasional
         incapacitating exacerbations
        With X-ray evidence of involvement of 2 or more major         10
         joints or 2 or more minor joint groups
    Note (1): The 20 pct and 10 pct ratings based on X-ray
     findings, above, will not be combined with ratings based on
     limitation of motion.
    Note (2): The 20 pct and 10 pct ratings based on X-ray
     findings, above, will not be utilized in rating conditions
     listed under diagnostic codes 5013 to 5024, inclusive.
5004 Arthritis, gonorrheal.
5005 Arthritis, pneumococcic.
5006 Arthritis, typhoid.
5007 Arthritis, syphilitic.
5008 Arthritis, streptococcic.
5009 Other specified forms of arthropathy (excluding gout).
    Note (1): Other specified forms of arthropathy include, but
     are not limited to, Charcot neuropathic, hypertrophic,
     crystalline, and other autoimmune arthropathies.
    Note (2): With the types of arthritis, diagnostic codes 5004
     through 5009, rate the acute phase under diagnostic code
     5002; rate any chronic residuals under diagnostic code
     5003.
5010 Post-traumatic arthritis: Rate as limitation of motion,
 dislocation, or other specified instability under the affected
 joint. If there are 2 or more joints affected, each rating
 shall be combined in accordance with Sec.   4.25.
5011 Decompression illness: Rate manifestations under the
 appropriate diagnostic code within the affected body system,
 such as arthritis for musculoskeletal residuals; auditory
 system for vestibular residuals; respiratory system for
 pulmonary barotrauma residuals; and neurologic system for
 cerebrovascular accident residuals.
5012 Bones, neoplasm, malignant, primary or secondary...........     100
    Note: The 100 percent rating will be continued for 1 year
     following the cessation of surgical, X-ray, antineoplastic
     chemotherapy or other prescribed therapeutic procedure. If
     there has been no local recurrence or metastases, rate
     based on residuals.
5013 Osteoporosis, residuals of.
5014 Osteomalacia, residuals of.
5015 Bones, neoplasm, benign.
5016 Osteitis deformans.
5017 Gout.
5018 [Removed]
5019 Bursitis.
5020 [Removed]
5021 Myositis.
5022 [Removed]
5023 Heterotopic ossification.
5024 Tenosynovitis, tendinitis, tendinosis or tendinopathy.

[[Page 422]]

 
    Note to DCs 5013 through 5024: Evaluate the diseases under
     diagnostic codes 5013 through 5024 as degenerative
     arthritis, based on limitation of motion of affected parts.
5025 Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
  With widespread musculoskeletal pain and tender points, with
   or without associated fatigue, sleep disturbance, stiffness,
   paresthesias, headache, irritable bowel symptoms, depression,
   anxiety, or Raynaud's-like symptoms:
    That are constant, or nearly so, and refractory to therapy..      40
    That are episodic, with exacerbations often precipitated by       20
     environmental or emotional stress or by overexertion, but
     that are present more than one-third of the time...........
    That require continuous medication for control..............      10
  Note: Widespread pain means pain in both the left and right
   sides of the body, that is both above and below the waist,
   and that affects both the axial skeleton (i.e., cervical
   spine, anterior chest, thoracic spine, or low back) and the
   extremities.
------------------------------------------------------------------------


                   Prosthetic Implants and Resurfacing
------------------------------------------------------------------------
                                                              Rating
                                                         ---------------
                                                           Major   Minor
------------------------------------------------------------------------
Note (1): When an evaluation is assigned for joint
 resurfacing or the prosthetic replacement of a joint
 under diagnostic codes 5051-5056, an additional rating
 under Sec.   4.71a may not also be assigned for that
 joint, unless otherwise directed.
Note (2): Only evaluate a revision procedure in the same
 manner as the original procedure under diagnostic codes
 5051-5056 if all the original components are replaced.
Note (3): The term ``prosthetic replacement'' in
 diagnostic codes 5051-5053 and 5055-5056 means a total
 replacement of the named joint. However, in DC 5054,
 ``prosthetic replacement'' means a total replacement of
 the head of the femur or of the acetabulum.
Note (4): The 100 percent rating for 1 year following
 implantation of prosthesis will commence after initial
 grant of the 1-month total rating assigned under Sec.
 4.30 following hospital discharge.
Note (5): The 100 percent rating for 4 months following
 implantation of prosthesis or resurfacing under DCs
 5054 and 5055 will commence after initial grant of the
 1-month total rating assigned under Sec.   4.30
 following hospital discharge.
Note (6): Special monthly compensation is assignable
 during the 100 percent rating period the earliest date
 permanent use of crutches is established.
5051 Shoulder replacement (prosthesis).
  Prosthetic replacement of the shoulder joint:
    For 1 year following implantation of prosthesis.....     100     100
    With chronic residuals consisting of severe, painful      60      50
     motion or weakness in the affected extremity.......
    With intermediate degrees of residual weakness, pain
     or limitation of motion, rate by analogy to
     diagnostic codes 5200 and 5203.
    Minimum rating......................................      30      20
5052 Elbow replacement (prosthesis).
  Prosthetic replacement of the elbow joint:
    For 1 year following implantation of prosthesis.....     100     100
    With chronic residuals consisting of severe painful       50      40
     motion or weakness in the affected extremity.......
    With intermediate degrees of residual weakness, pain
     or limitation of motion rate by analogy to
     diagnostic codes 5205 through 5208.
    Minimum evaluation..................................      30      20
5053 Wrist replacement (prosthesis).
  Prosthetic replacement of wrist joint:
    For 1 year following implantation of prosthesis.....     100     100
    With chronic residuals consisting of severe, painful      40      30
     motion or weakness in the affected extremity.......
    With intermediate degrees of residual weakness, pain
     or limitation of motion, rate by analogy to
     diagnostic code 5214.
    Minimum rating......................................      20      20
5054 Hip, resurfacing or replacement (prosthesis):
    For 4 months following implantation of prosthesis or  ......     100
     resurfacing........................................
    Prosthetic replacement of the head of the femur or
     of the acetabulum:
        Following implantation of prosthesis with         ......  \1\ 90
         painful motion or weakness such as to require
         the use of crutches............................
        Markedly severe residual weakness, pain or        ......      70
         limitation of motion following implantation of
         prosthesis.....................................
        Moderately severe residuals of weakness, pain or  ......      50
         limitation of motion...........................
        Minimum evaluation, total replacement only......  ......      30
Note: At the conclusion of the 100 percent evaluation
 period, evaluate resurfacing under diagnostic codes
 5250 through 5255; there is no minimum evaluation for
 resurfacing.
5055 Knee, resurfacing or replacement (prosthesis):
    For 4 months following implantation of prosthesis or  ......     100
     resurfacing........................................

[[Page 423]]

 
    Prosthetic replacement of knee joint:
        With chronic residuals consisting of severe       ......      60
         painful motion or weakness in the affected
         extremity......................................
        With intermediate degrees of residual weakness,
         pain or limitation of motion rate by analogy to
         diagnostic codes 5256, 5261, or 5262.
        Minimum evaluation, total replacement only......  ......      30
Note: At the conclusion of the 100 percent evaluation
 period, evaluate resurfacing under diagnostic codes
 5256 through 5262; there is no minimum evaluation for
 resurfacing.
5056 Ankle replacement (prosthesis).
  Prosthetic replacement of ankle joint:
    For 1 year following implantation of prosthesis.....  ......     100
    With chronic residuals consisting of severe painful   ......      40
     motion or weakness.................................
    With intermediate degrees of residual weakness, pain
     or limitation of motion rate by analogy to 5270 or
     5271.
    Minimum rating......................................  ......      20
------------------------------------------------------------------------
                      combinations of disabilities
------------------------------------------------------------------------
5104 Anatomical loss of one hand and loss of use of one   ......     \1\
 foot...................................................             100
5105 Anatomical loss of one foot and loss of use of one   ......     \1\
 hand...................................................             100
5106 Anatomical loss of both hands......................  ......     \1\
                                                                     100
5107 Anatomical loss of both feet.......................  ......     \1\
                                                                     100
5108 Anatomical loss of one hand and one foot...........  ......     \1\
                                                                     100
5109 Loss of use of both hands..........................  ......     \1\
                                                                     100
5110 Loss of use of both feet...........................  ......     \1\
                                                                     100
5111 Loss of use of one hand and one foot...............  ......     \1\
                                                                     100
------------------------------------------------------------------------
\1\ Also entitled to special monthly compensation.


                          Table II--Ratings for Multiple Losses of Extremities With Dictator's Rating Code and 38 CFR Citation
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               Impairment of other extremity
                                 -----------------------------------------------------------------------------------------------------------------------
                                                                          Anatomical loss or  Anatomical loss or    Anatomical loss     Anatomical loss
   Impairment of one extremity    Anatomical loss or  Anatomical loss or   loss of use above   loss of use above     near shoulder         near hip
                                   loss of use below   loss of use below   elbow (preventing   knee (preventing   (preventing use of  (preventing use of
                                         elbow               knee         use of prosthesis)  use of prosthesis)      prosthesis)         prosthesis)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Anatomical loss or loss of use    M Codes M-1 a, b,   L Codes L-1 d, e,   M\1/2\ Code M-5,    L\1/2\ Code L-2 c,  N Code N-3, 38 CFR  M Code M-3 c, 38
 below elbow.                      or c, 38 CFR        f, or g, 38 CFR     38 CFR 3.350        38 CFR 3.350        3.350 (f)(1)(xi).   CFR 3.350
                                   3.350 (c)(1)(i).    3.350(b).           (f)(1)(x).          (f)(1)(vi).                             (f)(1)(viii)
Anatomical loss or loss of use    ..................  L Codes L-1 a, b,   L\1/2\ Code L-2 b,  L\1/2\ Code L-2 a,  M Code M-3 b, 38    M Code M-3 a, 38
 below knee.                                           or c, 38 CFR        38 CFR 3.350        38 CFR 3.350        CFR 3.350           CFR 3.350
                                                       3.350(b).           (f)(1)(iii).        (f)(1)(i).          (f)(1)(iv).         (f)(1)(ii)
Anatomical loss or loss of use    ..................  ..................  N Code N-1, 38 CFR  M Code M-2 a, 38    N\1/2\ Code N-4,    M\1/2\ Code M-4 c,
 above elbow (preventing use of                                            3.350 (d)(1).       CFR 3.350           38 CFR 3.350        38 CFR 3.350
 prosthesis).                                                                                  (c)(1)(iii).        (f)(1)(ix).         (f)(1)(xi)
Anatomical loss or loss of use    ..................  ..................  ..................  M Code M-2 a, 38    M\1/2\ Code M-4 b,  M\1/2\ Code M-4 a,
 above knee (preventing use of                                                                 CFR 3.350           38 CFR 3.350        38 CFR 3.350
 prosthesis).                                                                                  (c)(1)(ii).         (f)(1)(vii).        (f)(1)(v)
Anatomical loss near shoulder     ..................  ..................  ..................  ..................  O Code O-1, 38 CFR  N Code N-2 b, 38
 (preventing use of prosthesis).                                                                                   3.350 (e)(1)(i).    CFR 3.350 (d)(3)
Anatomical loss near hip          ..................  ..................  ..................  ..................  ..................  N Code N-2 a, 38
 (preventing use of prosthesis).                                                                                                       CFR 3.350 (d)(2)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note.--Need for aid attendance or permanently bedridden qualifies for subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use of both
  lower extremities and loss of anal and bladder sphincter control qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2)). Where there are additional
  disabilities rated 50% or 100%, or anatomical or loss of use of a third extremity see 38 CFR 3.350(f) (3), (4) or (5).


[[Page 424]]


(Authority: 38 U.S.C. 1115)

                      Amputations: Upper Extremity
------------------------------------------------------------------------
                                                              Rating
                                                         ---------------
                                                           Major   Minor
------------------------------------------------------------------------
  Arm, amputation of:
5120 Complete amputation, upper extremity:
    Forequarter amputation (involving complete removal       \1\     \1\
     of the humerus along with any portion of the            100     100
     scapula, clavicle, and/or ribs)....................
    Disarticulation (involving complete removal of the    \1\ 90  \1\ 90
     humerus only)......................................
5121 Above insertion of deltoid.........................  \1\ 90  \1\ 80
5122 Below insertion of deltoid.........................  \1\ 80  \1\ 70
  Forearm, amputation of:
5123 Above insertion of pronator teres..................  \1\ 80  \1\ 70
5124 Below insertion of pronator teres..................  \1\ 70  \1\ 60
5125 Hand, loss of use of...............................  \1\ 70  \1\ 60
------------------------------------------------------------------------
                       multiple finger amputations
------------------------------------------------------------------------
5126 Five digits of one hand, amputation of.............  \1\ 70  \1\ 60
  Four digits of one hand, amputation of:
5127 Thumb, index, long and ring........................  \1\ 70  \1\ 60
5128 Thumb, index, long and little......................  \1\ 70  \1\ 60
5129 Thumb, index, ring and little......................  \1\ 70  \1\ 60
5130 Thumb, long, ring and little.......................  \1\ 70  \1\ 60
5131 Index, long, ring and little.......................      60      50
  Three digits of one hand, amputation of:
5132 Thumb, index and long..............................      60      50
5133 Thumb, index and ring..............................      60      50
5134 Thumb, index and little............................      60      50
5135 Thumb, long and ring...............................      60      50
5136 Thumb, long and little.............................      60      50
5137 Thumb, ring and little.............................      60      50
5138 Index, long and ring...............................      50      40
5139 Index, long and little.............................      50      40
5140 Index, ring and little.............................      50      40
5141 Long, ring and little..............................      40      30
  Two digits of one hand, amputation of:
5142 Thumb and index....................................      50      40
5143 Thumb and long.....................................      50      40
5144 Thumb and ring.....................................      50      40
5145 Thumb and little...................................      50      40
5146 Index and long.....................................      40      30
5147 Index and ring.....................................      40      30
5148 Index and little...................................      40      30
5149 Long and ring......................................      30      20
5150 Long and little....................................      30      20
5151 Ring and little....................................      30      20
  (a) The ratings for multiple finger amputations apply
   to amputations at the proximal interphalangeal joints
   or through proximal phalanges........................
  (b) Amputation through middle phalanges will be rated
   as prescribed for unfavorable ankylosis of the
   fingers..............................................
  (c) Amputations at distal joints, or through distal
   phalanges, other than negligible losses, will be
   rated as prescribed for favorable ankylosis of the
   fingers..............................................
  (d) Amputation or resection of metacarpal bones (more
   than one-half the bone lost) in multiple fingers
   injuries will require a rating of 10 percent added to
   (not combined with) the ratings, multiple finger
   amputations, subject to the amputation rule applied
   to the forearm.
  (e) Combinations of finger amputations at various
   levels, or finger amputations with ankylosis or
   limitation of motion of the fingers will be rated on
   the basis of the grade of disability; i.e.,
   amputation, unfavorable ankylosis, most
   representative of the levels or combinations. With an
   even number of fingers involved, and adjacent grades
   of disability, select the higher of the two grades.
  (f) Loss of use of the hand will be held to exist when
   no effective function remains other than that which
   would be equally well served by an amputation stump
   with a suitable prosthetic appliance.
------------------------------------------------------------------------
                        single finger amputations
------------------------------------------------------------------------
5152 Thumb, amputation of:
  With metacarpal resection.............................      40      30
  At metacarpophalangeal joint or through proximal            30      20
   phalanx..............................................
  At distal joint or through distal phalanx.............      20      20
5153 Index finger, amputation of
  With metacarpal resection (more than one-half the bone      30      20
   lost)................................................
  Without metacarpal resection, at proximal                   20      20
   interphalangeal joint or proximal thereto............
  Through middle phalanx or at distal joint.............      10      10
5154 Long finger, amputation of:
  With metacarpal resection (more than one-half the bone      20      20
   lost)................................................
  Without metacarpal resection, at proximal                   10      10
   interphalangeal joint or proximal thereto............
5155 Ring finger, amputation of:
  With metacarpal resection (more than one-half the bone      20      20
   lost)................................................
  Without metacarpal resection, at proximal                   10      10
   interphalangeal joint or proximal thereto............
5156 Little finger, amputation of:
  With metacarpal resection (more than one-half the bone      20      20
   lost)................................................
  Without metacarpal resection, at proximal                   10      10
   interphalangeal joint or proximal thereto............
  Note: The single finger amputation ratings are the
   only applicable ratings for amputations of whole or
   part of single fingers.
------------------------------------------------------------------------
\1\ Entitled to special monthly compensation.


[[Page 425]]

[GRAPHIC] [TIFF OMITTED] TC04NO91.004


                      Amputations: Lower Extremity
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
Thigh, amputation of:
5160 Complete amputation, lower extremity:

[[Page 426]]

 
    Trans-pelvic amputation (involving complete removal of the       \2\
     femur and intrinsic pelvic musculature along with any           100
     portion of the pelvic bones)...............................
    Disarticulation (involving complete removal of the femur and  \2\ 90
     intrinsic pelvic musculature only).........................
Note: Separately evaluate residuals involving other body systems
 (e.g., bowel impairment, bladder impairment) under the
 appropriate diagnostic code.
5161 Upper third, one-third of the distance from perineum to      \2\ 80
 knee joint measured from perineum..............................
5162 Middle or lower thirds.....................................  \2\ 60
  Leg, amputation of:
5163 With defective stump, thigh amputation recommended.........  \2\ 60
5164 Amputation not improvable by prosthesis controlled by        \2\ 60
 natural knee action............................................
5165 At a lower level, permitting prosthesis....................  \2\ 40
5166 Forefoot, amputation proximal to metatarsal bones (more      \2\ 40
 than one-half of metatarsal loss)..............................
5167 Foot, loss of use of.......................................  \2\ 40
5170 Toes, all, amputation of, without metatarsal loss or             30
 transmetatarsal, amputation of, with up to half of metatarsal
 loss...........................................................
5171 Toe, great, amputation of:
  With removal of metatarsal head...............................      30
  Without metatarsal involvement................................      10
5172 Toes, other than great, amputation of, with removal of
 metatarsal head:
  One or two....................................................      20
  Without metatarsal involvement................................       0
5173 Toes, three or four, amputation of, without metatarsal
 involvement:
  Including great toe...........................................      20
  Not including great toe.......................................      10
------------------------------------------------------------------------
\2\ Also entitled to special monthly compensation.


[[Page 427]]

[GRAPHIC] [TIFF OMITTED] TC04NO91.003


[[Page 428]]


                          The Shoulder and Arm
------------------------------------------------------------------------
                                                              Rating
                                                         ---------------
                                                           Major   Minor
------------------------------------------------------------------------
5200 Scapulohumeral articulation, ankylosis of:
  Note: The scapula and humerus move as one piece.
  Unfavorable, abduction limited to 25[deg] from side...      50      40
  Intermediate between favorable and unfavorable........      40      30
  Favorable, abduction to 60[deg], can reach mouth and        30      20
   head.................................................
5201 Arm, limitation of motion of:
    Flexion and/or abduction limited to 25[deg] from          40      30
     side...............................................
    Midway between side and shoulder level (flexion and/      30      20
     or abduction limited to 45[deg])...................
    At shoulder level (flexion and/or abduction limited       20      20
     to 90[deg])........................................
5202 Humerus, other impairment of:
    Loss of head of (flail shoulder)....................      80      70
    Nonunion of (false flail joint).....................      60      50
    Fibrous union of....................................      50      40
    Recurrent dislocation of at scapulohumeral joint:
        With frequent episodes and guarding of all arm        30      20
         movements......................................
        With infrequent episodes and guarding of              20      20
         movement only at shoulder level (flexion and/or
         abduction at 90 [deg]).........................
    Malunion of:
        Marked deformity................................      30      20
        Moderate deformity..............................      20      20
5203 Clavicle or scapula, impairment of:
  Dislocation of........................................      20      20
  Nonunion of:
    With loose movement.................................      20      20
    Without loose movement..............................      10      10
  Malunion of...........................................      10      10
  Or rate on impairment of function of contiguous joint.
------------------------------------------------------------------------


                          The Elbow and Forearm
------------------------------------------------------------------------
                                                              Rating
                                                         ---------------
                                                           Major   Minor
------------------------------------------------------------------------
5205 Elbow, ankylosis of:
  Unfavorable, at an angle of less than 50[deg] or with       60      50
   complete loss of supination or pronation.............
  Intermediate, at an angle of more than 90[deg], or          50      40
   between 70[deg] and 50[deg]..........................
  Favorable, at an angle between 90[deg] and 70[deg]....      40      30
5206 Forearm, limitation of flexion of:
  Flexion limited to 45[deg]............................      50      40
  Flexion limited to 55[deg]............................      40      30
  Flexion limited to 70[deg]............................      30      20
  Flexion limited to 90[deg]............................      20      20
  Flexion limited to 100[deg]...........................      10      10
  Flexion limited to 110[deg]...........................       0       0
5207 Forearm, limitation of extension of:
  Extension limited to 110[deg].........................      50      40
  Extension limited to 100[deg].........................      40      30
  Extension limited to 90[deg]..........................      30      20
  Extension limited to 75[deg]..........................      20      20
  Extension limited to 60[deg]..........................      10      10
  Extension limited to 45[deg]..........................      10      10
5208 Forearm, flexion limited to 100[deg] and extension       20      20
 to 45[deg].............................................
5209 Elbow, other impairment of Flail joint.............      60      50
  Joint fracture, with marked cubitus varus or cubitus        20      20
   valgus deformity or with ununited fracture of head of
   radius...............................................
5210 Radius and ulna, nonunion of, with flail false           50      40
 joint..................................................
5211 Ulna, impairment of:
  Nonunion in upper half, with false movement:
    With loss of bone substance (1 inch (2.5 cms.) or         40      30
     more) and marked deformity.........................
    Without loss of bone substance or deformity.........      30      20
    Nonunion in lower half..............................      20      20
    Malunion of, with bad alignment.....................      10      10
5212 Radius, impairment of:
  Nonunion in lower half, with false movement:
    With loss of bone substance (1 inch (2.5 cms.) or         40      30
     more) and marked deformity.........................
    Without loss of bone substance or deformity.........      30      20
    Nonunion in upper half..............................      20      20
    Malunion of, with bad alignment.....................      10      10
5213 Supination and pronation, impairment of:
  Loss of (bone fusion):
    The hand fixed in supination or hyperpronation......      40      30
    The hand fixed in full pronation....................      30      20
    The hand fixed near the middle of the arc or              20      20
     moderate pronation.................................
  Limitation of pronation:
    Motion lost beyond middle of arc....................      30      20
    Motion lost beyond last quarter of arc, the hand          20      20
     does not approach full pronation...................
  Limitation of supination:
    To 30[deg] or less..................................      10      10
  Note: In all the forearm and wrist injuries, codes
   5205 through 5213, multiple impaired finger movements
   due to tendon tie-up, muscle or nerve injury, are to
   be separately rated and combined not to exceed rating
   for loss of use of hand.
------------------------------------------------------------------------


                                The Wrist
------------------------------------------------------------------------
                                                              Rating
                                                         ---------------
                                                           Major   Minor
------------------------------------------------------------------------
5214 Wrist, ankylosis of:
  Unfavorable, in any degree of palmar flexion, or with       50      40
   ulnar or radial deviation............................
  Any other position, except favorable..................      40      30
  Favorable in 20[deg] to 30[deg] dorsiflexion..........      30      20
  Note: Extremely unfavorable ankylosis will be rated as
   loss of use of hands under diagnostic code 5125.
5215 Wrist, limitation of motion of:

[[Page 429]]

 
  Dorsiflexion less than 15[deg]........................      10      10
  Palmar flexion limited in line with forearm...........      10      10
------------------------------------------------------------------------


  Evaluation of Ankylosis or Limitation of Motion of Single or Multiple
                           Digits of the Hand
------------------------------------------------------------------------
                                                              Rating
                                                         ---------------
                                                           Major   Minor
------------------------------------------------------------------------
(1) For the index, long, ring, and little fingers         ......  ......
 (digits II, III, IV, and V), zero degrees of flexion
 represents the fingers fully extended, making a
 straight line with the rest of the hand. The position
 of function of the hand is with the wrist dorsiflexed
 20 to 30 degrees, the metacarpophalangeal and proximal
 interphalangeal joints flexed to 30 degrees, and the
 thumb (digit I) abducted and rotated so that the thumb
 pad faces the finger pads. Only joints in these
 positions are considered to be in favorable position.
 For digits II through V, the metacarpophalangeal joint
 has a range of zero to 90 degrees of flexion, the
 proximal interphalangeal joint has a range of zero to
 100 degrees of flexion, and the distal (terminal)
 interphalangeal joint has a range of zero to 70 or 80
 degrees of flexion.....................................
(2) When two or more digits of the same hand are          ......  ......
 affected by any combination of amputation, ankylosis,
 or limitation of motion that is not otherwise specified
 in the rating schedule, the evaluation level assigned
 will be that which best represents the overall
 disability (i.e., amputation, unfavorable or favorable
 ankylosis, or limitation of motion), assigning the
 higher level of evaluation when the level of disability
 is equally balanced between one level and the next
 higher level...........................................
(3) Evaluation of ankylosis of the index, long, ring,
 and little fingers:
    (i) If both the metacarpophalangeal and proximal      ......  ......
     interphalangeal joints of a digit are ankylosed,
     and either is in extension or full flexion, or
     there is rotation or angulation of a bone, evaluate
     as amputation without metacarpal resection, at
     proximal interphalangeal joint or proximal thereto.
    (ii) If both the metacarpophalangeal and proximal
     interphalangeal joints of a digit are ankylosed,
     evaluate as unfavorable ankylosis, even if each
     joint is individually fixed in a favorable position
    (iii) If only the metacarpophalangeal or proximal     ......  ......
     interphalangeal joint is ankylosed, and there is a
     gap of more than two inches (5.1 cm.) between the
     fingertip(s) and the proximal transverse crease of
     the palm, with the finger(s) flexed to the extent
     possible, evaluate as unfavorable ankylosis........
    (iv) If only the metacarpophalangeal or proximal      ......  ......
     interphalangeal joint is ankylosed, and there is a
     gap of two inches (5.1 cm.) or less between the
     fingertip(s) and the proximal transverse crease of
     the palm, with the finger(s) flexed to the extent
     possible, evaluate as favorable ankylosis..........
(4) Evaluation of ankylosis of the thumb:
    (i) If both the carpometacarpal and interphalangeal   ......  ......
     joints are ankylosed, and either is in extension or
     full flexion, or there is rotation or angulation of
     a bone, evaluate as amputation at
     metacarpophalangeal joint or through proximal
     phalanx............................................
    (ii) If both the carpometacarpal and interphalangeal  ......  ......
     joints are ankylosed, evaluate as unfavorable
     ankylosis, even if each joint is individually fixed
     in a favorable position............................
    (iii) If only the carpometacarpal or interphalangeal  ......  ......
     joint is ankylosed, and there is a gap of more than
     two inches (5.1 cm.) between the thumb pad and the
     fingers, with the thumb attempting to oppose the
     fingers, evaluate as unfavorable ankylosis.........
    (iv) If only the carpometacarpal or interphalangeal   ......  ......
     joint is ankylosed, and there is a gap of two
     inches (5.1 cm.) or less between the thumb pad and
     the fingers, with the thumb attempting to oppose
     the fingers, evaluate as favorable ankylosis.......
(5) If there is limitation of motion of two or more       ......  ......
 digits, evaluate each digit separately and combine the
 evaluations............................................
------------------------------------------------------------------------
                I. Multiple Digits: Unfavorable Ankylosis
------------------------------------------------------------------------
5216 Five digits of one hand, unfavorable ankylosis of..      60      50
Note: Also consider whether evaluation as amputation is
 warranted.
5217 Four digits of one hand, unfavorable ankylosis of:
    Thumb and any three fingers.........................      60      50
    Index, long, ring, and little fingers...............      50      40

[[Page 430]]

 
Note: Also consider whether evaluation as amputation is
 warranted.
5218 Three digits of one hand, unfavorable ankylosis of:
    Thumb and any two fingers...........................      50      40
    Index, long, and ring; index, long, and little; or        40      30
     index, ring, and little fingers....................
    Long, ring, and little fingers......................      30      20
Note: Also consider whether evaluation as amputation is
 warranted.
5219 Two digits of one hand, unfavorable ankylosis of:
    Thumb and any finger................................      40      30
    Index and long; index and ring; or index and little       30      20
     fingers............................................
    Long and ring; long and little; or ring and little        20      20
     fingers............................................
Note: Also consider whether evaluation as amputation is
 warranted.
------------------------------------------------------------------------
                II. Multiple Digits: Favorable Ankylosis
------------------------------------------------------------------------
5220 Five digits of one hand, favorable ankylosis of....      50      40
5221 Four digits of one hand, favorable ankylosis of:
    Thumb and any three fingers.........................      50      40
    Index, long, ring, and little fingers...............      40      30
5222 Three digits of one hand, favorable ankylosis of:
    Thumb and any two fingers...........................      40      30
    Index, long, and ring; index, long, and little; or        30      20
     index, ring, and little fingers....................
    Long, ring and little fingers.......................      20      20
5223 Two digits of one hand, favorable ankylosis of:
    Thumb and any finger................................      30      20
    Index and long; index and ring; or index and little       20      20
     fingers............................................
    Long and ring; long and little; or ring and little        10      10
     fingers............................................
------------------------------------------------------------------------
                   III. Ankylosis of Individual Digits
------------------------------------------------------------------------
5224 Thumb, ankylosis of:
    Unfavorable.........................................      20      20
    Favorable...........................................      10      10
Note: Also consider whether evaluation as amputation is
 warranted and whether an additional evaluation is
 warranted for resulting limitation of motion of other
 digits or interference with overall function of the
 hand.
5225 Index finger, ankylosis of:
    Unfavorable or favorable............................      10      10
Note: Also consider whether evaluation as amputation is
 warranted and whether an additional evaluation is
 warranted for resulting limitation of motion of other
 digits or interference with overall function of the
 hand.
5226 Long finger, ankylosis of:
    Unfavorable or favorable............................      10      10
Note: Also consider whether evaluation as amputation is
 warranted and whether an additional evaluation is
 warranted for resulting limitation of motion of other
 digits or interference with overall function of the
 hand.
5227 Ring or little finger, ankylosis of:
    Unfavorable or favorable............................       0       0
Note: Also consider whether evaluation as amputation is
 warranted and whether an additional evaluation is
 warranted for resulting limitation of motion of other
 digits or interference with overall function of the
 hand.
------------------------------------------------------------------------
              IV. Limitation of Motion of Individual Digits
------------------------------------------------------------------------
5228 Thumb, limitation of motion:
    With a gap of more than two inches (5.1 cm.) between      20      20
     the thumb pad and the fingers, with the thumb
     attempting to oppose the fingers...................
    With a gap of one to two inches (2.5 to 5.1 cm.)          10      10
     between the thumb pad and the fingers, with the
     thumb attempting to oppose the fingers.............
    With a gap of less than one inch (2.5 cm.) between         0       0
     the thumb pad and the fingers, with the thumb
     attempting to oppose the fingers...................
5229 Index or long finger, limitation of motion:
    With a gap of one inch (2.5 cm.) or more between the      10      10
     fingertip and the proximal transverse crease of the
     palm, with the finger flexed to the extent
     possible, or; with extension limited by more than
     30 degrees.........................................
    With a gap of less than one inch (2.5 cm.) between         0       0
     the fingertip and the proximal transverse crease of
     the palm, with the finger flexed to the extent
     possible, and; extension is limited by no more than
     30 degrees.........................................
5230 Ring or little finger, limitation of motion:
    Any limitation of motion............................       0       0
------------------------------------------------------------------------


[[Page 431]]


                                The Spine
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
  General Rating Formula for Diseases and Injuries of the Spine
 
(For diagnostic codes 5235 to 5243 unless 5243 is evaluated
 under the Formula for Rating Intervertebral Disc Syndrome Based
 on Incapacitating Episodes):
    With or without symptoms such as pain (whther or not it
     radiates), stiffness, or aching in the area of the spine
     affected by residuals of injury or disease
        Unfavorable ankylosis of the entire spine...............     100
        Unfavorable ankylosis of the entire thoracolumbar spine.      50
        Unfavorable ankylosis of the entire cervical spine; or,       40
         forward flexion of the thoracolumbar spine 30 degrees
         or less; or, favorable ankylosis of the entire
         thoracolumbar spine....................................
        Forward flexion of the cervical spine 15 degrees or           30
         less; or, favorable ankylosis of the entire cervical
         spine..................................................
        Forward flexion of the thoracolumbar spine greater than       20
         30 degrees but not greater than 60 degrees; or, forward
         flexion of the cervical spine greater than 15 degrees
         but not greater than 30 degrees; or, the combined range
         of motion of the thoracolumbar spine not greater than
         120 degrees; or, the combined range of motion of the
         cervical spine not greater than 170 degrees; or, muscle
         spasm or guarding severe enough to result in an
         abnormal gait or abnormal spinal contour such as
         scoliosis, reversed lordosis, or abnormal kyphosis.....
        Forward flexion of the thoracolumbar spine greater than       10
         60 degrees but not greater than 85 degrees; or, forward
         flexion of the cervical spine greater than 30 degrees
         but not greater than 40 degrees; or, combined range of
         motion of the thoracolumbar spine greater than 120
         degrees but not greater than 235 degrees; or, combined
         range of motion of the cervical spine greater than 170
         degrees but not greater than 335 degrees; or, muscle
         spasm, guarding, or localized tenderness not resulting
         in abnormal gait or abnormal spinal contour; or,
         vertebral body fracture with loss of 50 percent or more
         of the height..........................................
Note (1): Evaluate any associated objective neurologic
 abnormalities, including, but not limited to, bowel or bladder
 impairment, separately, under an appropriate diagnostic code.
Note (2): (See also Plate V.) For VA compensation purposes,
 normal forward flexion of the cervical spine is zero to 45
 degrees, extension is zero to 45 degrees, left and right
 lateral flexion are zero to 45 degrees, and left and right
 lateral rotation are zero to 80 degrees. Normal forward flexion
 of the thoracolumbar spine is zero to 90 degrees, extension is
 zero to 30 degrees, left and right lateral flexion are zero to
 30 degrees, and left and right lateral rotation are zero to 30
 degrees. The combined range of motion refers to the sum of the
 range of forward flexion, extension, left and right lateral
 flexion, and left and right rotation. The normal combined range
 of motion of the cervical spine is 340 degrees and of the
 thoracolumbar spine is 240 degrees. The normal ranges of motion
 for each component of spinal motion provided in this note are
 the maximum that can be used for calculation of the combined
 range of motion.
Note (3): In exceptional cases, an examiner may state that
 because of age, body habitus, neurologic disease, or other
 factors not the result of disease or injury of the spine, the
 range of motion of the spine in a particular individual should
 be considered normal for that individual, even though it does
 not conform to the normal range of motion stated in Note (2).
 Provided that the examiner supplies an explanation, the
 examiner's assessment that the range of motion is normal for
 that individual will be accepted.
Note (4): Round each range of motion measurement to the nearest
 five degrees.
Note (5): For VA compensation purposes, unfavorable ankylosis is
 a condition in which the entire cervical spine, the entire
 thoracolumbar spine, or the entire spine is fixed in flexion or
 extension, and the ankylosis results in one or more of the
 following: difficulty walking because of a limited line of
 vision; restricted opening of the mouth and chewing; breathing
 limited to diaphragmatic respiration; gastrointestinal symptoms
 due to pressure of the costal margin on the abdomen; dyspnea or
 dysphagia; atlantoaxial or cervical subluxation or dislocation;
 or neurologic symptoms due to nerve root stretching. Fixation
 of a spinal segment in neutral position (zero degrees) always
 represents favorable ankylosis.
Note (6): Separately evaluate disability of the thoracolumbar
 and cervical spine segments, except when there is unfavorable
 ankylosis of both segments, which will be rated as a single
 disability.
 5235 Vertebral fracture or dislocation
 5236 Sacroiliac injury and weakness
 5237 Lumbosacral or cervical strain
 5238 Spinal stenosis
 5239 Spondylolisthesis or segmental instability
 5240 Ankylosing spondylitis
 5241 Spinal fusion
5242 Degenerative arthritis, degenerative disc disease other
 than intervertebral disc syndrome (also, see either DC 5003 or
 5010)
5243 Intervertebral disc syndrome: Assign this diagnostic code
 only when there is disc herniation with compression and/or
 irritation of the adjacent nerve root; assign diagnostic code
 5242 for all other disc diagnoses.

[[Page 432]]

 
Evaluate intervertebral disc syndrome (preoperatively or
 postoperatively) either under the General Rating Formula for
 Diseases and Injuries of the Spine or under the Formula for
 Rating Intervertebral Disc Syndrome Based on Incapacitating
 Episodes, whichever method results in the higher evaluation
 when all disabilities are combined under Sec.   4.25.
5244 Traumatic paralysis, complete:
    Paraplegia: Rate under diagnostic code 5110.
    Quadriplegia: Rate separately under diagnostic codes 5109
     and 5110 and combine evaluations in accordance with Sec.
     4.25.
    Note: If traumatic paralysis does not cause loss of use of
     both hands or both feet, it is incomplete paralysis.
     Evaluate residuals of incomplete traumatic paralysis under
     the appropriate diagnostic code (e.g., Sec.   4.124a,
     Diseases of the Peripheral Nerves).
 
    Formula for Rating Intervertebral Disc Syndrome Based on
                     Incapacitating Episodes
 
With incapacitating episodes having a total duration of at least      60
 6 weeks during the past 12 months..............................
With incapacitating episodes having a total duration of at least      40
 4 weeks but less than 6 weeks during the past 12 months........
With incapacitating episodes having a total duration of at least      20
 2 weeks but less than 4 weeks during the past 12 months........
With incapacitating episodes having a total duration of at least      10
 one week but less than 2 weeks during the past 12 months.......
Note (1): For purposes of evaluations under diagnostic code
 5243, an incapacitating episode is a period of acute signs and
 symptoms due to intervertebral disc syndrome that requires bed
 rest prescribed by a physician and treatment by a physician.
Note (2): If intervertebral disc syndrome is present in more
 than one spinal segment, provided that the effects in each
 spinal segment are clearly distinct, evaluate each segment on
 the basis of incapacitating episodes or under the General
 Rating Formula for Diseases and Injuries of the Spine,
 whichever method results in a higher evaluation for that
 segment.
------------------------------------------------------------------------


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[GRAPHIC] [TIFF OMITTED] TR27AU03.003


[[Page 434]]


                            The Hip and Thigh
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5250 Hip, ankylosis of:
  Unfavorable, extremely unfavorable ankylosis, the foot not      \3\ 90
   reaching ground, crutches necessitated.......................
  Intermediate..................................................      70
  Favorable, in flexion at an angle between 20[deg] and 40[deg],      60
   and slight adduction or abduction............................
5251 Thigh, limitation of extension of:
  Extension limited to 5[deg]...................................      10
5252 Thigh, limitation of flexion of:
  Flexion limited to 10[deg]....................................      40
  Flexion limited to 20[deg]....................................      30
  Flexion limited to 30[deg]....................................      20
  Flexion limited to 45[deg]....................................      10
5253 Thigh, impairment of:
  Limitation of abduction of, motion lost beyond 10[deg]........      20
  Limitation of adduction of, cannot cross legs.................      10
  Limitation of rotation of, cannot toe-out more than 15[deg],        10
   affected leg.................................................
5254 Hip, flail joint...........................................      80
5255 Femur, impairment of:
    Fracture of shaft or anatomical neck of:
        With nonunion, with loose motion (spiral or oblique           80
         fracture)..............................................
        With nonunion, without loose motion, weight bearing           60
         preserved with aid of brace............................
        Fracture of surgical neck of, with false joint..........      60
    Malunion of:
        Evaluate under diagnostic codes 5256, 5257, 5260, or
         5261 for the knee, or 5250-5254 for the hip, whichever
         results in the highest evaluation.
------------------------------------------------------------------------
\3\ Entitled to special monthly compensation.


                            The Knee and Leg
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5256 Knee, ankylosis of:
  Extremely unfavorable, in flexion at an angle of 45[deg] or         60
   more.........................................................
  In flexion between 20[deg] and 45[deg]........................      50
  In flexion between 10[deg] and 20[deg]........................      40
  Favorable angle in full extension, or in slight flexion             30
   between 0[deg] and 10[deg]...................................
5257 Knee, other impairment of:
    Recurrent subluxation or instability:
        Unrepaired or failed repair of complete ligament tear         30
         causing persistent instability, and a medical provider
         prescribes both an assistive device (e.g., cane(s),
         crutch(es), walker) and bracing for ambulation.........
        One of the following:
            (a) Sprain, incomplete ligament tear, or repaired
             complete ligament tear causing persistent
             instability, and a medical provider prescribes a
             brace and/or assistive device (e.g., cane(s),
             crutch(es), walker) for ambulation.
            (b) Unrepaired or failed repair of complete ligament      20
             tear causing persistent instability, and a medical
             provider prescribes either an assistive device
             (e.g., cane(s), crutch(es), walker) or bracing for
             ambulation.........................................
        Sprain, incomplete ligament tear, or complete ligament        10
         tear (repaired, unrepaired, or failed repair) causing
         persistent instability, without a prescription from a
         medical provider for an assistive device (e.g.,
         cane(s), crutch(es), walker) or bracing for ambulation.
    Patellar instability:
        A diagnosed condition involving the patellofemoral            30
         complex with recurrent instability after surgical
         repair that requires a prescription by a medical
         provider for a brace and either a cane or a walker.....
        A diagnosed condition involving the patellofemoral            20
         complex with recurrent instability after surgical
         repair that requires a prescription by a medical
         provider for one of the following: A brace, cane, or
         walker.................................................
        A diagnosed condition involving the patellofemoral            10
         complex with recurrent instability (with or without
         history of surgical repair) that does not require a
         prescription from a medical provider for a brace, cane,
         or walker..............................................
    Note (1): For patellar instability, the patellofemoral
     complex consists of the quadriceps tendon, the patella, and
     the patellar tendon.
    Note (2): A surgical procedure that does not involve repair
     of one or more patellofemoral components that contribute to
     the underlying instability shall not qualify as surgical
     repair for patellar instability (including, but not limited
     to, arthroscopy to remove loose bodies and joint
     aspiration).
5258 Cartilage, semilunar, dislocated, with frequent episodes of      20
 ``locking,'' pain, and effusion into the joint.................
5259 Cartilage, semilunar, removal of, symptomatic..............      10
5260 Leg, limitation of flexion of:
  Flexion limited to 15[deg]....................................      30
  Flexion limited to 30[deg]....................................      20
  Flexion limited to 45[deg]....................................      10
  Flexion limited to 60[deg]....................................       0
5261 Leg, limitation of extension of:
  Extension limited to 45[deg]..................................      50
  Extension limited to 30[deg]..................................      40
  Extension limited to 20[deg]..................................      30
  Extension limited to 15[deg]..................................      20
  Extension limited to 10[deg]..................................      10
  Extension limited to 5[deg]...................................       0
5262 Tibia and fibula, impairment of:
    Nonunion of, with loose motion, requiring brace.............      40
    Malunion of:

[[Page 435]]

 
        Evaluate under diagnostic codes 5256, 5257, 5260, or
         5261 for the knee, or 5270 or 5271 for the ankle,
         whichever results in the highest evaluation.
    Medial tibial stress syndrome (MTSS), or shin splints:
        Requiring treatment for no less than 12 consecutive           30
         months, and unresponsive to surgery and either shoe
         orthotics or other conservative treatment, both lower
         extremities............................................
        Requiring treatment for no less than 12 consecutive           20
         months, and unresponsive to surgery and either shoe
         orthotics or other conservative treatment, one lower
         extremity..............................................
        Requiring treatment for no less than 12 consecutive           10
         months, and unresponsive to either shoe orthotics or
         other conservative treatment, one or both lower
         extremities............................................
        Treatment less than 12 consecutive months, one or both         0
         lower extremities......................................
5263 Genu recurvatum (acquired, traumatic, with weakness and          10
 insecurity in weight-bearing objectively demonstrated).........
------------------------------------------------------------------------


                                The Ankle
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5270 Ankle, ankylosis of:
  In plantar flexion at more than 40[deg], or in dorsiflexion at      40
   more than 10[deg] or with abduction, adduction, inversion or
   eversion deformity...........................................
  In plantar flexion, between 30[deg] and 40[deg], or in              30
   dorsiflexion, between 0[deg] and 10[deg].....................
  In plantar flexion, less than 30[deg].........................      20
5271 Ankle, limited motion of:
    Marked (less than 5 degrees dorsiflexion or less than 10          20
     degrees plantar flexion)...................................
    Moderate (less than 15 degrees dorsiflexion or less than 30       10
     degrees plantar flexion)...................................
5272 Subastragalar or tarsal joint, ankylosis of:
  In poor weight-bearing position...............................      20
  In good weight-bearing position...............................      10
5273 Os calcis or astragalus, malunion of:
  Marked deformity..............................................      20
  Moderate deformity............................................      10
5274 Astragalectomy.............................................      20
------------------------------------------------------------------------


                    Shortening of the Lower Extremity
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5275 Bones, of the lower extremity, shortening of:
  Over 4 inches (10.2 cms.).....................................  \3\ 60
  3\1/2\ to 4 inches (8.9 cms. to 10.2 cms.)....................  \3\ 50
  3 to 3\1/2\ inches (7.6 cms. to 8.9 cms.).....................      40
  2\1/2\ to 3 inches (6.4 cms. to 7.6 cms.).....................      30
  2 to 2\1/2\ inches (5.1 cms. to 6.4 cms.).....................      20
  1\1/4\ to 2 inches (3.2 cms. to 5.1 cms.).....................      10
  Note: Measure both lower extremities from anterior superior
   spine of the ilium to the internal malleolus of the tibia.
   Not to be combined with other ratings for fracture or faulty
   union in the same extremity.
------------------------------------------------------------------------
\3\ Also entitled to special monthly compensation.


                                The Foot
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5269 Plantar fasciitis:
    No relief from both non-surgical and surgical treatment,          30
     bilateral..................................................
    No relief from both non-surgical and surgical treatment,          20
     unilateral.................................................
    Otherwise, unilateral or bilateral..........................      10
        Note (1): With actual loss of use of the foot, rate 40
         percent................................................
        Note (2): If a veteran has been recommended for surgical
         intervention, but is not a surgical candidate, evaluate
         under the 20 percent or 30 percent criteria, whichever
         is applicable..........................................
5276 Flatfoot, acquired:
  Pronounced; marked pronation, extreme tenderness of plantar
   surfaces of the feet, marked inward displacement and severe
   spasm of the tendo achillis on manipulation, not improved by
   orthopedic shoes or appliances...............................
  Bilateral.....................................................      50
  Unilateral....................................................      30
  Severe; objective evidence of marked deformity (pronation,
   abduction, etc.), pain on manipulation and use accentuated,
   indication of swelling on use, characteristic callosities:
    Bilateral...................................................      30
    Unilateral..................................................      20
  Moderate; weight-bearing line over or medial to great toe,          10
   inward bowing of the tendo achillis, pain on manipulation and
   use of the feet, bilateral or unilateral.....................
  Mild; symptoms relieved by built-up shoe or arch support......       0
5277 Weak foot, bilateral:
  A symptomatic condition secondary to many constitutional
   conditions, characterized by atrophy of the musculature,
   disturbed circulation, and weakness:
    Rate the underlying condition, minimum rating...............      10
5278 Claw foot (pes cavus), acquired:
  Marked contraction of plantar fascia with dropped forefoot,
   all toes hammer toes, very painful callosities, marked varus
   deformity:
    Bilateral...................................................      50
    Unilateral..................................................      30
  All toes tending to dorsiflexion, limitation of dorsiflexion
   at ankle to right angle, shortened plantar fascia, and marked
   tenderness under metatarsal heads:
    Bilateral...................................................      30
    Unilateral..................................................      20
  Great toe dorsiflexed, some limitation of dorsiflexion at
   ankle, definite tenderness under metatarsal heads:
    Bilateral...................................................      10

[[Page 436]]

 
    Unilateral..................................................      10
  Slight........................................................       0
5279 Metatarsalgia, anterior (Morton's disease), unilateral, or       10
 bilateral......................................................
5280 Hallux valgus, unilateral:
  Operated with resection of metatarsal head....................      10
  Severe, if equivalent to amputation of great toe..............      10
5281 Hallux rigidus, unilateral, severe:
  Rate as hallux valgus, severe.
     Note: Not to be combined with claw foot ratings.
5282 Hammer toe:
  All toes, unilateral without claw foot........................      10
  Single toes...................................................       0
5283 Tarsal, or metatarsal bones, malunion of, or nonunion of:
  Severe........................................................      30
  Moderately severe.............................................      20
  Moderate......................................................      10
  Note: With actual loss of use of the foot, rate 40 percent.
5284 Foot injuries, other:
  Severe........................................................      30
  Moderately severe.............................................      20
  Moderate......................................................      10
  Note: With actual loss of use of the foot, rate 40 percent.
------------------------------------------------------------------------


                                The Skull
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5296 Skull, loss of part of, both inner and outer tables:
  With brain hernia.............................................      80
  Without brain hernia:
    Area larger than size of a 50-cent piece or 1.140 in \2\          50
     (7.355 cm \2\).............................................
    Area intermediate...........................................      30
    Area smaller than the size of a 25-cent piece or 0.716 in         10
     \2\ (4.619 cm \2\).........................................
    Note: Rate separately for intracranial complications.
------------------------------------------------------------------------


                                The Ribs
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5297 Ribs, removal of:
  More than six.................................................      50
  Five or six...................................................      40
  Three or four.................................................      30
  Two...........................................................      20
  One or resection of two or more ribs without regeneration.....      10
  Note (1): The rating for rib resection or removal is not to be
   applied with ratings for purrulent pleurisy, lobectomy,
   pneumonectomy or injuries of pleural cavity.
  Note (2): However, rib resection will be considered as rib
   removal in thoracoplasty performed for collapse therapy or to
   accomplish obliteration of space and will be combined with
   the rating for lung collapse, or with the rating for
   lobectomy, pneumonectomy or the graduated ratings for
   pulmonary tuberculosis.
------------------------------------------------------------------------


                               The Coccyx
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5298 Coccyx, removal of:
  Partial or complete, with painful residuals...................      10
  Without painful residuals.....................................       0
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 40 
FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct. 
2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 67 FR 
48785, July 26, 2002; 67 FR 54349, Aug. 22, 2002; 68 FR 51456, Aug. 27, 
2003; 69 FR 32450, June 10, 2004; 80 FR 42041, July 16, 2015; 85 FR 
76460, Nov. 30, 2020, 85 FR 85523, Dec. 29, 2020, 86 FR 8142, Feb. 4, 
2021]



Sec.  4.72  [Reserved]



Sec.  4.73  Schedule of ratings--muscle injuries.

    Note (1): When evaluating any claim involving muscle injuries 
resulting in loss of use of any extremity or loss of use of both 
buttocks (diagnostic code 5317, Muscle Group XVII), refer to Sec.  3.350 
of this chapter to determine whether the veteran may be entitled to 
special monthly compensation.
    Note (2): Ratings of slight, moderate, moderately severe, or severe 
for diagnostic codes 5301 through 5323 will be determined based upon the 
criteria contained in Sec.  4.56.

                       The Shoulder Girdle and Arm
------------------------------------------------------------------------
                                                           Rating
                                                  ----------------------
                                                   Dominant  Nondominant
------------------------------------------------------------------------
5301 Group I. Function: Upward rotation of
 scapula; elevation of arm above shoulder level.
 Extrinsic muscles of shoulder girdle: (1)
 Trapezius; (2) levator scapulae; (3) serratus
 magnus..........................................
    Severe.......................................       40          30
    Moderately Severe............................       30          20
    Moderate.....................................       10          10
    Slight.......................................        0           0
5302 Group II. Function: Depression of arm from
 vertical overhead to hanging at side (1, 2);
 downward rotation of scapula (3, 4); 1 and 2 act
 with Group III in forward and backward swing of
 arm. Extrinsic muscles of shoulder girdle: (1)
 Pectoralis major II (costosternal); (2)
 latissimus dorsi and teres major (teres major,
 although technically an intrinsic muscle, is
 included with latissimus dorsi); (3) pectoralis
 minor; (4) rhomboid.............................
    Severe.......................................       40          30
    Moderately Severe............................       30          20
    Moderate.....................................       20          20
    Slight.......................................        0           0

[[Page 437]]

 
5303 Group III. Function: Elevation and abduction
 of arm to level of shoulder; act with 1 and 2 of
 Group II in forward and backward swing of arm.
 Intrinsic muscles of shoulder girdle: (1)
 Pectoralis major I (clavicular); (2) deltoid....
    Severe.......................................       40          30
    Moderately Severe............................       30          20
    Moderate.....................................       20          20
    Slight.......................................        0           0
5304 Group IV. Function: Stabilization of
 shoulder against injury in strong movements,
 holding head of humerus in socket; abduction;
 outward rotation and inward rotation of arm.
 Intrinsic muscles of shoulder girdle: (1)
 Supraspinatus; (2) infraspinatus and teres
 minor; (3) subscapularis; (4) coracobrachialis..
    Severe.......................................       30          20
    Moderately Severe............................       20          20
    Moderate.....................................       10          10
    Slight.......................................        0           0
5305 Group V. Function: Elbow supination (1)
 (long head of biceps is stabilizer of shoulder
 joint); flexion of elbow (1, 2, 3). Flexor
 muscles of elbow: (1) Biceps; (2) brachialis;
 (3) brachioradialis.............................
    Severe.......................................       40          30
    Moderately Severe............................       30          20
    Moderate.....................................       10          10
    Slight.......................................        0           0
5306 Group VI. Function: Extension of elbow (long
 head of triceps is stabilizer of shoulder
 joint). Extensor muscles of the elbow: (1)
 Triceps; (2) anconeus...........................
    Severe.......................................       40          30
    Moderately Severe............................       30          20
    Moderate.....................................       10          10
    Slight.......................................        0           0
------------------------------------------------------------------------


                          The Forearm and Hand
------------------------------------------------------------------------
                                                           Rating
                                                  ----------------------
                                                   Dominant  Nondominant
------------------------------------------------------------------------
5307 Group VII. Function: Flexion of wrist and
 fingers. Muscles arising from internal condyle
 of humerus: Flexors of the carpus and long
 flexors of fingers and thumb; pronator..........
    Severe.......................................       40          30
    Moderately Severe............................       30          20
    Moderate.....................................       10          10
    Slight.......................................        0           0
5308 Group VIII. Function: Extension of wrist,
 fingers, and thumb; abduction of thumb. Muscles
 arising mainly from external condyle of humerus:
 Extensors of carpus, fingers, and thumb;
 supinator.......................................
    Severe.......................................       30          20
    Moderately Severe............................       20          20
    Moderate.....................................       10          10
    Slight.......................................        0           0
5309 Group IX. Function: The forearm muscles act
 in strong grasping movements and are
 supplemented by the intrinsic muscles in
 delicate manipulative movements. Intrinsic
 muscles of hand: Thenar eminence; short flexor,
 opponens, abductor and adductor of thumb;
 hypothenar eminence; short flexor, opponens and
 abductor of little finger; 4 lumbricales; 4
 dorsal and 3 palmar interossei..................
 
Note: The hand is so compact a structure that
 isolated muscle injuries are rare, being nearly
 always complicated with injuries of bones,
 joints, tendons, etc. Rate on limitation of
 motion, minimum 10 percent.
------------------------------------------------------------------------


                            The Foot and Leg
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5310 Group X. Function: Movements of forefoot and toes;
 propulsion thrust in walking. Intrinsic muscles of the foot:
 Plantar: (1) Flexor digitorum brevis; (2) abductor hallucis;
 (3) abductor digiti minimi; (4) quadratus plantae; (5)
 lumbricales; (6) flexor hallucis brevis; (7) adductor hallucis;
 (8) flexor digiti minimi brevis; (9) dorsal and plantar
 interossei. Other important plantar structures: Plantar
 aponeurosis, long plantar and calcaneonavicular ligament,
 tendons of posterior tibial, peroneus longus, and long flexors
 of great and little toes.......................................
    Severe......................................................      30
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
Dorsal: (1) Extensor hallucis brevis; (2) extensor digitorum
 brevis. Other important dorsal structures: cruciate, crural,
 deltoid, and other ligaments; tendons of long extensors of toes
 and peronei muscles............................................
    Severe......................................................      20
    Moderately Severe...........................................      10
    Moderate....................................................      10
    Slight......................................................       0
 
Note: Minimum rating for through-and-through wounds of the foot--
 10.
 
5311 Group XI. Function: Propulsion, plantar flexion of foot
 (1); stabilization of arch (2, 3); flexion of toes (4, 5);
 Flexion of knee (6). Posterior and lateral crural muscles, and
 muscles of the calf: (1) Triceps surae (gastrocnemius and
 soleus); (2) tibialis posterior; (3) peroneus longus; (4)
 peroneus brevis; (5) flexor hallucis longus; (6) flexor
 digitorum longus; (7) popliteus; (8) plantaris.................
    Severe......................................................      30
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
5312 Group XII. Function: Dorsiflexion (1); extension of toes
 (2); stabilization of arch (3). Anterior muscles of the leg:
 (1) Tibialis anterior; (2) extensor digitorum longus; (3)
 extensor hallucis longus; (4) peroneus tertius.................
    Severe......................................................      30

[[Page 438]]

 
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
------------------------------------------------------------------------


                       The Pelvic Girdle and Thigh
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5313 Group XIII. Function: Extension of hip and flexion of knee;
 outward and inward rotation of flexed knee; acting with rectus
 femoris and sartorius (see XIV, 1, 2) synchronizing
 simultaneous flexion of hip and knee and extension of hip and
 knee by belt-over-pulley action at knee joint. Posterior thigh
 group, Hamstring complex of 2-joint muscles: (1) Biceps
 femoris; (2) semimembranosus; (3) semitendinosus...............
    Severe......................................................      40
    Moderately Severe...........................................      30
    Moderate....................................................      10
    Slight......................................................       0
5314 Group XIV. Function: Extension of knee (2, 3, 4, 5);
 simultaneous flexion of hip and flexion of knee (1); tension of
 fascia lata and iliotibial (Maissiat's) band, acting with XVII
 (1) in postural support of body (6); acting with hamstrings in
 synchronizing hip and knee (1, 2). Anterior thigh group: (1)
 Sartorius; (2) rectus femoris; (3) vastus externus; (4) vastus
 intermedius; (5) vastus internus; (6) tensor vaginae femoris...
    Severe......................................................      40
    Moderately Severe...........................................      30
    Moderate....................................................      10
    Slight......................................................       0
5315 Group XV. Function: Adduction of hip (1, 2, 3, 4); flexion
 of hip (1, 2); flexion of knee (4). Mesial thigh group: (1)
 Adductor longus; (2) adductor brevis; (3) adductor magnus; (4)
 gracilis.......................................................
    Severe......................................................      30
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
5316 Group XVI. Function: Flexion of hip (1, 2, 3). Pelvic
 girdle group 1: (1) Psoas; (2) iliacus; (3) pectineus..........
    Severe......................................................      40
    Moderately Severe...........................................      30
    Moderate....................................................      10
    Slight......................................................       0
5317 Group XVII. Function: Extension of hip (1); abduction of
 thigh; elevation of opposite side of pelvis (2, 3); tension of
 fascia lata and iliotibial (Maissiat's) band, acting with XIV
 (6) in postural support of body steadying pelvis upon head of
 femur and condyles of femur on tibia (1). Pelvic girdle group
 2: (1) Gluteus maximus; (2) gluteus medius; (3) gluteus minimus
    Severe......................................................     *50
    Moderately Severe...........................................      40
    Moderate....................................................      20
    Slight......................................................       0
5318 Group XVIII. Function: Outward rotation of thigh and
 stabilization of hip joint. Pelvic girdle group 3: (1)
 Pyriformis; (2) gemellus (superior or inferior); (3) obturator
 (external or internal); (4) quadratus femoris..................
    Severe......................................................      30
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
------------------------------------------------------------------------
* If bilateral, see Sec.   3.350(a)(3) of this chapter to determine
  whether the veteran may be entitled to special monthly compensation.


                           The Torso and Neck
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5319 Group XIX. Function: Support and compression of abdominal
 wall and lower thorax; flexion and lateral motions of spine;
 synergists in strong downward movements of arm (1). Muscles of
 the abdominal wall: (1) Rectus abdominis; (2) external oblique;
 (3) internal oblique; (4) transversalis; (5) quadratus lumborum
    Severe......................................................      50
    Moderately Severe...........................................      30
    Moderate....................................................      10
    Slight......................................................       0
5320 Group XX. Function: Postural support of body; extension and
 lateral movements of spine. Spinal muscles: Sacrospinalis
 (erector spinae and its prolongations in thoracic and cervical
 regions).......................................................
    Cervical and thoracic region:...............................
    Severe......................................................      40
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
    Lumbar region:..............................................
    Severe......................................................      60
    Moderately Severe...........................................      40
    Moderate....................................................      20
    Slight......................................................       0
5321 Group XXI. Function: Respiration. Muscles of respiration:
 Thoracic muscle group..........................................
    Severe or Moderately Severe.................................      20
    Moderate....................................................      10
    Slight......................................................       0
5322 Group XXII. Function: Rotary and forward movements of the
 head; respiration; deglutition. Muscles of the front of the
 neck: (Lateral, supra-, and infrahyoid group.) (1) Trapezius I
 (clavicular insertion); (2) sternocleidomastoid; (3) the
 ``hyoid'' muscles; (4) sternothyroid; (5) digastric............
    Severe......................................................      30
    Moderately Severe...........................................      20
    Moderate....................................................      10
    Slight......................................................       0
5323 Group XXIII. Function: Movements of the head; fixation of
 shoulder movements. Muscles of the side and back of the neck:
 Suboccipital; lateral vertebral and anterior vertebral muscles.
    Severe......................................................      30
    Moderately Severe...........................................      20
    Moderate....................................................      10
Slight..........................................................       0
------------------------------------------------------------------------


                              Miscellaneous
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
5324 Diaphragm, rupture of, with herniation. Rate under
 diagnostic code 7346...........................................

[[Page 439]]

 
5325 Muscle injury, facial muscles. Evaluate functional
 impairment as seventh (facial) cranial nerve neuropathy
 (diagnostic code 8207), disfiguring scar (diagnostic code
 7800), etc. Minimum, if interfering to any extent with
 mastication--10................................................
5326 Muscle hernia, extensive. Without other injury to the
 muscle--10.....................................................
5327 Muscle, neoplasm of, malignant (excluding soft tissue
 sarcoma)--100..................................................
 
     Note: A rating of 100 percent shall continue beyond the
  cessation of any surgery, radiation treatment, antineoplastic
 chemotherapy or other therapeutic procedures. Six months after
  discontinuance of such treatment, the appropriate disability
   rating shall be determined by mandatory VA examination. Any
     change in evaluation based upon that or any subsequent
     examination shall be subject to the provisions of Sec.
 3.105(e) of this chapter. If there has been no local recurrence
     or metastasis, rate on residual impairment of function.
 
5328 Muscle, neoplasm of, benign, postoperative. Rate on
 impairment of function, i.e., limitation of motion, or scars,
 diagnostic code 7805, etc......................................
5329 Sarcoma, soft tissue (of muscle, fat, or fibrous connective
 tissue)--100...................................................
 
     Note: A rating of 100 percent shall continue beyond the
  cessation of any surgery, radiation treatment, antineoplastic
 chemotherapy or other therapeutic procedures. Six months after
  discontinuance of such treatment, the appropriate disability
   rating shall be determined by mandatory VA examination. Any
     change in evaluation based upon that or any subsequent
     examination shall be subject to the provisions of Sec.
 3.105(e) of this chapter. If there has been no local recurrence
     or metastasis, rate on residual impairment of function.
5330 Rhabdomyolysis, residuals of:
    Rate each affected muscle group separately and combine in
     accordance with Sec.   4.25................................
    Note: Separately evaluate any chronic renal complications
     within the appropriate body system.
5331 Compartment syndrome:
    Rate each affected muscle group separately and combine in
     accordance with Sec.   4.25................................
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[62 FR 30239, June 3, 1997, as amemded 85 FR 76464, Nov. 30, 2020]

                       The Organs of Special Sense



Sec.  4.75  General considerations for evaluating visual impairment.

    (a) Visual impairment. The evaluation of visual impairment is based 
on impairment of visual acuity (excluding developmental errors of 
refraction), visual field, and muscle function.
    (b) Examination for visual impairment. The examination must be 
conducted by a licensed optometrist or by a licensed ophthalmologist. 
The examiner must identify the disease, injury, or other pathologic 
process responsible for any visual impairment found. Examinations of 
visual fields or muscle function will be conducted only when there is a 
medical indication of disease or injury that may be associated with 
visual field defect or impaired muscle function. Unless medically 
contraindicated, the fundus must be examined with the claimant's pupils 
dilated.
    (c) Service-connected visual impairment of only one eye. Subject to 
the provisions of 38 CFR 3.383(a), if visual impairment of only one eye 
is service-connected, the visual acuity of the other eye will be 
considered to be 20/40 for purposes of evaluating the service-connected 
visual impairment.
    (d) Maximum evaluation for visual impairment of one eye. The 
evaluation for visual impairment of one eye must not exceed 30 percent 
unless there is anatomical loss of the eye. Combine the evaluation for 
visual impairment of one eye with evaluations for other disabilities of 
the same eye that are not based on visual impairment (e.g., 
disfigurement under diagnostic code 7800).
    (e) Anatomical loss of one eye with inability to wear a prosthesis. 
When the claimant has anatomical loss of one eye and is unable to wear a 
prosthesis, increase the evaluation for visual acuity under diagnostic 
code 6063 by 10 percent, but the maximum evaluation for visual 
impairment of both eyes must not exceed 100 percent. A 10-percent 
increase under this paragraph precludes an evaluation under diagnostic 
code 7800 based on gross distortion or asymmetry of the eye but not an 
evaluation under diagnostic code 7800 based on other characteristics of 
disfigurement.
    (f) Special monthly compensation. When evaluating visual impairment, 
refer to 38 CFR 3.350 to determine whether the claimant may be entitled 
to special monthly compensation. Footnotes in the schedule indicate 
levels of visual impairment that potentially establish entitlement to 
special monthly compensation; however, other levels of visual impairment 
combined with disabilities of other body systems may also establish 
entitlement.

(Authority: 38 U.S.C. 1114 and 1155)

[73 FR 66549, Nov. 10, 2008]

[[Page 440]]



Sec.  4.76  Visual acuity.

    (a) Examination of visual acuity. Examination of visual acuity must 
include the central uncorrected and corrected visual acuity for distance 
and near vision using Snellen's test type or its equivalent.
    (b) Evaluation of visual acuity. (1) Evaluate central visual acuity 
on the basis of corrected distance vision with central fixation, even if 
a central scotoma is present. However, when the lens required to correct 
distance vision in the poorer eye differs by more than three diopters 
from the lens required to correct distance vision in the better eye (and 
the difference is not due to congenital or developmental refractive 
error), and either the poorer eye or both eyes are service connected, 
evaluate the visual acuity of the poorer eye using either its 
uncorrected or corrected visual acuity, whichever results in better 
combined visual acuity.
    (2) Provided that he or she customarily wears contact lenses, 
evaluate the visual acuity of any individual affected by a corneal 
disorder that results in severe irregular astigmatism that can be 
improved more by contact lenses than by eyeglass lenses, as corrected by 
contact lenses.
    (3) In any case where the examiner reports that there is a 
difference equal to two or more scheduled steps between near and 
distance corrected vision, with the near vision being worse, the 
examination report must include at least two recordings of near and 
distance corrected vision and an explanation of the reason for the 
difference. In these cases, evaluate based on corrected distance vision 
adjusted to one step poorer than measured.
    (4) To evaluate the impairment of visual acuity where a claimant has 
a reported visual acuity that is between two sequentially listed visual 
acuities, use the visual acuity which permits the higher evaluation.

(Authority: 38 U.S.C. 1155)

[73 FR 66549, Nov. 10, 2008]



Sec.  4.76a  Computation of average concentric contraction of visual fields.

     Table III--Normal Visual Field Extent at 8 Principal Meridians
------------------------------------------------------------------------
                                                                Normal
                          Meridian                              degrees
------------------------------------------------------------------------
Temporally..................................................          85
Down temporally.............................................          85
Down........................................................          65
Down nasally................................................          50
Nasally.....................................................          60
Up nasally..................................................          55
Up..........................................................          45
Up temporally...............................................          55
                                                             -----------
 Total......................................................         500
------------------------------------------------------------------------


[[Page 441]]

[GRAPHIC] [TIFF OMITTED] TC04NO91.005

    Example of computation of concentric contraction under the schedule 
with abnormal findings taken from Figure 1.

------------------------------------------------------------------------
                            Loss                                Degrees
------------------------------------------------------------------------
Temporally..................................................          55
Down temporally.............................................          55
Down........................................................          45

[[Page 442]]

 
Down nasally................................................          30
Nasally.....................................................          40
Up nasally..................................................          35
Up..........................................................          25
Up temporally...............................................          35
                                                             -----------
 Total loss.................................................         320
------------------------------------------------------------------------
Remaining field 500[deg] minus 320[deg] = 180[deg]. 180[deg] / 8 = 22\1/
  2\[deg] average concentric contraction.


(Authority: 38 U.S.C. 1155)

[43 FR 45352, Oct. 2, 1978, as amended at 73 FR 66549, Nov. 10, 2008]



Sec.  4.77  Visual fields.

    (a) Examination of visual fields. Examiners must use either Goldmann 
kinetic perimetry or automated perimetry using Humphrey Model 750, 
Octopus Model 101, or later versions of these perimetric devices with 
simulated kinetic Goldmann testing capability. For phakic (normal) 
individuals, as well as for pseudophakic or aphakic individuals who are 
well adapted to intraocular lens implant or contact lens correction, 
visual field examinations must be conducted using a standard target size 
and luminance, which is Goldmann's equivalent III/4e. For aphakic 
individuals not well adapted to contact lens correction or pseudophakic 
individuals not well adapted to intraocular lens implant, visual field 
examinations must be conducted using Goldmann's equivalent IV/4e. The 
examiner must document the results for at least 16 meridians 22\1/2\ 
degrees apart for each eye and indicate the Goldmann equivalent used. 
See Table III for the normal extent (in degrees) of the visual fields at 
the 8 principal meridians (45 degrees apart). When the examiner 
indicates that additional testing is necessary to evaluate visual 
fields, the additional testing must be conducted using either a tangent 
screen or a 30-degree threshold visual field with the Goldmann III 
stimulus size. The examination report must document the results of 
either the tangent screen or of the 30-degree threshold visual field 
with the Goldmann III stimulus size.
    (b) Evaluation of visual fields. Determine the average concentric 
contraction of the visual field of each eye by measuring the remaining 
visual field (in degrees) at each of eight principal meridians 45 
degrees apart, adding them, and dividing the sum by eight.
    (c) Combination of visual field defect and decreased visual acuity. 
To determine the evaluation for visual impairment when both decreased 
visual acuity and visual field defect are present in one or both eyes 
and are service connected, separately evaluate the visual acuity and 
visual field defect (expressed as a level of visual acuity), and combine 
them under the provisions of Sec.  4.25.

[[Page 443]]

[GRAPHIC] [TIFF OMITTED] TC04NO91.006


(Authority: 38 U.S.C. 1155)

[53 FR 30262, Aug. 11, 1988, as amended at 73 FR 66549, Nov. 10, 2008; 
74 FR 7648, Feb. 19, 2009; 83 FR 15320, Apr. 10, 2018]



Sec.  4.78  Muscle function.

    (a) Examination of muscle function. The examiner must use a Goldmann 
perimeter chart or the Tangent Screen method that identifies the four 
major quadrants (upward, downward, left, and right lateral) and the 
central field (20 degrees or less) (see Figure 2). The examiner must 
document the results of muscle function testing by identifying the 
quadrant(s) and range(s) of degrees in which diplopia exists.
    (b) Evaluation of muscle function. (1) An evaluation for diplopia 
will be assigned to only one eye. When a claimant has both diplopia and 
decreased visual acuity or visual field defect, assign a level of 
corrected visual acuity for the poorer eye (or the affected eye, if 
disability of only one eye is service-connected) that is: one step 
poorer than it would otherwise warrant if the evaluation for diplopia 
under diagnostic code 6090 is 20/70 or 20/100; two steps poorer if the 
evaluation under diagnostic code 6090 is 20/200 or 15/200; or three 
steps poorer if the evaluation under diagnostic code 6090 is 5/200. This 
adjusted level of corrected visual acuity, however, must not exceed a 
level of 5/200. Use the adjusted visual acuity for the poorer eye (or 
the affected eye, if

[[Page 444]]

disability of only one eye is service-connected), and the corrected 
visual acuity for the better eye (or visual acuity of 20/40 for the 
other eye, if only one eye is service-connected) to determine the 
percentage evaluation for visual impairment under diagnostic codes 6065 
through 6066.
    (2) When diplopia extends beyond more than one quadrant or range of 
degrees, evaluate diplopia based on the quadrant and degree range that 
provides the highest evaluation.
    (3) When diplopia exists in two separate areas of the same eye, 
increase the equivalent visual acuity under diagnostic code 6090 to the 
next poorer level of visual acuity, not to exceed 5/200.

(Authority: 38 U.S.C. 1155)

[73 FR 66550, Nov. 10, 2008, as amended at 83 FR 15321, Apr. 10, 2018]



Sec.  4.79  Schedule of ratings--eye.

                           Diseases of the Eye
------------------------------------------------------------------------
                                                                 Rating
------------------------------------------------------------------------
General Rating Formula for Diseases of the Eye:
    Evaluate on the basis of either visual impairment due to
     the particular condition or on incapacitating episodes,
     whichever results in a higher evaluation
    With documented incapacitating episodes requiring 7 or            60
     more treatment visits for an eye condition during the
     past 12 months..........................................
    With documented incapacitating episodes requiring at              40
     least 5 but less than 7 treatment visits for an eye
     condition during the past 12 months.....................
    With documented incapacitating episodes requiring at              20
     least 3 but less than 5 treatment visits for an eye
     condition during the past 12 months.....................
    With documented incapacitating episodes requiring at              10
     least 1 but less than 3 treatment visits for an eye
     condition during the past 12 months.....................
    Note (1): For the purposes of evaluation under 38 CFR
     4.79, an incapacitating episode is an eye condition
     severe enough to require a clinic visit to a provider
     specifically for treatment purposes.....................
    Note (2): Examples of treatment may include but are not
     limited to: Systemic immunosuppressants or biologic
     agents; intravitreal or periocular injections; laser
     treatments; or other surgical interventions.............
    Note (3): For the purposes of evaluating visual
     impairment due to the particular condition, refer to 38
     CFR 4.75-4.78 and to Sec.   4.79, diagnostic codes 6061-
     6091....................................................
------------------------------------------------------------------------
6000 Choroidopathy, including uveitis, iritis, cyclitis, or
 choroiditis.
6001 Keratopathy.
6002 Scleritis.
6006 Retinopathy or maculopathy not otherwise specified
6007 Intraocular hemorrhage.
6008 Detachment of retina.
6009 Unhealed eye injury.
    Note: This code includes orbital trauma, as well as
     penetrating or non-penetrating eye injury
6010 Tuberculosis of eye:
    Active                                                           100
    Inactive: Evaluate under Sec.   4.88c or Sec.   4.89 of
     this part, whichever is appropriate.....................
6011 Retinal scars, atrophy, or irregularities:
    Localized scars, atrophy, or irregularities of the                10
     retina, unilateral or bilateral, that are centrally
     located and that result in an irregular, duplicated,
     enlarged, or diminished image...........................
    Alternatively, evaluate based on the General Rating
     Formula for Diseases of the Eye, if this would result in
     a higher evaluation
6012 Angle-closure glaucoma
    Evaluate under the General Rating Formula for Diseases of         10
     the Eye. Minimum evaluation if continuous medication is
     required................................................
6013 Open-angle glaucoma
    Evaluate under the General Rating Formula for Diseases of         10
     the Eye. Minimum evaluation if continuous medication is
     required................................................
6014 Malignant neoplasms of the eye, orbit, and adnexa
 (excluding skin):
    Malignant neoplasms of the eye, orbit, and adnexa                100
     (excluding skin) that require therapy that is comparable
     to those used for systemic malignancies, i.e., systemic
     chemotherapy, X-ray therapy more extensive than to the
     area of the eye, or surgery more extensive than
     enucleation.............................................
    Note: Continue the 100 percent rating beyond the
     cessation of any surgical, X-ray, antineoplastic
     chemotherapy, or other therapeutic procedure. Six months
     after discontinuance of such treatment, the appropriate
     disability rating will be determined by mandatory VA
     examination. Any change in evaluation based upon that or
     any subsequent examination will be subject to the
     provisions of Sec.   3.105(e) of this chapter. If there
     has been no local recurrence or metastasis, evaluate
     based on residuals
    Malignant neoplasms of the eye, orbit, and adnexa
     (excluding skin) that do not require therapy comparable
     to that for systemic malignancies:
    Separately evaluate visual and nonvisual impairment,
     e.g., disfigurement (diagnostic code 7800), and combine
     the evaluations.........................................
6015 Benign neoplasms of the eye, orbit, and adnexa
 (excluding skin):

[[Page 445]]

 
    Separately evaluate visual and nonvisual impairment,
     e.g., disfigurement (diagnostic code 7800), and combine
     the evaluations
------------------------------------------------------------------------
6016 Nystagmus, central......................................         10
6017 Trachomatous conjunctivitis:
    Active: Evaluate under the General Rating Formula for             30
     Diseases of the Eye, minimum rating.....................
    Inactive: Evaluate based on residuals, such as visual
     impairment and disfigurement (diagnostic code 7800)
6018 Chronic conjunctivitis (nontrachomatous):
    Active: Evaluate under the General Rating Formula for             10
     Diseases of the Eye, minimum rating.....................
    Inactive: Evaluate based on residuals, such as visual
     impairment and disfigurement (diagnostic code 7800)
6019 Ptosis, unilateral or bilateral:
    Evaluate based on visual impairment or, in the absence of
     visual impairment, on disfigurement (diagnostic code
     7800).
6020 Ectropion:
    Bilateral................................................         20
    Unilateral...............................................         10
6021 Entropion:
    Bilateral................................................         20
    Unilateral...............................................         10
6022 Lagophthalmos:
    Bilateral................................................         20
    Unilateral...............................................         10
6023 Loss of eyebrows, complete, unilateral or bilateral.....         10
6024 Loss of eyelashes, complete, unilateral or bilateral....         10
6025 Disorders of the lacrimal apparatus (epiphora,
 dacryocystitis, etc.):
    Bilateral................................................         20
    Unilateral...............................................         10
6026 Optic neuropathy
6027 Cataract:
    Preoperative: Evaluate under the General Rating Formula
     for Diseases of the Eye
    Postoperative: If a replacement lens is present
     (pseudophakia), evaluate under the General Rating
     Formula for Diseases of the Eye. If there is no
     replacement lens, evaluate based on aphakia (diagnostic
     code 6029)
6029 Aphakia or dislocation of crystalline lens:
    Evaluate based on visual impairment, and elevate the
     resulting level of visual impairment one step.
    Minimum (unilateral or bilateral)........................         30
6030 Paralysis of accommodation (due to neuropathy of the             20
 Oculomotor Nerve (cranial nerve III)).
6032 Loss of eyelids, partial or complete:
    Separately evaluate both visual impairment due to eyelid
     loss and nonvisual impairment, e.g., disfigurement
     (diagnostic code 7800), and combine the evaluations.
6034 Pterygium:
    Evaluate under the General Rating Formula for Diseases of
     the Eye, disfigurement (diagnostic code 7800),
     conjunctivitis (diagnostic code 6018), etc., depending
     on the particular findings, and combine in accordance
     with Sec.   4.25
6035 Keratoconus
6036 Status post corneal transplant:
    Evaluate under the General Rating Formula for Diseases of         10
     the Eye. Minimum, if there is pain, photophobia, and
     glare sensitivity.......................................
6037 Pinguecula:
    Evaluate based on disfigurement (diagnostic code 7800).
6040 Diabetic retinopathy
6042 Retinal dystrophy (including retinitis pigmentosa, wet
 or dry macular degeneration, early-onset macular
 degeneration, rod and/or cone dystrophy)
6046 Post-chiasmal disorders
------------------------------------------------------------------------
                   Impairment of Central Visual Acuity
------------------------------------------------------------------------
6061 Anatomical loss of both eyes \1\........................        100
6062 No more than light perception in both eyes \1\..........        100
6063 Anatomical loss of one eye: \1\
    In the other eye 5/200 (1.5/60)..........................        100
    In the other eye 10/200 (3/60)...........................         90
    In the other eye 15/200 (4.5/60).........................         80
    In the other eye 20/200 (6/60)...........................         70
    In the other eye 20/100 (6/30)...........................         60
    In the other eye 20/70 (6/21)............................         60
    In the other eye 20/50 (6/15)............................         50
    In the other eye 20/40 (6/12)............................         40
6064 No more than light perception in one eye: \1\
    In the other eye 5/200 (1.5/60)..........................        100
    In the other eye 10/200 (3/60)...........................         90
    In the other eye 15/200 (4.5/60).........................         80

[[Page 446]]

 
    In the other eye 20/200 (6/60)...........................         70
    In the other eye 20/100 (6/30)...........................         60
    In the other eye 20/70 (6/21)............................         50
    In the other eye 20/50 (6/15)............................         40
    In the other eye 20/40 (6/12)............................         30
6065 Vision in one eye 5/200 (1.5/60):
    In the other eye 5/200 (1.5/60)..........................     \1\100
    In the other eye 10/200 (3/60)...........................         90
    In the other eye 15/200 (4.5/60).........................         80
    In the other eye 20/200 (6/60)...........................         70
    In the other eye 20/100 (6/30)...........................         60
    In the other eye 20/70 (6/21)............................         50
    In the other eye 20/50 (6/15)............................         40
    In the other eye 20/40 (6/12)............................         30
6066 Visual acuity in one eye 10/200 (3/60) or better:
Vision in one eye 10/200 (3/60):
    In the other eye 10/200 (3/60)...........................         90
    In the other eye 15/200 (4.5/60).........................         80
    In the other eye 20/200 (6/60)...........................         70
    In the other eye 20/100 (6/30)...........................         60
    In the other eye 20/70 (6/21)............................         50
    In the other eye 20/50 (6/15)............................         40
    In the other eye 20/40 (6/12)............................         30
Vision in one eye 15/200 (4.5/60):
    In the other eye 15/200 (4.5/60).........................         80
    In the other eye 20/200 (6/60)...........................         70
    In the other eye 20/100 (6/30)...........................         60
    In the other eye 20/70 (6/21)............................         40
    In the other eye 20/50 (6/15)............................         30
    In the other eye 20/40 (6/12)............................         20
Vision in one eye 20/200 (6/60):
    In the other eye 20/200 (6/60)...........................         70
    In the other eye 20/100 (6/30)...........................         60
    In the other eye 20/70 (6/21)............................         40
    In the other eye 20/50 (6/15)............................         30
    In the other eye 20/40 (6/12)............................         20
Vision in one eye 20/100 (6/30):
    In the other eye 20/100 (6/30)...........................         50
    In the other eye 20/70 (6/21)............................         30
    In the other eye 20/50 (6/15)............................         20
    In the other eye 20/40 (6/12)............................         10
Vision in one eye 20/70 (6/21):
    In the other eye 20/70 (6/21)............................         30
    In the other eye 20/50 (6/15)............................         20
    In the other eye 20/40 (6/12)............................         10
Vision in one eye 20/50 (6/15):
    In the other eye 20/50 (6/15)............................         10
    In the other eye 20/40 (6/12)............................         10
Vision in one eye 20/40 (6/12):
    In the other eye 20/40 (6/12)............................         0
------------------------------------------------------------------------
\1\ Review for entitlement to special monthly compensation under 38 CFR
  3.350.


                 Ratings for Impairment of Visual Fields
------------------------------------------------------------------------
                                                                 Rating
------------------------------------------------------------------------
6080 Visual field defects:
    Homonymous hemianopsia...................................         30
Loss of temporal half of visual field:
    Bilateral................................................         30
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/70 (6/21)............
Loss of nasal half of visual field:
    Bilateral................................................         10
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/50 (6/15)............
Loss of inferior half of visual field:
    Bilateral................................................         30
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/70 (6/21)............
Loss of superior half of visual field:

[[Page 447]]

 
    Bilateral................................................         10
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/50 (6/15)............
Concentric contraction of visual field:
    With remaining field of 5 degrees: \1\
    Bilateral................................................        100
    Unilateral...............................................         30
    Or evaluate each affected eye as 5/200 (1.5/60)..........
With remaining field of 6 to 15 degrees:
    Bilateral................................................         70
    Unilateral...............................................         20
    Or evaluate each affected eye as 20/200 (6/60)...........
With remaining field of 16 to 30 degrees:
    Bilateral................................................         50
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/100 (6/30)...........
With remaining field of 31 to 45 degrees:
    Bilateral................................................         30
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/70 (6/21)............
With remaining field of 46 to 60 degrees:
    Bilateral................................................         10
    Unilateral...............................................         10
    Or evaluate each affected eye as 20/50 (6/15)............
6081 Scotoma, unilateral:
    Minimum, with scotoma affecting at least one-quarter of           10
     the visual field (quadrantanopsia) or with centrally
     located scotoma of any size.............................
    Alternatively, evaluate based on visual impairment due to
     scotoma, if that would result in a higher evaluation....
------------------------------------------------------------------------
\1\ Review for entitlement to special monthly compensation under 38 CFR
  3.350.


                Ratings for Impairment of Muscle Function
------------------------------------------------------------------------
                                                       Equivalent visual
                  Degree of diplopia                         acuity
------------------------------------------------------------------------
6090 Diplopia (double vision):
    (a) Central 20 degrees...........................     5/200 (1.5/60)
    (b) 21 degrees to 30 degrees
        (1) Down.....................................    15/200 (4.5/60)
        (2) Lateral..................................      20/100 (6/30)
        (3) Up.......................................       20/70 (6/21)
    (c) 31 degrees to 40 degrees
        (1) Down.....................................      20/200 (6/60)
        (2) Lateral..................................       20/70 (6/21)
        (3) Up.......................................       20/40 (6/12)
Note: In accordance with 38 CFR 4.31, diplopia that
 is occasional or that is correctable with spectacles
 is evaluated at 0 percent.
6091 Symblepharon:
    Evaluate under the General Rating Formula for
     Diseases of the Eye, lagophthalmos (diagnostic
     code 6022), disfigurement (diagnostic code
     7800), etc., depending on the particular
     findings, and combine in accordance with Sec.
     4.25
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[73 FR 66550, Nov. 10, 2008, as amended at 83 FR 15321, Apr. 10, 2018]



Sec. Sec.  4.80-4.84  [Reserved]

                      Impairment of Auditory Acuity



Sec.  4.85  Evaluation of hearing impairment.

    (a) An examination for hearing impairment for VA purposes must be 
conducted by a state-licensed audiologist and must include a controlled 
speech discrimination test (Maryland CNC) and a puretone audiometry 
test. Examinations will be conducted without the use of hearing aids.
    (b) Table VI, ``Numeric Designation of Hearing Impairment Based on 
Puretone Threshold Average and

[[Page 448]]

Speech Discrimination,'' is used to determine a Roman numeral 
designation (I through XI) for hearing impairment based on a combination 
of the percent of speech discrimination (horizontal rows) and the 
puretone threshold average (vertical columns). The Roman numeral 
designation is located at the point where the percentage of speech 
discrimination and puretone threshold average intersect.
    (c) Table VIa, ``Numeric Designation of Hearing Impairment Based 
Only on Puretone Threshold Average,'' is used to determine a Roman 
numeral designation (I through XI) for hearing impairment based only on 
the puretone threshold average. Table VIa will be used when the examiner 
certifies that use of the speech discrimination test is not appropriate 
because of language difficulties, inconsistent speech discrimination 
scores, etc., or when indicated under the provisions of Sec.  4.86.
    (d) ``Puretone threshold average,'' as used in Tables VI and VIa, is 
the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz, 
divided by four. This average is used in all cases (including those in 
Sec.  4.86) to determine the Roman numeral designation for hearing 
impairment from Table VI or VIa.
    (e) Table VII, ``Percentage Evaluations for Hearing Impairment,'' is 
used to determine the percentage evaluation by combining the Roman 
numeral designations for hearing impairment of each ear. The horizontal 
rows represent the ear having the better hearing and the vertical 
columns the ear having the poorer hearing. The percentage evaluation is 
located at the point where the row and column intersect.
    (f) If impaired hearing is service-connected in only one ear, in 
order to determine the percentage evaluation from Table VII, the non-
service-connected ear will be assigned a Roman Numeral designation for 
hearing impairment of I, subject to the provisions of Sec.  3.383 of 
this chapter.
    (g) When evaluating any claim for impaired hearing, refer to Sec.  
3.350 of this chapter to determine whether the veteran may be entitled 
to special monthly compensation due either to deafness, or to deafness 
in combination with other specified disabilities.
    (h) Numeric tables VI, VIA*, and VII.

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[GRAPHIC] [TIFF OMITTED] TR11MY99.005


[[Page 450]]


[GRAPHIC] [TIFF OMITTED] TR11MY99.006


[64 FR 25206, May 11, 1999]



Sec.  4.86  Exceptional patterns of hearing impairment.

    (a) When the puretone threshold at each of the four specified 
frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, 
the rating specialist will determine the Roman numeral designation for 
hearing impairment from either Table VI or Table VIa, whichever results 
in the higher numeral. Each ear will be evaluated separately.
    (b) When the puretone threshold is 30 decibels or less at 1000 
Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will 
determine the Roman numeral designation for hearing impairment from 
either Table VI or Table VIa, whichever results in the higher numeral. 
That numeral will then be elevated to the next higher

[[Page 451]]

Roman numeral. Each ear will be evaluated separately.

(Authority: 38 U.S.C. 1155)

[64 FR 25209, May 11, 1999]



Sec.  4.87  Schedule of ratings--ear.

                           Diseases of the Ear
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
6200 Chronic suppurative otitis media, mastoiditis, or
 cholesteatoma (or any combination):
  During suppuration, or with aural polyps......................      10
  Note: Evaluate hearing impairment, and complications such as
   labyrinthitis, tinnitus, facial nerve paralysis, or bone loss
   of skull, separately.
6201 Chronic nonsuppurative otitis media with effusion (serous
 otitis media):
  Rate hearing impairment
6202 Otosclerosis:
  Rate hearing impairment
6204 Peripheral vestibular disorders:
  Dizziness and occasional staggering...........................      30
  Occasional dizziness..........................................      10
  Note: Objective findings supporting the diagnosis of
   vestibular disequilibrium are required before a compensable
   evaluation can be assigned under this code. Hearing
   impairment or suppuration shall be separately rated and
   combined.
6205 Meniere's syndrome (endolymphatic hydrops):
  Hearing impairment with attacks of vertigo and cerebellar gait     100
   occurring more than once weekly, with or without tinnitus....
  Hearing impairment with attacks of vertigo and cerebellar gait      60
   occurring from one to four times a month, with or without
   tinnitus.....................................................
  Hearing impairment with vertigo less than once a month, with        30
   or without tinnitus..........................................
  Note: Evaluate Meniere's syndrome either under these criteria
   or by separately evaluating vertigo (as a peripheral
   vestibular disorder), hearing impairment, and tinnitus,
   whichever method results in a higher overall evaluation. But
   do not combine an evaluation for hearing impairment,
   tinnitus, or vertigo with an evaluation under diagnostic code
   6205.
6207 Loss of auricle:
  Complete loss of both.........................................      50
  Complete loss of one..........................................      30
  Deformity of one, with loss of one-third or more of the             10
   substance....................................................
6208 Malignant neoplasm of the ear (other than skin only).......     100
  Note: A rating of 100 percent shall continue beyond the
   cessation of any surgical, radiation treatment,
   antineoplastic chemotherapy or other therapeutic procedure.
   Six months after discontinuance of such treatment, the
   appropriate disability rating shall be determined by
   mandatory VA examination. Any change in evaluation based on
   that or any subsequent examination shall be subject to the
   provisions of Sec.   3.105(e) of this chapter. If there has
   been no local recurrence or metastasis, rate on residuals.
6209 Benign neoplasms of the ear (other than skin only):
  Rate on impairment of function.
6210 Chronic otitis externa:
  Swelling, dry and scaly or serous discharge, and itching            10
   requiring frequent and prolonged treatment...................
6211 Tympanic membrane, perforation of..........................       0
6260 Tinnitus, recurrent........................................      10
  Note (1): A separate evaluation for tinnitus may be combined
   with an evaluation under diagnostic codes 6100, 6200, 6204,
   or other diagnostic code, except when tinnitus supports an
   evaluation under one of those diagnostic codes.
  Note (2): Assign only a single evaluation for recurrent
   tinnitus, whether the sound is perceived in one ear, both
   ears, or in the head.
  Note (3): Do not evaluate objective tinnitus (in which the
   sound is audible to other people and has a definable cause
   that may or may not be pathologic) under this diagnostic
   code, but evaluate it as part of any underlying condition
   causing it.
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[64 FR 25210, May 11, 1999, as amended at 68 FR 25823, May 14, 2003]



Sec.  4.87a  Schedule of ratings--other sense organs.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
6275 Sense of smell, complete loss..............................      10
6276 Sense of taste, complete loss..............................      10
  Note: Evaluation will be assigned under diagnostic codes 6275
   or 6276 only if there is an anatomical or pathological basis
   for the condition.
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[64 FR 25210, May 11, 1999]

   Infectious Diseases, Immune Disorders and Nutritional Deficiencies



Sec.  4.88  [Reserved]



Sec.  4.88a  Chronic fatigue syndrome.

    (a) For VA purposes, the diagnosis of chronic fatigue syndrome 
requires:
    (1) new onset of debilitating fatigue severe enough to reduce daily 
activity to less than 50 percent of the usual level for at least six 
months; and
    (2) the exclusion, by history, physical examination, and laboratory 
tests, of all other clinical conditions that may produce similar 
symptoms; and
    (3) six or more of the following:
    (i) acute onset of the condition,
    (ii) low grade fever,
    (iii) nonexudative pharyngitis,

[[Page 452]]

    (iv) palpable or tender cervical or axillary lymph nodes,
    (v) generalized muscle aches or weakness,
    (vi) fatigue lasting 24 hours or longer after exercise,
    (vii) headaches (of a type, severity, or pattern that is different 
from headaches in the pre-morbid state),
    (viii) migratory joint pains,
    (ix) neuropsychologic symptoms,
    (x) sleep disturbance.
    (b) [Reserved]

[59 FR 60902, Nov. 29, 1994]



Sec.  4.88b  Schedule of ratings--infectious diseases, immune disorders
and nutritional deficiencies.

    Note: Rate any residual disability of infection within the 
appropriate body system as indicated by the notes in the evaluation 
criteria. As applicable, consider the long-term health effects 
potentially associated with infectious diseases as listed in Sec.  
3.317(d) of this chapter, specifically Brucellosis, Campylobacter 
jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium 
Tuberculosis, Nontyphoid Salmonella, Shigella, Visceral Leishmaniasis, 
and West Nile virus.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
General Rating Formula for Infectious Diseases:
    For active disease.........................................      100
    After active disease has resolved, rate at 0 percent for
     infection. Rate any residual disability of infection
     within the appropriate body system.
6300 Vibriosis (Cholera, Non-cholera):
    Evaluate under the General Rating Formula.
    Note: Rate residuals of cholera and non-cholera vibrio
     infections, such as renal failure, skin, and
     musculoskeletal conditions, within the appropriate body
     system.
6301 Visceral leishmaniasis:
    As active disease..........................................      100
    Note 1: Continue a 100 percent evaluation beyond the
     cessation of treatment for active disease. Six months
     after discontinuance of such treatment, determine the
     appropriate disability rating by mandatory VA examination.
     Any change in evaluation based upon that or any subsequent
     examination shall be subject to the provisions of Sec.
     3.105(e) of this chapter. Thereafter, rate under the
     appropriate body system any residual disability of
     infection, which includes, but is not limited to liver
     damage and bone marrow disease.
    Note 2: Confirm the recurrence of active infection by
     culture, histopathology, or other diagnostic laboratory
     testing.
 
6302 Leprosy (Hansen's disease):
    As active disease..........................................      100
    Note: Continue a 100 percent evaluation beyond the
     cessation of treatment for active disease. Six months
     after discontinuance of such treatment, determine the
     appropriate disability rating by mandatory VA examination.
     Any change in evaluation based upon that or any subsequent
     examination shall be subject to the provisions of Sec.
     3.105(e) of this chapter. Thereafter, rate under the
     appropriate body system any residual disability of
     infection, which includes, but is not limited to, skin
     lesions, peripheral neuropathy, or amputations.
 
6304 Malaria:
    Evaluate under the General Rating Formula.
    Note 1: The diagnosis of malaria, both initially and during
     relapse, depends on the identification of the malarial
     parasites in blood smears or other specific diagnostic
     laboratory tests such as antigen detection, immunologic
     (immunochromatographic) tests, and molecular testing such
     as polymerase chain reaction tests.
    Note 2: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, liver or splenic damage, and central nervous
     system conditions.
 
6305 Lymphatic filariasis, to include elephantiasis:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, epididymitis, lymphangitis, lymphatic
     obstruction, or lymphedema affecting extremities,
     genitals, and/or breasts.
6306 Bartonellosis:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, endocarditis or skin lesions.
6307 Plague:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection.
6308 Relapsing Fever:
    Evaluate under the General Rating Formula.

[[Page 453]]

 
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, liver or spleen damage, iritis, uveitis, or
     central nervous system involvement.
6309 Rheumatic fever:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, heart damage.
6310 Syphilis, and other treponema infections:
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, diseases of the nervous system, vascular
     system, eyes, or ears (see DC 7004, DC 8013, DC 8014, DC
     8015, and DC 9301).
6311 Tuberculosis, miliary:
    As active disease..........................................      100
    Inactive disease: See Sec.  Sec.   4.88c and 4.89.
    Note 1: Confirm the recurrence of active infection by
     culture, histopathology, or other diagnostic laboratory
     testing.
    Note 2: Rate under the appropriate body system any residual
     disability of infection which includes, but is not limited
     to, skin conditions and conditions of the respiratory,
     central nervous, musculoskeletal, ocular,
     gastrointestinal, and genitourinary systems and those
     residuals listed in Sec.   4.88c.
6312 Nontuberculosis mycobacterium infection:
    As active disease..........................................      100
    Note 1: Continue the rating of 100 percent for the duration
     of treatment for active disease followed by a mandatory VA
     exam. If there is no relapse, rate on residuals. Any
     change in evaluation based upon that or any subsequent
     examination shall be subject to the provisions of Sec.
     3.105(e) of this chapter.
    Note 2: Confirm the recurrence of active infection by
     culture, histopathology, or other diagnostic laboratory
     testing.
    Note 3: Rate under the appropriate body system any residual
     disability of infection which includes, but is not limited
     to, skin conditions and conditions of the respiratory,
     central nervous, musculoskeletal, ocular,
     gastrointestinal, and genitourinary systems and those
     residuals listed in Sec.   4.88c.
6313 Avitaminosis:
    Marked mental changes, moist dermatitis, inability to            100
     retain adequate nourishment, exhaustion, and cachexia.....
    With all of the symptoms listed below, plus mental symptoms       60
     and impaired bodily vigor.................................
    With stomatitis, diarrhea, and symmetrical dermatitis......       40
    With stomatitis, or achlorhydria, or diarrhea..............       20
    Confirmed diagnosis with nonspecific symptoms such as:            10
     decreased appetite, weight loss, abdominal discomfort,
     weakness, inability to concentrate and irritability.......
6314 Beriberi:
    As active disease:
    With congestive heart failure, anasarca, or Wernicke-            100
     Korsakoff syndrome........................................
    With cardiomegaly, or; with peripheral neuropathy with            60
     footdrop or atrophy of thigh or calf muscles..............
    With peripheral neuropathy with absent knee or ankle jerks        30
     and loss of sensation, or; with symptoms such as weakness,
     fatigue, anorexia, dizziness, heaviness and stiffness of
     legs, headache or sleep disturbance.......................
    Thereafter rate residuals under the appropriate body
     system.
6315 Pellagra:
    Marked mental changes, moist dermatitis, inability to            100
     retain adequate nourishment, exhaustion, and cachexia.....
    With all of the symptoms listed below, plus mental symptoms       60
     and impaired bodily vigor.................................
    With stomatitis, diarrhea, and symmetrical dermatitis......       40
    With stomatitis, or achlorhydria, or diarrhea..............       20
    Confirmed diagnosis with nonspecific symptoms such as:            10
     decreased appetite, weight loss, abdominal discomfort,
     weakness, inability to concentrate and irritability.......
6316 Brucellosis:
    Evaluate under the General Rating Formula.
    Note 1: Culture, serologic testing, or both must confirm
     the initial diagnosis and recurrence of active infection.
    Note 2: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, meningitis, liver, spleen and musculoskeletal
     conditions.
6317 Rickettsial, ehrlichia, and anaplasma infections:
    Evaluate under the General Rating Formula.
    Note 1: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, bone marrow, spleen, central nervous system,
     and skin conditions.
    Note 2: This diagnostic code includes, but is not limited
     to, scrub typhus, Rickettsial pox, African tick-borne
     fever, Rocky Mountain spotted fever, ehrlichiosis, or
     anaplasmosis.
6318 Melioidosis:
    Evaluate under the General Rating Formula.
    Note 1: Confirm by culture or other specific diagnostic
     laboratory tests the initial diagnosis and any relapse or
     chronic activity of infection.
    Note 2: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, arthritis, lung lesions, or meningitis.
6319 Lyme disease:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, arthritis, Bell's palsy, radiculopathy,
     ocular, or cognitive dysfunction.
6320 Parasitic diseases otherwise not specified:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection.
6325 Hyperinfection syndrome or disseminated strongyloidiasis:

[[Page 454]]

 
    As active disease..........................................      100
    Note: Continue the rating of 100 percent through active
     disease followed by a mandatory VA exam. If there is no
     relapse, rate on residual disability. Any change in
     evaluation based upon that or any subsequent examination
     shall be subject to the provisions of Sec.   3.105(e) of
     this chapter.
6326 Schistosomiasis:
    As acute or asymptomatic chronic disease...................        0
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, conditions of the liver, intestinal system,
     female genital tract, genitourinary tract, or central
     nervous system.
6329 Hemorrhagic fevers, including dengue, yellow fever, and
 others:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, conditions of the central nervous system,
     liver, or kidney.
6330 Campylobacter jejuni infection:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, Guillain-Barre syndrome, reactive arthritis,
     or uveitis.
6331 Coxiella burnetii infection (Q fever):
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, chronic hepatitis, endocarditis,
     osteomyelitis, post Q-fever chronic fatigue syndrome, or
     vascular infections.
6333 Nontyphoid salmonella infections:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, reactive arthritis.
6334 Shigella infections:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, hemolytic-uremic syndrome or reactive
     arthritis.
6335 West Nile virus infection:
    Evaluate under the General Rating Formula.
    Note: Rate under the appropriate body system any residual
     disability of infection, which includes, but is not
     limited to, variable physical, functional, or cognitive
     disabilities.
6350 Lupus erythematosus, systemic (disseminated):
    Not to be combined with ratings under DC 7809 Acute, with        100
     frequent exacerbations, producing severe impairment of
     health....................................................
    Exacerbations lasting a week or more, 2 or 3 times per year       60
    Exacerbations once or twice a year or symptomatic during          10
     the past 2 years..........................................
 
    Note: Evaluate this condition either by combining the
     evaluations for residuals under the appropriate system, or
     by evaluating DC 6350, whichever method results in a
     higher evaluation.
 
6351 HIV-related illness:
    AIDS with recurrent opportunistic infections (see Note 3)        100
     or with secondary diseases afflicting multiple body
     systems; HIV-related illness with debility and progressive
     weight loss...............................................
    Refractory constitutional symptoms, diarrhea, and                 60
     pathological weight loss; or minimum rating following
     development of AIDS-related opportunistic infection or
     neoplasm..................................................
    Recurrent constitutional symptoms, intermittent diarrhea,         30
     and use of approved medication(s); or minimum rating with
     T4 cell count less than 200...............................
    Following development of HIV-related constitutional               10
     symptoms; T4 cell count between 200 and 500; use of
     approved medication(s); or with evidence of depression or
     memory loss with employment limitations...................
    Asymptomatic, following initial diagnosis of HIV infection,        0
     with or without lymphadenopathy or decreased T4 cell count
    Note 1: In addition to standard therapies and regimens, the
     term ``approved medication(s)'' includes treatment
     regimens and medications prescribed as part of a research
     protocol at an accredited medical institution.
    Note 2: Diagnosed psychiatric illness, central nervous
     system manifestations, opportunistic infections, and
     neoplasms may be rated separately under the appropriate
     diagnostic codes if a higher overall evaluation results,
     provided the disability symptoms do not overlap with
     evaluations otherwise assignable above.
    Note 3: The following list of opportunistic infections are
     considered AIDS-defining conditions, that is, a diagnosis
     of AIDS follows if a person has HIV and one more of these
     infections, regardless of the CD4 count--candidiasis of
     the bronchi, trachea, esophagus, or lungs; invasive
     cervical cancer; coccidioidomycosis; cryptococcosis;
     cryptosporidiosis; cytomegalovirus (particularly CMV
     retinitis); HIV-related encephalopathy; herpes simplex-
     chronic ulcers for greater than one month, or bronchitis,
     pneumonia, or esophagitis; histoplasmosis; isosporiasis
     (chronic intestinal); Kaposi's sarcoma; lymphoma;
     mycobacterium avium complex; tuberculosis; pneumocystis
     jirovecii (carinii) pneumonia; pneumonia, recurrent;
     progressive multifocal leukoencephalopathy; salmonella
     septicemia, recurrent; toxoplasmosis of the brain; and
     wasting syndrome due to HIV.
6354 Chronic fatigue syndrome (CFS):
    Debilitating fatigue, cognitive impairments (such as
     inability to concentrate, forgetfulness, or confusion), or
     a combination of other signs and symptoms:
        Which are nearly constant and so severe as to restrict       100
         routine daily activities almost completely and which
         may occasionally preclude self-care...................
        Which are nearly constant and restrict routine daily          60
         activities to less than 50 percent of the pre-illness
         level; or which wax and wane, resulting in periods of
         incapacitation of at least six weeks total duration
         per year..............................................

[[Page 455]]

 
        Which are nearly constant and restrict routine daily          40
         activities from 50 to 75 percent of the pre-illness
         level; or which wax and wane, resulting in periods of
         incapacitation of at least four but less than six
         weeks total duration per year.........................
        Which are nearly constant and restrict routine daily          20
         activities by less than 25 percent of the pre-illness
         level; or which wax and wane, resulting in periods of
         incapacitation of at least two but less than four
         weeks total duration per year.........................
        Which wax and wane but result in periods of                   10
         incapacitation of at least one but less than two weeks
         total duration per year; or symptoms controlled by
         continuous medication.................................
        Note: For the purpose of evaluating this disability,
         incapacitation exists only when a licensed physician
         prescribes bed rest and treatment.
------------------------------------------------------------------------


[61 FR 39875, July 31, 1996, as amended at 84 FR 28230, June 18, 2019]



Sec.  4.88c  Ratings for inactive nonpulmonary tuberculosis initially
entitled after August 19, 1968.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
For 1 year after date of inactivity, following active                100
 tuberculosis...................................................
Thereafter: Rate residuals under the specific body system or
 systems affected.
Following the total rating for the 1 year period after date of
 inactivity, the schedular evaluation for residuals of
 nonpulmonary tuberculosis, i.e., ankylosis, surgical removal of
 a part, etc., will be assigned under the appropriate diagnostic
 code for the residual preceded by the diagnostic code for
 tuberculosis of the body part affected. For example,
 tuberculosis of the hip joint with residual ankylosis would be
 coded 5001-5250. Where there are existing residuals of
 pulmonary and nonpulmonary conditions, the evaluations for
 residual separate functional impairment may be combined.
Where there are existing pulmonary and nonpulmonary conditions,
 the total rating for the 1 year, after attainment of
 inactivity, may not be applied to both conditions during the
 same period. However, the total rating during the 1-year period
 for the pulmonary or for the nonpulmonary condition will be
 utilized, combined with evaluation for residuals of the
 condition not covered by the 1-year total evaluation, so as to
 allow any additional benefit provided during such period.
------------------------------------------------------------------------


[34 FR 5062, Mar. 11, 1969. Redesignated at 59 FR 60902, Nov. 29, 1994]



Sec.  4.89  Ratings for inactive nonpulmonary tuberculosis in effect
on August 19, 1968.

    Public Law 90-493 repealed section 356 of title 38, United States 
Code which provided graduated ratings for inactive tuberculosis. The 
repealed section, however, still applies to the case of any veteran who 
on August 19, 1968, was receiving or entitled to receive compensation 
for tuberculosis. The use of the protective provisions of Pub. L. 90-493 
should be mentioned in the discussion portion of all ratings in which 
these provisions are applied. For use in rating cases in which the 
protective provisions of Pub. L. 90-493 apply, the former evaluations 
are retained in this section.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
For 2 years after date of inactivity, following active               100
 tuberculosis, which was clinically identified during service or
 subsequently...................................................
Thereafter, for 4 years, or in any event, to 6 years after date       50
 of inactivity..................................................
Thereafter, for 5 years, or to 11 years after date of inactivity      30
Thereafter, in the absence of a schedular compensable permanent        0
 residual.......................................................
Following the total rating for the 2-year period after date of
 inactivity, the schedular evaluation for residuals of
 nonpulmonary tuberculosis, i.e., ankylosis, surgical removal of
 a part, etc., if in excess of 50 percent or 30 percent will be
 assigned under the appropriate diagnostic code for the specific
 residual preceded by the diagnostic code for tuberculosis of
 the body part affected. For example, tuberculosis of the
 hipjoint with residual ankylosis would be coded 5001-5250.
The graduated ratings for nonpulmonary tuberculosis will not be
 combined with residuals of nonpulmonary tuberculosis unless the
 graduated rating and the rating for residual disability cover
 separate functional losses, e.g., graduated ratings for
 tuberculosis of the kidney and residuals of tuberculosis of the
 spine. Where there are existing pulmonary and nonpulmonary
 conditions, the graduated evaluation for the pulmonary, or for
 the nonpulmonary, condition will be utilized, combined with
 evaluations for residuals of the condition not covered by the
 graduated evaluation utilized, so as to provide the higher
 evaluation over such period.
The ending dates of all graduated ratings of nonpulmonary
 tuberculosis will be controlled by the date of attainment of
 inactivity.
These ratings are applicable only to veterans with nonpulmonary
 tuberculosis active on or after October 10, 1949.
------------------------------------------------------------------------


[29 FR 6718, May 22, 1964, as amended at 34 FR 5062, Mar. 11, 1969; 43 
FR 45361, Oct. 2, 1978]

[[Page 456]]

                         The Respiratory System



Sec.  4.96  Special provisions regarding evaluation of respiratory
conditions.

    (a) Rating coexisting respiratory conditions. Ratings under 
diagnostic codes 6600 through 6817 and 6822 through 6847 will not be 
combined with each other. Where there is lung or pleural involvement, 
ratings under diagnostic codes 6819 and 6820 will not be combined with 
each other or with diagnostic codes 6600 through 6817 or 6822 through 
6847. A single rating will be assigned under the diagnostic code which 
reflects the predominant disability with elevation to the next higher 
evaluation where the severity of the overall disability warrants such 
elevation. However, in cases protected by the provisions of Pub. L. 90-
493, the graduated ratings of 50 and 30 percent for inactive 
tuberculosis will not be elevated.
    (b) Rating ``protected'' tuberculosis cases. Public Law 90-493 
repealed section 356 of title 38, United States Code which had provided 
graduated ratings for inactive tuberculosis. The repealed section, 
however, still applies to the case of any veteran who on August 19, 
1968, was receiving or entitled to receive compensation for 
tuberculosis. The use of the protective provisions of Pub. L. 90-493 
should be mentioned in the discussion portion of all ratings in which 
these provisions are applied. For application in rating cases in which 
the protective provisions of Pub. L. 90-493 apply the former evaluations 
pertaining to pulmonary tuberculosis are retained in Sec.  4.97.
    (c) Special monthly compensation. When evaluating any claim 
involving complete organic aphonia, refer to Sec.  3.350 of this chapter 
to determine whether the veteran may be entitled to special monthly 
compensation. Footnotes in the schedule indicate conditions which 
potentially establish entitlement to special monthly compensation; 
however, there are other conditions in this section which under certain 
circumstances also establish entitlement to special monthly 
compensation.
    (d) Special provisions for the application of evaluation criteria 
for diagnostic codes 6600, 6603, 6604, 6825-6833, and 6840-6845. (1) 
Pulmonary function tests (PFT's) are required to evaluate these 
conditions except:
    (i) When the results of a maximum exercise capacity test are of 
record and are 20 ml/kg/min or less. If a maximum exercise capacity test 
is not of record, evaluate based on alternative criteria.
    (ii) When pulmonary hypertension (documented by an echocardiogram or 
cardiac catheterization), cor pulmonale, or right ventricular 
hypertrophy has been diagnosed.
    (iii) When there have been one or more episodes of acute respiratory 
failure.
    (iv) When outpatient oxygen therapy is required.
    (2) If the DLCO (SB) (Diffusion Capacity of the Lung for Carbon 
Monoxide by the Single Breath Method) test is not of record, evaluate 
based on alternative criteria as long as the examiner states why the 
test would not be useful or valid in a particular case.
    (3) When the PFT's are not consistent with clinical findings, 
evaluate based on the PFT's unless the examiner states why they are not 
a valid indication of respiratory functional impairment in a particular 
case.
    (4) Post-bronchodilator studies are required when PFT's are done for 
disability evaluation purposes except when the results of pre-
bronchodilator pulmonary function tests are normal or when the examiner 
determines that post-bronchodilator studies should not be done and 
states why.
    (5) When evaluating based on PFT's, use post-bronchodilator results 
in applying the evaluation criteria in the rating schedule unless the 
post-bronchodilator results were poorer than the pre-bronchodilator 
results. In those cases, use the pre-bronchodilator values for rating 
purposes.
    (6) When there is a disparity between the results of different PFT's 
(FEV-1 (Forced Expiratory Volume in one second), FVC (Forced Vital 
Capacity), etc.), so that the level of evaluation would differ depending 
on which test result is used, use the test result that the examiner 
states most accurately reflects the level of disability.
    (7) If the FEV-1 and the FVC are both greater than 100 percent, do 
not assign

[[Page 457]]

a compensable evaluation based on a decreased FEV-1/FVC ratio.

(Authority: 38 U.S.C. 1155)

[34 FR 5062, Mar. 11, 1969, as amended at 61 FR 46727, Sept. 5, 1996; 71 
FR 52459, Sept. 6, 2006]



Sec.  4.97  Schedule of ratings--respiratory system.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
                     DISEASES OF THE NOSE AND THROAT
------------------------------------------------------------------------
6502 Septum, nasal, deviation of:
    Traumatic only,
        With 50-percent obstruction of the nasal passage on           10
         both sides or complete obstruction on one side........
6504 Nose, loss of part of, or scars:
    Exposing both nasal passages...............................       30
    Loss of part of one ala, or other obvious disfigurement....       10
 
Note: Or evaluate as DC 7800, scars, disfiguring, head, face,
 or neck.
 
6510 Sinusitis, pansinusitis, chronic.
6511 Sinusitis, ethmoid, chronic.
6512 Sinusitis, frontal, chronic.
6513 Sinusitis, maxillary, chronic.
6514 Sinusitis, sphenoid, chronic.
    General Rating Formula for Sinusitis (DC's 6510 through
     6514):
        Following radical surgery with chronic osteomyelitis,         50
         or; near constant sinusitis characterized by
         headaches, pain and tenderness of affected sinus, and
         purulent discharge or crusting after repeated
         surgeries.............................................
        Three or more incapacitating episodes per year of             30
         sinusitis requiring prolonged (lasting four to six
         weeks) antibiotic treatment, or; more than six non-
         incapacitating episodes per year of sinusitis
         characterized by headaches, pain, and purulent
         discharge or crusting.................................
        One or two incapacitating episodes per year of                10
         sinusitis requiring prolonged (lasting four to six
         weeks) antibiotic treatment, or; three to six non-
         incapacitating episodes per year of sinusitis
         characterized by headaches, pain, and purulent
         discharge or crusting.................................
        Detected by X-ray only.................................        0
 
    Note: An incapacitating episode of sinusitis means one that
     requires bed rest and treatment by a physician.
 
6515 Laryngitis, tuberculous, active or inactive.
    Rate under Sec.  Sec.   4.88c or 4.89, whichever is
     appropriate.
6516 Laryngitis, chronic:
    Hoarseness, with thickening or nodules of cords, polyps,          30
     submucous infiltration, or pre-malignant changes on biopsy
    Hoarseness, with inflammation of cords or mucous membrane..       10
6518 Laryngectomy, total.......................................  \1\ 100
    Rate the residuals of partial laryngectomy as laryngitis
     (DC 6516), aphonia (DC 6519), or stenosis of larynx (DC
     6520).
6519 Aphonia, complete organic:
    Constant inability to communicate by speech................  \1\ 100
    Constant inability to speak above a whisper................       60
 
    Note: Evaluate incomplete aphonia as laryngitis, chronic
     (DC 6516).
 
6520 Larynx, stenosis of, including residuals of laryngeal
 trauma (unilateral or bilateral):
    Forced expiratory volume in one second (FEV-1) less than 40      100
     percent of predicted value, with Flow-Volume Loop
     compatible with upper airway obstruction, or; permanent
     tracheostomy..............................................
    FEV-1 of 40- to 55-percent predicted, with Flow-Volume Loop       60
     compatible with upper airway obstruction..................
    FEV-1 of 56- to 70-percent predicted, with Flow-Volume Loop       30
     compatible with upper airway obstruction..................
    FEV-1 of 71- to 80-percent predicted, with Flow-Volume Loop       10
     compatible with upper airway obstruction..................
 
    Note: Or evaluate as aphonia (DC 6519).
 
6521 Pharynx, injuries to:
    Stricture or obstruction of pharynx or nasopharynx, or;           50
     absence of soft palate secondary to trauma, chemical burn,
     or granulomatous disease, or; paralysis of soft palate
     with swallowing difficulty (nasal regurgitation) and
     speech impairment.........................................
6522 Allergic or vasomotor rhinitis:
    With polyps................................................       30
    Without polyps, but with greater than 50-percent                  10
     obstruction of nasal passage on both sides or complete
     obstruction on one side...................................
6523 Bacterial rhinitis:
    Rhinoscleroma..............................................       50
    With permanent hypertrophy of turbinates and with greater         10
     than 50-percent obstruction of nasal passage on both sides
     or complete obstruction on one side.......................
6524 Granulomatous rhinitis:

[[Page 458]]

 
    Wegener's granulomatosis, lethal midline granuloma.........      100
    Other types of granulomatous infection.....................       20
------------------------------------------------------------------------
                   DISEASES OF THE TRACHEA AND BRONCHI
------------------------------------------------------------------------
6600 Bronchitis, chronic:
    FEV-1 less than 40 percent of predicted value, or; the           100
     ratio of Forced Expiratory Volume in one second to Forced
     Vital Capacity (FEV-1/FVC) less than 40 percent, or;
     Diffusion Capacity of the Lung for Carbon Monoxide by the
     Single Breath Method (DLCO (SB)) less than 40-percent
     predicted, or; maximum exercise capacity less than 15 ml/
     kg/min oxygen consumption (with cardiac or respiratory
     limitation), or; cor pulmonale (right heart failure), or;
     right ventricular hypertrophy, or; pulmonary hypertension
     (shown by Echo or cardiac catheterization), or; episode(s)
     of acute respiratory failure, or; requires outpatient
     oxygen therapy............................................
    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60
     to 55 percent, or; DLCO (SB) of 40- to 55-percent
     predicted, or; maximum oxygen consumption of 15 to 20 ml/
     kg/min (with cardiorespiratory limit).....................
    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30
     to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..
    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10
     to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..
6601 Bronchiectasis:
    With incapacitating episodes of infection of at least six        100
     weeks total duration per year.............................
    With incapacitating episodes of infection of four to six          60
     weeks total duration per year, or; near constant findings
     of cough with purulent sputum associated with anorexia,
     weight loss, and frank hemoptysis and requiring antibiotic
     usage almost continuously.................................
    With incapacitating episodes of infection of two to four          30
     weeks total duration per year, or; daily productive cough
     with sputum that is at times purulent or blood-tinged and
     that requires prolonged (lasting four to six weeks)
     antibiotic usage more than twice a year...................
    Intermittent productive cough with acute infection                10
     requiring a course of antibiotics at least twice a year...
    Or rate according to pulmonary impairment as for chronic
     bronchitis (DC 6600).
 
    Note: An incapacitating episode is one that requires
     bedrest and treatment by a physician.
 
6602 Asthma, bronchial:
    FEV-1 less than 40-percent predicted, or; FEV-1/FVC less         100
     than 40 percent, or; more than one attack per week with
     episodes of respiratory failure, or; requires daily use of
     systemic (oral or parenteral) high dose corticosteroids or
     immuno-suppressive medications............................
    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60
     to 55 percent, or; at least monthly visits to a physician
     for required care of exacerbations, or; intermittent (at
     least three per year) courses of systemic (oral or
     parenteral) corticosteroids...............................
    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30
     to 70 percent, or; daily inhalational or oral
     bronchodilator therapy, or; inhalational anti-inflammatory
     medication................................................
    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10
     to 80 percent, or; intermittent inhalational or oral
     bronchodilator therapy....................................
 
    Note: In the absence of clinical findings of asthma at time
     of examination, a verified history of asthmatic attacks
     must be of record.
 
6603 Emphysema, pulmonary:
    FEV-1 less than 40 percent of predicted value, or; the           100
     ratio of Forced Expiratory Volume in one second to Forced
     Vital Capacity (FEV-1/FVC) less than 40 percent, or;
     Diffusion Capacity of the Lung for Carbon Monoxide by the
     Single Breath Method (DLCO (SB)) less than 40-percent
     predicted, or; maximum exercise capacity less than 15 ml/
     kg/min oxygen consumption (with cardiac or respiratory
     limitation), or; cor pulmonale (right heart failure), or;
     right ventricular hypertrophy, or; pulmonary hypertension
     (shown by Echo or cardiac catheterization), or; episode(s)
     of acute respiratory failure, or; requires outpatient
     oxygen therapy............................................
    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60
     to 55 percent, or; DLCO (SB) of 40- to 55-percent
     predicted, or; maximum oxygen consumption of 15 to 20 ml/
     kg/min (with cardiorespiratory limit).....................
    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30
     to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..
    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10
     to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..
6604 Chronic obstructive pulmonary disease:
    FEV-1 less than 40 percent of predicted value, or; the           100
     ratio of Forced Expiratory Volume in one second to Forced
     Vital Capacity (FEV-1/FVC) less than 40 percent, or;
     Diffusion Capacity of the Lung for Carbon Monoxide by the
     Single Breath Method (DLCO (SB)) less than 40-percent
     predicted, or; maximum exercise capacity less than 15 ml/
     kg/min oxygen consumption (with cardiac or respiratory
     limitation), or; cor pulmonale (right heart failure), or;
     right ventricular hypertrophy, or; pulmonary hypertension
     (shown by Echo or cardiac catheterization), or; episode(s)
     of acute respiratory failure, or; requires outpatient
     oxygen therapy............................................
    FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40         60
     to 55 percent, or; DLCO (SB) of 40- to 55-percent
     predicted, or; maximum oxygen consumption of 15 to 20 ml/
     kg/min (with cardiorespiratory limit).....................
    FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56         30
     to 70 percent, or; DLCO (SB) 56- to 65-percent predicted..
    FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71         10
     to 80 percent, or; DLCO (SB) 66- to 80-percent predicted..
------------------------------------------------------------------------
             DISEASES OF THE LUNGS AND PLEURA--TUBERCULOSIS
     Ratings for Pulmonary Tuberculosis Entitled on August 19, 1968
------------------------------------------------------------------------
6701 Tuberculosis, pulmonary, chronic, far advanced, active....      100

[[Page 459]]

 
6702 Tuberculosis, pulmonary, chronic, moderately advanced,          100
 active........................................................
6703 Tuberculosis, pulmonary, chronic, minimal, active.........      100
6704 Tuberculosis, pulmonary, chronic, active, advancement           100
 unspecified...................................................
6721 Tuberculosis, pulmonary, chronic, far advanced, inactive..
6722 Tuberculosis, pulmonary, chronic, moderately advanced,
 inactive......................................................
6723 Tuberculosis, pulmonary, chronic, minimal, inactive.......
6724 Tuberculosis, pulmonary, chronic, inactive, advancement
 unspecified...................................................
    General Rating Formula for Inactive Pulmonary Tuberculosis:      100
     For two years after date of inactivity, following active
     tuberculosis, which was clinically identified during
     service or subsequently...................................
    Thereafter for four years, or in any event, to six years          50
     after date of inactivity..................................
    Thereafter, for five years, or to eleven years after date         30
     of inactivity.............................................
    Following far advanced lesions diagnosed at any time while        30
     the disease process was active, minimum...................
    Following moderately advanced lesions, provided there is          20
     continued disability, emphysema, dyspnea on exertion,
     impairment of health, etc.................................
    Otherwise..................................................        0
 
Note (1): The 100-percent rating under codes 6701 through 6724
 is not subject to a requirement of precedent hospital
 treatment. It will be reduced to 50 percent for failure to
 submit to examination or to follow prescribed treatment upon
 report to that effect from the medical authorities. When a
 veteran is placed on the 100-percent rating for inactive
 tuberculosis, the medical authorities will be appropriately
 notified of the fact, and of the necessity, as given in
 footnote 1 to 38 U.S.C. 1156 (and formerly in 38 U.S.C. 356,
 which has been repealed by Public Law 90-493), to notify the
 Veterans Service Center in the event of failure to submit to
 examination or to follow treatment.
Note (2): The graduated 50-percent and 30-percent ratings and
 the permanent 30 percent and 20 percent ratings for inactive
 pulmonary tuberculosis are not to be combined with ratings for
 other respiratory disabilities. Following thoracoplasty the
 rating will be for removal of ribs combined with the rating
 for collapsed lung. Resection of the ribs incident to
 thoracoplasty will be rated as removal.
------------------------------------------------------------------------
 Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19,
                                  1968
------------------------------------------------------------------------
6730 Tuberculosis, pulmonary, chronic, active..................      100
 
    Note: Active pulmonary tuberculosis will be considered
     permanently and totally disabling for non-service-
     connected pension purposes in the following circumstances:
        (a) Associated with active tuberculosis involving other
         than the respiratory system.
        (b) With severe associated symptoms or with extensive
         cavity formation.
        (c) Reactivated cases, generally.
        (d) With advancement of lesions on successive
         examinations or while under treatment.
        (e) Without retrogression of lesions or other evidence
         of material improvement at the end of six months
         hospitalization or without change of diagnosis from
         ``active'' at the end of 12 months hospitalization.
         Material improvement means lessening or absence of
         clinical symptoms, and X-ray findings of a stationary
         or retrogressive lesion.
 
6731 Tuberculosis, pulmonary, chronic, inactive:
    Depending on the specific findings, rate residuals as
     interstitial lung disease, restrictive lung disease, or,
     when obstructive lung disease is the major residual, as
     chronic bronchitis (DC 6600). Rate thoracoplasty as
     removal of ribs under DC 5297.
 
    Note: A mandatory examination will be requested immediately
     following notification that active tuberculosis evaluated
     under DC 6730 has become inactive. Any change in
     evaluation will be carried out under the provisions of
     Sec.   3.105(e).
 
6732 Pleurisy, tuberculous, active or inactive:
    Rate under Sec.  Sec.   4.88c or 4.89, whichever is
     appropriate.
------------------------------------------------------------------------
                         NONTUBERCULOUS DISEASES
------------------------------------------------------------------------
6817 Pulmonary Vascular Disease:
    Primary pulmonary hypertension, or; chronic pulmonary            100
     thromboembolism with evidence of pulmonary hypertension,
     right ventricular hypertrophy, or cor pulmonale, or;
     pulmonary hypertension secondary to other obstructive
     disease of pulmonary arteries or veins with evidence of
     right ventricular hypertrophy or cor pulmonale............
    Chronic pulmonary thromboembolism requiring anticoagulant         60
     therapy, or; following inferior vena cava surgery without
     evidence of pulmonary hypertension or right ventricular
     dysfunction...............................................
    Symptomatic, following resolution of acute pulmonary              30
     embolism..................................................
    Asymptomatic, following resolution of pulmonary                    0
     thromboembolism...........................................
 
    Note: Evaluate other residuals following pulmonary embolism
     under the most appropriate diagnostic code, such as
     chronic bronchitis (DC 6600) or chronic pleural effusion
     or fibrosis (DC 6844), but do not combine that evaluation
     with any of the above evaluations.
 
    6819 Neoplasms, malignant, any specified part of                 100
     respiratory system exclusive of skin growths..............
 
     Note: A rating of 100 percent shall continue beyond the
     cessation of any surgical, X-ray, antineoplastic
     chemotherapy or other therapeutic procedure. Six months
     after discontinuance of such treatment, the appropriate
     disability rating shall be determined by mandatory VA
     examination. Any change in evaluation based upon that or
     any subsequent examination shall be subject to the
     provisions of Sec.   3.105(e) of this chapter. If there
     has been no local recurrence or metastasis, rate on
     residuals.
 
6820 Neoplasms, benign, any specified part of respiratory
 system. Evaluate using an appropriate respiratory analogy.
------------------------------------------------------------------------

[[Page 460]]

 
                    Bacterial Infections of the Lung
------------------------------------------------------------------------
6822 Actinomycosis.
6823 Nocardiosis.
6824 Chronic lung abscess.
    General Rating Formula for Bacterial Infections of the Lung
     (diagnostic codes 6822 through 6824):
        Active infection with systemic symptoms such as fever,       100
         night sweats, weight loss, or hemoptysis..............
    Depending on the specific findings, rate residuals as
     interstitial lung disease, restrictive lung disease, or,
     when obstructive lung disease is the major residual, as
     chronic bronchitis (DC 6600).
------------------------------------------------------------------------
                        Interstitial Lung Disease
------------------------------------------------------------------------
6825 Diffuse interstitial fibrosis (interstitial pneumonitis,
 fibrosing alveolitis).
6826 Desquamative interstitial pneumonitis.
6827 Pulmonary alveolar proteinosis.
6828 Eosinophilic granuloma of lung.
6829 Drug-induced pulmonary pneumonitis and fibrosis.
6830 Radiation-induced pulmonary pneumonitis and fibrosis.
6831 Hypersensitivity pneumonitis (extrinsic allergic
 alveolitis).
6832 Pneumoconiosis (silicosis, anthracosis, etc.).
6833 Asbestosis.
    General Rating Formula for Interstitial Lung Disease
     (diagnostic codes 6825 through 6833):
        Forced Vital Capacity (FVC) less than 50-percent             100
         predicted, or; Diffusion Capacity of the Lung for
         Carbon Monoxide by the Single Breath Method (DLCO
         (SB)) less than 40-percent predicted, or; maximum
         exercise capacity less than 15 ml/kg/min oxygen
         consumption with cardiorespiratory limitation, or; cor
         pulmonale or pulmonary hypertension, or; requires
         outpatient oxygen therapy.............................
        FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40-      60
          to 55-percent predicted, or; maximum exercise
         capacity of 15 to 20 ml/kg/min oxygen consumption with
         cardiorespiratory limitation..........................
        FVC of 65- to 74-percent predicted, or; DLCO (SB) of 56-      30
          to 65-percent predicted..............................
        FVC of 75- to 80-percent predicted, or; DLCO (SB) of 66-      10
          to 80-percent predicted..............................
------------------------------------------------------------------------
                          Mycotic Lung Disease
------------------------------------------------------------------------
6834 Histoplasmosis of lung.
6835 Coccidioidomycosis.
6836 Blastomycosis.
6837 Cryptococcosis.
6838 Aspergillosis.
6839 Mucormycosis.
    General Rating Formula for Mycotic Lung Disease (diagnostic
     codes 6834 through 6839):
        Chronic pulmonary mycosis with persistent fever, weight      100
         loss, night sweats, or massive hemoptysis.............
        Chronic pulmonary mycosis requiring suppressive therapy       50
         with no more than minimal symptoms such as occasional
         minor hemoptysis or productive cough..................
        Chronic pulmonary mycosis with minimal symptoms such as       30
         occasional minor hemoptysis or productive cough.......
        Healed and inactive mycotic lesions, asymptomatic......        0
 
    Note: Coccidioidomycosis has an incubation period up to 21
     days, and the disseminated phase is ordinarily manifest
     within six months of the primary phase. However, there are
     instances of dissemination delayed up to many years after
     the initial infection which may have been unrecognized.
     Accordingly, when service connection is under
     consideration in the absence of record or other evidence
     of the disease in service, service in southwestern United
     States where the disease is endemic and absence of
     prolonged residence in this locality before or after
     service will be the deciding factor.
------------------------------------------------------------------------
                        Restrictive Lung Disease
------------------------------------------------------------------------
6840 Diaphragm paralysis or paresis.
6841 Spinal cord injury with respiratory insufficiency.
6842 Kyphoscoliosis, pectus excavatum, pectus carinatum.
6843 Traumatic chest wall defect, pneumothorax, hernia, etc.
6844 Post-surgical residual (lobectomy, pneumonectomy, etc.).
6845 Chronic pleural effusion or fibrosis.
    General Rating Formula for Restrictive Lung Disease
     (diagnostic codes 6840 through 6845):
        FEV-1 less than 40 percent of predicted value, or; the       100
         ratio of Forced Expiratory Volume in one second to
         Forced Vital Capacity (FEV-1/FVC) less than 40
         percent, or; Diffusion Capacity of the Lung for Carbon
         Monoxide by the Single Breath Method (DLCO (SB)) less
         than 40-percent predicted, or; maximum exercise
         capacity less than 15 ml/kg/min oxygen consumption
         (with cardiac or respiratory limitation), or; cor
         pulmonale (right heart failure), or; right ventricular
         hypertrophy, or; pulmonary hypertension (shown by Echo
         or cardiac catheterization), or; episode(s) of acute
         respiratory failure, or; requires outpatient oxygen
         therapy...............................................
        FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of        60
         40 to 55 percent, or; DLCO (SB) of 40- to 55-percent
         predicted, or; maximum oxygen consumption of 15 to 20
         ml/kg/min (with cardiorespiratory limit)..............
        FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of        30
         56 to 70 percent, or; DLCO (SB) 56- to 65-percent
         predicted.............................................

[[Page 461]]

 
        FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of        10
         71 to 80 percent, or; DLCO (SB) 66- to 80-percent
         predicted.............................................
    Or rate primary disorder.
 
    Note (1): A 100-percent rating shall be assigned for
     pleurisy with empyema, with or without pleurocutaneous
     fistula, until resolved.
 
    Note (2): Following episodes of total spontaneous
     pneumothorax, a rating of 100 percent shall be assigned as
     of the date of hospital admission and shall continue for
     three months from the first day of the month after
     hospital discharge.
 
    Note (3): Gunshot wounds of the pleural cavity with bullet
     or missile retained in lung, pain or discomfort on
     exertion, or with scattered rales or some limitation of
     excursion of diaphragm or of lower chest expansion shall
     be rated at least 20-percent disabling. Disabling injuries
     of shoulder girdle muscles (Groups I to IV) shall be
     separately rated and combined with ratings for respiratory
     involvement. Involvement of Muscle Group XXI (DC 5321),
     however, will not be separately rated.
 
6846 Sarcoidosis:
    Cor pulmonale, or; cardiac involvement with congestive           100
     heart failure, or; progressive pulmonary disease with
     fever, night sweats, and weight loss despite treatment....
    Pulmonary involvement requiring systemic high dose                60
     (therapeutic) corticosteroids for control.................
    Pulmonary involvement with persistent symptoms requiring          30
     chronic low dose (maintenance) or intermittent
     corticosteroids...........................................
    Chronic hilar adenopathy or stable lung infiltrates without        0
     symptoms or physiologic impairment........................
    Or rate active disease or residuals as chronic bronchitis
     (DC 6600) and extra-pulmonary involvement under specific
     body system involved......................................
6847 Sleep Apnea Syndromes (Obstructive, Central, Mixed):
    Chronic respiratory failure with carbon dioxide retention        100
     or cor pulmonale, or; requires tracheostomy...............
    Requires use of breathing assistance device such as               50
     continuous airway pressure (CPAP) machine.................
    Persistent day-time hypersomnolence........................       30
    Asymptomatic but with documented sleep disorder breathing..       0
------------------------------------------------------------------------
\1\ Review for entitlement to special monthly compensation under Sec.
  3.350 of this chapter.


[61 FR 46728, Sept. 5, 1996, as amended at 71 FR 28586, May 17, 2006]

                        The Cardiovascular System



Sec.  4.100  Application of the evaluation criteria for diagnostic 
codes 7000-7007, 7011, and 7015-7020.

    (a) Whether or not cardiac hypertrophy or dilatation (documented by 
electrocardiogram, echocardiogram, or X-ray) is present and whether or 
not there is a need for continuous medication must be ascertained in all 
cases.
    (b) Even if the requirement for a 10% (based on the need for 
continuous medication) or 30% (based on the presence of cardiac 
hypertrophy or dilatation) evaluation is met, METs testing is required 
in all cases except:
    (1) When there is a medical contraindication.
    (2) When the left ventricular ejection fraction has been measured 
and is 50% or less.
    (3) When chronic congestive heart failure is present or there has 
been more than one episode of congestive heart failure within the past 
year.
    (4) When a 100% evaluation can be assigned on another basis.
    (c) If left ventricular ejection fraction (LVEF) testing is not of 
record, evaluate based on the alternative criteria unless the examiner 
states that the LVEF test is needed in a particular case because the 
available medical information does not sufficiently reflect the severity 
of the veteran's cardiovascular disability.

[71 FR 52460, Sept. 6, 2006]



Sec. Sec.  4.101-4.103  [Reserved]



Sec.  4.104  Schedule of ratings--cardiovascular system.

                          Diseases of the Heart
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
Note (1): Evaluate cor pulmonale, which is a form of secondary
 heart disease, as part of the pulmonary condition that causes
 it.
Note (2): One MET (metabolic equivalent) is the energy cost of
 standing quietly at rest and represents an oxygen uptake of 3.5
 milliliters per kilogram of body weight per minute. When the
 level of METs at which dyspnea, fatigue, angina, dizziness, or
 syncope develops is required for evaluation, and a laboratory
 determination of METs by exercise testing cannot be done for
 medical reasons, an estimation by a medical examiner of the
 level of activity (expressed in METs and supported by specific
 examples, such as slow stair climbing or shoveling snow) that
 results in dyspnea, fatigue, angina, dizziness, or syncope may
 be used.

[[Page 462]]

 
7000 Valvular heart disease (including rheumatic heart disease):
    During active infection with valvular heart damage and for       100
     three months following cessation of therapy for the active
     infection..................................................
    Thereafter, with valvular heart disease (documented by
     findings on physical examination and either echocardiogram,
     Doppler echocardiogram, or cardiac catheterization)
     resulting in:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electro-cardiogram, echocardiogram, or X-ray...............
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7001 Endocarditis:
    For three months following cessation of therapy for active       100
     infection with cardiac involvement.........................
    Thereafter, with endocarditis (documented by findings on
     physical examination and either echocardiogram, Doppler
     echocardiogram, or cardiac catheterization) resulting in:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7002 Pericarditis:
    For three months following cessation of therapy for active       100
     infection with cardiac involvement.........................
    Thereafter, with documented pericarditis resulting in:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electro-cardiogram, echocardiogram, or X-ray...............
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7003 Pericardial adhesions:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electro-cardiogram, echocardiogram, or X-ray...............
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7004 Syphilitic heart disease:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
 

[[Page 463]]

 
Note: Evaluate syphilitic aortic aneurysms under DC 7110 (aortic
 aneurysm).
 
7005 Arteriosclerotic heart disease (Coronary artery disease):
    With documented coronary artery disease resulting in:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
 
Note: If nonservice-connected arteriosclerotic heart disease is
 superimposed on service-connected valvular or other non-
 arteriosclerotic heart disease, request a medical opinion as to
 which condition is causing the current signs and symptoms.
 
7006 Myocardial infarction:
    During and for three months following myocardial infarction,     100
     documented by laboratory tests.............................
    Thereafter:
 
    With history of documented myocardial infarction, resulting
     in:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7007 Hypertensive heart disease:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7008 Hyperthyroid heart disease.
  Rate under the appropriate cardiovascular diagnostic code,
   depending on particular findings.
7010 Supraventricular arrhythmias:
    Paroxysmal atrial fibrillation or other supraventricular          30
     tachycardia, with more than four episodes per year
     documented by ECG or Holter monitor........................
    Permanent atrial fibrillation (lone atrial fibrillation),         10
     or; one to four episodes per year of paroxysmal atrial
     fibrillation or other supraventricular tachycardia
     documented by ECG or Holter monitor........................
7011 Ventricular arrhythmias (sustained):
    For indefinite period from date of hospital admission for        100
     initial evaluation and medical therapy for a sustained
     ventricular arrhythmia, or; for indefinite period from date
     of hospital admission for ventricular aneurysmectomy, or;
     with an automatic implantable Cardioverter-Defibrillator
     (AICD) in place............................................
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
 

[[Page 464]]

 
Note: A rating of 100 percent shall be assigned from the date of
  hospital admission for initial evaluation and medical therapy
    for a sustained ventricular arrhythmia or for ventricular
 aneurysmectomy. Six months following discharge, the appropriate
      disability rating shall be determined by mandatory VA
  examination. Any change in evaluation based upon that or any
  subsequent examination shall be subject to the provisions of
                Sec.   3.105(e) of this chapter.
 
7015 Atrioventricular block:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication or a pacemaker required..........
 
Note: Unusual cases of arrhythmia such as atrioventricular block
 associated with a supraventricular arrhythmia or pathological
 bradycardia should be submitted to the Director, Compensation
 Service. Simple delayed P-R conduction time, in the absence of
 other evidence of cardiac disease, is not a disability.
 
7016 Heart valve replacement (prosthesis):
    For indefinite period following date of hospital admission       100
     for valve replacement......................................
    Thereafter:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
 
Note: A rating of 100 percent shall be assigned as of the date
 of hospital admission for valve replacement. Six months
 following discharge, the appropriate disability rating shall be
 determined by mandatory VA examination. Any change in
 evaluation based upon that or any subsequent examination shall
 be subject to the provisions of Sec.   3.105(e) of this
 chapter.
 
7017 Coronary bypass surgery:
    For three months following hospital admission for surgery...     100
    Thereafter:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload greater than 7 METs but not greater than 10 METs         10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
7018 Implantable cardiac pacemakers:
    For two months following hospital admission for implantation     100
     or reimplantation..........................................
    Thereafter:
    Evaluate as supraventricular arrhythmias (DC 7010),               10
     ventricular arrhythmias (DC 7011), or atrioventricular
     block (DC 7015). Minimum...................................
 
Note: Evaluate implantable Cardioverter-Defibrillators (AICD's)
 under DC 7011.
 
7019 Cardiac transplantation:
    For an indefinite period from date of hospital admission for     100
     cardiac transplantation....................................
    Thereafter:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
        Minimum.................................................      30
 
Note: A rating of 100 percent shall be assigned as of the date
 of hospital admission for cardiac transplantation. One year
 following discharge, the appropriate disability rating shall be
 determined by mandatory VA examination. Any change in
 evaluation based upon that or any subsequent examination shall
 be subject to the provisions of Sec.   3.105(e) of this
 chapter.
 

[[Page 465]]

 
7020 Cardiomyopathy:
    Chronic congestive heart failure, or; workload of 3 METs or      100
     less results in dyspnea, fatigue, angina, dizziness, or
     syncope, or; left ventricular dysfunction with an ejection
     fraction of less than 30 percent...........................
    More than one episode of acute congestive heart failure in        60
     the past year, or; workload of greater than 3 METs but not
     greater than 5 METs results in dyspnea, fatigue, angina,
     dizziness, or syncope, or; left ventricular dysfunction
     with an ejection fraction of 30 to 50 percent..............
    Workload of greater than 5 METs but not greater than 7 METs       30
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; evidence of cardiac hypertrophy or dilatation on
     electrocardiogram, echocardiogram, or X-ray................
    Workload of greater than 7 METs but not greater than 10 METs      10
     results in dyspnea, fatigue, angina, dizziness, or syncope,
     or; continuous medication required.........................
Diseases of the Arteries and Veins
7101 Hypertensive vascular disease (hypertension and isolated
 systolic hypertension):
    Diastolic pressure predominantly 130 or more................      60
    Diastolic pressure predominantly 120 or more................      40
    Diastolic pressure predominantly 110 or more, or; systolic        20
     pressure predominantly 200 or more.........................
    Diastolic pressure predominantly 100 or more, or; systolic        10
     pressure predominantly 160 or more, or; minimum evaluation
     for an individual with a history of diastolic pressure
     predominantly 100 or more who requires continuous
     medication for control.....................................
 
Note (1): Hypertension or isolated systolic hypertension must be
 confirmed by readings taken two or more times on at least three
 different days. For purposes of this section, the term
 hypertension means that the diastolic blood pressure is
 predominantly 90mm. or greater, and isolated systolic
 hypertension means that the systolic blood pressure is
 predominantly 160mm. or greater with a diastolic blood pressure
 of less than 90mm.
Note (2): Evaluate hypertension due to aortic insufficiency or
 hyperthyroidism, which is usually the isolated systolic type,
 as part of the condition causing it rather than by a separate
 evaluation.
Note (3): Evaluate hypertension separately from hypertensive
 heart disease and other types of heart disease.
 
7110 Aortic aneurysm:
    If five centimeters or larger in diameter, or; if                100
     symptomatic, or; for indefinite period from date of
     hospital admission for surgical correction (including any
     type of graft insertion)...................................
    Precluding exertion.........................................      60
    Evaluate residuals of surgical correction according to organ
     systems affected.
 
Note: A rating of 100 percent shall be assigned as of the date
 of admission for surgical correction. Six months following
 discharge, the appropriate disability rating shall be
 determined by mandatory VA examination. Any change in
 evaluation based upon that or any subsequent examination shall
 be subject to the provisions of Sec.   3.105(e) of this
 chapter.
 
7111 Aneurysm, any large artery:
    If symptomatic, or; for indefinite period from date of           100
     hospital admission for surgical correction.................
    Following surgery:
    Ischemic limb pain at rest, and; either deep ischemic ulcers     100
     or ankle/brachial index of 0.4 or less.....................
    Claudication on walking less than 25 yards on a level grade       60
     at 2 miles per hour, and; persistent coldness of the
     extremity, one or more deep ischemic ulcers, or ankle/
     brachial index of 0.5 or less..............................
    Claudication on walking between 25 and 100 yards on a level       40
     grade at 2 miles per hour, and; trophic changes (thin skin,
     absence of hair, dystrophic nails) or ankle/brachial index
     of 0.7 or less.............................................
    Claudication on walking more than 100 yards, and; diminished      20
     peripheral pulses or ankle/brachial index of 0.9 or less...
Note (1): The ankle/brachial index is the ratio of the systolic
 blood pressure at the ankle (determined by Doppler study)
 divided by the simultaneous brachial artery systolic blood
 pressure. The normal index is 1.0 or greater.
Note (2): These evaluations are for involvement of a single
 extremity. If more than one extremity is affected, evaluate
 each extremity separately and combine (under Sec.   4.25),
 using the bilateral factor, if applicable.
Note (3): A rating of 100 percent shall be assigned as of the
 date of hospital admission for surgical correction. Six months
 following discharge, the appropriate disability rating shall be
 determined by mandatory VA examination. Any change in
 evaluation based upon that or any subsequent examination shall
 be subject to the provisions of Sec.   3.105(e) of this
 chapter.
 
7112 Aneurysm, any small artery:
    Asymptomatic................................................       0
 
Note: If symptomatic, evaluate according to body system
 affected. Following surgery, evaluate residuals under the body
 system affected.
 
7113 Arteriovenous fistula, traumatic:
    With high output heart failure..............................     100
    Without heart failure but with enlarged heart, wide pulse         60
     pressure, and tachycardia..................................
    Without cardiac involvement but with edema, stasis
     dermatitis, and either ulceration or cellulitis:
        Lower extremity.........................................      50
        Upper extremity.........................................      40
    With edema or stasis dermatitis:
        Lower extremity.........................................      30
        Upper extremity.........................................      20
7114 Arteriosclerosis obliterans:
    Ischemic limb pain at rest, and; either deep ischemic ulcers     100
     or ankle/brachial index of 0.4 or less.....................

[[Page 466]]

 
    Claudication on walking less than 25 yards on a level grade       60
     at 2 miles per hour, and; either persistent coldness of the
     extremity or ankle/brachial index of 0.5 or less...........
    Claudication on walking between 25 and 100 yards on a level       40
     grade at 2 miles per hour, and; trophic changes (thin skin,
     absence of hair, dystrophic nails) or ankle/brachial index
     of 0.7 or less.............................................
    Claudication on walking more than 100 yards, and; diminished      20
     peripheral pulses or ankle/brachial index of 0.9 or less...
 
Note (1): The ankle/brachial index is the ratio of the systolic
 blood pressure at the ankle (determined by Doppler study)
 divided by the simultaneous brachial artery systolic blood
 pressure. The normal index is 1.0 or greater.
Note (2): Evaluate residuals of aortic and large arterial bypass
 surgery or arterial graft as arteriosclerosis obliterans.
Note (3): These evaluations are for involvement of a single
 extremity. If more than one extremity is affected, evaluate
 each extremity separately and combine (under Sec.   4.25),
 using the bilateral factor (Sec.   4.26), if applicable.
 
7115 Thrombo-angiitis obliterans (Buerger's Disease):
    Ischemic limb pain at rest, and; either deep ischemic ulcers     100
     or ankle/brachial index of 0.4 or less.....................
    Claudication on walking less than 25 yards on a level grade       60
     at 2 miles per hour, and; either persistent coldness of the
     extremity or ankle/brachial index of 0.5 or less...........
    Claudication on walking between 25 and 100 yards on a level       40
     grade at 2 miles per hour, and; trophic changes (thin skin,
     absence of hair, dystrophic nails) or ankle/brachial index
     of 0.7 or less.............................................
    Claudication on walking more than 100 yards, and; diminished      20
     peripheral pulses or ankle/brachial index of 0.9 or less...
 
Note (1): The ankle/brachial index is the ratio of the systolic
 blood pressure at the ankle (determined by Doppler study)
 divided by the simultaneous brachial artery systolic blood
 pressure. The normal index is 1.0 or greater.
Note (2): These evaluations are for involvement of a single
 extremity. If more than one extremity is affected, evaluate
 each extremity separately and combine (under Sec.   4.25),
 using the bilateral factor (Sec.   4.26), if applicable.
 
7117 Raynaud's syndrome:
    With two or more digital ulcers plus autoamputation of one       100
     or more digits and history of characteristic attacks.......
    With two or more digital ulcers and history of                    60
     characteristic attacks.....................................
    Characteristic attacks occurring at least daily.............      40
    Characteristic attacks occurring four to six times a week...      20
    Characteristic attacks occurring one to three times a week..      10
Note: For purposes of this section, characteristic attacks
 consist of sequential color changes of the digits of one or
 more extremities lasting minutes to hours, sometimes with pain
 and paresthesias, and precipitated by exposure to cold or by
 emotional upsets. These evaluations are for the disease as a
 whole, regardless of the number of extremities involved or
 whether the nose and ears are involved.
 
7118 Angioneurotic edema:
    Attacks without laryngeal involvement lasting one to seven        40
     days or longer and occurring more than eight times a year,
     or; attacks with laryngeal involvement of any duration
     occurring more than twice a year...........................
    Attacks without laryngeal involvement lasting one to seven        20
     days and occurring five to eight times a year, or; attacks
     with laryngeal involvement of any duration occurring once
     or twice a year............................................
    Attacks without laryngeal involvement lasting one to seven        10
     days and occurring two to four times a year................
7119 Erythromelalgia:
    Characteristic attacks that occur more than once a day, last     100
     an average of more than two hours each, respond poorly to
     treatment, and that restrict most routine daily activities.
    Characteristic attacks that occur more than once a day, last      60
     an average of more than two hours each, and respond poorly
     to treatment, but that do not restrict most routine daily
     activities.................................................
    Characteristic attacks that occur daily or more often but         30
     that respond to treatment..................................
    Characteristic attacks that occur less than daily but at          10
     least three times a week and that respond to treatment.....
 
Note: For purposes of this section, a characteristic attack of
 erythromelalgia consists of burning pain in the hands, feet, or
 both, usually bilateral and symmetrical, with increased skin
 temperature and redness, occurring at warm ambient
 temperatures. These evaluations are for the disease as a whole,
 regardless of the number of extremities involved.
 
7120 Varicose veins:
    With the following findings attributed to the effects of         100
     varicose veins: Massive board-like edema with constant pain
     at rest....................................................
    Persistent edema or subcutaneous induration, stasis               60
     pigmentation or eczema, and persistent ulceration..........
    Persistent edema and stasis pigmentation or eczema, with or       40
     without intermittent ulceration............................
    Persistent edema, incompletely relieved by elevation of           20
     extremity, with or without beginning stasis pigmentation or
     eczema.....................................................
    Intermittent edema of extremity or aching and fatigue in leg      10
     after prolonged standing or walking, with symptoms relieved
     by elevation of extremity or compression hosiery...........
    Asymptomatic palpable or visible varicose veins.............       0
 
Note: These evaluations are for involvement of a single
 extremity. If more than one extremity is involved, evaluate
 each extremity separately and combine (under Sec.   4.25),
 using the bilateral factor (Sec.   4.26), if applicable.
 

[[Page 467]]

 
7121 Post-phlebitic syndrome of any etiology:
    With the following findings attributed to venous disease:
        Massive board-like edema with constant pain at rest.....     100
        Persistent edema or subcutaneous induration, stasis           60
         pigmentation or eczema, and persistent ulceration......
        Persistent edema and stasis pigmentation or eczema, with      40
         or without intermittent ulceration.....................
        Persistent edema, incompletely relieved by elevation of       20
         extremity, with or without beginning stasis
         pigmentation or eczema.................................
        Intermittent edema of extremity or aching and fatigue in      10
         leg after prolonged standing or walking, with symptoms
         relieved by elevation of extremity or compression
         hosiery................................................
        Asymptomatic palpable or visible varicose veins.........       0
 
Note: These evaluations are for involvement of a single
 extremity. If more than one extremity is involved, evaluate
 each extremity separately and combine (under Sec.   4.25),
 using the bilateral factor (Sec.   4.26), if applicable.
 
7122 Cold injury residuals:
    With the following in affected parts:
        Arthralgia or other pain, numbness, or cold sensitivity       30
         plus two or more of the following: tissue loss, nail
         abnormalities, color changes, locally impaired
         sensation, hyperhidrosis, X-ray abnormalities
         (osteoporosis, subarticular punched out lesions, or
         osteoarthritis)........................................
        Arthralgia or other pain, numbness, or cold sensitivity       20
         plus tissue loss, nail abnormalities, color changes,
         locally impaired sensation, hyperhidrosis, or X-ray
         abnormalities (osteoporosis, subarticular punched out
         lesions, or osteoarthritis)............................
        Arthralgia or other pain, numbness, or cold sensitivity.      10
 
Note (1): Separately evaluate amputations of fingers or toes,
 and complications such as squamous cell carcinoma at the site
 of a cold injury scar or peripheral neuropathy, under other
 diagnostic codes. Separately evaluate other disabilities that
 have been diagnosed as the residual effects of cold injury,
 such as Raynaud's phenomenon, muscle atrophy, etc., unless they
 are used to support an evaluation under diagnostic code 7122.
Note (2): Evaluate each affected part (e.g., hand, foot, ear,
 nose) separately and combine the ratings in accordance with
 Sec.  Sec.   4.25 and 4.26.
 
7123 Soft tissue sarcoma (of vascular origin)...................     100
 
Note: A rating of 100 percent shall continue beyond the
 cessation of any surgical, X-ray, antineoplastic chemotherapy
 or other therapeutic procedure. Six months after discontinuance
 of such treatment, the appropriate disability rating shall be
 determined by mandatory VA examination. Any change in
 evaluation based upon that or any subsequent examination shall
 be subject to the provisions of Sec.   3.105(e) of this
 chapter. If there has been no local recurrence or metastasis,
 rate on residuals.
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[62 FR 65219, Dec. 11, 1997, as amended at 63 FR 37779, July 14, 1998; 
71 FR 52460, Sept. 6, 2006; 79 FR 2100, Jan. 13, 2014; 82 FR 50804, Nov. 
2, 2017]

                          The Digestive System



Sec.  4.110  Ulcers.

    Experience has shown that the term ``peptic ulcer'' is not 
sufficiently specific for rating purposes. Manifest differences in 
ulcers of the stomach or duodenum in comparison with those at an 
anastomotic stoma are sufficiently recognized as to warrant two separate 
graduated descriptions. In evaluating the ulcer, care should be taken 
that the findings adequately identify the particular location.



Sec.  4.111  Postgastrectomy syndromes.

    There are various postgastrectomy symptoms which may occur following 
anastomotic operations of the stomach. When present, those occurring 
during or immediately after eating and known as the ``dumping syndrome'' 
are characterized by gastrointestinal complaints and generalized 
symptoms simulating hypoglycemia; those occurring from 1 to 3 hours 
after eating usually present definite manifestations of hypoglycemia.



Sec.  4.112  Weight loss.

    For purposes of evaluating conditions in Sec.  4.114, the term 
``substantial weight loss'' means a loss of greater than 20 percent of 
the individual's baseline weight, sustained for three months or longer; 
and the term ``minor weight loss'' means a weight loss of 10 to 20 
percent of the individual's baseline weight, sustained for three months 
or longer. The term ``inability to gain

[[Page 468]]

weight'' means that there has been substantial weight loss with 
inability to regain it despite appropriate therapy. ``Baseline weight'' 
means the average weight for the two-year-period preceding onset of the 
disease.

(Authority: 38 U.S.C. 1155)

[66 FR 29488, May 31, 2001]



Sec.  4.113  Coexisting abdominal conditions.

    There are diseases of the digestive system, particularly within the 
abdomen, which, while differing in the site of pathology, produce a 
common disability picture characterized in the main by varying degrees 
of abdominal distress or pain, anemia and disturbances in nutrition. 
Consequently, certain coexisting diseases in this area, as indicated in 
the instruction under the title ``Diseases of the Digestive System,'' do 
not lend themselves to distinct and separate disability evaluations 
without violating the fundamental principle relating to pyramiding as 
outlined in Sec.  4.14.



Sec.  4.114  Schedule of ratings--digestive system.

    Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, 
and 7345 to 7348 inclusive will not be combined with each other. A 
single evaluation will be assigned under the diagnostic code which 
reflects the predominant disability picture, with elevation to the next 
higher evaluation where the severity of the overall disability warrants 
such elevation.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
7200 Mouth, injuries of.
  Rate as for disfigurement and impairment of function of
   mastication.
7201 Lips, injuries of.
  Rate as for disfigurement of face.
7202 Tongue, loss of whole or part:
  With inability to communicate by speech.......................     100
  One-half or more..............................................      60
  With marked speech impairment.................................      30
7203 Esophagus, stricture of:
  Permitting passage of liquids only, with marked impairment of       80
   general health...............................................
  Severe, permitting liquids only...............................      50
  Moderate......................................................      30
7204 Esophagus, spasm of (cardiospasm).
  If not amenable to dilation, rate as for the degree of
   obstruction (stricture).
7205 Esophagus, diverticulum of, acquired.
  Rate as for obstruction (stricture).
7301 Peritoneum, adhesions of:
  Severe; definite partial obstruction shown by X-ray, with           50
   frequent and prolonged episodes of severe colic distension,
   nausea or vomiting, following severe peritonitis, ruptured
   appendix, perforated ulcer, or operation with drainage.......
  Moderately severe; partial obstruction manifested by delayed        30
   motility of barium meal and less frequent and less prolonged
   episodes of pain.............................................
  Moderate; pulling pain on attempting work or aggravated by          10
   movements of the body, or occasional episodes of colic pain,
   nausea, constipation (perhaps alternating with diarrhea) or
   abdominal distension.........................................
  Mild..........................................................       0
  Note: Ratings for adhesions will be considered when there is
   history of operative or other traumatic or infectious
   (intraabdominal) process, and at least two of the following:
   disturbance of motility, actual partial obstruction, reflex
   disturbances, presence of pain.
7304 Ulcer, gastric.
7305 Ulcer, duodenal:
  Severe; pain only partially relieved by standard ulcer              60
   therapy, periodic vomiting, recurrent hematemesis or melena,
   with manifestations of anemia and weight loss productive of
   definite impairment of health................................
  Moderately severe; less than severe but with impairment of          40
   health manifested by anemia and weight loss; or recurrent
   incapacitating episodes averaging 10 days or more in duration
   at least four or more times a year...........................
  Moderate; recurring episodes of severe symptoms two or three        20
   times a year averaging 10 days in duration; or with
   continuous moderate manifestations...........................
  Mild; with recurring symptoms once or twice yearly............      10
7306 Ulcer, marginal (gastrojejunal):
  Pronounced; periodic or continuous pain unrelieved by standard     100
   ulcer therapy with periodic vomiting, recurring melena or
   hematemesis, and weight loss. Totally incapacitating.........
  Severe; same as pronounced with less pronounced and less            60
   continuous symptoms with definite impairment of health.......
  Moderately severe; intercurrent episodes of abdominal pain at       40
   least once a month partially or completely relieved by ulcer
   therapy, mild and transient episodes of vomiting or melena...
  Moderate; with episodes of recurring symptoms several times a       20
   year.........................................................
  Mild; with brief episodes of recurring symptoms once or twice       10
   yearly.......................................................
7307 Gastritis, hypertrophic (identified by gastroscope):
  Chronic; with severe hemorrhages, or large ulcerated or eroded      60
   areas........................................................
  Chronic; with multiple small eroded or ulcerated areas, and         30
   symptoms.....................................................
  Chronic; with small nodular lesions, and symptoms.............      10
  Gastritis, atrophic.
  A complication of a number of diseases, including pernicious
   anemia.
  Rate the underlying condition.
7308 Postgastrectomy syndromes:
  Severe; associated with nausea, sweating, circulatory               60
   disturbance after meals, diarrhea, hypoglycemic symptoms, and
   weight loss with malnutrition and anemia.....................

[[Page 469]]

 
  Moderate; less frequent episodes of epigastric disorders with       40
   characteristic mild circulatory symptoms after meals but with
   diarrhea and weight loss.....................................
  Mild; infrequent episodes of epigastric distress with               20
   characteristic mild circulatory symptoms or continuous mild
   manifestations...............................................
7309 Stomach, stenosis of.
  Rate as for gastric ulcer.
7310 Stomach, injury of, residuals.
  Rate as peritoneal adhesions.
7311 Residuals of injury of the liver:
  Depending on the specific residuals, separately evaluate as
   adhesions of peritoneum (diagnostic code 7301), cirrhosis of
   liver (diagnostic code 7312), and chronic liver disease
   without cirrhosis (diagnostic code 7345).
7312 Cirrhosis of the liver, primary biliary cirrhosis, or
 cirrhotic phase of sclerosing cholangitis:
  Generalized weakness, substantial weight loss, and persistent      100
   jaundice, or; with one of the following refractory to
   treatment: ascites, hepatic encephalopathy, hemorrhage from
   varices or portal gastropathy (erosive gastritis)............
  History of two or more episodes of ascites, hepatic                 70
   encephalopathy, or hemorrhage from varices or portal
   gastropathy (erosive gastritis), but with periods of
   remission between attacks....................................
  History of one episode of ascites, hepatic encephalopathy, or       50
   hemorrhage from varices or portal gastropathy (erosive
   gastritis)...................................................
  Portal hypertension and splenomegaly, with weakness, anorexia,      30
   abdominal pain, malaise, and at least minor weight loss......
  Symptoms such as weakness, anorexia, abdominal pain, and            10
   malaise......................................................
  Note: For evaluation under diagnostic code 7312, documentation
   of cirrhosis (by biopsy or imaging) and abnormal liver
   function tests must be present.
7314 Cholecystitis, chronic:
  Severe; frequent attacks of gall bladder colic................      30
  Moderate; gall bladder dyspepsia, confirmed by X-ray                10
   technique, and with infrequent attacks (not over two or three
   a year) of gall bladder colic, with or without jaundice......
  Mild..........................................................       0
7315 Cholelithiasis, chronic.
  Rate as for chronic cholecystitis.
7316 Cholangitis, chronic.
  Rate as for chronic cholecystitis.
7317 Gall bladder, injury of.
  Rate as for peritoneal adhesions.
7318 Gall bladder, removal of:
  With severe symptoms..........................................      30
  With mild symptoms............................................      10
  Nonsymptomatic................................................       0
  Spleen, disease or injury of.
   See Hemic and Lymphatic Systems.
7319 Irritable colon syndrome (spastic colitis, mucous colitis,
 etc.):
  Severe; diarrhea, or alternating diarrhea and constipation,         30
   with more or less constant abdominal distress................
  Moderate; frequent episodes of bowel disturbance with               10
   abdominal distress...........................................
  Mild; disturbances of bowel function with occasional episodes        0
   of abdominal distress........................................
7321 Amebiasis:
  Mild gastrointestinal disturbances, lower abdominal cramps,         10
   nausea, gaseous distention, chronic constipation interrupted
   by diarrhea..................................................
  Asymptomatic..................................................       0
  Note: Amebiasis with or without liver abscess is parallel in
   symptomatology with ulcerative colitis and should be rated on
   the scale provided for the latter. Similarly, lung abscess
   due to amebiasis will be rated under the respiratory system
   schedule, diagnostic code 6809.
7322 Dysentery, bacillary.
  Rate as for ulcerative colitis................................
7323 Colitis, ulcerative:
  Pronounced; resulting in marked malnutrition, anemia, and          100
   general debility, or with serious complication as liver
   abscess......................................................
  Severe; with numerous attacks a year and malnutrition, the          60
   health only fair during remissions...........................
  Moderately severe; with frequent exacerbations................      30
  Moderate; with infrequent exacerbations.......................      10
7324 Distomiasis, intestinal or hepatic:
  Severe symptoms...............................................      30
  Moderate symptoms.............................................      10
  Mild or no symptoms...........................................       0
7325 Enteritis, chronic.
  Rate as for irritable colon syndrome.
7326 Enterocolitis, chronic.
  Rate as for irritable colon syndrome.
7327 Diverticulitis.
  Rate as for irritable colon syndrome, peritoneal adhesions, or
   colitis, ulcerative, depending upon the predominant
   disability picture.
7328 Intestine, small, resection of:
  With marked interference with absorption and nutrition,             60
   manifested by severe impairment of health objectively
   supported by examination findings including material weight
   loss.........................................................
  With definite interference with absorption and nutrition,           40
   manifested by impairment of health objectively supported by
   examination findings including definite weight loss..........
  Symptomatic with diarrhea, anemia and inability to gain weight      20
  Note: Where residual adhesions constitute the predominant
   disability, rate under diagnostic code 7301.
7329 Intestine, large, resection of:
  With severe symptoms, objectively supported by examination          40
   findings.....................................................
  With moderate symptoms........................................      20
  With slight symptoms..........................................      10
  Note: Where residual adhesions constitute the predominant
   disability, rate under diagnostic code 7301.
7330 Intestine, fistula of, persistent, or after attempt at
 operative closure:
  Copious and frequent, fecal discharge.........................     100
  Constant or frequent, fecal discharge.........................      60
  Slight infrequent, fecal discharge............................      30
  Healed; rate for peritoneal adhesions.
7331 Peritonitis, tuberculous, active or inactive:
  Active........................................................     100
  Inactive: See Sec.  Sec.   4.88b and 4.89.
7332 Rectum and anus, impairment of sphincter control:
  Complete loss of sphincter control............................     100
  Extensive leakage and fairly frequent involuntary bowel             60
   movements....................................................
  Occasional involuntary bowel movements, necessitating wearing       30
   of pad.......................................................
  Constant slight, or occasional moderate leakage...............      10
  Healed or slight, without leakage.............................       0
7333 Rectum and anus, stricture of:
  Requiring colostomy...........................................     100
  Great reduction of lumen, or extensive leakage................      50
  Moderate reduction of lumen, or moderate constant leakage.....      30

[[Page 470]]

 
7334 Rectum, prolapse of:
  Severe (or complete), persistent..............................      50
  Moderate, persistent or frequently recurring..................      30
  Mild with constant slight or occasional moderate leakage......      10
7335 Ano, fistula in.
  Rate as for impairment of sphincter control.
7336 Hemorrhoids, external or internal:
  With persistent bleeding and with secondary anemia, or with         20
   fissures.....................................................
  Large or thrombotic, irreducible, with excessive redundant          10
   tissue, evidencing frequent recurrences......................
  Mild or moderate..............................................       0
7337 Pruritus ani.
  Rate for the underlying condition.
7338 Hernia, inguinal:
  Large, postoperative, recurrent, not well supported under           60
   ordinary conditions and not readily reducible, when
   considered inoperable........................................
  Small, postoperative recurrent, or unoperated irremediable,         30
   not well supported by truss, or not readily reducible........
  Postoperative recurrent, readily reducible and well supported       10
   by truss or belt.............................................
  Not operated, but remediable..................................       0
  Small, reducible, or without true hernia protrusion...........       0
  Note: Add 10 percent for bilateral involvement, provided the
   second hernia is compensable. This means that the more
   severely disabling hernia is to be evaluated, and 10 percent,
   only, added for the second hernia, if the latter is of
   compensable degree.
7339 Hernia, ventral, postoperative:
  Massive, persistent, severe diastasis of recti muscles or          100
   extensive diffuse destruction or weakening of muscular and
   fascial support of abdominal wall so as to be inoperable.....
  Large, not well supported by belt under ordinary conditions...      40
  Small, not well supported by belt under ordinary conditions,        20
   or healed ventral hernia or post-operative wounds with
   weakening of abdominal wall and indication for a supporting
   belt.........................................................
  Wounds, postoperative, healed, no disability, belt not               0
   indicated....................................................
7340 Hernia, femoral.
  Rate as for inguinal hernia.
7342 Visceroptosis, symptomatic, marked.........................      10
7343 Malignant neoplasms of the digestive system, exclusive of       100
 skin growths...................................................
  Note: A rating of 100 percent shall continue beyond the
   cessation of any surgical, X-ray, antineoplastic chemotherapy
   or other therapeutic procedure. Six months after
   discontinuance of such treatment, the appropriate disability
   rating shall be determined by mandatory VA examination. Any
   change in evaluation based upon that or any subsequent
   examination shall be subject to the provisions of Sec.
   3.105(e) of this chapter. If there has been no local
   recurrence or metastasis, rate on residuals.
7344 Benign neoplasms, exclusive of skin growths:
  Evaluate under an appropriate diagnostic code, depending on
   the predominant disability or the specific residuals after
   treatment.
7345 Chronic liver disease without cirrhosis (including
 hepatitis B, chronic active hepatitis, autoimmune hepatitis,
 hemochromatosis, drug-induced hepatitis, etc., but excluding
 bile duct disorders and hepatitis C):
  Near-constant debilitating symptoms (such as fatigue, malaise,     100
   nausea, vomiting, anorexia, arthralgia, and right upper
   quadrant pain)...............................................
  Daily fatigue, malaise, and anorexia, with substantial weight       60
   loss (or other indication of malnutrition), and hepatomegaly,
   or; incapacitating episodes (with symptoms such as fatigue,
   malaise, nausea, vomiting, anorexia, arthralgia, and right
   upper quadrant pain) having a total duration of at least six
   weeks during the past 12-month period, but not occurring
   constantly...................................................
  Daily fatigue, malaise, and anorexia, with minor weight loss        40
   and hepatomegaly, or; incapacitating episodes (with symptoms
   such as fatigue, malaise, nausea, vomiting, anorexia,
   arthralgia, and right upper quadrant pain) having a total
   duration of at least four weeks, but less than six weeks,
   during the past 12-month period..............................
  Daily fatigue, malaise, and anorexia (without weight loss or        20
   hepatomegaly), requiring dietary restriction or continuous
   medication, or; incapacitating episodes (with symptoms such
   as fatigue, malaise, nausea, vomiting, anorexia, arthralgia,
   and right upper quadrant pain) having a total duration of at
   least two weeks, but less than four weeks, during the past 12-
   month period.................................................
  Intermittent fatigue, malaise, and anorexia, or;                    10
   incapacitating episodes (with symptoms such as fatigue,
   malaise, nausea, vomiting, anorexia, arthralgia, and right
   upper quadrant pain) having a total duration of at least one
   week, but less than two weeks, during the past 12-month
   period.......................................................
  Nonsymptomatic................................................       0
  Note (1): Evaluate sequelae, such as cirrhosis or malignancy
   of the liver, under an appropriate diagnostic code, but do
   not use the same signs and symptoms as the basis for
   evaluation under DC 7354 and under a diagnostic code for
   sequelae. (See Sec.   4.14.).
  Note (2): For purposes of evaluating conditions under
   diagnostic code 7345, ``incapacitating episode'' means a
   period of acute signs and symptoms severe enough to require
   bed rest and treatment by a physician.
  Note (3): Hepatitis B infection must be confirmed by serologic
   testing in order to evaluate it under diagnostic code 7345.
7346 Hernia hiatal:
  Symptoms of pain, vomiting, material weight loss and                60
   hematemesis or melena with moderate anemia; or other symptom
   combinations productive of severe impairment of health.......
  Persistently recurrent epigastric distress with dysphagia,          30
   pyrosis, and regurgitation, accompanied by substernal or arm
   or shoulder pain, productive of considerable impairment of
   health.......................................................
  With two or more of the symptoms for the 30 percent evaluation      10
   of less severity.............................................
7347 Pancreatitis:
  With frequently recurrent disabling attacks of abdominal pain      100
   with few pain free intermissions and with steatorrhea,
   malabsorption, diarrhea and severe malnutrition..............
  With frequent attacks of abdominal pain, loss of normal body        60
   weight and other findings showing continuing pancreatic
   insufficiency between acute attacks..........................

[[Page 471]]

 
  Moderately severe; with at least 4-7 typical attacks of             30
   abdominal pain per year with good remission between attacks..
  With at least one recurring attack of typical severe abdominal      10
   pain in the past year........................................
  Note 1: Abdominal pain in this condition must be confirmed as
   resulting from pancreatitis by appropriate laboratory and
   clinical studies.
  Note 2: Following total or partial pancreatectomy, rate under
   above, symptoms, minimum rating 30 percent.
7348 Vagotomy with pyloroplasty or gastroenterostomy:
  Followed by demonstrably confirmative postoperative                 40
   complications of stricture or continuing gastric retention...
  With symptoms and confirmed diagnosis of alkaline gastritis,        30
   or of confirmed persisting diarrhea..........................
  Recurrent ulcer with incomplete vagotomy......................      20
  Note: Rate recurrent ulcer following complete vagotomy under
   diagnostic code 7305, minimum rating 20 percent; and rate
   dumping syndrome under diagnostic code 7308.
7351 Liver transplant:
  For an indefinite period from the date of hospital admission       100
   for transplant surgery.......................................
  Minimum.......................................................      30
  Note: A rating of 100 percent shall be assigned as of the date
   of hospital admission for transplant surgery and shall
   continue. One year following discharge, the appropriate
   disability rating shall be determined by mandatory VA
   examination. Any change in evaluation based upon that or any
   subsequent examination shall be subject to the provisions of
   Sec.   3.105(e) of this chapter.
7354 Hepatitis C (or non-A, non-B hepatitis):
  With serologic evidence of hepatitis C infection and the
   following signs and symptoms due to hepatitis C infection:
   Near-constant debilitating symptoms (such as fatigue,             100
   malaise, nausea, vomiting, anorexia, arthralgia, and right
   upper quadrant pain).........................................
  Daily fatigue, malaise, and anorexia, with substantial weight       60
   loss (or other indication of malnutrition), and hepatomegaly,
   or; incapacitating episodes (with symptoms such as fatigue,
   malaise, nausea, vomiting, anorexia, arthralgia, and right
   upper quadrant pain) having a total duration of at least six
   weeks during the past 12-month period, but not occurring
   constantly...................................................
  Daily fatigue, malaise, and anorexia, with minor weight loss        40
   and hepatomegaly, or; incapacitating episodes (with symptoms
   such as fatigue, malaise, nausea, vomiting, anorexia,
   arthralgia, and right upper quadrant pain) having a total
   duration of at least four weeks, but less than six weeks,
   during the past 12-month period..............................
  Daily fatigue, malaise, and anorexia (without weight loss or        20
   hepatomegaly), requiring dietary restriction or continuous
   medication, or; incapacitating episodes (with symptoms such
   as fatigue, malaise, nausea, vomiting, anorexia, arthralgia,
   and right upper quadrant pain) having a total duration of at
   least two weeks, but less than four weeks, during the past 12-
   month period.................................................
  Intermittent fatigue, malaise, and anorexia, or;                    10
   incapacitating episodes (with symptoms such as fatigue,
   malaise, nausea, vomiting, anorexia, arthralgia, and right
   upper quadrant pain) having a total duration of at least one
   week, but less than two weeks, during the past 12-month
   period.......................................................
  Nonsymptomatic................................................       0
  Note (1): Evaluate sequelae, such as cirrhosis or malignancy
   of the liver, under an appropriate diagnostic code, but do
   not use the same signs and symptoms as the basis for
   evaluation under DC 7354 and under a diagnostic code for
   sequelae. (See Sec.   4.14.).
  Note (2): For purposes of evaluating conditions under
   diagnostic code 7354, ``incapacitating episode'' means a
   period of acute signs and symptoms severe enough to require
   bed rest and treatment by a physician.
------------------------------------------------------------------------


(Authority: 38 U.S.C. 1155)

[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40 
FR 42540, Sept. 15, 1975; 41 FR 11301, Mar. 18, 1976; 66 FR 29488, May 
31, 2001]

                        The Genitourinary System



Sec.  4.115  Nephritis.

    Albuminuria alone is not nephritis, nor will the presence of 
transient albumin and casts following acute febrile illness be taken as 
nephritis. The glomerular type of nephritis is usually preceded by or 
associated with severe infectious disease; the onset is sudden, and the 
course marked by red blood cells, salt retention, and edema; it may 
clear up entirely or progress to a chronic condition. The 
nephrosclerotic type, originating in hypertension or arteriosclerosis, 
develops slowly, with minimum laboratory findings, and is associated 
with natural progress. Separate ratings are not to be assigned for 
disability from disease of the heart and any form of nephritis, on 
account of the close interrelationships of cardiovascular disabilities. 
If, however, absence of a kidney is the sole renal disability, even if 
removal was required because of nephritis, the absent kidney and any 
hypertension or heart disease will be separately rated. Also, in the 
event that chronic renal disease has progressed to the point where 
regular

[[Page 472]]

dialysis is required, any coexisting hypertension or heart disease will 
be separately rated.

[41 FR 34258, Aug. 13, 1976, as amended at 59 FR 2527, Jan. 18, 1994]



Sec.  4.115a  Ratings of the genitourinary system--dysfunctions.

    Diseases of the genitourinary system generally result in 
disabilities related to renal or voiding dysfunctions, infections, or a 
combination of these. The following section provides descriptions of 
various levels of disability in each of these symptom areas. Where 
diagnostic codes refer the decisionmaker to these specific areas 
dysfunction, only the predominant area of dysfunction shall be 
considered for rating purposes. Since the areas of dysfunction described 
below do not cover all symptoms resulting from genitourinary diseases, 
specific diagnoses may include a description of symptoms assigned to 
that diagnosis.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
Renal dysfunction:
  Requiring regular dialysis, or precluding more than sedentary      100
   activity from one of the following: persistent edema and
   albuminuria; or, BUN more than 80mg%; or, creatinine more
   than 8mg%; or, markedly decreased function of kidney or other
   organ systems, especially cardiovascular.....................
  Persistent edema and albuminuria with BUN 40 to 80mg%; or,          80
   creatinine 4 to 8mg%; or, generalized poor health
   characterized by lethargy, weakness, anorexia, weight loss,
   or limitation of exertion....................................
  Constant albuminuria with some edema; or, definite decrease in      60
   kidney function; or, hypertension at least 40 percent
   disabling under diagnostic code 7101.........................
  Albumin constant or recurring with hyaline and granular casts       30
   or red blood cells; or, transient or slight edema or
   hypertension at least 10 percent disabling under diagnostic
   code 7101....................................................
  Albumin and casts with history of acute nephritis; or,               0
   hypertension non-compensable under diagnostic code 7101......
Voiding dysfunction:
  Rate particular condition as urine leakage, frequency, or       ......
   obstructed voiding
  Continual Urine Leakage, Post Surgical Urinary Diversion,
   Urinary Incontinence, or Stress Incontinence:
  Requiring the use of an appliance or the wearing of absorbent       60
   materials which must be changed more than 4 times per day....
  Requiring the wearing of absorbent materials which must be          40
   changed 2 to 4 times per day.................................
  Requiring the wearing of absorbent materials which must be          20
   changed less than 2 times per day............................
Urinary frequency:
  Daytime voiding interval less than one hour, or; awakening to       40
   void five or more times per night............................
  Daytime voiding interval between one and two hours, or;             20
   awakening to void three to four times per night..............
  Daytime voiding interval between two and three hours, or;           10
   awakening to void two times per night........................
Obstructed voiding:
  Urinary retention requiring intermittent or continuous              30
   catheterization..............................................
  Marked obstructive symptomatology (hesitancy, slow or weak
   stream, decreased force of stream) with any one or
   combination of the following:
    1. Post void residuals greater than 150 cc.
    2. Uroflowmetry; markedly diminished peak flow rate (less
     than 10 cc/sec).
    3. Recurrent urinary tract infections secondary to
     obstruction.
    4. Stricture disease requiring periodic dilatation every 2        10
     to 3 months................................................
  Obstructive symptomatology with or without stricture disease         0
   requiring dilatation 1 to 2 times per year...................
Urinary tract infection:
  Poor renal function: Rate as renal dysfunction.
  Recurrent symptomatic infection requiring drainage/frequent         30
   hospitalization (greater than two times/year), and/or
   requiring continuous intensive management....................
  Long-term drug therapy, 1-2 hospitalizations per year and/or        10
   requiring intermittent intensive management..................
------------------------------------------------------------------------


[59 FR 2527, Jan. 18, 1994; 59 FR 10676, Mar. 7, 1994]



Sec.  4.115b  Ratings of the genitourinary system--diagnoses.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
      Note: When evaluating any claim involving loss or loss of
       use of one or more creative organs, refer to Sec.   3.350
       of this chapter to determine whether the veteran may be
       entitled to special monthly compensation. Footnotes in
       the schedule indicate conditions which potentially
       establish entitlement to special monthly compensation;
       however, there are other conditions in this section which
       under certain circumstances also establish entitlement to
       special monthly compensation.
 
7500 Kidney, removal of one:
      Minimum evaluation........................................      30
      Or rate as renal dysfunction if there is nephritis,
       infection, or pathology of the other.
7501 Kidney, abscess of:
      Rate as urinary tract infection...........................  ......

[[Page 473]]

 
7502 Nephritis, chronic:
      Rate as renal dysfunction.
7504 Pyelonephritis, chronic:
      Rate as renal dysfunction or urinary tract infection,
       whichever is predominant.
7505 Kidney, tuberculosis of:
      Rate in accordance with Sec.  Sec.   4.88b or 4.89,
       whichever is appropriate.
7507 Nephrosclerosis, arteriolar:
      Rate according to predominant symptoms as renal
       dysfunction, hypertension or heart disease. If rated
       under the cardiovascular schedule, however, the
       percentage rating which would otherwise be assigned will
       be elevated to the next higher evaluation.
7508 Nephrolithiasis:
      Rate as hydronephrosis, except for recurrent stone
       formation requiring one or more of the following:
        1. diet therapy
        2. drug therapy
        3. invasive or non-invasive procedures more than two          30
         times/year.............................................
7509 Hydronephrosis:
      Severe; Rate as renal dysfunction.
    Frequent attacks of colic with infection (pyonephrosis),          30
     kidney function impaired...................................
    Frequent attacks of colic, requiring catheter drainage......      20
    Only an occasional attack of colic, not infected and not          10
     requiring catheter drainage................................
7510 Ureterolithiasis:
      Rate as hydronephrosis, except for recurrent stone
       formation requiring one or more of the following:
        1. diet therapy
        2. drug therapy
        3. invasive or non-invasive procedures more than two          30
         times/year.............................................
7511 Ureter, stricture of:
      Rate as hydronephrosis, except for recurrent stone
       formation requiring one or more of the following:
        1. diet therapy
        2. drug therapy
        3. invasive or non-invasive procedures more than two          30
         times/year.............................................
7512 Cystitis, chronic, includes interstitial and all
 etiologies, infectious and non-infectious:
      Rate as voiding dysfunction.
7515 Bladder, calculus in, with symptoms interfering with
 function:
      Rate as voiding dysfunction
7516 Bladder, fistula of:
      Rate as voiding dysfunction or urinary tract infection,
       whichever is predominant.
      Postoperative, suprapubic cystotomy.......................     100
7517 Bladder, injury of:
      Rate as voiding dysfunction.
7518 Urethra, stricture of:
      Rate as voiding dysfunction.
7519 Urethra, fistual of:
      Rate as voiding dysfunction.
      Multiple urethroperineal fistulae.........................     100
7520 Penis, removal of half or more.............................      30
      Or rate as voiding dysfunction.
7521 Penis removal of glans.....................................      20
      Or rate as voiding dysfunction.
7522 Penis, deformity, with loss of erectile power--20 \1\......
7523 Testis, atrophy complete:..................................
      Both--20 \1\
      One--0 \1\
7524 Testis, removal:...........................................
      Both--30 \1\
      One--0 \1\
 
      Note: In cases of the removal of one testis as the result
       of a service-incurred injury or disease, other than an
       undescended or congenitally undeveloped testis, with the
       absence or nonfunctioning of the other testis unrelated
       to service, an evaluation of 30 percent will be assigned
       for the service-connected testicular loss. Testis,
       underscended, or congenitally undeveloped is not a
       ratable disability.
 
7525 Epididymo-orchitis, chronic only:
      Rate as urinary tract infection.
      For tubercular infections: Rate in accordance with Sec.
       Sec.   4.88b or 4.89, whichever is appropriate.
7527 Prostate gland injuries, infections, hypertrophy,
 postoperative residuals:
      Rate as voiding dysfunction or urinary tract infection,
       whichever is predominant.
7528 Malignant neoplasms of the genitourinary system............     100
      Note--Following the cessation of surgical, X-ray,
       antineoplastic chemotherapy or other therapeutic
       procedure, the rating of 100 percent shall continue with
       a mandatory VA examination at the expiration of six
       months. Any change in evaluation based upon that or any
       subsequent examination shall be subject to the provisions
       of Sec.   3.105(e) of this chapter. If there has been no
       local reoccurrence or metastasis, rate on residuals as
       voiding dysfunction or renal dysfunction, whichever is
       predominant.
7529 Benign neoplasms of the genitourinary system:
      Rate as voiding dysfunction or renal dysfunction,
       whichever is predominant.
7530 Chronic renal disease requiring regular dialysis:
      Rate as renal dysfunction.
7531 Kidney transplant:
      Following transplant surgery..............................     100
      Thereafter: Rate on residuals as renal dysfunction,             30
       minimum rating...........................................

[[Page 474]]

 
      Note--The 100 percent evaluation shall be assigned as of
       the date of hospital admission for transplant surgery and
       shall continue with a mandatory VA examination one year
       following hospital discharge. Any change in evaluation
       based upon that or any subsequent examination shall be
       subject to the provisions of Sec.   3.105(e) of this
       chapter.
7532 Renal tubular disorders (such as renal glycosurias,
 aminoacidurias, renal tubular acidosis, Fanconi's syndrome,
 Bartter's syndrome, related disorders of Henle's loop and
 proximal or distal nephron function, etc.):
      Minimum rating for symptomatic condition..................      20
      Or rate as renal dysfunction.
7533 Cystic diseases of the kidneys (polycystic disease, uremic
 medullary cystic disease, Medullary sponge kidney, and similar
 conditions):
      Rate as renal dysfunction.
7534 Atherosclerotic renal disease (renal artery stenosis or
 atheroembolic renal disease):
      Rate as renal dysfunction.
7535 Toxic nephropathy (antibotics, radiocontrast agents,
 nonsteroidal anti-inflammatory agents, heavy metals, and
 similar agents):
      Rate as renal dysfunction.
7536 Glomerulonephritis:
      Rate as renal dysfunction.
7537 Interstitial nephritis:
      Rate as renal dysfunction.
7538 Papillary necrosis:
      Rate as renal dysfunction.
7539 Renal amyloid disease:
      Rate as renal dysfunction.
7540 Disseminated intravascular coagulation with renal cortical
 necrosis:
      Rate as renal dysfunction.
7541 Renal involvement in diabetes mellitus, sickle cell anemia,
 systemic lupus erythematosus, vasculitis, or other systemic
 disease processes.
      Rate as renal dysfunction.
7542 Neurogenic bladder:
      Rate as voiding dysfunction.
------------------------------------------------------------------------
\1\ Review for entitlement to special monthly compensation under Sec.
  3.350 of this chapter.


[59 FR 2527, Jan. 18, 1994; 59 FR 14567, Mar. 29, 1994, as amended at 59 
FR 46339, Sept. 8, 1994]

          Gynecological Conditions and Disorders of the Breast



Sec.  4.116  Schedule of ratings--gynecological conditions and disorders
of the breast.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
    Note 1: Natural menopause, primary amenorrhea, and
     pregnancy and childbirth are not disabilities for rating
     purposes. Chronic residuals of medical or surgical
     complications of pregnancy may be disabilities for rating
     purposes.
    Note 2: When evaluating any claim involving loss or loss of
     use of one or more creative organs or anatomical loss of
     one or both breasts, refer to Sec.   3.350 of this chapter
     to determine whether the veteran may be entitled to
     special monthly compensation. Footnotes in the schedule
     indicate conditions which potentially establish
     entitlement to special monthly compensation; however,
     almost any condition in this section might, under certain
     circumstances, establish entitlement to special monthly
     compensation.
7610 Vulva or clitoris, disease or injury of (including
 vulvovaginitis)
7611 Vagina, disease or injury of.
7612 Cervix, disease or injury of.
7613 Uterus, disease, injury, or adhesions of.
7614 Fallopian tube, disease, injury, or adhesions of
 (including pelvic inflammatory disease (PID)).
7615 Ovary, disease, injury, or adhesions of.
General Rating Formula for Disease, Injury, or Adhesions of
 Female Reproductive Organs (diagnostic codes 7610 through
 7615):
    Symptoms not controlled by continuous treatment............       30
    Symptoms that require continuous treatment.................       10
    Symptoms that do not require continuous treatment..........        0
    Note: For the purpose of VA disability evaluation, a         .......
     disease, injury, or adhesions of the ovaries resulting in
     ovarian dysfunction affecting the menstrual cycle, such as
     dysmenorrhea and secondary amenorrhea, shall be rated
     under diagnostic code 7615
7617 Uterus and both ovaries, removal of, complete:
    For three months after removal.............................  \1\ 100
    Thereafter.................................................   \1\ 50
7618 Uterus, removal of, including corpus:
    For three months after removal.............................  \1\ 100
    Thereafter.................................................   \1\ 30
7619 Ovary, removal of:
    For three months after removal.............................  \1\ 100
    Thereafter:
        Complete removal of both ovaries.......................   \1\ 30
        Removal of one with or without partial removal of the      \1\ 0
         other.................................................
    Note: In cases of the removal of one ovary as the result of
     a service-connected injury or disease, with the absence or
     nonfunctioning of a second ovary unrelated to service, an
     evaluation of 30 percent will be assigned for the service-
     connected ovarian loss
7620 Ovaries, atrophy of both, complete........................   \1\ 20

[[Page 475]]

 
7621 Complete or incomplete pelvic organ prolapse due to              10
 injury, disease, or surgical complications of pregnancy.......
    Note: Pelvic organ prolapse occurs when a pelvic organ such
     as bladder, urethra, uterus, vagina, small bowel, or
     rectum drops (prolapse) from its normal place in the
     abdomen. Conditions associated with pelvic organ prolapse
     include: uterine or vaginal vault prolapse, cystocele,
     urethrocele, rectocele, enterocele, or any combination
     thereof. Evaluate pelvic organ prolapse under DC 7621.
     Evaluate separately any genitourinary, digestive, or skin
     symptoms under the appropriate diagnostic code(s) and
     combine all evaluations with the 10 percent evaluation
     under DC 7621
7624 Fistula, rectovaginal:
    Vaginal fecal leakage at least once a day requiring wearing      100
     of pad....................................................
    Vaginal fecal leakage four or more times per week, but less       60
     than daily, requiring wearing of pad......................
    Vaginal fecal leakage one to three times per week requiring       30
     wearing of pad............................................
    Vaginal fecal leakage less than once a week................       10
    Without leakage............................................        0
7625 Fistula, urethrovaginal:
    Multiple urethrovaginal fistulae...........................      100
    Requiring the use of an appliance or the wearing of               60
     absorbent materials which must be changed more than four
     times per day.............................................
    Requiring the wearing of absorbent materials which must be        40
     changed two to four times per day.........................
    Requiring the wearing of absorbent materials which must be        20
     changed less than two times per day.......................
7626 Breast, surgery of:
    Following radical mastectomy:
        Both...................................................    \1\80
        One....................................................    \1\50
    Following modified radical mastectomy:
        Both...................................................    \1\60
        One....................................................    \1\40
    Following simple mastectomy or wide local excision with
     significant alteration of size or form:
        Both...................................................    \1\50
        One....................................................    \1\30
    Following wide local excision without significant
     alteration of size or form:
        Both or one............................................        0
    Note: For VA purposes:
        (1) Radical mastectomy means removal of the entire
         breast, underlying pectoral muscles, and regional
         lymph nodes up to the coracoclavicular ligament.......
        (2) Modified radical mastectomy means removal of the
         entire breast and axillary lymph nodes (in continuity
         with the breast). Pectoral muscles are left intact....
        (3) Simple (or total) mastectomy means removal of all
         of the breast tissue, nipple, and a small portion of
         the overlying skin, but lymph nodes and muscles are
         left intact...........................................
        (4) Wide local excision (including partial mastectomy,
         lumpectomy, tylectomy, segmentectomy, and
         quadrantectomy) means removal of a portion of the
         breast tissue.........................................
7627 Malignant neoplasms of gynecological system...............      100
    Note: A rating of 100 percent shall continue beyond the
     cessation of any surgical, radiation, antineoplastic
     chemotherapy or other therapeutic procedures. Six months
     after discontinuance of such treatment, the appropriate
     disability rating shall be determined by mandatory VA
     examination. Any change in evaluation based upon that or
     any subsequent examination shall be subject to the
     provisions of Sec.   3.105(e) of this chapter. Rate
     chronic residuals to include scars, lymphedema,
     disfigurement, and/or other impairment of function under
     the appropriate diagnostic code(s) within the appropriate
     body system
7628 Benign neoplasms of gynecological system. Rate chronic
 residuals to include scars, lymphedema, disfigurement, and/or
 other impairment of function under the appropriate diagnostic
 code(s) within the appropriate body system
7629 Endometriosis:
    Lesions involving bowel or bladder confirmed by                   50
     laparoscopy, pelvic pain or heavy or irregular bleeding
     not controlled by treatment, and bowel or bladder symptoms
    Pelvic pain or heavy or irregular bleeding not controlled         30
     by treatment..............................................
    Pelvic pain or heavy or irregular bleeding requiring              10
     continuous treatment for control..........................
    Note: Diagnosis of endometriosis must be substantiated by
     laparoscopy.
7630 Malignant neoplasms of the breast.........................      100
    Note: A rating of 100 percent shall continue beyond the
     cessation of any surgical, radiation, antineoplastic
     chemotherapy or other therapeutic procedure. Six months
     after discontinuance of such treatment, the appropriate
     disability rating shall be determined by mandatory VA
     examination. Any change in evaluation based upon that or
     any subsequent examination shall be subject to the
     provisions of Sec.   3.105(e) of this chapter. Rate
     chronic residuals according to impairment of function due
     to scars, lymphedema, or disfigurement (e.g., limitation
     of arm, shoulder, and wrist motion, or loss of grip
     strength, or loss of sensation, or residuals from
     harvesting of muscles for reconstructive purposes), and/or
     under diagnostic code 7626
7631 Benign neoplasms of the breast and other injuries of the
 breast. Rate chronic residuals according to impairment of
 function due to scars, lymphedema, or disfigurement (e.g.,
 limitation of arm, shoulder, and wrist motion, or loss of grip
 strength, or loss of sensation, or residuals from harvesting
 of muscles for reconstructive purposes), and/or under
 diagnostic code 7626
7632 Female sexual arousal disorder (FSAD).....................    \1\ 0
------------------------------------------------------------------------
\1\ Review for entitlement to special monthly compensation under Sec.
  3.350 of this chapter.


[[Page 476]]


(Authority: 38 U.S.C. 1155)

[60 FR 19855, Apr. 21, 1995, as amended at 67 FR 6874, Feb. 14, 2002; 67 
FR 37695, May 30, 2002; 83 FR 15071, Apr. 9, 2018]

                  The Hematologic and Lymphatic Systems



Sec.  4.117  Schedule of ratings--hemic and lymphatic systems.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
7702 Agranulocytosis, acquired:
    Requiring bone marrow transplant; or infections recurring,       100
     on average, at least once every six weeks per 12-month
     period....................................................
    Requiring intermittent myeloid growth factors (granulocyte        60
     colony-stimulating factor (G-CSF) or granulocyte-
     macrophage colony-stimulating factor (GM-CSF) or
     continuous immunosuppressive therapy such as cyclosporine
     to maintain absolute neutrophil count (ANC) greater than
     500/microliter ([micro]l) but less than 1000/[micro]l; or
     infections recurring, on average, at least once every
     three months per 12-month period..........................
    Requiring intermittent myeloid growth factors to maintain         30
     ANC greater than 1000/[micro]l; or infections recurring,
     on average, at least once per 12-month period but less
     than once every three months per 12-month period..........
    Requiring continuous medication (e.g., antibiotics) for           10
     control; or requiring intermittent use of a myeloid growth
     factor to maintain ANC greater than or equal to 1500/
     [micro]l..................................................
Note: A 100 percent evaluation for bone marrow transplant shall
 be assigned as of the date of hospital admission and shall
 continue with a mandatory VA examination six months following
 hospital discharge. Any change in evaluation based upon that
 or any subsequent examination shall be subject to the
 provisions of Sec.   3.105(e) of this chapter.................
 
7703 Leukemia (except for chronic myelogenous leukemia):
    When there is active disease or during a treatment phase...      100
    Otherwise rate residuals under the appropriate diagnostic
     code(s)...................................................
    Chronic lymphocytic leukemia or monoclonal B-cell                  0
     lymphocytosis (MBL), asymptomatic, Rai Stage 0............
Note (1): A 100 percent evaluation shall continue beyond the cessation
 of any surgical therapy, radiation therapy, antineoplastic
 chemotherapy, or other therapeutic procedures. Six months after
 discontinuance of such treatment, the appropriate disability rating
 shall be determined by mandatory VA examination. Any change in
 evaluation based upon that or any subsequent examination shall be
 subject to the provisions of Sec.   3.105(e) of this chapter. If there
 has been no recurrence, rate on residuals..............................
Note (2): Evaluate symptomatic chronic lymphocytic leukemia that is at
 Rai Stage I, II, III, or IV the same as any other leukemia evaluated
 under this diagnostic code.............................................
Note (3): Evaluate residuals of leukemia or leukemia therapy under the
 appropriate diagnostic code(s). Myeloproliferative Disorders:
 (Diagnostic Codes 7704, 7718, 7719)....................................
 
7704 Polycythemia vera:
    Requiring peripheral blood or bone marrow stem-cell              100
     transplant or chemotherapy (including myelosuppressants)
     for the purpose of ameliorating the symptom burden........
    Requiring phlebotomy 6 or more times per 12-month period or       60
     molecularly targeted therapy for the purpose of
     controlling RBC count.....................................
    Requiring phlebotomy 4-5 times per 12-month period, or if         30
     requiring continuous biologic therapy or myelosuppressive
     agents, to include interferon, to maintain platelets
     <200,000 or white blood cells (WBC) <12,000...............
    Requiring phlebotomy 3 or fewer times per 12-month period         10
     or if requiring biologic therapy or interferon on an
     intermittent basis as needed to maintain all blood values
     at reference range levels
    Note (1): Rate complications such as hypertension, gout, stroke, or
     thrombotic disease separately......................................
    Note (2): If the condition undergoes leukemic transformation,
     evaluate as leukemia under diagnostic code 7703....................
Note (3): A 100 percent evaluation shall be assigned as of the date of
 hospital admission for peripheral blood or bone marrow stem cell
 transplant; or during the period of treatment with chemotherapy
 (including myelosuppressants). Six months following hospital discharge
 or, in the case of chemotherapy treatment, six months after completion
 of treatment, the appropriate disability rating shall be determined by
 mandatory VA examination. Any reduction in evaluation based upon that
 or any subsequent examination shall be subject to the provisions of
 Sec.   3.105(e) of this chapter........................................
 
7705 Immune thrombocytopenia:
    Requiring chemotherapy for chronic refractory                    100
     thrombocytopenia; or a platelet count 30,000 or below
     despite treatment.........................................
    Requiring immunosuppressive therapy; or for a platelet            70
     count higher than 30,000 but not higher than 50,000, with
     history of hospitalization because of severe bleeding
     requiring intravenous immune globulin, high-dose
     parenteral corticosteroids, and platelet transfusions.....
    Platelet count higher than 30,000 but not higher than             30
     50,000, with either immune thrombocytopenia or mild mucous
     membrane bleeding which requires oral corticosteroid
     therapy or intravenous immune globulin....................
    Platelet count higher than 30,000 but not higher than             10
     50,000, not requiring treatment...........................
    Platelet count above 50,000 and asymptomatic; or for immune        0
     thrombocytopenia in remission.............................
    Note (1): Separately evaluate splenectomy under diagnostic code 7706
     and combine with an evaluation under this diagnostic code..........
    Note (2): A 100 percent evaluation shall continue beyond the
     cessation of chemotherapy. Six months after discontinuance of such
     treatment, the appropriate disability rating shall be determined by
     mandatory VA examination. Any reduction in evaluation based upon
     that or any subsequent examination shall be subject to the
     provisions of Sec.   3.105(e) of this chapter......................
7706 Splenectomy...............................................       20

[[Page 477]]

 
    Note: Separately rate complications such as systemic infections with
     encapsulated bacteria..............................................
 
    Note: Separately rate complications such as systemic infections with
     encapsulated bacteria..............................................
 
7707 Spleen, injury of, healed.
    Rate for any residuals.
7709 Hodgkin's lymphoma:
    With active disease or during a treatment phase............      100
 
    Note: A 100 percent evaluation shall continue beyond the
     cessation of any surgical therapy, radiation therapy,
     antineoplastic chemotherapy, or other therapeutic
     procedures. Six months after discontinuance of such
     treatment, the appropriate disability rating shall be
     determined by mandatory VA examination. Any reduction in
     evaluation based upon that or any subsequent examination
     shall be subject to the provisions of Sec.   3.105(e) of
     this chapter. If there has been no local recurrence or
     metastasis, rate on residuals under the appropriate
     diagnostic code(s)........................................
 
7710 Adenitis, tuberculous, active or inactive:
    Rate under Sec.   4.88c or 4.89 of this part, whichever is
     appropriate...............................................
7712 Multiple myeloma:
    Symptomatic multiple myeloma...............................      100
    Asymptomatic, smoldering, or monoclonal gammopathy of              0
     undetermined significance (MGUS)..........................
    Note (1): Current validated biomarkers of symptomatic multiple
     myeloma and asymptomatic multiple myeloma, smoldering, or
     monoclonal gammopathy of undetermined significance (MGUS) are
     acceptable for the diagnosis of multiple myeloma as defined by the
     American Society of Hematology (ASH) and International Myeloma
     Working Group (IMWG)...............................................
    Note (2): The 100 percent evaluation shall continue for five years
     after the diagnosis of symptomatic multiple myeloma, at which time
     the appropriate disability evaluation shall be determined by
     mandatory VA examination. Any reduction in evaluation based upon
     that or any subsequent examination shall be subject to the
     provisions of Sec.   3.105(e) and Sec.   3.344 (a) and (b) of this
     chapter............................................................
7714 Sickle cell anemia:
    With at least 4 or more painful episodes per 12-month            100
     period, occurring in skin, joints, bones, or any major
     organs, caused by hemolysis and sickling of red blood
     cells, with anemia, thrombosis, and infarction, with
     residual symptoms precluding even light manual labor......
    With 3 painful episodes per 12-month period or with               60
     symptoms precluding other than light manual labor.........
    With 1 or 2 painful episodes per 12-month period...........       30
    Asymptomatic, established case in remission, but with             10
     identifiable organ impairment.............................
    Note: Sickle cell trait alone, without a history of directly
     attributable pathological findings, is not a ratable disability.
     Cases of symptomatic sickle cell trait will be forwarded to the
     Director, Compensation Service, for consideration under Sec.
     3.321(b)(1) of this chapter........................................
 
7715 Non-Hodgkin's lymphoma:
    When there is active disease, during treatment phase, or         100
     with indolent and non-contiguous phase of low grade NHL...
 
    Note: A 100 percent evaluation shall continue beyond the cessation
     of any surgical therapy, radiation therapy, antineoplastic
     chemotherapy, or other therapeutic procedures. Two years after
     discontinuance of such treatment, the appropriate disability rating
     shall be determined by mandatory VA examination. Any reduction in
     evaluation based upon that or any subsequent examination shall be
     subject to the provisions of Sec.   3.105(e) of this chapter. If
     there has been no recurrence, rate on residuals under the
     appropriate diagnostic code(s).....................................
 
7716 Aplastic anemia:
    Requiring peripheral blood or bone marrow stem cell              100
     transplant; or requiring transfusion of platelets or red
     cells, on average, at least once every six weeks per 12-
     month period; or infections recurring, on average, at
     least once every six weeks per 12-month period............
    Requiring transfusion of platelets or red cells, on               60
     average, at least once every three months per 12-month
     period; or infections recurring, on average, at least once
     every three months per 12-month period; or using
     continuous therapy with immunosuppressive agent or newer
     platelet stimulating factors..............................
    Requiring transfusion of platelets or red cells, on               30
     average, at least once per 12-month period; or infections
     recurring, on average, at least once per 12-month period..
 
    Note (1): A 100 percent evaluation for peripheral blood or bone
     marrow stem cell transplant shall be assigned as of the date of
     hospital admission and shall continue with a mandatory VA
     examination six months following hospital discharge. Any change in
     evaluation based upon that or any subsequent examination shall be
     subject to the provisions of Sec.   3.105(e) of this chapter.......
    Note (2): The term ``newer platelet stimulating factors'' includes
     medication, factors, or other agents approved by the United States
     Food and Drug Administration.......................................
7717 AL amyloidosis (primary amyloidosis)                            100
7718 Essential thrombocythemia and primary myelofibrosis:
    Requiring either continuous myelosuppressive therapy or,         100
     for six months following hospital admission, peripheral
     blood or bone marrow stem cell transplant, or
     chemotherapy, or interferon treatment.....................
    Requiring continuous or intermittent myelosuppressive             70
     therapy, or chemotherapy, or interferon treatment to
     maintain platelet count <500 x 10 \9\/L...................
    Requiring continuous or intermittent myelosuppressive             30
     therapy, or chemotherapy, or interferon treatment to
     maintain platelet count of 200,000-400,000, or white blood
     cell (WBC) count of 4,000-10,000..........................
    Asymptomatic...............................................        0
    Note (1): If the condition undergoes leukemic transformation,
     evaluate as leukemia under diagnostic code 7703....................

[[Page 478]]

 
    Note (2): A 100 percent evaluation shall be assigned as of the date
     of hospital admission for peripheral blood or bone marrow stem cell
     transplant; or during the period of treatment with chemotherapy
     (including myelosuppressants). Six months following hospital
     discharge or, in the case of chemotherapy treatment, six months
     after completion of treatment, the appropriate disability rating
     shall be determined by mandatory VA examination. Any reduction in
     evaluation based upon that or any subsequent examination shall be
     subject to the provisions of Sec.   3.105(e) of this chapter.......
7719 Chronic myelogenous leukemia (CML) (chronic myeloid
 leukemia or chronic granulocytic leukemia):
    Requiring peripheral blood or bone marrow stem cell              100
     transplant, or continuous myelosuppressive or
     immunosuppressive therapy treatment.......................
    Requiring intermittent myelosuppressive therapy, or               60
     molecularly targeted therapy with tyrosine kinase
     inhibitors, or interferon treatment when not in apparent
     remission.................................................
    In apparent remission on continuous molecularly targeted          30
     therapy with tyrosine kinase inhibitors...................
    Note (1): If the condition undergoes leukemic transformation,
     evaluate as leukemia under diagnostic code 7703....................
    Note (2): A 100 percent evaluation shall be assigned as of the date
     of hospital admission for peripheral blood or bone marrow stem cell
     transplant; or during the period of treatment with chemotherapy
     (including myelosuppressants). Six months following hospital
     discharge or, in the case of chemotherapy treatment, six months
     after completion of treatment, the appropriate disability rating
     shall be determined by mandatory VA examination. Any reduction in
     evaluation based upon that or any subsequent examination shall be
     subject to the provisions of Sec.   3.105 of this chapter..........
7720 Iron deficiency anemia:
    Requiring intravenous iron infusions 4 or more times per 12-      30
     month period..............................................
    Requiring intravenous iron infusions at least 1 time but          10
     less than 4 times per 12-month period, or requiring
     continuous treatment with oral supplementation............
    Asymptomatic or requiring treatment only by dietary                0
     modification..............................................
    Note: Do not evaluate iron deficiency anemia due to blood loss under
     this diagnostic code. Evaluate iron deficiency anemia due to blood
     loss under the criteria for the condition causing the blood loss...
7721 Folic acid deficiency:
    Requiring continuous treatment with high-dose oral                10
     supplementation...........................................
    Asymptomatic or requiring treatment only by dietary                0
     modification..............................................
7722 Pernicious anemia and Vitamin B12 deficiency anemia:
    For initial diagnosis requiring transfusion due to severe        100
     anemia, or if there are signs or symptoms related to
     central nervous system impairment, such as encephalopathy,
     myelopathy, or severe peripheral neuropathy, requiring
     parenteral B12 therapy....................................
    Requiring continuous treatment with Vitamin B12 injections,       10
     Vitamin B12 sublingual or high-dose oral tablets, or
     Vitamin B12 nasal spray or gel............................
    Note: A 100 percent evaluation for pernicious anemia and Vitamin B12
     deficiency shall be assigned as of the date of the initial
     diagnosis requiring transfusion due to severe anemia or parenteral
     B12 therapy and shall continue with a mandatory VA examination six
     months following hospital discharge or cessation of parenteral B12
     therapy. Any reduction in evaluation based upon that or any
     subsequent examination shall be subject to the provisions of Sec.
     3.105(e) of this chapter. Thereafter, evaluate at 10 percent and
     separately evaluate any residual effects of pernicious anemia, such
     as neurologic involvement causing peripheral neuropathy,
     myelopathy, dementia, or related gastrointestinal residuals, under
     the most appropriate diagnostic code...............................
7723 Acquired hemolytic anemia:
    Requiring a bone marrow transplant or continuous                 100
     intravenous or immunosuppressive therapy (e.g.,
     prednisone, Cytoxan, azathioprine, or rituximab)..........
    Requiring immunosuppressive medication 4 or more times per        60
     12-month period...........................................
    Requiring at least 2 but less than 4 courses of                   30
     immunosuppressive therapy per 12-month period.............
    Requiring one course of immunosuppressive therapy per 12-         10
     month period..............................................
    Asymptomatic...............................................        0
    Note (1): A 100 percent evaluation for bone marrow transplant shall
     be assigned as of the date of hospital admission and shall continue
     for six months after hospital discharge with a mandatory VA
     examination six months following hospital discharge. Any reduction
     in evaluation based upon that or any subsequent examination shall
     be subject to the provisions of Sec.   3.105(e) of this chapter....
    Note (2): Separately evaluate splenectomy under diagnostic code 7706
     and combine with an evaluation under diagnostic code 7723..........
7724 Solitary plasmacytoma:
    Solitary plasmacytoma, when there is active disease or           100
     during a treatment phase..................................
    Note (1): A 100 percent evaluation shall continue beyond the
     cessation of any surgical therapy, radiation therapy,
     antineoplastic chemotherapy, or other therapeutic procedures
     (including autologous stem cell transplantation). Six months after
     discontinuance of such treatment, the appropriate disability rating
     shall be determined by mandatory VA examination. Any change in
     evaluation based upon that or any subsequent examination shall be
     subject to the provisions of Sec.   3.105(e) of this chapter. If
     there has been no recurrence, rate residuals under the appropriate
     diagnostic codes...................................................
    Note (2): Rate a solitary plasmacytoma that has developed into
     multiple myeloma as symptomatic multiple myeloma...................
    Note (3): Rate residuals of plasma cell dysplasia (e.g., thrombosis)
     and adverse effects of medical treatment (e.g., neuropathy) under
     the appropriate diagnostic codes...................................
7725 Myelodysplastic syndromes:
    Requiring peripheral blood or bone marrow stem cell              100
     transplant; or requiring chemotherapy.....................

[[Page 479]]

 
    Requiring 4 or more blood or platelet transfusions per 12-        60
     month period; or infections requiring hospitalization 3 or
     more times per 12-month period............................
    Requiring at least 1 but no more than 3 blood or platelet         30
     transfusions per 12-month period; infections requiring
     hospitalization at least 1 but no more than 2 times per 12-
     month period; or requiring biologic therapy on an ongoing
     basis or erythropoiesis stimulating agent (ESA) for 12
     weeks or less per 12-month period.........................
    Note (1): If the condition progresses to leukemia, evaluate as
     leukemia under diagnostic code 7703................................
    Note (2): A 100 percent evaluation shall be assigned as of the date
     of hospital admission for peripheral blood or bone marrow stem cell
     transplant, or during the period of treatment with chemotherapy,
     and shall continue with a mandatory VA examination six months
     following hospital discharge or, in the case of chemotherapy
     treatment, six months after completion of treatment. Any reduction
     in evaluation based upon that or any subsequent examination shall
     be subject to the provisions of Sec.   3.105(e) of this chapter. If
     there has been no recurrence, residuals will be rated under the
     appropriate diagnostic codes.......................................
------------------------------------------------------------------------


[60 FR 49227, Sept. 22, 1995, as amended at 77 FR 6467, Feb. 8, 2012; 79 
FR 2100, Jan. 13, 2014; 83 FR 54254, Oct. 29, 2018; 83 FR 54881, Nov. 1, 
2018]

                                The Skin



Sec.  4.118  Schedule of ratings--skin.

    (a) For the purposes of this section, systemic therapy is treatment 
that is administered through any route (orally, injection, suppository, 
intranasally) other than the skin, and topical therapy is treatment that 
is administered through the skin.
    (b) Two or more skin conditions may be combined in accordance with 
Sec.  4.25 only if separate areas of skin are involved. If two or more 
skin conditions involve the same area of skin, then only the highest 
evaluation shall be used.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
7800 Burn scar(s) of the head, face, or neck; scar(s) of the
 head, face, or neck due to other causes; or other disfigurement
 of the head, face, or neck:
    With visible or palpable tissue loss and either gross             80
     distortion or asymmetry of three or more features or paired
     sets of features (nose, chin, forehead, eyes (including
     eyelids), ears (auricles), cheeks, lips), or; with six or
     more characteristics of disfigurement......................
    With visible or palpable tissue loss and either gross             50
     distortion or asymmetry of two features or paired sets of
     features (nose, chin, forehead, eyes (including eyelids),
     ears (auricles), cheeks, lips), or; with four or five
     characteristics of disfigurement...........................
    With visible or palpable tissue loss and either gross             30
     distortion or asymmetry of one feature or paired set of
     features (nose, chin, forehead, eyes (including eyelids),
     ears (auricles), cheeks, lips), or; with two or three
     characteristics of disfigurement...........................
    With one characteristic of disfigurement....................      10
    Note (1):The 8 characteristics of disfigurement, for
     purposes of evaluation under Sec.   4.118, are:
    Scar 5 or more inches (13 or more cm.) in length.
    Scar at least one-quarter inch (0.6 cm.) wide at widest
     part.
    Surface contour of scar elevated or depressed on palpation.
    Scar adherent to underlying tissue.
    Skin hypo-or hyper-pigmented in an area exceeding six square
     inches (39 sq. cm.).
    Skin texture abnormal (irregular, atrophic, shiny, scaly,
     etc.) in an area exceeding six square inches (39 sq. cm.).
    Underlying soft tissue missing in an area exceeding six
     square inches (39 sq. cm.).
    Skin indurated and inflexible in an area exceeding six
     square inches (39 sq. cm.).
    Note (2): Rate tissue loss of the auricle under DC 6207
     (loss of auricle) and anatomical loss of the eye under DC
     6061 (anatomical loss of both eyes) or DC 6063 (anatomical
     loss of one eye), as appropriate.
    Note (3): Take into consideration unretouched color
     photographs when evaluating under these criteria.
    Note (4): Separately evaluate disabling effects other than
     disfigurement that are associated with individual scar(s)
     of the head, face, or neck, such as pain, instability, and
     residuals of associated muscle or nerve injury, under the
     appropriate diagnostic code(s) and apply Sec.   4.25 to
     combine the evaluation(s) with the evaluation assigned
     under this diagnostic code.
    Note (5): The characteristic(s) of disfigurement may be
     caused by one scar or by multiple scars; the
     characteristic(s) required to assign a particular
     evaluation need not be caused by a single scar in order to
     assign that evaluation.
7801 Burn scar(s) or scar(s) due to other causes, not of the
 head, face, or neck, that are associated with underlying soft
 tissue damage:
    Area or areas of 144 square inches (929 sq. cm.) or greater.      40
    Area or areas of at least 72 square inches (465 sq. cm.) but      30
     less than 144 square inches (929 sq. cm.)..................
    Area or areas of at least 12 square inches (77 sq. cm.) but       20
     less than 72 square inches (465 sq. cm.)...................
    Area or areas of at least 6 square inches (39 sq. cm.) but        10
     less than 12 square inches (77 sq. cm.)....................

[[Page 480]]

 
    Note (1): For the purposes of DCs 7801 and 7802, the six (6)
     zones of the body are defined as each extremity, anterior
     trunk, and posterior trunk. The midaxillary line divides
     the anterior trunk from the posterior trunk................
    Note (2): A separate evaluation may be assigned for each
     affected zone of the body under this diagnostic code if
     there are multiple scars, or a single scar, affecting
     multiple zones of the body. Combine the separate
     evaluations under Sec.   4.25. Alternatively, if a higher
     evaluation would result from adding the areas affected from
     multiple zones of the body, a single evaluation may also be
     assigned under this diagnostic code........................
7802 Burn scar(s) or scar(s) due to other causes, not of the
 head, face, or neck, that are not associated with underlying
 soft tissue damage:
    Area or areas of 144 square inches (929 sq. cm.) or greater.      10
    Note (1): For the purposes of DCs 7801 and 7802, the six (6)
     zones of the body are defined as each extremity, anterior
     trunk, and posterior trunk. The midaxillary line divides
     the anterior trunk from the posterior trunk................
    Note (2): A separate evaluation may be assigned for each
     affected zone of the body under this diagnostic code if
     there are multiple scars, or a single scar, affecting
     multiple zones of the body. Combine the separate
     evaluations under Sec.   4.25. Alternatively, if a higher
     evaluation would result from adding the areas affected from
     multiple zones of the body, a single evaluation may also be
     assigned under this diagnostic code........................
7804 Scar(s), unstable or painful:..............................
    Five or more scars that are unstable or painful.............      30
    Three or four scars that are unstable or painful............      20
    One or two scars that are unstable or painful...............      10
    Note (1): An unstable scar is one where, for any reason,
     there is frequent loss of covering of skin over the scar.
    Note (2): If one or more scars are both unstable and
     painful, add 10 percent to the evaluation that is based on
     the total number of unstable or painful scars
    Note (3): Scars evaluated under diagnostic codes 7800, 7801,
     7802, or 7805 may also receive an evaluation under this
     diagnostic code, when applicable
7805 Scars, other; and other effects of scars evaluated under
 diagnostic codes 7800, 7801, 7802, or 7804:
    Evaluate any disabling effect(s) not considered in a rating
     provided under diagnostic codes 7800-04 under an
     appropriate diagnostic code................................
General Rating Formula For The Skin For DCs 7806, 7809, 7813-
 7816, 7820-7822, and 7824:
    At least one of the following...............................      60
    Characteristic lesions involving more than 40 percent of the
     entire body or more than 40 percent of exposed areas
     affected; or
    Constant or near-constant systemic therapy including, but         60
     not limited to, corticosteroids, phototherapy, retinoids,
     biologics, photochemotherapy, psoralen with long-wave
     ultraviolet-A light (PUVA), or other immunosuppressive
     drugs required over the past 12-month period...............
At least one of the following...................................      30
Characteristic lesions involving 20 to 40 percent of the entire
 body or 20 to 40 percent of exposed areas affected; or Systemic
 therapy including, but not limited to, corticosteroids,
 phototherapy, retinoids, biologics, photochemotherapy, PUVA, or
 other immunosuppressive drugs required for a total duration of
 6 weeks or more, but not constantly, over the past 12-month
 period.........................................................
    At least one of the following...............................      10
    Characteristic lesions involving at least 5 percent, but
     less than 20 percent, of the entire body affected; or
    At least 5 percent, but less than 20 percent, of exposed
     areas affected; or
    Intermittent systemic therapy including, but not limited to,
     corticosteroids, phototherapy, retinoids, biologics,
     photochemotherapy, PUVA, or other immunosuppressive drugs
     required for a total duration of less than 6 weeks over the
     past 12-month period.......................................
    No more than topical therapy required over the past 12-month       0
     period and at least one of the following...................
    Characteristic lesions involving less than 5 percent of the
     entire body affected; or
    Characteristic lesions involving less than 5 percent of
     exposed areas affected.....................................
    Or rate as disfigurement of the head, face, or neck (DC
     7800) or scars (DCs 7801, 7802, 7804, or 7805), depending
     upon the predominant disability. This rating instruction
     does not apply to DC 7824..................................
7806 Dermatitis or eczema.
    Evaluate under the General Rating Formula for the Skin......
7807 American (New World) leishmaniasis (mucocutaneous,
 espundia):
    Rate as disfigurement of the head, face, or neck (DC 7800),
     scars (DC's 7801, 7802, 7803, 7804, or 7805), or dermatitis
     (DC 7806), depending upon the predominant disability.......
    Note: Evaluate non-cutaneous (visceral) leishmaniasis under
     DC 6301 (visceral leishmaniasis).
7808 Old World leishmaniasis (cutaneous, Oriental sore):
    Rate as disfigurement of the head, face, or neck (DC 7800),
     scars (DC's, 7801, 7802, 7803, 7804, or 7805), or
     dermatitis (DC 7806), depending upon the predominant
     disabililty................................................
    Note: Evaluate non-cutaneous (visceral) leishmaniasis under
     DC 6301 (visceral leishmaniasis).
7809 Discoid lupus erythematosus.
    Evaluate under the General Rating Formula for the Skin......
    Note: Do not combine with ratings under DC 6350.............
7811 Tuberculosis luposa (lupus vulgaris), active or inactive:
    Rate under Sec.  Sec.   4.88c or 4.89, whichever is
     appropriate................................................

[[Page 481]]

 
7813 Dermatophytosis (ringworm: Of body, tinea corporis; of
 head, tinea capitis; of feet, tinea pedis; of beard area, tinea
 barbae; of nails, tinea unguium (onychomycosis); of inguinal
 area (jock itch), tinea cruris; tinea versicolor).
    Evaluate under the General Rating Formula for the Skin......
7815 Bullous disorders (including pemphigus vulgaris, pemphigus
 foliaceous, bullous pemphigoid, dermatitis herpetiformis,
 epidermolysis bullosa acquisita, benign chronic familial
 pemphigus (Hailey-Hailey), and porphyria cutanea tarda).
    Evaluate under the General Rating Formula for the Skin......
    Note: Rate complications and residuals of mucosal
     involvement (ocular, oral, gastrointestinal, respiratory,
     or genitourinary) separately under the appropriate
     diagnostic code............................................
7816 Psoriasis.
    Evaluate under the General Rating Formula for the Skin......
    Note: Rate complications such as psoriatic arthritis and
     other clinical manifestations (e.g., oral mucosa, nails)
     separately under the appropriate diagnostic code...........
7817 Erythroderma:
    Generalized involvement of the skin with systemic                100
     manifestations (such as fever, weight loss, or
     hypoproteinemia) AND one of the following..................
    Constant or near-constant systemic therapy such as
     therapeutic doses of corticosteroids, other
     immunosuppressive drugs, retinoids, PUVA (psoralen with
     long-wave ultraviolet-A light), UVB (ultraviolet-B light)
     treatments, biologics, or electron beam therapy required
     over the past 12 month period; or
    No current treatment due to a documented history of              100
     treatment failure with 2 or more treatment regimens........
    Generalized involvement of the skin without systemic
     manifestations and one of the following....................
    Constant or near-constant systemic therapy such as
     therapeutic doses of corticosteroids, other
     immunosuppressive drugs, retinoids, PUVA, UVB treatments,
     biologics, or electron beam therapy required over the past
     12-month period; or........................................
    No current treatment due to a documented history of               60
     treatment failure with 1 treatment regimen.................
    Any extent of involvement of the skin, and any of the             30
     following therapies required for a total duration of 6
     weeks or more, but not constantly, over the past 12-month
     period: systemic therapy such as therapeutic doses of
     corticosteroids, other immunosuppressive drugs, retinoids,
     PUVA, UVB treatments, biologics, or electron beam therapy..
    Any extent of involvement of the skin, and any of the             10
     following therapies required for a total duration of less
     than 6 weeks over the past 12-month period: systemic
     therapy such as therapeutic doses of corticosteroids, other
     immunosuppressive drugs, retinoids, PUVA, UVB treatments,
     biologics, or electron beam therapy........................
    Any extent of involvement of the skin, and no more than            0
     topical therapy required over the past 12-month period.....
    Note: Treatment failure is defined as either disease
     progression, or less than a 25 percent reduction in the
     extent and severity of disease after four weeks of
     prescribed therapy, as documented by medical records.......
7818 Malignant skin neoplasms (other than malignant melanoma):
    Rate as disfigurement of the head, face, or neck (DC 7800),
     scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment
     of function................................................
    Note: If a skin malignancy requires therapy that is
     comparable to that used for systemic malignancies, i.e.,
     systemic chemotherapy, X-ray therapy more extensive than to
     the skin, or surgery more extensive than wide local
     excision, a 100-percent evaluation will be assigned from
     the date of onset of treatment, and will continue, with a
     mandatory VA examination six months following the
     completion of such antineoplastic treatment, and any change
     in evaluation based upon that or any subsequent examination
     will be subject to the provisions of Sec.   3.105(e) of
     this chapter. If there has been no local recurrence or
     metastasis, evaluation will then be made on residuals. If
     treatment is confined to the skin, the provisions for a 100-
     percent evaluation do not apply.
7819 Benign skin neoplasms:
    Rate as disfigurement of the head, face, or neck (DC 7800),
     scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment
     of function................................................
7820 Infections of the skin not listed elsewhere (including
 bacterial, fungal, viral, treponemal, and parasitic diseases).
    Evaluate under the General Rating Formula for the Skin......
7821 Cutaneous manifestations of collagen-vascular diseases not
 listed elsewhere (including scleroderma, calcinosis cutis,
 subacute cutaneous lupus erythematosus, and dermatomyositis).
    Evaluate under the General Rating Formula for the Skin......
7822 Papulosquamous disorders not listed elsewhere (including
 lichen planus, large or small plaque parapsoriasis, pityriasis
 lichenoides et varioliformis acuta (PLEVA), lymphomatoid
 papulosus, mycosis fungoides, and pityriasis rubra pilaris
 (PRP)).
    Evaluate under the General Rating Formula for the Skin......
7823 Vitiligo:
    With exposed areas affected.................................      10
    With no exposed areas affected..............................       0
7824 Diseases of keratinization (including icthyoses, Darier's
 disease, and palmoplantar keratoderma).
    Evaluate under the General Rating Formula for the Skin......
7825 Chronic urticaria:
    For the purposes of this diagnostic code, chronic urticaria
     is defined as continuous urticaria at least twice per week,
     off treatment, for a period of six weeks or more...........

[[Page 482]]

 
    Chronic refractory urticaria that requires third line             60
     treatment for control (e.g., plasmapheresis, immunotherapy,
     immunosuppressives) due to ineffectiveness with first and
     second line treatments.....................................
    Chronic urticaria that requires second line treatment (e.g.,      30
     corticosteroids, sympathomimetics, leukotriene inhibitors,
     neutrophil inhibitors, thyroid hormone) for control........
    Chronic urticaria that requires first line treatment              10
     (antihistamines) for control...............................
7826 Vasculitis, primary cutaneous:
    Persistent documented vasculitis episodes refractory to           60
     continuous immunosuppressive therapy.......................
    All of the following........................................      30
    Recurrent documented vasculitic episodes occurring four or
     more times over the past 12-month period; and
    Requiring intermittent systemic immunosuppressive therapy         30
     for control................................................
    At least one of the following...............................      10
    Recurrent documented vasculitic episodes occurring one to
     three times over the past 12-month period, and requiring
     intermittent systemic immunosuppressive therapy for
     control; or
    Without recurrent documented vasculitic episodes but
     requiring continuous systemic medication for control.......
    Or rate as disfigurement of the head, face, or neck (DC
     7800) or scars (DCs 7801, 7802, 7804, or 7805), depending
     upon the predominant disability............................
7827 Erythema multiforme; Toxic epidermal necrolysis:
    Recurrent mucosal, palmar, or plantar involvement impairing       60
     mastication, use of hands, or ambulation occurring four or
     more times over the past 12-month period despite ongoing
     immunosuppressive therapy..................................
    All of the following........................................      30
    Recurrent mucosal, palmar, or plantar involvement not
     impairing mastication, use of hands, or ambulation,
     occurring four or more times over the past 12-month period;
     andrequiring intermittent systemic therapy.................
    At least one of the following...............................      10
    One to three episodes of mucosal, palmar, or plantar
     involvement not impairing mastication, use of hands, or
     ambulation, occurring over the past 12-month period AND
     requiring intermittent systemic therapy; or
    Without recurrent episodes, but requiring continuous
     systemic medication for control............................
    Or rate as disfigurement of the head, face, or neck (DC
     7800) or scars (DCs 7801, 7802, 7804, or 7805), depending
     upon the predominant disability............................
    Note: For the purposes of this DC only, systemic therapy may
     consist of one or more of the following treatment agents:
     immunosuppressives, antihistamines, or sympathomimetics....
7828 Acne:
    Deep acne (deep inflamed nodules and pus-filled cysts)            30
     affecting 40 percent or more of the face and neck..........
    Deep acne (deep inflamed nodules and pus-filled cysts)            10
     affecting less than 40 percent of the face and neck, or
     deep acne other than on the face and neck..................
Superficial acne (comedones, papules, pustules) of any extent...       0
    Or rate as disfigurement of the head, face, or neck (DC
     7800) or scars (DCs 7801, 7802, 7804, or 7805), depending
     upon the predominant disability............................
7829 Chloracne:
    Deep acne (deep inflamed nodules and pus-filled cysts)            30
     affecting 40 percent or more of the face and neck..........
    Deep acne (deep inflamed nodules and pus-filled cysts)            20
     affecting the intertriginous areas (the axilla of the arm,
     the anogenital region, skin folds of the breasts, or
     between digits)............................................
    Deep acne (deep inflamed nodules and pus-filled cysts)            10
     affecting less than 40 percent of the face and neck; or
     deep acne affecting non-intertriginous areas of the body
     (other than the face and neck).............................
    Superficial acne (comedones, papules, pustules) of any             0
     extent.....................................................
    Or rate as disfigurement of the head, face, or neck (DC
     7800) or scars (DCs 7801, 7802, 7804, or 7805), depending
     upon the predominant disability............................
7830 Scarring alopecia:
    Affecting more than 40 percent of the scalp.................      20
    Affecting 20 to 40 percent of the scalp.....................      10
    Affecting less than 20 percent of the scalp.................       0
7831 Alopecia areata:
    With loss of all body hair..................................      10
    With loss of hair limited to scalp and face.................       0
7832 Hyperhidrosis:
    Unable to handle paper or tools because of moisture, and          30
     unresponsive to therapy....................................
    Able to handle paper or tools after therapy.................       0
7833 Malignant melanoma:
    Rate as scars (DC's 7801, 7802, 7803, 7804, or 7805),
     disfigurement of the head, face, or neck (DC 7800), or
     impairment of function (under the appropriate body system).
    Note: If a skin malignancy requires therapy that is
     comparable to that used for systemic malignancies, i.e.,
     systemic chemotherapy, X-ray therapy more extensive than to
     the skin, or surgery more extensive than wide local
     excision, a 100-percent evaluation will be assigned from
     the date of onset of treatment, and will continue, with a
     mandatory VA examination six months following the
     completion of such antineoplastic treatment, and any change
     in evaluation based upon that or any subsequent examination
     will be subject to the provisions of Sec.   3.105(e). If
     there has been no local recurrence or metastasis,
     evaluation will then be made on residuals. If treatment is
     confined to the skin, the provisions for a 100-percent
     evaluation do not apply.
------------------------------------------------------------------------


[[Page 483]]


(Authority: 38 U.S.C. 1155)

[67 FR 49596, July 31, 2002; 67 FR 58448, 58449, Sept. 16, 2002; 73 FR 
54710, Oct. 23, 2008; 77 FR 2910, Jan. 20, 2012; 83 FR 32597, July 13, 
2018; 83 FR 38663, Aug. 7, 2018]

                          The Endocrine System



Sec.  4.119  Schedule of ratings--endocrine system.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
7900 Hyperthyroidism, including, but not limited to, Graves'
 disease:
  For six months after initial diagnosis........................      30
  Thereafter, rate residuals of disease or complications of
   medical treatment within the appropriate diagnostic code(s)
   within the appropriate body system.
  Note (1): If hyperthyroid cardiovascular or cardiac disease is
   present, separately evaluate under DC 7008 (hyperthyroid
   heart disease).
  Note (2): Separately evaluate eye involvement occurring as a
   manifestation of Graves' Disease as diplopia (DC 6090);
   impairment of central visual acuity (DCs 6061-6066); or under
   the most appropriate DCs in Sec.   4.79.
7901 Thyroid enlargement, toxic:
  Note (1): Evaluate symptoms of hyperthyroidism under DC 7900,
   hyperthyroidism, including, but not limited to, Graves'
   disease.
  Note (2): If disfigurement of the neck is present due to
   thyroid disease or enlargement, separately evaluate under DC
   7800 (burn scar(s) of the head, face, or neck; scar(s) of the
   head, face, or neck due to other causes; or other
   disfigurement of the head, face, or neck).
7902 Thyroid enlargement, nontoxic:
  Note (1): Evaluate symptoms due to pressure on adjacent organs
   (such as the trachea, larynx, or esophagus) under the
   appropriate diagnostic code(s) within the appropriate body
   system.
  Note (2): If disfigurement of the neck is present due to
   thyroid disease or enlargement, separately evaluate under DC
   7800 (burn scar(s) of the head, face, or neck; scar(s) of the
   head, face, or neck due to other causes; or other
   disfigurement of the head, face, or neck).
7903 Hypothyroidism:
  Hypothyroidism manifesting as myxedema (cold intolerance,          100
   muscular weakness, cardiovascular involvement (including, but
   not limited to hypotension, bradycardia, and pericardial
   effusion), and mental disturbance (including, but not limited
   to dementia, slowing of thought and depression)).............
  Note (1): This evaluation shall continue for six months beyond
   the date that an examining physician has determined crisis
   stabilization. Thereafter, the residual effects of
   hypothyroidism shall be rated under the appropriate
   diagnostic code(s) within the appropriate body system(s)
   (e.g., eye, digestive, and mental disorders).
  Hypothyroidism without myxedema...............................      30
  Note (2): This evaluation shall continue for six months after
   initial diagnosis. Thereafter, rate residuals of disease or
   medical treatment under the most appropriate diagnostic
   code(s) under the appropriate body system (e.g., eye,
   digestive, mental disorders).
  Note (3): If eye involvement, such as exophthalmos, corneal
   ulcer, blurred vision, or diplopia, is also present due to
   thyroid disease, also separately evaluate under the
   appropriate diagnostic code(s) in Sec.   4.79, Schedule of
   Ratings--Eye (such as diplopia (DC 6090) or impairment of
   central visual acuity (DCs 6061-6066)).
7904 Hyperparathyroidism:
  For six months from date of discharge following surgery.......     100
  Note (1): After six months, rate on residuals under the
   appropriate diagnostic code(s) within the appropriate body
   system(s) based on a VA examination.
  Hypercalcemia (indicated by at least one of the following:          60
   Total Ca greater than 12 mg/dL (3-3.5 mmol/L), Ionized Ca
   greater than 5.6 mg/dL (2-2.5 mmol/L), creatinine clearance
   less than 60 mL/min, bone mineral density T-score less than
   2.5 SD (below mean) at any site or previous fragility
   fracture)....................................................
  Note (2): Where surgical intervention is indicated, this
   evaluation shall continue until the day of surgery, at which
   time the provisions pertaining to a 100-percent evaluation
   shall apply.
  Note (3): Where surgical intervention is not indicated, this
   evaluation shall continue for six months after pharmacologic
   treatment begins. After six months, rate on residuals under
   the appropriate diagnostic code(s) within the appropriate
   body system(s) based on a VA examination.
  Symptoms such as fatigue, anorexia, nausea, or constipation         10
   that occur despite surgery; or in individuals who are not
   candidates for surgery but require continuous medication for
   control......................................................
  Asymptomatic..................................................       0
  Note (4): Following surgery or other treatment, evaluate
   chronic residuals, such as nephrolithiasis (kidney stones),
   decreased renal function, fractures, vision problems, and
   cardiovascular complications, under the appropriate
   diagnostic codes.
7905 Hypoparathyroidism:
  For three months after initial diagnosis......................     100
  Thereafter, evaluate chronic residuals, such as
   nephrolithiasis (kidney stones), cataracts, decreased renal
   function, and congestive heart failure under the appropriate
   diagnostic codes.
7906 Thyroiditis:
  With normal thyroid function (euthyroid)......................       0
  Note: Manifesting as hyperthyroidism, evaluate as
   hyperthyroidism, including, but not limited to, Graves'
   disease (DC 7900); manifesting as hypothyroidism, evaluate as
   hypothyroidism (DC 7903).
7907 Cushing's syndrome:
  As active, progressive disease, including areas of                 100
   osteoporosis, hypertension, and proximal upper and lower
   extremity muscle wasting that results in inability to rise
   from squatting position, climb stairs, rise from a deep chair
   without assistance, or raise arms............................

[[Page 484]]

 
  Proximal upper or lower extremity muscle wasting that results       60
   in inability to rise from squatting position, climb stairs,
   rise from a deep chair without assistance, or raise arms.....
  With striae, obesity, moon face, glucose intolerance, and           30
   vascular fragility...........................................
  Note: The evaluations specifically indicated under this
   diagnostic code shall continue for six months following
   initial diagnosis. After six months, rate on residuals under
   the appropriate diagnostic code(s) within the appropriate
   body system(s).
7908 Acromegaly:
  Evidence of increased intracranial pressure (such as visual        100
   field defect), arthropathy, glucose intolerance, and either
   hypertension or cardiomegaly.................................
  Arthropathy, glucose intolerance, and hypertension............      60
  Enlargement of acral parts or overgrowth of long bones........      30
7909 Diabetes insipidus:
  For three months after initial diagnosis......................      30
  Note: Thereafter, if diabetes insipidus has subsided, rate
   residuals under the appropriate diagnostic code(s) within the
   appropriate body system.
  With persistent polyuria or requiring continuous hormonal           10
   therapy......................................................
7911 Addison's disease (adrenocortical insufficiency):
  Four or more crises during the past year......................      60
  Three crises during the past year, or; five or more episodes        40
   during the past year.........................................
  One or two crises during the past year, or; two to four             20
   episodes during the past year, or; weakness and fatigability,
   or; corticosteroid therapy required for control..............
  Note (1): An Addisonian ``crisis'' consists of the rapid onset
   of peripheral vascular collapse (with acute hypotension and
   shock), with findings that may include: anorexia; nausea;
   vomiting; dehydration; profound weakness; pain in abdomen,
   legs, and back; fever; apathy, and depressed mentation with
   possible progression to coma, renal shutdown, and death.
  Note (2): An Addisonian ``episode,'' for VA purposes, is a
   less acute and less severe event than an Addisonian crisis
   and may consist of anorexia, nausea, vomiting, diarrhea,
   dehydration, weakness, malaise, orthostatic hypotension, or
   hypoglycemia, but no peripheral vascular collapse.
  Note (3): Tuberculous Addison's disease will be evaluated as
   active or inactive tuberculosis. If inactive, these
   evaluations are not to be combined with the graduated ratings
   of 50 percent or 30 percent for non-pulmonary tuberculosis
   specified under Sec.   4.88b. Assign the higher rating.
7912 Polyglandular syndrome (multiple endocrine neoplasia,
 autoimmune polyglandular syndrome):
  Evaluate according to major manifestations to include, but not
   limited to, Type I diabetes mellitus, hyperthyroidism,
   hypothyroidism, hypoparathyroidism, or Addison's disease.
7913 Diabetes mellitus:
  Requiring more than one daily injection of insulin, restricted     100
   diet, and regulation of activities (avoidance of strenuous
   occupational and recreational activities) with episodes of
   ketoacidosis or hypoglycemic reactions requiring at least
   three hospitalizations per year or weekly visits to a
   diabetic care provider, plus either progressive loss of
   weight and strength or complications that would be
   compensable if separately evaluated..........................
  Requiring one or more daily injection of insulin, restricted        60
   diet, and regulation of activities with episodes of
   ketoacidosis or hypoglycemic reactions requiring one or two
   hospitalizations per year or twice a month visits to a
   diabetic care provider, plus complications that would not be
   compensable if separately evaluated..........................
  Requiring one or more daily injection of insulin, restricted        40
   diet, and regulation of activities...........................
  Requiring one or more daily injection of insulin and                20
   restricted diet, or; oral hypoglycemic agent and restricted
   diet.........................................................
  Manageable by restricted diet only............................      10
  Note (1): Evaluate compensable complications of diabetes
   separately unless they are part of the criteria used to
   support a 100-percent evaluation. Noncompensable
   complications are considered part of the diabetic process
   under DC 7913.
  Note (2): When diabetes mellitus has been conclusively
   diagnosed, do not request a glucose tolerance test solely for
   rating purposes.
7914 Neoplasm, malignant, any specified part of the endocrine        100
 system
  Note: A rating of 100 percent shall continue beyond the
   cessation of any surgical, X-ray, antineoplastic chemotherapy
   or other therapeutic procedure. Six months after
   discontinuance of such treatment, the appropriate disability
   rating shall be determined by mandatory VA examination. Any
   change in evaluation based upon that or any subsequent
   examination shall be subject to the provisions of Sec.
   3.105(e) of this chapter. If there has been no local
   recurrence or metastasis, rate on residuals.
7915 Neoplasm, benign, any specified part of the endocrine
 system:
  Rate as residuals of endocrine dysfunction.
7916 Hyperpituitarism (prolactin secreting pituitary
 dysfunction):
  Note: Evaluate as malignant or benign neoplasm, as
   appropriate.
7917 Hyperaldosteronism (benign or malignant):
  Note: Evaluate as malignant or benign neoplasm, as
   appropriate.
7918 Pheochromocytoma (benign or malignant):
  Note: Evaluate as malignant or benign neoplasm as appropriate.
7919 C-cell hyperplasia of the thyroid:
  If antineoplastic therapy is required, evaluate as a malignant
   neoplasm under DC 7914. If a prophylactic thyroidectomy is
   performed (based upon genetic testing) and antineoplastic
   therapy is not required, evaluate as hypothyroidism under DC
   7903.
------------------------------------------------------------------------


[61 FR 20446, May 7, 1996, as amended at 82 FR 50804, Nov. 2, 2017]

[[Page 485]]

            Neurological Conditions and Convulsive Disorders



Sec.  4.120  Evaluations by comparison.

    Disability in this field is ordinarily to be rated in proportion to 
the impairment of motor, sensory or mental function. Consider especially 
psychotic manifestations, complete or partial loss of use of one or more 
extremities, speech disturbances, impairment of vision, disturbances of 
gait, tremors, visceral manifestations, injury to the skull, etc. In 
rating disability from the conditions in the preceding sentence refer to 
the appropriate schedule. In rating peripheral nerve injuries and their 
residuals, attention should be given to the site and character of the 
injury, the relative impairment in motor function, trophic changes, or 
sensory disturbances.



Sec.  4.121  Identification of epilepsy.

    When there is doubt as to the true nature of epileptiform attacks, 
neurological observation in a hospital adequate to make such a study is 
necessary. To warrant a rating for epilepsy, the seizures must be 
witnessed or verified at some time by a physician. As to frequency, 
competent, consistent lay testimony emphasizing convulsive and immediate 
post-convulsive characteristics may be accepted. The frequency of 
seizures should be ascertained under the ordinary conditions of life 
(while not hospitalized).



Sec.  4.122  Psychomotor epilepsy.

    The term psychomotor epilepsy refers to a condition that is 
characterized by seizures and not uncommonly by a chronic psychiatric 
disturbance as well.
    (a) Psychomotor seizures consist of episodic alterations in 
conscious control that may be associated with automatic states, 
generalized convulsions, random motor movements (chewing, lip smacking, 
fumbling), hallucinatory phenomena (involving taste, smell, sound, 
vision), perceptual illusions (deja vu, feelings of loneliness, 
strangeness, macropsia, micropsia, dreamy states), alterations in 
thinking (not open to reason), alterations in memory, abnormalities of 
mood or affect (fear, alarm, terror, anger, dread, well-being), and 
autonomic disturbances (sweating, pallor, flushing of the face, visceral 
phenomena such as nausea, vomiting, defecation, a rising feeling of 
warmth in the abdomen). Automatic states or automatisms are 
characterized by episodes of irrational, irrelevant, disjointed, 
unconventional, asocial, purposeless though seemingly coordinated and 
purposeful, confused or inappropriate activity of one to several minutes 
(or, infrequently, hours) duration with subsequent amnesia for the 
seizure. Examples: A person of high social standing remained seated, 
muttered angrily, and rubbed the arms of his chair while the National 
Anthem was being played; an apparently normal person suddenly disrobed 
in public; a man traded an expensive automobile for an antiquated 
automobile in poor mechanical condition and after regaining conscious 
control, discovered that he had signed an agreement to pay an additional 
sum of money in the trade. The seizure manifestations of psychomotor 
epilepsy vary from patient to patient and in the same patient from 
seizure to seizure.
    (b) A chronic mental disorder is not uncommon as an interseizure 
manifestation of psychomotor epilepsy and may include psychiatric 
disturbances extending from minimal anxiety to severe personality 
disorder (as distinguished from developmental) or almost complete 
personality disintegration (psychosis). The manifestations of a chronic 
mental disorder associated with psychomotor epilepsy, like those of the 
seizures, are protean in character.



Sec.  4.123  Neuritis, cranial or peripheral.

    Neuritis, cranial or peripheral, characterized by loss of reflexes, 
muscle atrophy, sensory disturbances, and constant pain, at times 
excruciating, is to be rated on the scale provided for injury of the 
nerve involved, with a maximum equal to severe, incomplete, paralysis. 
See nerve involved for diagnostic code number and rating. The maximum 
rating which may be assigned for neuritis not characterized by organic 
changes referred to in this section will be that for moderate, or with 
sciatic nerve involvement, for moderately severe, incomplete paralysis.

[[Page 486]]



Sec.  4.124  Neuralgia, cranial or peripheral.

    Neuralgia, cranial or peripheral, characterized usually by a dull 
and intermittent pain, of typical distribution so as to identify the 
nerve, is to be rated on the same scale, with a maximum equal to 
moderate incomplete paralysis. See nerve involved for diagnostic code 
number and rating. Tic douloureux, or trifacial neuralgia, may be rated 
up to complete paralysis of the affected nerve.



Sec.  4.124a  Schedule of ratings--neurological conditions and convulsive 
disorders.

[With the exceptions noted, disability from the following diseases and 
their residuals may be rated from 10 percent to 100 percent in 
proportion to the impairment of motor, sensory, or mental function. 
Consider especially psychotic manifestations, complete or partial loss 
of use of one or more extremities, speech disturbances, impairment of 
vision, disturbances of gait, tremors, visceral manifestations, etc., 
referring to the appropriate bodily system of the schedule. With partial 
loss of use of one or more extremities from neurological lesions, rate 
by comparison with the mild, moderate, severe, or complete paralysis of 
peripheral nerves]

             Organic Diseases of the Central Nervous System
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
8000 Encephalitis, epidemic, chronic:
  As active febrile disease.....................................     100
  Rate residuals, minimum.......................................      10
  Brain, new growth of:
8002 Malignant..................................................     100
  Note: The rating in code 8002 will be continued for 2 years
   following cessation of surgical, chemotherapeutic or other
   treatment modality. At this point, if the residuals have
   stabilized, the rating will be made on neurological residuals
   according to symptomatology.
  Minimum rating................................................      30
8003 Benign, minimum............................................      60
  Rate residuals, minimum.......................................      10
8004 Paralysis agitans:
  Minimum rating................................................      30
8005 Bulbar palsy...............................................     100
8007 Brain, vessels, embolism of.
8008 Brain, vessels, thrombosis of.
8009 Brain, vessels, hemorrhage from:
  Rate the vascular conditions under Codes 8007 through 8009,        100
   for 6 months.................................................
  Rate residuals, thereafter, minimum...........................      10
8010 Myelitis:
  Minimum rating................................................      10
8011 Poliomyelitis, anterior:
  As active febrile disease.....................................     100
  Rate residuals, minimum.......................................      10
8012 Hematomyelia:
  For 6 months..................................................     100
  Rate residuals, minimum.......................................      10
8013 Syphilis, cerebrospinal.
8014 Syphilis, meningovascular.
8015 Tabes dorsalis.
  Note: Rate upon the severity of convulsions, paralysis, visual
   impairment or psychotic involvement, etc.
8017 Amyotrophic lateral sclerosis                                   100
  Note: Consider the need for special monthly compensation.
8018 Multiple sclerosis:
  Minimum rating................................................      30
8019 Meningitis, cerebrospinal, epidemic:
  As active febrile disease.....................................     100
  Rate residuals, minimum.......................................      10
8020 Brain, abscess of:
  As active disease.............................................     100
  Rate residuals, minimum.......................................      10
  Spinal cord, new growths of:..................................
8021 Malignant..................................................     100
  Note: The rating in code 8021 will be continued for 2 years
   following cessation of surgical, chemotherapeutic or other
   treatment modality. At this point, if the residuals have
   stabilized, the rating will be made on neurological residuals
   according to symptomatology.
  Minimum rating................................................      30
8022 Benign, minimum rating.....................................      60
  Rate residuals, minimum.......................................      10
8023 Progressive muscular atrophy:
  Minimum rating................................................      30
8024 Syringomyelia:
  Minimum rating................................................      30
8025 Myasthenia gravis:
  Minimum rating................................................      30
  Note: It is required for the minimum ratings for residuals
   under diagnostic codes 8000-8025, that there be ascertainable
   residuals. Determinations as to the presence of residuals not
   capable of objective verification, i.e., headaches,
   dizziness, fatigability, must be approached on the basis of
   the diagnosis recorded; subjective residuals will be accepted
   when consistent with the disease and not more likely
   attributable to other disease or no disease. It is of
   exceptional importance that when ratings in excess of the
   prescribed minimum ratings are assigned, the diagnostic codes
   utilized as bases of evaluation be cited, in addition to the
   codes identifying the diagnoses.
8045 Residuals of traumatic brain injury (TBI):
    There are three main areas of dysfunction that may result
     from TBI and have profound effects on functioning:
     cognitive (which is common in varying degrees after TBI),
     emotional/behavioral, and physical. Each of these areas of
     dysfunction may require evaluation.........................

[[Page 487]]

 
    Cognitive impairment is defined as decreased memory,
     concentration, attention, and executive functions of the
     brain. Executive functions are goal setting, speed of
     information processing, planning, organizing, prioritizing,
     self-monitoring, problem solving, judgment, decision
     making, spontaneity, and flexibility in changing actions
     when they are not productive. Not all of these brain
     functions may be affected in a given individual with
     cognitive impairment, and some functions may be affected
     more severely than others. In a given individual, symptoms
     may fluctuate in severity from day to day. Evaluate
     cognitive impairment under the table titled ``Evaluation of
     Cognitive Impairment and Other Residuals of TBI Not
     Otherwise Classified.''....................................
    Subjective symptoms may be the only residual of TBI or may
     be associated with cognitive impairment or other areas of
     dysfunction. Evaluate subjective symptoms that are
     residuals of TBI, whether or not they are part of cognitive
     impairment, under the subjective symptoms facet in the
     table titled ``Evaluation of Cognitive Impairment and Other
     Residuals of TBI Not Otherwise Classified.'' However,
     separately evaluate any residual with a distinct diagnosis
     that may be evaluated under another diagnostic code, such
     as migraine headache or Meniere's disease, even if that
     diagnosis is based on subjective symptoms, rather than
     under the ``Evaluation of Cognitive Impairment and Other
     Residuals of TBI Not Otherwise Classified'' table..........
    Evaluate emotional/behavioral dysfunction under Sec.   4.130
     (Schedule of ratings--mental disorders) when there is a
     diagnosis of a mental disorder. When there is no diagnosis
     of a mental disorder, evaluate emotional/behavioral
     symptoms under the criteria in the table titled
     ``Evaluation of Cognitive Impairment and Other Residuals of
     TBI Not Otherwise Classified.''............................
    Evaluate physical (including neurological) dysfunction based
     on the following list, under an appropriate diagnostic
     code: Motor and sensory dysfunction, including pain, of the
     extremities and face; visual impairment; hearing loss and
     tinnitus; loss of sense of smell and taste; seizures; gait,
     coordination, and balance problems; speech and other
     communication difficulties, including aphasia and related
     disorders, and dysarthria; neurogenic bladder; neurogenic
     bowel; cranial nerve dysfunctions; autonomic nerve
     dysfunctions; and endocrine dysfunctions...................
    The preceding list of types of physical dysfunction does not
     encompass all possible residuals of TBI. For residuals not
     listed here that are reported on an examination, evaluate
     under the most appropriate diagnostic code. Evaluate each
     condition separately, as long as the same signs and
     symptoms are not used to support more than one evaluation,
     and combine under Sec.   4.25 the evaluations for each
     separately rated condition. The evaluation assigned based
     on the ``Evaluation of Cognitive Impairment and Other
     Residuals of TBI Not Otherwise Classified'' table will be
     considered the evaluation for a single condition for
     purposes of combining with other disability evaluations....
    Consider the need for special monthly compensation for such
     problems as loss of use of an extremity, certain sensory
     impairments, erectile dysfunction, the need for aid and
     attendance (including for protection from hazards or
     dangers incident to the daily environment due to cognitive
     impairment), being housebound, etc.........................
------------------------------------------------------------------------
   Evaluation of Cognitive Impairment and Subjective Symptoms
------------------------------------------------------------------------
The table titled ``Evaluation of Cognitive Impairment and Other
 Residuals of TBI Not Otherwise Classified'' contains 10
 important facets of TBI related to cognitive impairment and
 subjective symptoms. It provides criteria for levels of
 impairment for each facet, as appropriate, ranging from 0 to 3,
 and a 5th level, the highest level of impairment, labeled
 ``total.'' However, not every facet has every level of
 severity. The Consciousness facet, for example, does not
 provide for an impairment level other than ``total,'' since any
 level of impaired consciousness would be totally disabling.
 Assign a 100-percent evaluation if ``total'' is the level of
 evaluation for one or more facets. If no facet is evaluated as
 ``total,'' assign the overall percentage evaluation based on
 the level of the highest facet as follows: 0 = 0 percent; 1 =
 10 percent; 2 = 40 percent; and 3 = 70 percent. For example,
 assign a 70 percent evaluation if 3 is the highest level of
 evaluation for any facet.......................................
    Note (1): There may be an overlap of manifestations of
     conditions evaluated under the table titled ``Evaluation Of
     Cognitive Impairment And Other Residuals Of TBI Not
     Otherwise Classified'' with manifestations of a comorbid
     mental or neurologic or other physical disorder that can be
     separately evaluated under another diagnostic code. In such
     cases, do not assign more than one evaluation based on the
     same manifestations. If the manifestations of two or more
     conditions cannot be clearly separated, assign a single
     evaluation under whichever set of diagnostic criteria
     allows the better assessment of overall impaired
     functioning due to both conditions. However, if the
     manifestations are clearly separable, assign a separate
     evaluation for each condition..............................

[[Page 488]]

 
    Note (2): Symptoms listed as examples at certain evaluation
     levels in the table are only examples and are not symptoms
     that must be present in order to assign a particular
     evaluation.................................................
    Note (3): ``Instrumental activities of daily living'' refers
     to activities other than self-care that are needed for
     independent living, such as meal preparation, doing
     housework and other chores, shopping, traveling, doing
     laundry, being responsible for one's own medications, and
     using a telephone. These activities are distinguished from
     ``Activities of daily living,'' which refers to basic self-
     care and includes bathing or showering, dressing, eating,
     getting in or out of bed or a chair, and using the toilet..
    Note (4): The terms ``mild,'' ``moderate,'' and ``severe''
     TBI, which may appear in medical records, refer to a
     classification of TBI made at, or close to, the time of
     injury rather than to the current level of functioning.
     This classification does not affect the rating assigned
     under diagnostic code 8045.................................
    Note (5): A veteran whose residuals of TBI are rated under a
     version of Sec.   4.124a, diagnostic code 8045, in effect
     before October 23, 2008 may request review under diagnostic
     code 8045, irrespective of whether his or her disability
     has worsened since the last review. VA will review that
     veteran's disability rating to determine whether the
     veteran may be entitled to a higher disability rating under
     diagnostic code 8045. A request for review pursuant to this
     note will be treated as a claim for an increased rating for
     purposes of determining the effective date of an increased
     rating awarded as a result of such review; however, in no
     case will the award be effective before October 23, 2008.
     For the purposes of determining the effective date of an
     increased rating awarded as a result of such review, VA
     will apply 38 CFR 3.114, if applicable.....................
8046 Cerebral arteriosclerosis:
  Purely neurological disabilities, such as hemiplegia, cranial
   nerve paralysis, etc., due to cerebral arteriosclerosis will
   be rated under the diagnostic codes dealing with such
   specific disabilities, with citation of a hyphenated
   diagnostic code (e.g., 8046-8207).
  Purely subjective complaints such as headache, dizziness,
   tinnitus, insomnia and irritability, recognized as
   symptomatic of a properly diagnosed cerebral
   arteriosclerosis, will be rated 10 percent and no more under
   diagnostic code 9305. This 10 percent rating will not be
   combined with any other rating for a disability due to
   cerebral or generalized arteriosclerosis. Ratings in excess
   of 10 percent for cerebral arteriosclerosis under diagnostic
   code 9305 are not assignable in the absence of a diagnosis of
   multi-infarct dementia with cerebral arteriosclerosis.
  Note: The ratings under code 8046 apply only when the
   diagnosis of cerebral arteriosclerosis is substantiated by
   the entire clinical picture and not solely on findings of
   retinal arteriosclerosis.
------------------------------------------------------------------------


    Evaluation of Cognitive Impairment and Other Residuals of TBI Not
                          Otherwise Classified
------------------------------------------------------------------------
 Facets of cognitive impairment and
other residuals of TBI not otherwise   Level of          Criteria
             classified               impairment
------------------------------------------------------------------------
Memory, attention, concentration,            0    No complaints of
 executive functions.                              impairment of memory,
                                                   attention,
                                                   concentration, or
                                                   executive functions.
                                             1    A complaint of mild
                                                   loss of memory (such
                                                   as having difficulty
                                                   following a
                                                   conversation,
                                                   recalling recent
                                                   conversations,
                                                   remembering names of
                                                   new acquaintances, or
                                                   finding words, or
                                                   often misplacing
                                                   items), attention,
                                                   concentration, or
                                                   executive functions,
                                                   but without objective
                                                   evidence on testing.
                                             2    Objective evidence on
                                                   testing of mild
                                                   impairment of memory,
                                                   attention,
                                                   concentration, or
                                                   executive functions
                                                   resulting in mild
                                                   functional
                                                   impairment.
                                             3    Objective evidence on
                                                   testing of moderate
                                                   impairment of memory,
                                                   attention,
                                                   concentration, or
                                                   executive functions
                                                   resulting in moderate
                                                   functional
                                                   impairment.

[[Page 489]]

 
                                         Total    Objective evidence on
                                                   testing of severe
                                                   impairment of memory,
                                                   attention,
                                                   concentration, or
                                                   executive functions
                                                   resulting in severe
                                                   functional
                                                   impairment.
Judgment............................         0    Normal.
                                             1    Mildly impaired
                                                   judgment. For complex
                                                   or unfamiliar
                                                   decisions,
                                                   occasionally unable
                                                   to identify,
                                                   understand, and weigh
                                                   the alternatives,
                                                   understand the
                                                   consequences of
                                                   choices, and make a
                                                   reasonable decision.
                                             2    Moderately impaired
                                                   judgment. For complex
                                                   or unfamiliar
                                                   decisions, usually
                                                   unable to identify,
                                                   understand, and weigh
                                                   the alternatives,
                                                   understand the
                                                   consequences of
                                                   choices, and make a
                                                   reasonable decision,
                                                   although has little
                                                   difficulty with
                                                   simple decisions.
                                             3    Moderately severely
                                                   impaired judgment.
                                                   For even routine and
                                                   familiar decisions,
                                                   occasionally unable
                                                   to identify,
                                                   understand, and weigh
                                                   the alternatives,
                                                   understand the
                                                   consequences of
                                                   choices, and make a
                                                   reasonable decision.
                                         Total    Severely impaired
                                                   judgment. For even
                                                   routine and familiar
                                                   decisions, usually
                                                   unable to identify,
                                                   understand, and weigh
                                                   the alternatives,
                                                   understand the
                                                   consequences of
                                                   choices, and make a
                                                   reasonable decision.
                                                   For example, unable
                                                   to determine
                                                   appropriate clothing
                                                   for current weather
                                                   conditions or judge
                                                   when to avoid
                                                   dangerous situations
                                                   or activities.
Social interaction..................         0    Social interaction is
                                                   routinely
                                                   appropriate.
                                             1    Social interaction is
                                                   occasionally
                                                   inappropriate.
                                             2    Social interaction is
                                                   frequently
                                                   inappropriate.
                                             3    Social interaction is
                                                   inappropriate most or
                                                   all of the time.
Orientation.........................         0    Always oriented to
                                                   person, time, place,
                                                   and situation.
                                             1    Occasionally
                                                   disoriented to one of
                                                   the four aspects
                                                   (person, time, place,
                                                   situation) of
                                                   orientation.
                                             2    Occasionally
                                                   disoriented to two of
                                                   the four aspects
                                                   (person, time, place,
                                                   situation) of
                                                   orientation or often
                                                   disoriented to one
                                                   aspect of
                                                   orientation.
                                             3    Often disoriented to
                                                   two or more of the
                                                   four aspects (person,
                                                   time, place,
                                                   situation) of
                                                   orientation.
                                         Total    Consistently
                                                   disoriented to two or
                                                   more of the four
                                                   aspects (person,
                                                   time, place,
                                                   situation) of
                                                   orientation.
Motor activity (with intact motor            0    Motor activity normal.
 and sensory system).
                                             1    Motor activity normal
                                                   most of the time, but
                                                   mildly slowed at
                                                   times due to apraxia
                                                   (inability to perform
                                                   previously learned
                                                   motor activities,
                                                   despite normal motor
                                                   function).
                                             2    Motor activity mildly
                                                   decreased or with
                                                   moderate slowing due
                                                   to apraxia.
                                             3    Motor activity
                                                   moderately decreased
                                                   due to apraxia.
                                         Total    Motor activity
                                                   severely decreased
                                                   due to apraxia.
Visual spatial orientation..........         0    Normal.
                                             1    Mildly impaired.
                                                   Occasionally gets
                                                   lost in unfamiliar
                                                   surroundings, has
                                                   difficulty reading
                                                   maps or following
                                                   directions. Is able
                                                   to use assistive
                                                   devices such as GPS
                                                   (global positioning
                                                   system).

[[Page 490]]

 
                                             2    Moderately impaired.
                                                   Usually gets lost in
                                                   unfamiliar
                                                   surroundings, has
                                                   difficulty reading
                                                   maps, following
                                                   directions, and
                                                   judging distance. Has
                                                   difficulty using
                                                   assistive devices
                                                   such as GPS (global
                                                   positioning system).
                                             3    Moderately severely
                                                   impaired. Gets lost
                                                   even in familiar
                                                   surroundings, unable
                                                   to use assistive
                                                   devices such as GPS
                                                   (global positioning
                                                   system).
                                         Total    Severely impaired. May
                                                   be unable to touch or
                                                   name own body parts
                                                   when asked by the
                                                   examiner, identify
                                                   the relative position
                                                   in space of two
                                                   different objects, or
                                                   find the way from one
                                                   room to another in a
                                                   familiar environment.
Subjective symptoms.................         0    Subjective symptoms
                                                   that do not interfere
                                                   with work;
                                                   instrumental
                                                   activities of daily
                                                   living; or work,
                                                   family, or other
                                                   close relationships.
                                                   Examples are: mild or
                                                   occasional headaches,
                                                   mild anxiety.
                                             1    Three or more
                                                   subjective symptoms
                                                   that mildly interfere
                                                   with work;
                                                   instrumental
                                                   activities of daily
                                                   living; or work,
                                                   family, or other
                                                   close relationships.
                                                   Examples of findings
                                                   that might be seen at
                                                   this level of
                                                   impairment are:
                                                   intermittent
                                                   dizziness, daily mild
                                                   to moderate
                                                   headaches, tinnitus,
                                                   frequent insomnia,
                                                   hypersensitivity to
                                                   sound,
                                                   hypersensitivity to
                                                   light.
                                             2    Three or more
                                                   subjective symptoms
                                                   that moderately
                                                   interfere with work;
                                                   instrumental
                                                   activities of daily
                                                   living; or work,
                                                   family, or other
                                                   close relationships.
                                                   Examples of findings
                                                   that might be seen at
                                                   this level of
                                                   impairment are:
                                                   marked fatigability,
                                                   blurred or double
                                                   vision, headaches
                                                   requiring rest
                                                   periods during most
                                                   days.
Neurobehavioral effects.............         0    One or more
                                                   neurobehavioral
                                                   effects that do not
                                                   interfere with
                                                   workplace interaction
                                                   or social
                                                   interaction. Examples
                                                   of neurobehavioral
                                                   effects are:
                                                   Irritability,
                                                   impulsivity,
                                                   unpredictability,
                                                   lack of motivation,
                                                   verbal aggression,
                                                   physical aggression,
                                                   belligerence, apathy,
                                                   lack of empathy,
                                                   moodiness, lack of
                                                   cooperation,
                                                   inflexibility, and
                                                   impaired awareness of
                                                   disability. Any of
                                                   these effects may
                                                   range from slight to
                                                   severe, although
                                                   verbal and physical
                                                   aggression are likely
                                                   to have a more
                                                   serious impact on
                                                   workplace interaction
                                                   and social
                                                   interaction than some
                                                   of the other effects.
                                             1    One or more
                                                   neurobehavioral
                                                   effects that
                                                   occasionally
                                                   interfere with
                                                   workplace
                                                   interaction, social
                                                   interaction, or both
                                                   but do not preclude
                                                   them.
                                             2    One or more
                                                   neurobehavioral
                                                   effects that
                                                   frequently interfere
                                                   with workplace
                                                   interaction, social
                                                   interaction, or both
                                                   but do not preclude
                                                   them.

[[Page 491]]

 
                                             3    One or more
                                                   neurobehavioral
                                                   effects that
                                                   interfere with or
                                                   preclude workplace
                                                   interaction, social
                                                   interaction, or both
                                                   on most days or that
                                                   occasionally require
                                                   supervision for
                                                   safety of self or
                                                   others.
Communication.......................         0    Able to communicate by
                                                   spoken and written
                                                   language (expressive
                                                   communication), and
                                                   to comprehend spoken
                                                   and written language.
                                             1    Comprehension or
                                                   expression, or both,
                                                   of either spoken
                                                   language or written
                                                   language is only
                                                   occasionally
                                                   impaired. Can
                                                   communicate complex
                                                   ideas.
                                             2    Inability to
                                                   communicate either by
                                                   spoken language,
                                                   written language, or
                                                   both, more than
                                                   occasionally but less
                                                   than half of the
                                                   time, or to
                                                   comprehend spoken
                                                   language, written
                                                   language, or both,
                                                   more than
                                                   occasionally but less
                                                   than half of the
                                                   time. Can generally
                                                   communicate complex
                                                   ideas.
                                             3    Inability to
                                                   communicate either by
                                                   spoken language,
                                                   written language, or
                                                   both, at least half
                                                   of the time but not
                                                   all of the time, or
                                                   to comprehend spoken
                                                   language, written
                                                   language, or both, at
                                                   least half of the
                                                   time but not all of
                                                   the time. May rely on
                                                   gestures or other
                                                   alternative modes of
                                                   communication. Able
                                                   to communicate basic
                                                   needs.
                                         Total    Complete inability to
                                                   communicate either by
                                                   spoken language,
                                                   written language, or
                                                   both, or to
                                                   comprehend spoken
                                                   language, written
                                                   language, or both.
                                                   Unable to communicate
                                                   basic needs.
Consciousness.......................     Total    Persistently altered
                                                   state of
                                                   consciousness, such
                                                   as vegetative state,
                                                   minimally responsive
                                                   state, coma.
------------------------------------------------------------------------


                         Miscellaneous Diseases
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
8100 Migraine:
  With very frequent completely prostrating and prolonged             50
   attacks productive of severe economic inadaptability.........
  With characteristic prostrating attacks occurring on an             30
   average once a month over last several months................
  With characteristic prostrating attacks averaging one in 2          10
   months over last several months..............................
  With less frequent attacks....................................       0
8103 Tic, convulsive:
  Severe........................................................      30
  Moderate......................................................      10
  Mild..........................................................       0
  Note: Depending upon frequency, severity, muscle groups
   involved.
8104 Paramyoclonus multiplex (convulsive state, myoclonic type):
  Rate as tic; convulsive; severe cases.........................      60
8105 Chorea, Sydenham's:
  Pronounced, progressive grave types...........................     100
  Severe........................................................      80
  Moderately severe.............................................      50
  Moderate......................................................      30
  Mild..........................................................      10
  Note: Consider rheumatic etiology and complications.
8106 Chorea, Huntington's.
  Rate as Sydenham's chorea. This, though a familial disease,
   has its onset in late adult life, and is considered a ratable
   disability.
8107 Athetosis, acquired.
  Rate as chorea.
8108 Narcolepsy.
  Rate as for epilepsy, petit mal.
------------------------------------------------------------------------


                     Diseases of the Cranial Nerves
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
  Disability from lesions of peripheral portions of first,
   second, third, fourth, sixth, and eighth nerves will be rated
   under the Organs of Special Sense. The ratings for the
   cranial nerves are for unilateral involvement; when
   bilateral, combine but without the bilateral factor.
  Fifth (trigeminal) cranial nerve
8205 Paralysis of:
  Complete......................................................      50
  Incomplete, severe............................................      30
  Incomplete, moderate..........................................      10

[[Page 492]]

 
  Note: Dependent upon relative degree of sensory manifestation
   or motor loss.
8305 Neuritis.
8405 Neuralgia.
  Note: Tic douloureux may be rated in accordance with severity,
   up to complete paralysis.
  Seventh (facial) cranial nerve
8207 Paralysis of:
    Complete....................................................      30
    Incomplete, severe..........................................      20
    Incomplete, moderate........................................      10
  Note: Dependent upon relative loss of innervation of facial
   muscles.
8307 Neuritis.
8407 Neuralgia.
  Ninth (glossopharyngeal) cranial nerve........................
8209 Paralysis of:
  Complete......................................................      30
  Incomplete, severe............................................      20
  Incomplete, moderate..........................................      10
  Note: Dependent upon relative loss of ordinary sensation in
   mucous membrane of the pharynx, fauces, and tonsils.
8309 Neuritis.
8409 Neuralgia.
  Tenth (pneumogastric, vagus) cranial nerve....................
8210 Paralysis of:
  Complete......................................................      50
  Incomplete, severe............................................      30
  Incomplete, moderate..........................................      10
  Note : Dependent upon extent of sensory and motor loss to
   organs of voice, respiration, pharynx, stomach and heart.
8310 Neuritis.
8410 Neuralgia.
  Eleventh (spinal accessory, external branch) cranial nerve.
8211 Paralysis of:
  Complete......................................................      30
  Incomplete, severe............................................      20
  Incomplete, moderate..........................................      10
  Note: Dependent upon loss of motor function of sternomastoid
   and trapezius muscles.
8311 Neuritis.
8411 Neuralgia.
  Twelfth (hypoglossal) cranial nerve.
8212 Paralysis of:
  Complete......................................................      50
  Incomplete, severe............................................      30
  Incomplete, moderate..........................................      10
  Note: Dependent upon loss of motor function of tongue.
8312 Neuritis.
8412 Neuralgia.
------------------------------------------------------------------------


                    Diseases of the Peripheral Nerves
------------------------------------------------------------------------
                                                             Rating
                  Schedule of ratings                  -----------------
                                                         Major    Minor
------------------------------------------------------------------------
The term ``incomplete paralysis,'' with this and other
 peripheral nerve injuries, indicates a degree of lost
 or impaired function substantially less than the type
 picture for complete paralysis given with each nerve,
 whether due to varied level of the nerve lesion or to
 partial regeneration. When the involvement is wholly
 sensory, the rating should be for the mild, or at
 most, the moderate degree. The ratings for the
 peripheral nerves are for unilateral involvement;
 when bilateral, combine with application of the
 bilateral factor.
   Upper radicular group (fifth and sixth cervicals)
 
8510 Paralysis of:
  Complete; all shoulder and elbow movements lost or         70       60
   severely affected, hand and wrist movements not
   affected...........................................
  Incomplete:
    Severe............................................       50       40
    Moderate..........................................       40       30
    Mild..............................................       20       20
8610 Neuritis.
8710 Neuralgia.
 
                Middle radicular group
 
8511 Paralysis of:
  Complete; adduction, abduction and rotation of arm,        70       60
   flexion of elbow, and extension of wrist lost or
   severely affected..................................
  Incomplete:
    Severe............................................       50       40
    Moderate..........................................       40       30
    Mild..............................................       20       20
8611 Neuritis.
8711 Neuralgia.
 
                 Lower radicular group
 
8512 Paralysis of:
  Complete; all intrinsic muscles of hand, and some or       70       60
   all of flexors of wrist and fingers, paralyzed
   (substantial loss of use of hand)..................
  Incomplete:
    Severe............................................       50       40
    Moderate..........................................       40       30
    Mild..............................................       20       20
8612 Neuritis.
8712 Neuralgia.
 
                 All radicular groups
 
8513 Paralysis of:
  Complete............................................       90       80
  Incomplete:
    Severe............................................       70       60
    Moderate..........................................       40       30
    Mild..............................................       20       20

[[Page 493]]

 
8613 Neuritis.
8713 Neuralgia.
 
        The musculospiral nerve (radial nerve)
 
8514 Paralysis of:
  Complete; drop of hand and fingers, wrist and              70       60
   fingers perpetually flexed, the thumb adducted
   falling within the line of the outer border of the
   index finger; can not extend hand at wrist, extend
   proximal phalanges of fingers, extend thumb, or
   make lateral movement of wrist; supination of hand,
   extension and flexion of elbow weakened, the loss
   of synergic motion of extensors impairs the hand
   grip seriously; total paralysis of the triceps
   occurs only as the greatest rarity.................
  Incomplete:
    Severe............................................       50       40
    Moderate..........................................       30       20
    Mild..............................................       20       20
8614 Neuritis.
8714 Neuralgia.
 
  Note: Lesions involving only ``dissociation of extensor communis
   digitorum'' and ``paralysis below the extensor communis digitorum,''
   will not exceed the moderate rating under code 8514.
 
                   The median nerve
 
8515 Paralysis of:
  Complete; the hand inclined to the ulnar side, the         70       60
   index and middle fingers more extended than
   normally, considerable atrophy of the muscles of
   the thenar eminence, the thumb in the plane of the
   hand (ape hand); pronation incomplete and
   defective, absence of flexion of index finger and
   feeble flexion of middle finger, cannot make a
   fist, index and middle fingers remain extended;
   cannot flex distal phalanx of thumb, defective
   opposition and abduction of the thumb, at right
   angles to palm; flexion of wrist weakened; pain
   with trophic disturbances..........................
  Incomplete:
    Severe............................................       50       40
    Moderate..........................................       30       20
    Mild..............................................       10       10
8615 Neuritis.
8715 Neuralgia.
 
                    The ulnar nerve
 
8516 Paralysis of:
  Complete; the ``griffin claw'' deformity, due to           60       50
   flexor contraction of ring and little fingers,
   atrophy very marked in dorsal interspace and thenar
   and hypothenar eminences; loss of extension of ring
   and little fingers cannot spread the fingers (or
   reverse), cannot adduct the thumb; flexion of wrist
   weakened...........................................
  Incomplete:
    Severe............................................       40       30
    Moderate..........................................       30       20
    Mild..............................................       10       10
8616 Neuritis.
8716 Neuralgia.
 
                Musculocutaneous nerve
 
8517 Paralysis of:
  Complete; weakness but not loss of flexion of elbow        30       20
   and supination of forearm..........................
  Incomplete:
    Severe............................................       20       20
    Moderate..........................................       10       10
    Mild..............................................        0        0
8617 Neuritis.
8717 Neuralgia.
 
                   Circumflex nerve
 
8518 Paralysis of:
  Complete; abduction of arm is impossible, outward          50       40
   rotation is weakened; muscles supplied are deltoid
   and teres minor....................................
  Incomplete:
    Severe............................................       30       20
    Moderate..........................................       10       10
    Mild..............................................        0        0
8618 Neuritis.
8718 Neuralgia.
 
                  Long thoracic nerve
 
8519 Paralysis of:
  Complete; inability to raise arm above shoulder            30       20
   level, winged scapula deformity....................
  Incomplete:
    Severe............................................       20       20
    Moderate..........................................       10       10
    Mild..............................................        0        0
 
  Note: Not to be combined with lost motion above shoulder level.
 
8619 Neuritis.
8719 Neuralgia.
 
  Note: Combined nerve injuries should be rated by reference to the
   major involvement, or if sufficient in extent, consider radicular
   group ratings.
------------------------------------------------------------------------


------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
                         Sciatic nerve
 
8520 Paralysis of:
  Complete; the foot dangles and drops, no active movement            80
   possible of muscles below the knee, flexion of knee weakened
   or (very rarely) lost.......................................
  Incomplete:
    Severe, with marked muscular atrophy.......................       60
    Moderately severe..........................................       40
    Moderate...................................................       20
    Mild.......................................................       10

[[Page 494]]

 
8620 Neuritis.
8720 Neuralgia.
 
           External popliteal nerve (common peroneal)
 
8521 Paralysis of:
  Complete; foot drop and slight droop of first phalanges of          40
   all toes, cannot dorsiflex the foot, extension (dorsal
   flexion) of proximal phalanges of toes lost; abduction of
   foot lost, adduction weakened; anesthesia covers entire
   dorsum of foot and toes.....................................
  Incomplete:
    Severe.....................................................       30
    Moderate...................................................       20
    Mild.......................................................       10
8621 Neuritis.
8721 Neuralgia.
 
         Musculocutaneous nerve (superficial peroneal)
 
8522 Paralysis of:
  Complete; eversion of foot weakened..........................       30
  Incomplete:
    Severe.....................................................       20
    Moderate...................................................       10
    Mild.......................................................        0
8622 Neuritis.
8722 Neuralgia.
 
             Anterior tibial nerve (deep peroneal)
 
8523 Paralysis of:
  Complete; dorsal flexion of foot lost........................       30
  Incomplete:
    Severe.....................................................       20
    Moderate...................................................       10
    Mild.......................................................        0
8623 Neuritis.
8723 Neuralgia.
 
               Internal popliteal nerve (tibial)
 
8524 Paralysis of:
  Complete; plantar flexion lost, frank adduction of foot             40
   impossible, flexion and separation of toes abolished; no
   muscle in sole can move; in lesions of the nerve high in
   popliteal fossa, plantar flexion of foot is lost............
  Incomplete:
    Severe.....................................................       30
    Moderate...................................................       20
    Mild.......................................................       10
8624 Neuritis.
8724 Neuralgia.
 
                     Posterior tibial nerve
 
8525 Paralysis of:
  Complete; paralysis of all muscles of sole of foot,                 30
   frequently with painful paralysis of a causalgic nature;
   toes cannot be flexed; adduction is weakened; plantar
   flexion is impaired.........................................
  Incomplete:
    Severe.....................................................       20
    Moderate...................................................       10
    Mild.......................................................       10
8625 Neuritis.
8725 Neuralgia.
 
                Anterior crural nerve (femoral)
 
8526 Paralysis of:
  Complete; paralysis of quadriceps extensor muscles...........       40
  Incomplete:
    Severe.....................................................       30
    Moderate...................................................       20
    Mild.......................................................       10
8626 Neuritis.
8726 Neuralgia.
 
                    Internal saphenous nerve
 
8527 Paralysis of:
  Severe to complete...........................................       10
  Mild to moderate.............................................        0
8627 Neuritis.
8727 Neuralgia.
 
                        Obturator nerve
 
8528 Paralysis of:
  Severe to complete...........................................       10
  Mild or moderate.............................................        0
8628 Neuritis.
8728 Neuralgia.
 
               External cutaneous nerve of thigh
 
8529 Paralysis of:
  Severe to complete...........................................       10
  Mild or moderate.............................................        0
8629 Neuritis.
8729 Neuralgia.
 
                      Ilio-inguinal nerve
 
8530 Paralysis of:
  Severe to complete...........................................       10
  Mild or moderate.............................................        0
8630 Neuritis.
8730 Neuralgia.
8540 Soft-tissue sarcoma (of neurogenic origin)................      100
 
  Note: The 100 percent rating will be continued for 6 months following
   the cessation of surgical, X-ray, antineoplastic chemotherapy or
   other therapeutic procedure. At this point, if there has been no
   local recurrence or metastases, the rating will be made on residuals.
------------------------------------------------------------------------


                             The Epilepsies
------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
  A thorough study of all material in Sec.  Sec.   4.121 and
   4.122 of the preface and under the ratings for epilepsy is
   necessary prior to any rating action.
8910 Epilepsy, grand mal.
  Rate under the general rating formula for major seizures.
8911 Epilepsy, petit mal.

[[Page 495]]

 
  Rate under the general rating formula for minor seizures.
  Note (1): A major seizure is characterized by the generalized
   tonic-clonic convulsion with unconsciousness.
  Note (2): A minor seizure consists of a brief interruption in
   consciousness or conscious control associated with staring or
   rhythmic blinking of the eyes or nodding of the head
   (``pure'' petit mal), or sudden jerking movements of the
   arms, trunk, or head (myoclonic type) or sudden loss of
   postural control (akinetic type).
  General Rating Formula for Major and Minor Epileptic Seizures:
    Averaging at least 1 major seizure per month over the last       100
     year.......................................................
    Averaging at least 1 major seizure in 3 months over the last      80
     year; or more than 10 minor seizures weekly................
    Averaging at least 1 major seizure in 4 months over the last      60
     year; or 9-10 minor seizures per week......................
    At least 1 major seizure in the last 6 months or 2 in the         40
     last year; or averaging at least 5 to 8 minor seizures
     weekly.....................................................
    At least 1 major seizure in the last 2 years; or at least 2       20
     minor seizures in the last 6 months........................
    A confirmed diagnosis of epilepsy with a history of seizures      10
  Note (1): When continuous medication is shown necessary for
   the control of epilepsy, the minimum evaluation will be 10
   percent. This rating will not be combined with any other
   rating for epilepsy.
  Note (2): In the presence of major and minor seizures, rate
   the predominating type.
  Note (3): There will be no distinction between diurnal and
   nocturnal major seizures.
8912 Epilepsy, Jacksonian and focal motor or sensory.
8913 Epilepsy, diencephalic.
  Rate as minor seizures, except in the presence of major and
   minor seizures, rate the predominating type.
8914 Epilepsy, psychomotor.
  Major seizures:
    Psychomotor seizures will be rated as major seizures under
     the general rating formula when characterized by automatic
     states and/or generalized convulsions with unconsciousness.
  Minor seizures:
    Psychomotor seizures will be rated as minor seizures under
     the general rating formula when characterized by brief
     transient episodes of random motor movements,
     hallucinations, perceptual illusions, abnormalities of
     thinking, memory or mood, or autonomic disturbances.
------------------------------------------------------------------------
Mental Disorders in Epilepsies: A nonpsychotic organic brain syndrome
  will be rated separately under the appropriate diagnostic code (e.g.,
  9304 or 9326). In the absence of a diagnosis of non-psychotic organic
  psychiatric disturbance (psychotic, psychoneurotic or personality
  disorder) if diagnosed and shown to be secondary to or directly
  associated with epilepsy will be rated separately. The psychotic or
  psychroneurotic disorder will be rated under the appropriate
  diagnostic code. The personality disorder will be rated as a dementia
  (e.g., diagnostic code 9304 or 9326).
Epilepsy and Unemployability: (1) Rating specialists must bear in mind
  that the epileptic, although his or her seizures are controlled, may
  find employment and rehabilitation difficult of attainment due to
  employer reluctance to the hiring of the epileptic.
(2) Where a case is encountered with a definite history of unemployment,
  full and complete development should be undertaken to ascertain
  whether the epilepsy is the determining factor in his or her inability
  to obtain employment.
(3) The assent of the claimant should first be obtained for permission
  to conduct this economic and social survey. The purpose of this survey
  is to secure all the relevant facts and data necessary to permit of a
  true judgment as to the reason for his or her unemployment and should
  include information as to:
(a) Education;
(b) Occupations prior and subsequent to service;
(c) Places of employment and reasons for termination;
(d) Wages received;
(e) Number of seizures.
(4) Upon completion of this survey and current examination, the case
  should have rating board consideration. Where in the judgment of the
  rating board the veteran's unemployability is due to epilepsy and
  jurisdiction is not vested in that body by reason of schedular
  evaluations, the case should be submitted to the Compensation Service
  or the Director, Pension and Fiduciary Service.


(Authority: 38 U.S.C. 1155)

[29 FR 6718, May 22, 1964, as amended at 40 FR 42540, Sept. 15, 1975; 41 
FR 11302, Mar. 18, 1976; 43 FR 45362, Oct. 2, 1978; 54 FR 4282, Jan. 30, 
1989; 54 FR 49755, Dec. 1, 1989; 55 FR 154, Jan. 3, 1990; 56 FR 51653, 
Oct. 15, 1991; 57 FR 24364, June 9, 1992; 70 FR 75399, Dec. 20, 2005; 73 
FR 54705, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 76 FR 78824, Dec. 
20, 2011; 79 FR 2100, Jan. 13, 2014]

                            Mental Disorders



Sec.  4.125  Diagnosis of mental disorders.

    (a) If the diagnosis of a mental disorder does not conform to DSM-5 
or is not supported by the findings on the examination report, the 
rating agency shall return the report to the examiner to substantiate 
the diagnosis. Diagnostic and Statistical Manual of Mental Disorders, 
Fifth Edition (DSM-5), American Psychiatric Association (2013), is 
incorporated by reference into this section with the approval of the 
Director of the Federal Register under 5 U.S.C. 552(a) and 1 CFR part 
51. To enforce any edition other than that specified in this section, 
the Department of Veterans Affairs must publish notice of change in the 
Federal Register and the material must be available to the public. All 
approved material is available from the American Psychiatric 
Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-
3901, 703-907-7300, http://www.dsm5.org. It is also available for 
inspection at the Office of Regulation Policy and Management, Department 
of Veterans Affairs, 810 Vermont Avenue NW., Room 1068,

[[Page 496]]

Washington, DC 20420. It is also available for inspection at the 
National Archives and Records Administration (NARA). For information on 
the availability of this information at NARA, call 202-741-6030 or go to 
http://www.archives.gov/federal_register/code_of_federal_regulations/
ibr_publications.html.
    (b) If the diagnosis of a mental disorder is changed, the rating 
agency shall determine whether the new diagnosis represents progression 
of the prior diagnosis, correction of an error in the prior diagnosis, 
or development of a new and separate condition. If it is not clear from 
the available records what the change of diagnosis represents, the 
rating agency shall return the report to the examiner for a 
determination.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996, as amended at 79 FR 45099, Aug. 4, 2014]



Sec.  4.126  Evaluation of disability from mental disorders.

    (a) When evaluating a mental disorder, the rating agency shall 
consider the frequency, severity, and duration of psychiatric symptoms, 
the length of remissions, and the veteran's capacity for adjustment 
during periods of remission. The rating agency shall assign an 
evaluation based on all the evidence of record that bears on 
occupational and social impairment rather than solely on the examiner's 
assessment of the level of disability at the moment of the examination.
    (b) When evaluating the level of disability from a mental disorder, 
the rating agency will consider the extent of social impairment, but 
shall not assign an evaluation solely on the basis of social impairment.
    (c) Neurocognitive disorders shall be evaluated under the general 
rating formula for mental disorders; neurologic deficits or other 
impairments stemming from the same etiology (e.g., a head injury) shall 
be evaluated separately and combined with the evaluation for 
neurocognitive disorders (see Sec.  4.25).
    (d) When a single disability has been diagnosed both as a physical 
condition and as a mental disorder, the rating agency shall evaluate it 
using a diagnostic code which represents the dominant (more disabling) 
aspect of the condition (see Sec.  4.14).

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996, as amended at 79 FR 45099, Aug. 4, 2014]



Sec.  4.127  Intellectual disability (intellectual developmental disorder)
and personality disorders.

    Intellectual disability (intellectual developmental disorder) and 
personality disorders are not diseases or injuries for compensation 
purposes, and, except as provided in Sec.  3.310(a) of this chapter, 
disability resulting from them may not be service-connected. However, 
disability resulting from a mental disorder that is superimposed upon 
intellectual disability (intellectual developmental disorder) or a 
personality disorder may be service-connected.

(Authority: 38 U.S.C. 1155)

[79 FR 45100, Aug. 4, 2014]



Sec.  4.128  Convalescence ratings following extended hospitalization.

    If a mental disorder has been assigned a total evaluation due to a 
continuous period of hospitalization lasting six months or more, the 
rating agency shall continue the total evaluation indefinitely and 
schedule a mandatory examination six months after the veteran is 
discharged or released to nonbed care. A change in evaluation based on 
that or any subsequent examination shall be subject to the provisions of 
Sec.  3.105(e) of this chapter.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]



Sec.  4.129  Mental disorders due to traumatic stress.

    When a mental disorder that develops in service as a result of a 
highly stressful event is severe enough to bring about the veteran's 
release from active military service, the rating agency shall assign an 
evaluation of not less than 50 percent and schedule an examination 
within the six month period

[[Page 497]]

following the veteran's discharge to determine whether a change in 
evaluation is warranted.

(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]



Sec.  4.130  Schedule of ratings--Mental disorders.

    The nomenclature employed in this portion of the rating schedule is 
based upon the American Psychiatric Association's Diagnostic and 
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (see Sec.  
4.125 for availability information). Rating agencies must be thoroughly 
familiar with this manual to properly implement the directives in Sec.  
4.125 through Sec.  4.129 and to apply the general rating formula for 
mental disorders in Sec.  4.130. The schedule for rating for mental 
disorders is set forth as follows:

9201 Schizophrenia
9202 [Removed]
9203 [Removed]
9204 [Removed]
9205 [Removed]
9208 Delusional disorder
9210 Other specified and unspecified schizophrenia spectrum and other 
          psychotic disorders
9211 Schizoaffective disorder
9300 Delirium
9301 Major or mild neurocognitive disorder due to HIV or other 
          infections
9304 Major or mild neurocognitive disorder due to traumatic brain injury
9305 Major or mild vascular neurocognitive disorder
9310 Unspecified neurocognitive disorder
9312 Major or mild neurocognitive disorder due to Alzheimer's disease
9326 Major or mild neurocognitive disorder due to another medical 
          condition or substance/medication-induced major or mild 
          neurocognitive disorder
9327 [Removed]
9400 Generalized anxiety disorder
9403 Specific phobia; social anxiety disorder (social phobia)
9404 Obsessive compulsive disorder
9410 Other specified anxiety disorder
9411 Posttraumatic stress disorder
9412 Panic disorder and/or agoraphobia
9413 Unspecified anxiety disorder
9416 Dissociative amnesia; dissociative identity disorder
9417 Depersonalization/Derealization disorder
9421 Somatic symptom disorder
9422 Other specified somatic symptom and related disorder
9423 Unspecified somatic symptom and related disorder
9424 Conversion disorder (functional neurological symptom disorder)
9425 Illness anxiety disorder
9431 Cyclothymic disorder
9432 Bipolar disorder
9433 Persistent depressive disorder (dysthymia)
9434 Major depressive disorder
9435 Unspecified depressive disorder
9440 Chronic adjustment disorder


               General Rating Formula for Mental Disorders
------------------------------------------------------------------------
                                                                 Rating
------------------------------------------------------------------------
Total occupational and social impairment, due to such                100
 symptoms as: gross impairment in thought processes or
 communication; persistent delusions or hallucinations;
 grossly inappropriate behavior; persistent danger of hurting
 self or others; intermittent inability to perform activities
 of daily living (including maintenance of minimal personal
 hygiene); disorientation to time or place; memory loss for
 names of close relatives, own occupation, or own name.
Occupational and social impairment, with deficiencies in most         70
 areas, such as work, school, family relations, judgment,
 thinking, or mood, due to such symptoms as: suicidal
 ideation; obsessional rituals which interfere with routine
 activities; speech intermittently illogical, obscure, or
 irrelevant; near-continuous panic or depression affecting
 the ability to function independently, appropriately and
 effectively; impaired impulse control (such as unprovoked
 irritability with periods of violence); spatial
 disorientation; neglect of personal appearance and hygiene;
 difficulty in adapting to stressful circumstances (including
 work or a worklike setting); inability to establish and
 maintain effective relationships.
Occupational and social impairment with reduced reliability           50
 and productivity due to such symptoms as: flattened affect;
 circumstantial, circumlocutory, or stereotyped speech; panic
 attacks more than once a week; difficulty in understanding
 complex commands; impairment of short- and long-term memory
 (e.g., retention of only highly learned material, forgetting
 to complete tasks); impaired judgment; impaired abstract
 thinking; disturbances of motivation and mood; difficulty in
 establishing and maintaining effective work and social
 relationships.
Occupational and social impairment with occasional decrease           30
 in work efficiency and intermittent periods of inability to
 perform occupational tasks (although generally functioning
 satisfactorily, with routine behavior, self-care, and
 conversation normal), due to such symptoms as: depressed
 mood, anxiety, suspiciousness, panic attacks (weekly or less
 often), chronic sleep impairment, mild memory loss (such as
 forgetting names, directions, recent events).
Occupational and social impairment due to mild or transient           10
 symptoms which decrease work efficiency and ability to
 perform occupational tasks only during periods of
 significant stress, or symptoms controlled by continuous
 medication.
A mental condition has been formally diagnosed, but symptoms           0
 are not severe enough either to interfere with occupational
 and social functioning or to require continuous medication.
------------------------------------------------------------------------


[[Page 498]]

9520 Anorexia nervosa
9521 Bulimia nervosa


                   Rating Formula for Eating Disorders
------------------------------------------------------------------------
                                                                 Rating
------------------------------------------------------------------------
Self-induced weight loss to less than 80 percent of expected         100
 minimum weight, with incapacitating episodes of at least six
 weeks total duration per year, and requiring hospitalization
 more than twice a year for parenteral nutrition or tube
 feeding.
Self-induced weight loss to less than 85 percent of expected          60
 minimum weight with incapacitating episodes of six or more
 weeks total duration per year.
Self-induced weight loss to less than 85 percent of expected          30
 minimum weight with incapacitating episodes of more than two
 but less than six weeks total duration per year.
Binge eating followed by self-induced vomiting or other               10
 measures to prevent weight gain, or resistance to weight
 gain even when below expected minimum weight, with diagnosis
 of an eating disorder and incapacitating episodes of up to
 two weeks total duration per year.
Binge eating followed by self-induced vomiting or other                0
 measures to prevent weight gain, or resistance to weight
 gain even when below expected minimum weight, with diagnosis
 of an eating disorder but without incapacitating episodes.
------------------------------------------------------------------------
Note 1: An incapacitating episode is a period during which bed rest and
  treatment by a physician are required.
Note 2: Ratings under diagnostic codes 9201 to 9440 will be evaluated
  using the General Rating Formula for Mental Disorders. Ratings under
  diagnostic codes 9520 and 9521 will be evaluated using the General
  Rating Formula for Eating Disorders.


(Authority: 38 U.S.C. 1155)

[79 FR 45100, Aug. 4, 2014]

                       Dental and Oral Conditions



Sec.  4.149  [Reserved]



Sec.  4.150  Schedule of ratings--dental and oral conditions.

------------------------------------------------------------------------
                                                                  Rating
------------------------------------------------------------------------
Note (1): For VA compensation purposes, diagnostic imaging
 studies include, but are not limited to, conventional
 radiography (X-ray), computed tomography (CT), magnetic
 resonance imaging (MRI), positron emission tomography (PET),
 radionuclide bone scanning, or ultrasonography
Note (2): Separately evaluate loss of vocal articulation, loss
 of smell, loss of taste, neurological impairment, respiratory
 dysfunction, and other impairments under the appropriate
 diagnostic code and combine under Sec.   4.25 for each
 separately rated condition
9900 Maxilla or mandible, chronic osteomyelitis, osteonecrosis
 or osteoradionecrosis of:
    Rate as osteomyelitis, chronic under diagnostic code 5000...
9901 Mandible, loss of, complete, between angles................     100
9902 Mandible, loss of, including ramus, unilaterally or
 bilaterally:
    Loss of one-half or more,...................................
        Involving temporomandibular articulation................
    Not replaceable by prosthesis...............................      70
    Replaceable by prosthesis...................................      50
        Not involving temporomandibular articulation.
    Not replaceable by prosthesis...............................      40
    Replaceable by prosthesis...................................      30
    Loss of less than one-half,
        Involving temporomandibular articulation.
    Not replaceable by prosthesis...............................      70
    Replaceable by prosthesis...................................      50
        Not involving temporomandibular articulation.
    Not replaceable by prosthesis...............................      20
    Replaceable by prosthesis...................................      10
9903 Mandible, nonunion of, confirmed by diagnostic imaging
 studies:
    Severe, with false motion...................................      30
    Moderate, without false motion..............................      10
9904 Mandible, malunion of:
    Displacement, causing severe anterior or posterior open bite      20
    Displacement, causing moderate anterior or posterior open         10
     bite.......................................................
    Displacement, not causing anterior or posterior open bite...       0
9905 Temporomandibular disorder (TMD):
    Interincisal range:
        0 to 10 millimeters (mm) of maximum unassisted vertical
         opening.
            With dietary restrictions to all mechanically             50
             altered foods......................................
            Without dietary restrictions to mechanically altered      40
             foods..............................................
        11 to 20 mm of maximum unassisted vertical opening.
            With dietary restrictions to all mechanically             40
             altered foods......................................
            Without dietary restrictions to mechanically altered      30
             foods..............................................
        21 to 29 mm of maximum unassisted vertical opening.
            With dietary restrictions to full liquid and pureed       40
             foods..............................................
            With dietary restrictions to soft and semi-solid          30
             foods..............................................
            Without dietary restrictions to mechanically altered      20
             foods..............................................

[[Page 499]]

 
        30 to 34 mm of maximum unassisted vertical opening.
            With dietary restrictions to full liquid and pureed       30
             foods..............................................
            With dietary restrictions to soft and semi-solid          20
             foods..............................................
            Without dietary restrictions to mechanically altered      10
             foods..............................................
    Lateral excursion range of motion:
            0 to 4 mm...........................................      10
Note (1): Ratings for limited interincisal movement shall not be
 combined with ratings for limited lateral excursion............
Note (2): For VA compensation purposes, the normal maximum
 unassisted range of vertical jaw opening is from 35 to 50 mm...
Note (3): For VA compensation purposes, mechanically altered
 foods are defined as altered by blending, chopping, grinding or
 mashing so that they are easy to chew and swallow. There are
 four levels of mechanically altered foods: full liquid, puree,
 soft, and semisolid foods. To warrant elevation based on
 mechanically altered foods, the use of texture-modified diets
 must be recorded or verified by a physician....................
9908 Condyloid process, loss of, one or both sides..............      30
9909 Coronoid process, loss of:
    Bilateral...................................................      20
    Unilateral..................................................      10
9911 Hard palate, loss of:
    Loss of half or more, not replaceable by prosthesis.........      30
    Loss of less than half, not replaceable by prosthesis.......      20
    Loss of half or more, replaceable by prosthesis.............      10
    Loss of less than half, replaceable by prosthesis...........       0
9913 Teeth, loss of, due to loss of substance of body of maxilla
 or mandible without loss of continuity:
    Where the lost masticatory surface cannot be restored by
     suitable prosthesis:
        Loss of all teeth.......................................      40
        Loss of all upper teeth.................................      30
        Loss of all lower teeth.................................      30
        All upper and lower posterior teeth missing.............      20
        All upper and lower anterior teeth missing..............      20
        All upper anterior teeth missing........................      10
        All lower anterior teeth missing........................      10
        All upper and lower teeth on one side missing...........      10
    Where the loss of masticatory surface can be restored by           0
     suitable prosthesis........................................
    Note--These ratings apply only to bone loss through trauma
     or disease such as osteomyelitis, and not to the loss of
     the alveolar process as a result of periodontal disease,
     since such loss is not considered disabling................
9914 Maxilla, loss of more than half:
    Not replaceable by prosthesis...............................     100
    Replaceable by prosthesis...................................      50
9915 Maxilla, loss of half or less:
    Loss of 25 to 50 percent:
        Not replaceable by prosthesis...........................      40
        Replaceable by prosthesis...............................      30
    Loss of less than 25 percent:
        Not replaceable by prosthesis...........................      20
        Replaceable by prosthesis...............................       0
9916 Maxilla, malunion or nonunion of:
    Nonunion,
        With false motion.......................................      30
        Without false motion....................................      10
    Malunion,
        With displacement, causing severe anterior or posterior       30
         open bite..............................................
        With displacement, causing moderate anterior or               10
         posterior open bite....................................
        With displacement, causing mild anterior or posterior          0
         open bite..............................................
Note: For VA compensation purposes, the severity of maxillary
 nonunion is dependent upon the degree of abnormal mobility of
 maxilla fragments following treatment (i.e., presence or
 absence of false motion), and maxillary nonunion must be
 confirmed by diagnostic imaging studies........................
9917 Neoplasm, hard and soft tissue, benign:
    Rate as loss of supporting structures (bone or teeth) and/or
     functional impairment due to scarring.
9918 Neoplasm, hard and soft tissue, malignant..................     100
Note: A rating of 100 percent shall continue beyond the
 cessation of any surgical, radiation, antineoplastic
 chemotherapy or other therapeutic procedure. Six months after
 discontinuance of such treatment, the appropriate disability
 rating shall be determined by mandatory VA examination. Any
 change in evaluation based upon that or any subsequent
 examination shall be subject to the provisions of Sec.
 3.105(e) of this chapter. If there has been no local recurrence
 or metastasis, rate on residuals such as loss of supporting
 structures (bone or teeth) and/or functional impairment due to
 scarring.......................................................
------------------------------------------------------------------------


[59 FR 2530, Jan. 18, 1994, as amended at 82 FR 36083, Aug. 3, 2017]



Sec. Appendix A to Part 4--Table of Amendments and Effective Dates Since 
                                  1946

----------------------------------------------------------------------------------------------------------------
                                                  Diagnostic
                     Sec.                          code No.
----------------------------------------------------------------------------------------------------------------
4.71a.........................................            5000  Evaluation February 1, 1962.
4.71a.........................................            5001  Evaluation March 11, 1969; criterion February 7,
                                                                 2021.
                                                          5002  Evaluation March 1, 1963; title, criteria, note
                                                                 February 7, 2021.
                                                          5003  Added July 6, 1950; title February 7, 2021.
                                                          5009  Title, evaluation, note February 7, 2021.
                                                          5010  Title, criteria February 7, 2021.

[[Page 500]]

 
                                                          5011  Title, criteria February 7, 2021.
                                                          5012  Criterion March 10, 1976; title, note February
                                                                 7, 2021.
                                                          5013  Title February 7, 2021.
                                                          5014  Title February 7, 2021.
                                                          5015  Title February 7, 2021.
                                                          5018  Removed February 7, 2021.
                                                          5020  Removed November 30, 2020.
                                                          5022  Removed February 7, 2021.
                                                          5023  Title February 7, 2021.
                                                          5024  Criterion March 1, 1963; title, criteria
                                                                 February 7, 2021.
                                                          5025  Added May 7, 1996.
                                                          5051  Added September 22, 1978; note February 7, 2021.
                                                          5052  Added September 22, 1978; note February 7, 2021.
                                                          5053  Added September 22, 1978; note February 7, 2021.
                                                          5054  Added September 22, 1978; title, criterion, and
                                                                 note February 7, 2021.
                                                          5055  Added September 22, 1978; title, criterion, and
                                                                 note February 7, 2021.
                                                          5056  Added September 22, 1978; note February 7, 2021.
                                                     5100-5103  Removed March 10, 1976.
                                                          5104  Criterion March 10, 1976.
                                                          5105  Criterion March 10, 1976.
                                                          5120  Title, criterion February 7, 2021.
                                                          5160  Title, criterion, note February 7, 2021.
                                                          5164  Evaluation June 9, 1952.
                                                          5166  Criterion September 22, 1978.
                                                          5170  Title February 7, 2021.
                                                          5172  Added July 6, 1950.
                                                          5173  Added June 9, 1952.
                                                          5174  Added September 9, 1975; removed September 22,
                                                                 1978.
                                                          5201  Criterion February 7, 2021.
                                                          5202  Criterion February 7, 2021.
                                                          5211  Criterion September 22, 1978.
                                                          5212  Criterion September 22, 1978.
                                                          5214  Criterion September 22, 1978.
                                                          5216  Preceding paragraph criterion September 22,
                                                                 1978.
                                                          5217  Criterion August 26, 2002.
                                                          5218  Criterion August 26, 2002.
                                                          5219  Criterion September 22, 1978; criterion August
                                                                 26, 2002.
                                                          5220  Preceding paragraph criterion September 22,
                                                                 1978; criterion August 26, 2002.
                                                          5223  Criterion August 26, 2002.
                                                          5224  Criterion August 26, 2002.
                                                          5225  Criterion August 26, 2002.
                                                          5226  Criterion August 26, 2002.
                                                          5227  Criterion September 22, 1978; criterion August
                                                                 26, 2002.
                                                          5228  Added August 26, 2002.
                                                          5229  Added August 26, 2002.
                                                          5230  Added August 26, 2002.
                                                          5235  Replaces 5285-5295 September 26, 2003.
                                                          5236  Replaces 5285-5295 September 26, 2003.
                                                          5237  Replaces 5285-5295 September 26, 2003.
                                                          5238  Replaces 5285-5295 September 26, 2003.
                                                          5239  Replaces 5285-5295 September 26, 2003.
                                                          5240  Replaces 5285-5295 September 26, 2003.
                                                          5241  Replaces 5285-5295 September 26, 2003.
                                                          5242  Replaces 5285-5295 September 26, 2003; Title
                                                                 February 7, 2021.
                                                          5243  Replaces 5285-5295 September 26, 2003; Criterion
                                                                 September 26, 2003; Title February 7, 2021.
                                                          5244  Added February 7, 2021.
                                                          5255  Criterion July 6, 1950; criterion February 7,
                                                                 2021.
                                                          5257  Evaluation July 6, 1950; criterion and note
                                                                 February 7, 2021.
                                                          5262  Criterion February 7, 2021.
                                                          5264  Added September 9, 1975; removed September 22,
                                                                 1978.
                                                          5269  Added February 7, 2021.
                                                          5271  Criterion February 7, 2021.
                                                          5275  Criterion March 10, 1976; criterion September
                                                                 22, 1978.
                                                          5293  Criterion March 10, 1976; criterion September
                                                                 23, 2002; revised and moved to 5235-5243
                                                                 September 26, 2003.
                                                          5294  Evaluation March 10, 1976; revised and moved to
                                                                 5235-5243 September 26, 2003.
                                                          5295  Evaluation March 10, 1976; revised and moved to
                                                                 5235-5243 September 26, 2003.
                                                          5296  Criterion March 10, 1976.
                                                          5297  Criterion August 23, 1948; criterion February 1,
                                                                 1962.
                                                          5298  Added August 23, 1948.

[[Page 501]]

 
4.73..........................................  ..............  Introduction Note criterion July 3, 1997; second
                                                                 Note added February 7, 2021.
                                                          5317  Criterion September 22, 1978.
                                                          5324  Added February 1, 1962.
                                                          5325  Criterion July 3, 1997.
                                                          5327  Added March 10, 1976; criterion October 15,
                                                                 1991; criterion July 3, 1997.
                                                          5328  Added NOTE March 10, 1976.
                                                          5329  Added NOTE July 3, 1997.
                                                          5330  Added February 7, 2021.
                                                          5331  Added February 7, 2021.
4.77..........................................  ..............  Revised May 13, 2018.
4.78..........................................  ..............  Revised May 13, 2018.
4.79..........................................  ..............  Introduction criterion May 13, 2018; Revised
                                                                 General Rating Formula for Diseases of the Eye
                                                                 NOTE revised May 13, 2018.
                                                          6000  Criterion May 13, 2018.
                                                          6001  Criterion May 13, 2018.
                                                          6002  Criterion May 13, 2018.
                                                          6006  Title May 13, 2018. Criterion May 13, 2018.
                                                          6007  Criterion May 13, 2018.
                                                          6008  Criterion May 13, 2018.
                                                          6009  Criterion May 13, 2018.
                                                          6011  Evaluation May 13, 2018.
                                                          6012  Evaluation May 13, 2018.
                                                          6013  Evaluation May 13, 2018.
                                                          6014  Title May 13, 2018.
                                                          6015  Title May 13, 2018.
                                                          6017  Evaluation May 13, 2018.
                                                          6018  Evaluation May 13, 2018.
                                                          6019  Evaluation.
                                                          6026  Evaluation May 13, 2018.
                                                          6027  Evaluation May 13, 2018.
                                                          6034  Evaluation May 13, 2018.
                                                          6035  Evaluation May 13, 2018.
                                                          6036  Evaluation May 13, 2018.
                                                          6040  Added May 13, 2018.
                                                          6042  Added May 13, 2018.
                                                          6046  Added May 13, 2018.
                                                          6091  Evaluation May 13, 2018.
4.84a.........................................  ..............  Table V criterion July 1, 1994.
                                                          6010  Criterion March 11, 1969.
                                                          6019  Criterion September 22, 1978.
                                                          6029  NOTE August 23, 1948; criterion September 22,
                                                                 1978.
                                                          6035  Added September 9, 1975.
                                                     6050-6062  Removed March 10, 1976.
                                                          6061  Added March 10, 1976.
                                                          6062  Added March 10, 1976.
                                                     6063-6079  Criterion September 22, 1978.
                                                          6064  Criterion March 10, 1976.
                                                          6071  Criterion March 10, 1976.
                                                          6076  Evaluation August 23, 1948.
                                                          6080  Criterion September 22, 1978.
                                                          6081  Criterion March 10, 1976.
                                                          6090  Criterion September 22, 1978; criterion
                                                                 September 12, 1988.
4.84b.........................................            6260  Added October 1, 1961; criterion October 1,
                                                                 1961; evaluation March 10, 1976; removed
                                                                 December 18, 1987; re-designated Sec.   4.87a
                                                                 December 18, 1987.
4.87..........................................  ..............  Tables VI and VII replaced by new Tables VI,
                                                                 VIA, and VII December 18, 1987. 6200-6260
                                                                 revised and re-designated Sec.   4.87 June 10,
                                                                 1999.
4.87a.........................................       6200-6260  Moved to Sec.   4.87 June 10, 1999.
                                                     6275-6276  Moved from Sec.   4.87b June 10, 1999.
                                                     6277-6297  March 23, 1956 removed, December 17, 1987; Table
                                                                 II revised Table V March 10, 1976; Table II
                                                                 revised to Table VII September 22, 1978; text
                                                                 from Sec.   4.84b Schedule of ratings-ear re-
                                                                 designated from Sec.   4.87 December 17, 1987.
                                                          6286  Removed December 17, 1987.
                                                          6291  Criterion March 10, 1976; removed December 17,
                                                                 1987.
                                                          6297  Criterion March 10, 1976; removed December 17,
                                                                 1987.
4.87b.........................................  ..............  Removed June 10, 1999.
4.88a.........................................  ..............  March 11, 1969; re-designated Sec.   4.88b
                                                                 November 29, 1994; Sec.   4.88a added to read
                                                                 ``Chronic fatigue syndrome''; criterion
                                                                 November 29, 1994.
4.88b.........................................  ..............  Added March 11, 1969; re-designated Sec.   4.88c
                                                                 November 29, 1994; Sec.   4.88a re-designated
                                                                 to Sec.   4.88b November 29, 1994; General
                                                                 Rating Formula for Infectious Diseases added
                                                                 August 11, 2019.
                                                          6300  Criterion August 30, 1996; title, criterion, and
                                                                 note August 11, 2019.
                                                          6301  Criterion, note August 11, 2019.
                                                          6302  Criterion September 22, 1978; criterion August
                                                                 30, 1996; criterion, note August 11, 2019.

[[Page 502]]

 
                                                          6304  Evaluation August 30, 1996; criterion, note
                                                                 August 11, 2019.
                                                          6305  Criterion March 1, 1989; evaluation August 30,
                                                                 1996; title, criterion, note August 11, 2019.
                                                          6306  Evaluation August 30, 1996; criterion, note
                                                                 August 11, 2019.
                                                          6307  Criterion May 13, 2018; criterion, note August
                                                                 11, 2019.
                                                          6308  Criterion August 30, 1996; criterion, note
                                                                 August 11, 2019.
                                                          6309  Added March 1, 1963; criterion March 1, 1989;
                                                                 criterion August 30, 1996; criterion, note
                                                                 August 11, 2019.
                                                          6310  Criterion, note August 11, 2019.
                                                          6311  Criterion, note August 11, 2019.
                                                          6312  Added August 11, 2019.
                                                          6314  Evaluation March 1, 1989; evaluation August 30,
                                                                 1996.
                                                          6315  Criterion August 30, 1996.
                                                          6316  Evaluation March 1, 1989; evaluation August 30,
                                                                 1996; criterion, note August 11, 2019.
                                                          6317  Criterion August 30, 1996; title, criterion,
                                                                 note August 11, 2019.
                                                          6318  Added March 1, 1989; criterion August 30, 1996;
                                                                 criterion, note August 11, 2019.
                                                          6319  Added August 30, 1996; criterion, note August
                                                                 11, 2019.
                                                          6320  Added August 30, 1996; criterion, note August
                                                                 11, 2019.
                                                          6325  Added August 11, 2019.
                                                          6326  Added August 11, 2019.
                                                          6329  Added August 11, 2019.
                                                          6330  Added August 11, 2019.
                                                          6331  Added August 11, 2019.
                                                          6333  Added August 11, 2019.
                                                          6334  Added August 11, 2019.
                                                          6335  Added August 11, 2019.
                                                          6350  Evaluation March 1, 1963; evaluation March 10,
                                                                 1976; evaluation August 30, 1996.
                                                          6351  Added March 1, 1989; evaluation March 24, 1992;
                                                                 criterion August 30, 1996; criterion, note
                                                                 August 11, 2019.
                                                          6352  Added March 1, 1989; removed March 24, 1992.
                                                          6353  Added March 1, 1989; removed March 24, 1992.
                                                          6354  Added November 29, 1994; criterion August 30,
                                                                 1996; title, criterion, note August 11, 2019.
4.88c.........................................  ..............  Re-designated from Sec.   4.88b November 29,
                                                                 1994.
4.89..........................................  ..............  Ratings for nonpulmonary TB December 1, 1949;
                                                                 criterion March 11, 1969.
4.97..........................................            6502  Criterion October 7, 1996.
                                                          6504  Criterion October 7, 1996.
                                                     6510-6514  Criterion October 7, 1996.
                                                          6515  Criterion March 11, 1969.
                                                          6516  Criterion October 7, 1996.
                                                          6517  Removed October 7, 1996.
                                                          6518  Criterion October 7, 1996.
                                                          6519  Criterion October 7, 1996.
                                                          6520  Criterion October 7, 1996.
                                                          6521  Added October 7, 1996.
                                                          6522  Added October 7, 1996.
                                                          6523  Added October 7, 1996.
                                                          6524  Added October 7, 1996.
                                                          6600  Evaluation September 9, 1975; criterion October
                                                                 7, 1996.
                                                          6601  Criterion October 7, 1996.
                                                          6602  Criterion September 9, 1975; criterion October
                                                                 7, 1996.
                                                          6603  Added September 9, 1975; criterion October 7,
                                                                 1996.
                                                          6604  Added October 7, 1996.
                                                          6701  Evaluation October 7, 1996.
                                                          6702  Evaluation October 7, 1996.
                                                          6703  Evaluation October 7, 1996.
                                                          6704  Subparagraph (1) following December 1, 1949;
                                                                 criterion March 11, 1969; criterion September
                                                                 22, 1978.
                                                          6705  Removed March 11, 1969.
                                                     6707-6710  Added March 11, 1969; removed September 22,
                                                                 1978.
                                                          6721  Criterion July 6, 1950; criterion September 22,
                                                                 1978.
                                                          6724  Second note following December 1, 1949;
                                                                 criterion March 11, 1969; evaluation October 7,
                                                                 1996.
                                                     6725-6728  Added March 11, 1969; removed September 22,
                                                                 1978.
                                                          6730  Added September 22, 1978; criterion October 7,
                                                                 1996.
                                                          6731  Evaluation September 22, 1978; criterion October
                                                                 7, 1996.
                                                          6732  Criterion March 11, 1969.
                                                          6800  Criterion September 9, 1975; removed October 7,
                                                                 1996.
                                                          6801  Removed October 7, 1996.
                                                          6802  Criterion September 9, 1975; removed October 7,
                                                                 1996.
                                                     6810-6813  Removed October 7, 1996.

[[Page 503]]

 
                                                          6814  Criterion March 10, 1976; removed October 7,
                                                                 1996.
                                                          6815  Removed October 7, 1996.
                                                          6816  Removed October 7, 1996.
                                                          6817  Evaluation October 7, 1996.
                                                          6818  Removed October 7, 1996.
                                                          6819  Criterion March 10, 1976; criterion October 7,
                                                                 1996.
                                                          6821  Evaluation August 23, 1948.
                                                     6822-6847  Added October 7, 1996.
4.104.........................................            7000  Evaluation July 6, 1950; evaluation September
                                                                 22, 1978; evaluation January 12, 1998.
                                                          7001  Evaluation January 12, 1998.
                                                          7002  Evaluation January 12, 1998.
                                                          7003  Evaluation January 12, 1998.
                                                          7004  Criterion September 22, 1978; evaluation January
                                                                 12, 1998.
                                                          7005  Evaluation September 9, 1975; evaluation
                                                                 September 22, 1978; evaluation January 12,
                                                                 1998.
                                                          7006  Evaluation January 12, 1998.
                                                          7007  Evaluation September 22, 1978; evaluation
                                                                 January 12, 1998.
                                                          7008  Evaluation January 12, 1998; criterion December
                                                                 10, 2017.
                                                          7010  Evaluation January 12, 1998.
                                                          7011  Evaluation January 12, 1998.
                                                          7013  Removed January 12, 1998.
                                                          7014  Removed January 12, 1998.
                                                          7015  Evaluation September 9, 1975; criterion January
                                                                 12, 1998.
                                                          7016  Added September 9, 1975; evaluation January 12,
                                                                 1998.
                                                          7017  Added September 22, 1978; evaluation January 12,
                                                                 1998.
                                                          7018  Added January 12, 1998.
                                                          7019  Added January 12, 1998.
                                                          7020  Added January 12, 1998.
                                                          7100  Evaluation July 6, 1950.
                                                          7101  Criterion September 1, 1960; criterion September
                                                                 9, 1975; criterion January 12, 1998.
                                                          7110  Evaluation September 9, 1975; evaluation January
                                                                 12, 1998.
                                                          7111  Criterion September 9, 1975; evaluation January
                                                                 12, 1998.
                                                          7112  Evaluation January 12, 1998.
                                                          7113  Evaluation January 12, 1998.
                                                          7114  Added June 9, 1952; evaluation January 12, 1998.
                                                          7115  Added June 9, 1952; evaluation January 12, 1998.
                                                          7116  Added June 9, 1952; evaluation March 10, 1976;
                                                                 removed January 12, 1998.
                                                          7117  Added June 9, 1952; evaluation January 12, 1998.
                                                          7118  Criterion January 12, 1998.
                                                          7119  Evaluation January 12, 1998.
                                                          7120  Note following July 6, 1950; evaluation January
                                                                 12, 1998.
                                                          7121  Criterion July 6, 1950; evaluation March 10,
                                                                 1976; evaluation January 12, 1998.
                                                          7122  Last sentence of Note following July 6, 1950;
                                                                 evaluation January 12, 1998; criterion August
                                                                 13, 1998.
                                                          7123  Added October 15, 1991; criterion January 12,
                                                                 1998.
4.114.........................................  ..............  Introduction paragraph revised March 10, 1976.
                                                          7304  Evaluation November 1, 1962.
                                                          7305  Evaluation November 1, 1962.
                                                          7308  Evaluation April 8, 1959.
                                                          7311  Criterion July 2, 2001.
                                                          7312  Evaluation March 10, 1976; evaluation July 2,
                                                                 2001.
                                                          7313  Evaluation March 10, 1976; removed July 2, 2001.
                                                          7319  Evaluation November 1, 1962.
                                                          7321  Evaluation July 6, 1950; criterion March 10,
                                                                 1976.
                                                          7328  Evaluation November 1, 1962.
                                                          7329  Evaluation November 1, 1962.
                                                          7330  Evaluation November 1, 1962.
                                                          7331  Criterion March 11, 1969.
                                                          7332  Evaluation November 1, 1962.
                                                          7334  Evaluation July 6, 1950; evaluation November 1,
                                                                 1962.
                                                          7339  Criterion March 10, 1976.
                                                          7341  Removed March 10, 1976.
                                                          7343  Criterion March 10, 1976; criterion July 2,
                                                                 2001.
                                                          7344  Criterion July 2, 2001.
                                                          7345  Evaluation August 23, 1948; evaluation February
                                                                 17, 1955; evaluation July 2, 2001.
                                                          7346  Evaluation February 1, 1962.
                                                          7347  Added September 9, 1975.
                                                          7348  Added March 10, 1976.
                                                          7351  Added July 2, 2001.
                                                          7354  Added July 2, 2001.

[[Page 504]]

 
4.115a........................................  ..............  Re-designated and revised as Sec.   4.115b; new
                                                                 Sec.   4.115a ``Ratings of the genitourinary
                                                                 system-dysfunctions'' added February 17, 1994.
4.115b........................................            7500  Note July 6, 1950; evaluation February 17, 1994,
                                                                 criterion September 8, 1994.
                                                          7501  Evaluation February 17, 1994.
                                                          7502  Evaluation February 17, 1994.
                                                          7503  Removed February 17, 1994.
                                                          7504  Criterion February 17, 1994.
                                                          7505  Criterion March 11, 1969; evaluation February
                                                                 17, 1994.
                                                          7507  Criterion February 17, 1994.
                                                          7508  Evaluation February 17, 1994.
                                                          7509  Criterion February 17, 1994.
                                                          7510  Evaluation February 17, 1994.
                                                          7511  Evaluation February 17, 1994.
                                                          7512  Evaluation February 17, 1994.
                                                          7513  Removed February 17, 1994.
                                                          7514  Criterion March 11, 1969; removed February 17,
                                                                 1994.
                                                          7515  Criterion February 17, 1994.
                                                          7516  Criterion February 17, 1994.
                                                          7517  Criterion February 17, 1994.
                                                          7518  Evaluation February 17, 1994.
                                                          7519  Evaluation March 10, 1976; evaluation February
                                                                 17, 1994.
                                                          7520  Criterion February 17, 1994.
                                                          7521  Criterion February 17, 1994.
                                                          7522  Criterion September 8, 1994.
                                                          7523  Criterion September 8, 1994.
                                                          7524  Note July 6, 1950; evaluation February 17, 1994;
                                                                 evaluation September 8, 1994.
                                                          7525  Criterion March 11, 1969; evaluation February
                                                                 17, 1994.
                                                          7526  Removed February 17, 1994.
                                                          7527  Criterion February 17, 1994.
                                                          7528  Criterion March 10, 1976; criterion February 17,
                                                                 1994.
                                                          7529  Criterion February 17, 1994.
                                                          7530  Added September 9, 1975; evaluation February 17,
                                                                 1994.
                                                          7531  Added September 9, 1975; criterion February 17,
                                                                 1994.
                                                     7532-7542  Added February 17, 1994.
4.116.........................................  ..............  Sec.   4.116 removed and Sec.   4.116a re-
                                                                 designated Sec.   4.116 ``Schedule of ratings-
                                                                 gynecological conditions and disorders of the
                                                                 breasts'' May 22, 1995.
                                                          7610  Criterion May 22, 1995; title May 13, 2018.
                                                          7611  Criterion May 22, 1995.
                                                          7612  Criterion May 22, 1995.
                                                          7613  Criterion May 22, 1995.
                                                          7614  Criterion May 22, 1995.
                                                          7615  Criterion May 22, 1995; note May 13, 2018.
                                                          7617  Criterion May 22, 1995.
                                                          7618  Criterion May 22, 1995.
                                                          7619  Criterion May 22, 1995; note May 13, 2018.
                                                          7620  Criterion May 22, 1995.
                                                          7621  Criterion May 22, 1995; evaluation May 13, 2018.
                                                          7622  Removed May 13, 2018.
                                                          7623  Removed May 13, 2018.
                                                          7624  Criterion August 9, 1976; evaluation May 22,
                                                                 1995.
                                                          7625  Criterion August 9, 1976; evaluation May 22,
                                                                 1995.
                                                          7626  Criterion May 22, 1995; criterion March 18,
                                                                 2002.
                                                          7627  Criterion March 10, 1976; criterion May 22,
                                                                 1995; title, note May 13, 2018.
                                                          7628  Added May 22, 1995; title, criterion May 13,
                                                                 2018.
                                                          7629  Added May 22, 1995.
                                                          7630  Added May 13, 2018.
                                                          7631  Added May 13, 2018.
                                                          7632  Added May 13, 2018.
4.117.........................................            7700  Removed December 9, 2018.
                                                          7701  Removed October 23, 1995.
                                                          7702  Evaluation October 23, 1995; title December 9,
                                                                 2018; evaluation December 9, 2018.
                                                          7703  Evaluation August 23, 1948; criterion October
                                                                 23, 1995; evaluation December 9, 2018;
                                                                 criterion December 9, 2018.
                                                          7704  Evaluation October 23, 1995; evaluation December
                                                                 9, 2018.
                                                          7705  Evaluation October 23, 1995; title December 9,
                                                                 2018; evaluation December 9, 2018; criterion
                                                                 December 9, 2018.
                                                          7706  Evaluation October 23, 1995; note December 9,
                                                                 2018; criterion October 23, 1995.
                                                          7707  Criterion October 23, 1995.
                                                          7709  Evaluation March 10, 1976; criterion October 23,
                                                                 1995; title December 9, 2018; criterion
                                                                 December 9, 2018.
                                                          7710  Criterion October 23, 1995; criterion December
                                                                 9, 2018.

[[Page 505]]

 
                                                          7711  Criterion October 23, 1995.
                                                          7712  Added December 9, 2018.
                                                          7713  Removed October 23, 1995.
                                                          7714  Added September 9, 1975; criterion October 23,
                                                                 1995; criterion December 9, 2018.
                                                          7715  Added October 26, 1990; criterion December 9,
                                                                 2018.
                                                          7716  Added October 23, 1995; evaluation December 9,
                                                                 2018; criterion December 9, 2018.
                                                          7717  Added March 9, 2012.
                                                          7718  Added December 9, 2018.
                                                          7719  Added December 9, 2018.
                                                          7720  Added December 9, 2018.
                                                          7721  Added December 9, 2018.
                                                          7722  Added December 9, 2018.
                                                          7723  Added December 9, 2018.
                                                          7724  Added December 9, 2018.
                                                          7725  Added December 9, 2018.
4.118.........................................            7800  Evaluation August 30, 2002; criterion October
                                                                 23, 2008.
                                                          7801  Criterion July 6, 1950; criterion August 30,
                                                                 2002; criterion October 23, 2008; title, note
                                                                 1, note 2 August 13, 2018.
                                                          7802  Criterion September 22, 1978; criterion August
                                                                 30, 2002; criterion October 23, 2008; title,
                                                                 note 1, note 2 August 13, 2018.
                                                          7803  Criterion August 30, 2002; removed October 23,
                                                                 2008.
                                                          7804  Criterion July 6, 1950; criterion September 22,
                                                                 1978; criterion and evaluation October 23,
                                                                 2008.
                                                          7805  Criterion October 23, 2008; title August 13,
                                                                 2018.
                                                                General Rating Formula for DCs 7806, 7809, 7813-
                                                                 7816, 7820-7822, and 7824 added August 13,
                                                                 2018.
                                                          7806  Criterion September 9, 1975; evaluation August
                                                                 30, 2002; criterion August 13, 2018.
                                                          7807  Criterion August 30, 2002.
                                                          7808  Criterion August 30, 2002.
                                                          7809  Criterion August 30, 2002; title, criterion
                                                                 August 13, 2018.
                                                          7810  Removed August 30, 2002.
                                                          7811  Criterion March 11, 1969; evaluation August 30,
                                                                 2002.
                                                          7812  Removed August 30, 2002.
                                                          7813  Criterion August 30, 2002; title, criterion
                                                                 August 13, 2018.
                                                          7814  Removed August 30, 2002.
                                                          7815  Evaluation August 30, 2002; criterion, note
                                                                 August 13, 2018.
                                                          7816  Evaluation August 30, 2002; criterion, note
                                                                 August 13, 2018.
                                                          7817  Evaluation August 30, 2002; title, criterion,
                                                                 note August 13, 2018.
                                                          7818  Criterion August 30, 2002.
                                                          7819  Criterion August 30, 2002.
                                                          7820  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7821  Added August 30, 2002; title, criterion August
                                                                 13, 2018.
                                                          7822  Added August 30, 2002; title, criterion August
                                                                 13, 2018.
                                                          7823  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7824  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7825  Added August 30, 2002; title, criterion August
                                                                 13, 2018.
                                                          7826  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7827  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7828  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7829  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7830  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7831  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7832  Added August 30, 2002; criterion August 13,
                                                                 2018.
                                                          7833  Added August 30, 2002; criterion August 13,
                                                                 2018.
4.119.........................................            7900  Criterion August 13, 1981; evaluation June 9,
                                                                 1996; title December 10, 2017; evaluation
                                                                 December 10, 2017; criterion December 10, 2017;
                                                                 note December 10, 2017.
                                                          7901  Criterion August 13, 1981; evaluation June 9,
                                                                 1996; title December 10, 2017; evaluation
                                                                 December 10, 2017; criterion December 10, 2017;
                                                                 note December 10, 2017.
                                                          7902  Evaluation August 13, 1981; criterion June 9,
                                                                 1996; title December 10, 2017; evaluation
                                                                 December 10, 2017; criterion December 10, 2017;
                                                                 note December 10, 2017.
                                                          7903  Criterion August 13, 1981; evaluation June 9,
                                                                 1996; evaluation December 10, 2017; criterion
                                                                 December 10, 2017; note December 10, 2017.
                                                          7904  Criterion August 13, 1981; evaluation June 9,
                                                                 1996; evaluation December 10, 2017; criterion
                                                                 December 10, 2017; note December 10, 2017.
                                                          7905  Evaluation; August 13, 1981; evaluation June 9,
                                                                 1996; evaluation December 10, 2017; criterion
                                                                 December 10, 2017.
                                                          7906  Added December 10, 2017.

[[Page 506]]

 
                                                          7907  Evaluation; August 13, 1981; evaluation June 9,
                                                                 1996; criterion December 10, 2017; note
                                                                 December 10, 2017.
                                                          7908  Criterion August 13, 1981; criterion June 9,
                                                                 1996; criterion December 10, 2017.
                                                          7909  Evaluation August 13, 1981; criterion June 9,
                                                                 1996; evaluation June 9, 1996; criterion
                                                                 December 10, 2017; evaluation December 10,
                                                                 2017; note December 10, 2017.
                                                          7910  Removed June 9, 1996.
                                                          7911  Evaluation March 11, 1969; evaluation August 13,
                                                                 1981; criterion June 9, 1996; title December
                                                                 10, 2017; note December 10, 2017.
                                                          7912  Title December 10, 2017; criterion December 10,
                                                                 2017.
                                                          7913  Criterion September 9, 1975; criterion August
                                                                 13, 1981; criterion June 6, 1996; evaluation
                                                                 June 9, 1996; criterion December 10, 2017; note
                                                                 December 10, 2017.
                                                          7914  Criterion March 10, 1976; criterion August 13,
                                                                 1981; criterion June 9, 1996.
                                                          7915  Criterion June 9, 1996; criterion December 10,
                                                                 2017.
                                                          7916  Added June 9, 1996; note December 10, 2017.
                                                          7917  Added June 9, 1996; note December 10, 2017.
                                                          7918  Added June 9, 1996; note December 10, 2017.
                                                          7919  Added June 9, 1996; evaluation June 9, 1996;
                                                                 criterion December 10, 2017; note December 10,
                                                                 2017.
4.124a........................................            8002  Criterion September 22, 1978.
                                                          8021  Criterion September 22, 1978; criterion October
                                                                 1, 1961; criterion March 10, 1976; criterion
                                                                 March 1, 1989.
                                                          8045  Criterion and evaluation October 23, 2008.
                                                          8046  Added October 1, 1961; criterion March 10, 1976;
                                                                 criterion March 1, 1989.
                                                          8100  Evaluation June 9, 1953.
                                                          8540  Added October 15, 1991.
                                                          8910  Added October 1, 1961.
                                                          8911  Added October 1, 1961; evaluation September 9,
                                                                 1975.
                                                          8912  Added October 1, 1961.
                                                          8913  Added October 1, 1961.
                                                          8914  Added October 1, 1961; criterion September 9,
                                                                 1975; criterion March 10, 1976.
                                                     8910-8914  Evaluations September 9, 1975.
4.125--4.132..................................  ..............  All Diagnostic Codes under Mental Disorders
                                                                 October 1, 1961; except as to evaluation for
                                                                 Diagnostic Codes 9500 through 9511 September 9,
                                                                 1975.
4.130.........................................  ..............  Re-designated from Sec.   4.132 November 7,
                                                                 1996.
                                                          9200  Removed February 3, 1988.
                                                          9201  Criterion February 3, 1988; Title August 4,
                                                                 2014.
                                                          9202  Criterion February 3, 1988; removed August 4,
                                                                 2014.
                                                          9203  Criterion February 3, 1988; removed August 4,
                                                                 2014.
                                                          9204  Criterion February 3, 1988; removed August 4,
                                                                 2014.
                                                          9205  Criterion February 3, 1988; criterion November
                                                                 7, 1996; Removed August 4, 2014.
                                                          9206  Criterion February 3, 1988; removed November 7,
                                                                 1996.
                                                          9207  Criterion February 3, 1988; removed November 7,
                                                                 1996.
                                                          9208  Criterion February 3, 1988; removed November 7,
                                                                 1996.
                                                          9209  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9210  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9211  Added November 7, 1996.
                                                          9300  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996.
                                                          9301  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9302  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9303  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9304  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9305  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9306  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9307  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9308  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9309  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9310  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9311  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.

[[Page 507]]

 
                                                          9312  Added March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9313  Added March 10, 1976; removed February 3, 1988.
                                                          9314  Added March 10, 1976; removed February 3, 1988.
                                                          9315  Added March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                     9316-9321  Added March 10, 1976; removed February 3, 1988.
                                                          9322  Added March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9323  Added March 10, 1976; removed February 3, 1988.
                                                          9324  Added March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9325  Added March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9326  Added March 10, 1976; removed February 3, 1988;
                                                                 added November 7, 1996; Title August 4, 2014.
                                                          9327  Added November 7, 1996; removed August 4, 2014.
                                                     9400-9411  Evaluations February 3, 1988.
                                                          9400  Criterion March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9401  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9402  Criterion March 10, 1976; criterion February 3,
                                                                 1988; removed November 7, 1996.
                                                          9403  Criterion March 10, 1976; criterion February 3,
                                                                 1988; criterion November 7, 1996; Title August
                                                                 4, 2014.
                                                          9410  Added March 10, 1976; criterion February 3,
                                                                 1988; Title August 4, 2014.
                                                          9411  Added February 3, 1988.
                                                          9412  Added November 7, 1996.
                                                          9413  Added November 7, 1996; Title August 4, 2014.
                                                          9416  Added November 7, 1996; Title August 4, 2014.
                                                          9417  Added November 7, 1996; Title August 4, 2014.
                                                          9421  Added November 7, 1996; Title August 4, 2014.
                                                          9422  Added November 7, 1996; Title August 4, 2014.
                                                          9423  Added November 7, 1996; Title August 4, 2014.
                                                          9424  Added November 7, 1996; Title August 4, 2014.
                                                          9425  Added November 7, 1996; Title August 4, 2014.
                                                          9431  Added November 7, 1996.
                                                          9432  Added November 7, 1996.
                                                          9433  Added November 7, 1996; Title August 4, 2014.
                                                          9434  Added November 7, 1996.
                                                          9435  Added November 7, 1996; Title August 4, 2014.
                                                          9440  Added November 7, 1996.
                                                          9500  Criterion March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9501  Criterion March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9502  Criterion March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9503  Removed March 10, 1976.
                                                          9504  Criterion September 9, 1975; removed March 10,
                                                                 1976.
                                                          9505  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9506  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9507  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9508  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9509  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9510  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9511  Added March 10, 1976; criterion February 3,
                                                                 1988.
                                                          9520  Added November 7, 1996.
                                                          9521  Added November 7, 1996.
4.132.........................................  ..............  Re-designated as Sec.   4.130 November 7, 1996.
4.150.........................................            9900  Criterion September 22, 1978; criterion February
                                                                 17, 1994; title September 10, 2017.
                                                          9901  Criterion February 17, 1994.
                                                          9902  Criterion February 17, 1994; evaluation
                                                                 September 10, 2017; title September 10, 2017.
                                                          9903  Criterion February 17, 1994; evaluation
                                                                 September 10, 2017; title September 10, 2017.
                                                          9904  Criterion September 10, 2017.
                                                          9905  Criterion September 22, 1978; evaluation
                                                                 February 17, 1994; evaluation September 10,
                                                                 2017; title September 10, 2017.
                                                          9906  Removed September 10, 2017.
                                                          9907  Removed September 10, 2017.
                                                          9910  Removed February 17, 1994.
                                                          9911  Criterion and title September 10, 2017.
                                                          9912  Removed September 10, 2017.
                                                          9913  Criterion February 17, 1994.
                                                          9914  Added February 17, 1994.
                                                          9915  Added February 17, 1994.
                                                          9916  Added February 17, 1994; criterion September 10,
                                                                 2017.
                                                          9917  Added September 10, 2017.

[[Page 508]]

 
                                                          9918  Added September 10, 2017.
----------------------------------------------------------------------------------------------------------------


[72 FR 12983, Mar. 20, 2007; 72 FR 16728, Apr. 5, 2007, as amended at 73 
FR 54708, 54711, Sept. 23, 2008; 73 FR 69554, Nov. 19, 2008; 77 FR 6467, 
Feb. 8, 2012; 79 FR 45101, Aug. 4, 2014; 80 FR 42042, July 16, 2015; 82 
FR 36084, Aug. 3, 2017; 82 FR 50806, Nov. 2, 2017; 83 FR 15072, Apr. 9, 
2018; 83 FR 15323, Apr. 10, 2018; 83 FR 32600, July 13, 2018; 83 FR 
54257, Oct. 29, 2018; 84 FR 28233, June 18, 2019; 85 FR 76464, Nov. 30, 
2020; 86 FR 8143, Feb. 4, 2021]



       Sec. Appendix B to Part 4--Numerical Index of Disabilities

------------------------------------------------------------------------
        Diagnostic Code No.
------------------------------------------------------------------------
                       THE MUSCULOSKELETAL SYSTEM
                  Acute, Subacute, or Chronic Diseases
------------------------------------------------------------------------
5000..............................  Osteomyelitis, acute, subacute, or
                                     chronic.
5001..............................  Bones and Joints, tuberculosis.
5002..............................  Multi-joint arthritis (except post-
                                     traumatic and gout), 2 or more
                                     joints, as an active process.
5003..............................  Degenerative arthritis, other than
                                     post-traumatic.
5004..............................  Arthritis, gonorrheal.
5005..............................  Arthritis, pneumococcic.
5006..............................  Arthritis, typhoid.
5007..............................  Arthritis, syphilitic.
5008..............................  Arthritis, streptococcic.
5009..............................  Other specified forms of arthropathy
                                     (excluding gout).
5010..............................  Post-traumatic arthritis.
5011..............................  Decompression illness.
5012..............................  Bones, neoplasm, malignant, primary
                                     or secondary.
5013..............................  Osteoporosis, residuals of.
5014..............................  Osteomalacia, residuals of.
5015..............................  Bones, neoplasm, benign.
5016..............................  Osteitis deformans.
5017..............................  Gout.
5018..............................  [Removed]
5019..............................  Bursitis.
5020..............................  [Removed]
5021..............................  Myositis.
5022..............................  [Removed]
5023..............................  Heterotopic ossification.
5024..............................  Tenosynovitis, tendinitis,
                                     tendinosis or tendinopathy.
5025..............................  Fibromyalgia.
------------------------------------------------------------------------
                           Prosthetic Implants
------------------------------------------------------------------------
5051..............................  Shoulder replacement (prosthesis).
5052..............................  Elbow replacement (prosthesis).
5053..............................  Wrist replacement (prosthesis).
5054..............................  Hip, resurfacing or replacement
                                     (prosthesis).
5055..............................  Knee, resurfacing or replacement
                                     (prosthesis).
5056..............................  Ankle replacement (prosthesis).
------------------------------------------------------------------------
                       Combination of Disabilities
------------------------------------------------------------------------
5104..............................  Anatomical loss of one hand and loss
                                     of use of one foot.
5105..............................  Anatomical loss of one foot and loss
                                     of use of one hand.
5106..............................  Anatomical loss of both hands.
5107..............................  Anatomical loss of both feet.
5108..............................  Anatomical loss of one hand and one
                                     foot.
5109..............................  Loss of use of both hands.
5110..............................  Loss of use of both feet.
5111..............................  Loss of use of one hand and one
                                     foot.
------------------------------------------------------------------------
                      Amputations: Upper Extremity
------------------------------------------------------------------------
Arm amputation of:
5120..............................  Complete amputation, upper
                                     extremity.
5121..............................  Above insertion of deltoid.
5122..............................  Below insertion of deltoid.
------------------------------------------------------------------------
Forearm amputation of:
5123..............................  Above insertion of pronator teres.
5124..............................  Below insertion of pronator teres.

[[Page 509]]

 
5125..............................  Hand, loss of use of.
------------------------------------------------------------------------
                       Multiple Finger Amputations
------------------------------------------------------------------------
5126..............................  Five digits of one hand.
------------------------------------------------------------------------
Four digits of one hand:
5127..............................  Thumb, index, long and ring.
5128..............................  Thumb, index, long and little.
5129..............................  Thumb, index, ring and little.
5130..............................  Thumb, long, ring and little.
5131..............................  Index, long, ring and little.
------------------------------------------------------------------------
Three digits of one hand:
5132..............................  Thumb, index and long.
5133..............................  Thumb, index and ring.
5134..............................  Thumb, index and little.
5135..............................  Thumb, long and ring.
5136..............................  Thumb, long and little.
5137..............................  Thumb, ring and little.
5138..............................  Index, long and ring.
5139..............................  Index, long and little.
5140..............................  Index, ring and little.
5141..............................  Long, ring and little.
------------------------------------------------------------------------
Two digits of one hand:
5142..............................  Thumb and index.
5143..............................  Thumb and long.
5144..............................  Thumb and ring.
5145..............................  Thumb and little.
5146..............................  Index and long.
5147..............................  Index and ring.
5148..............................  Index and little.
5149..............................  Long and ring.
5150..............................  Long and little.
5151..............................  Ring and little.
------------------------------------------------------------------------
Single finger:
5152..............................  Thumb.
5153..............................  Index finger.
5154..............................  Long finger.
5155..............................  Ring finger.
5156..............................  Little finger.
------------------------------------------------------------------------
                      Amputations: Lower Extremity
------------------------------------------------------------------------
Thigh amputation of:
5160..............................  Complete amputation, lower
                                     extremity.
5161..............................  Upper third.
5162..............................  Middle or lower thirds.
------------------------------------------------------------------------
Leg amputation of:
5163..............................  With defective stump.
5164..............................  Not improvable by prosthesis
                                     controlled by natural knee action.
5165..............................  At a lower level, permitting
                                     prosthesis.
5166..............................  Forefoot, proximal to metatarsal
                                     bones.
5167..............................  Foot, loss of use of.
5170..............................  Toes, all, amputation of, without
                                     metatarsal loss or transmetatarsal,
                                     amputation of, with up to half of
                                     metatarsal loss.
5171..............................  Toe, great.
5172..............................  Toes, other than great, with removal
                                     of metatarsal head.
5173..............................  Toes, three or more, without
                                     metatarsal involvement.
------------------------------------------------------------------------
                            Shoulder and Arm
------------------------------------------------------------------------
5200..............................  Scapulohumeral articulation,
                                     ankylosis.
5201..............................  Arm, limitation of motion.
5202..............................  Humerus, other impairment.
5203..............................  Clavicle or scapula, impairment.
------------------------------------------------------------------------
                            Elbow and Forearm
------------------------------------------------------------------------
5205..............................  Elbow, ankylosis.
5206..............................  Forearm, limitation of flexion.
5207..............................  Forearm, limitation of extension.

[[Page 510]]

 
5208..............................  Forearm, flexion limited.
5209..............................  Elbow, other impairment.
5210..............................  Radius and ulna, nonunion.
5211..............................  Ulna, impairment.
5212..............................  Radius, impairment.
5213..............................  Supination and pronation,
                                     impairment.
------------------------------------------------------------------------
                                  Wrist
------------------------------------------------------------------------
5214..............................  Wrist, ankylosis.
5215..............................  Wrist, limitation of motion.
------------------------------------------------------------------------
                          Limitation of Motion
------------------------------------------------------------------------
Multiple Digits: Unfavorable Ankylosis:
5216..............................  Five digits of one hand.
5217..............................  Four digits of one hand.
5218..............................  Three digits of one hand.
5219..............................  Two digits of one hand.
------------------------------------------------------------------------
Multiple Digits: Favorable
 Ankylosis:
5220..............................  Five digits of one hand.
5221..............................  Four digits of one hand.
5222..............................  Three digits of one hand.
5223..............................  Two digits of one hand.
------------------------------------------------------------------------
Ankylosis of Individual Digits:
5224..............................  Thumb.
5225..............................  Index finger.
5226..............................  Long finger.
5227..............................  Ring or little finger.
------------------------------------------------------------------------
Limitation of Motion of Individual Digits:
5228..............................  Thumb.
5229..............................  Index or long finger.
5230..............................  Ring or little finger.
------------------------------------------------------------------------
                                  Spine
------------------------------------------------------------------------
5235..............................  Vertebral fracture or dislocation.
5236..............................  Sacroiliac injury and weakness.
5237..............................  Lumbosacral or cervical strain.
5238..............................  Spinal stenosis.
5239..............................  Spondylolisthesis or segmental
                                     instability.
5240..............................  Ankylosing spondylitis.
5241..............................  Spinal fusion.
5242..............................  Degenerative arthritis, degenerative
                                     disc disease other than
                                     intervertebral disc syndrome (also,
                                     see either DC 5003 or 5010).
5243..............................  Intervertebral disc syndrome.
5244..............................  Traumatic paralysis, complete.
------------------------------------------------------------------------
                              Hip and Thigh
------------------------------------------------------------------------
5250..............................  Hip, ankylosis.
5251..............................  Thigh, limitation of extension.
5252..............................  Thigh, limitation of flexion.
5253..............................  Thigh, impairment.
5254..............................  Hip, flail joint.
5255..............................  Femur, impairment.
------------------------------------------------------------------------
                              Knee and Leg
------------------------------------------------------------------------
5256..............................  Knee, ankylosis.
5257..............................  Knee, other impairment.
5258..............................  Cartilage, semilunar, dislocated.
5259..............................  Cartilage, semilunar, removal.
5260..............................  Leg, limitation of flexion.
5261..............................  Leg, limitation of extension.
5262..............................  Tibia and fibula, impairment.
5263..............................  Genu recurvatum.
------------------------------------------------------------------------
                                  Ankle
------------------------------------------------------------------------
5270..............................  Ankle, ankylosis.

[[Page 511]]

 
5271..............................  Ankle, limited motion.
5272..............................  Subastragalar or tarsal joint,
                                     ankylosis.
5273..............................  Os calcis or astragalus, malunion.
5274..............................  Astragalectomy.
------------------------------------------------------------------------
                    Shortening of the Lower Extremity
------------------------------------------------------------------------
5275..............................  Bones, of the lower extremity
------------------------------------------------------------------------
                                The Foot
------------------------------------------------------------------------
5269..............................  Plantar fasciitis.
5276..............................  Flatfoot, acquired.
5277..............................  Weak foot, bilateral.
5278..............................  Claw foot (pes cavus), acquired.
5279..............................  Metatarsalgia, anterior (Morton's
                                     disease).
5280..............................  Hallux valgus.
5281..............................  Hallux rigidus.
5282..............................  Hammer toe.
5283..............................  Tarsal or metatarsal bones.
5284..............................  Foot injuries, other.
------------------------------------------------------------------------
                                The Skull
------------------------------------------------------------------------
5296..............................  Loss of part of.
------------------------------------------------------------------------
                                The Ribs
------------------------------------------------------------------------
5297..............................  Removal of.
------------------------------------------------------------------------
                               The Coccyx
------------------------------------------------------------------------
5298..............................  Removal of.
------------------------------------------------------------------------
                             MUSCLE INJURIES
                         Shoulder Girdle and Arm
------------------------------------------------------------------------
5301..............................  Group I Function: Upward rotation of
                                     scapula.
5302..............................  Group II Function: Depression of
                                     arm.
5303..............................  Group III Function: Elevation and
                                     abduction of arm.
5304..............................  Group IV Function: Stabilization of
                                     shoulder.
5305..............................  Group V Function: Elbow supination.
5306..............................  Group VI Function: Extension of
                                     elbow.
------------------------------------------------------------------------
                            Forearm and Hand
------------------------------------------------------------------------
5307..............................  Group VII Function: Flexion of wrist
                                     and fingers.
5308..............................  Group VIII Function: Extension of
                                     wrist, fingers, thumb.
5309..............................  Group IX Function: Forearm muscles.
------------------------------------------------------------------------
                              Foot and Leg
------------------------------------------------------------------------
5310..............................  Group X Function: Movement of
                                     forefoot and toes.
5311..............................  Group XI Function: Propulsion of
                                     foot.
5312..............................  Group XII Function: Dorsiflexion.
------------------------------------------------------------------------
                         Pelvic Girdle and Thigh
------------------------------------------------------------------------
5313..............................  Group XIII Function: Extension of
                                     hip and flexion of knee.
5314..............................  Group XIV Function: Extension of
                                     knee.
5315..............................  Group XV Function: Adduction of hip.
5316..............................  Group XVI Function: Flexion of hip.
5317..............................  Group XVII Function: Extension of
                                     hip.
5318..............................  Group XVIII Function: Outward
                                     rotation of thigh.
------------------------------------------------------------------------
                             Torso and Neck
------------------------------------------------------------------------
5319..............................  Group XIX Function: Abdominal wall
                                     and lower thorax.
5320..............................  Group XX Function: Postural support
                                     of body.
5321..............................  Group XXI Function: Respiration.
5322..............................  Group XXII Function: Rotary and
                                     forward movements, head.
5323..............................  Group XXIII Function: Movements of
                                     head.
------------------------------------------------------------------------
                              Miscellaneous
------------------------------------------------------------------------
5324..............................  Diaphragm, rupture.

[[Page 512]]

 
5325..............................  Muscle injury, facial muscles.
5326..............................  Muscle hernia.
5327..............................  Muscle, neoplasm of, malignant.
5328..............................  Muscle, neoplasm of, benign.
5329..............................  Sarcoma, soft tissue.
5330..............................  Rhabdomyolysis, residuals of.
5331..............................  Compartment syndrome.
------------------------------------------------------------------------
                                 THE EYE
                           Diseases of the Eye
------------------------------------------------------------------------
6000..............................  Choroidopathy, including uveitis,
                                     iritis, cyclitis, or choroiditis.
6001..............................  Keratopathy.
6002..............................  Scleritis.
6003..............................  Iritis.
6004..............................  Cyclitis.
6005..............................  Choroiditis.
6006..............................  Retinopathy or maculopathy not
                                     otherwise specified.
6007..............................  Intraocular hemorrhage.
6008..............................  Detachment of retina.
6009..............................  Unhealed eye injury.
6010..............................  Tuberculosis of eye.
6011..............................  Retinal scars, atrophy, or
                                     irregularities.
6012..............................  Angle-closure glaucoma.
6013..............................  Open-angle glaucoma.
6014..............................  Malignant neoplasms of the eye,
                                     orbit, and adnexa (excluding skin).
6015..............................  Benign neoplasms of the eye, orbit,
                                     and adnexa (excluding skin).
6016..............................  Nystagmus, central.
6017..............................  Conjunctivitis, trachomatous,
                                     chronic.
6018..............................  Conjunctivitis, other, chronic.
6019..............................  Ptosis unilateral or bilateral.
6020..............................  Ectropion.
6021..............................  Entropion.
6022..............................  Lagophthalmos.
6023..............................  Eyebrows, loss.
6024..............................  Eyelashes, loss.
6025..............................  Disorders of the lacrimal apparatus
                                     (epiphora, dacrocystitis, etc.).
6026..............................  Optic neuropathy.
6027..............................  Cataract.
6028..............................  Cataract, senile, and others.
6029..............................  Aphakia.
6030..............................  Accommodation, paralysis.
6031..............................  Dacryocystitis.
6032..............................  Eyelids, loss of portion.
6033..............................  Lens, crystalline, dislocation.
6034..............................  Pterygium.
6035..............................  Keratoconus.
6036..............................  Status post corneal transplant.
6040..............................  Diabetic retinopathy.
6042..............................  Retinal dystrophy (including
                                     retinitis pigmentosa, wet or dry
                                     macular degeneration, early-onset
                                     macular degeneration, rod and/or
                                     cone dystrophy).
6046..............................  Post-chiasmal disorders.
------------------------------------------------------------------------
                   Impairment of Central Visual Acuity
------------------------------------------------------------------------
6061..............................  Anatomical loss both eyes.
6062..............................  Blindness, both eyes, only light
                                     perception.
------------------------------------------------------------------------
Anatomical loss of 1 eye:
6063..............................  Other eye 5/200 (1.5/60).
6064..............................  Other eye 10/200 (3/60).
6064..............................  Other eye 15/200 (4.5/60).
6064..............................  Other eye 20/200 (6/60).
6065..............................  Other eye 20/100 (6/30).
6065..............................  Other eye 20/70 (6/21).
6065..............................  Other eye 20/50 (6/15).
6066..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Blindness in 1 eye, only light perception:
6067..............................  Other eye 5/200 (1.5/60).
6068..............................  Other eye 10/200 (3/60).
6068..............................  Other eye 15/200 (4.5/60).
6068..............................  Other eye 20/200 (6/60).
6069..............................  Other eye 20/100 (6/30).

[[Page 513]]

 
6069..............................  Other eye 20/70 (6/21).
6069..............................  Other eye 20/50 (6/15).
6070..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 5/200 (1.5/60):
6071..............................  Other eye 5/200 (1.5/60).
6072..............................  Other eye 10/200 (3/60).
6072..............................  Other eye 15/200 (4.5/60).
6072..............................  Other eye 20/200 (6/60).
6073..............................  Other eye 20/100 (6/30).
6073..............................  Other eye 20/70 (6/21).
6073..............................  Other eye 20/50 (6/15).
6074..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 10/200 (3/60):
6075..............................  Other eye 10/200 (3/60).
6075..............................  Other eye 15/200 (4.5/60).
6075..............................  Other eye 20/200 (6/60).
6076..............................  Other eye 20/100 (6/30).
6076..............................  Other eye 20/70 (6/21).
6076..............................  Other eye 20/50 (6/15).
6077..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 15/200 (4.5/60):
6075..............................  Other eye 15/200 (4.5/60).
6075..............................  Other eye 20/200 (6/60).
6076..............................  Other eye 20/100 (6/30).
6076..............................  Other eye 20/70 (6/21).
6076..............................  Other eye 20/50 (6/15).
6077..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 20/200 (6/60):
6075..............................  Other eye 20/200 (6/60).
6076..............................  Other eye 20/100 (6/30).
6076..............................  Other eye 20/70 (6/21).
6076..............................  Other eye 20/50 (6/15).
6077..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 20/100 (6/30):
6078..............................  Other eye 20/100 (6/30).
6078..............................  Other eye 20/70 (6/21).
6078..............................  Other eye 20/50 (6/15).
6079..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 20/70 (6/21):
6078..............................  Other eye 20/70 (6/21).
6078..............................  Other eye 20/50 (6/15).
6079..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Vision in 1 eye 20/50 (6/15):
6078..............................  Other eye 20/50 (6/15).
6079..............................  Other eye 20/40 (6/12).
------------------------------------------------------------------------
Impairment of Field Vision:
6080..............................  Field vision, impairment.
6081..............................  Scotoma.
------------------------------------------------------------------------
Impairment of Muscle Function:
6090..............................  Diplopia.
6091..............................  Symblepharon.
6092..............................  Diplopia, limited muscle function.
------------------------------------------------------------------------
                                 THE EAR
------------------------------------------------------------------------
6200..............................  Chronic suppurative otitis media.
6201..............................  Chronic nonsuppurative otitis media.
6202..............................  Otosclerosis.
6204..............................  Peripheral vestibular disorders.
6205..............................  Meniere's syndrome.
6207..............................  Loss of auricle.
6208..............................  Malignant neoplasm.
6209..............................  Benign neoplasm.
6210..............................  Chronic otitis externa.
6211..............................  Tympanic membrane.
6260..............................  Tinnitus, recurrent.
------------------------------------------------------------------------

[[Page 514]]

 
                           OTHER SENSE ORGANS
------------------------------------------------------------------------
6275..............................  Smell, complete loss.
6276..............................  Taste, complete loss.
------------------------------------------------------------------------
   INFECTIOUS DISEASES, IMMUNE DISORDERS AND NUTRITIONAL DEFICIENCIES
------------------------------------------------------------------------
6300..............................  Vibriosis (Cholera, Non-cholera).
6301..............................  Visceral Leishmaniasis.
6302..............................  Leprosy (Hansen's Disease).
6304..............................  Malaria.
6305..............................  Lymphatic filariasis, to include
                                     elephantiasis.
6306..............................  Bartonellosis.
6307..............................  Plague.
6308..............................  Relapsing fever.
6309..............................  Rheumatic fever.
6310..............................  Syphilis.
6311..............................  Tuberculosis, miliary.
6312..............................  Nontuberculosis mycobacterium
                                     infection.
6313..............................  Avitaminosis.
6314..............................  Beriberi.
6315..............................  Pellagra.
6316..............................  Brucellosis.
6317..............................  Rickettsial, ehrlichia, and
                                     anaplasma infections.
6318..............................  Melioidosis.
6319..............................  Lyme disease.
6320..............................  Parasitic diseases.
6325..............................  Hyperinfection syndrome or
                                     disseminated strongyloidiasis.
6326..............................  Schistosomiasis.
6329..............................  Hemorrhagic fevers, including
                                     dengue, yellow fever, and others.
6330..............................  Campylobacter jejuni infection.
6331..............................  Coxiella burnetii infection (Q
                                     Fever).
6333..............................  Nontyphoid salmonella infections.
6334..............................  Shigella infections.
6335..............................  West Nile virus infection.
6350..............................  Lupus erythematosus.
6351..............................  HIV-Related Illness.
6354..............................  Chronic Fatigue Syndrome (CFS).
------------------------------------------------------------------------
                         THE RESPIRATORY SYSTEM
                             Nose and Throat
------------------------------------------------------------------------
6502..............................  Septum, nasal, deviation.
6504..............................  Nose, loss of part of, or scars.
6510..............................  Sinusitis, pansinusitis, chronic.
6511..............................  Sinusitis, ethmoid, chronic.
6512..............................  Sinusitis, frontal, chronic.
6513..............................  Sinusitis, maxillary, chronic.
6514..............................  Sinusitis, sphenoid, chronic.
6515..............................  Laryngitis, tuberculous.
6516..............................  Laryngitis, chronic.
6518..............................  Laryngectomy, total.
6519..............................  Aphonia, complete organic.
6520..............................  Larynx, stenosis of.
6521..............................  Pharynx, injuries to.
6522..............................  Allergic or vasomotor rhinitis.
6523..............................  Bacterial rhinitis.
6524..............................  Granulomatous rhinitis.
------------------------------------------------------------------------
                           Trachea and Bronchi
------------------------------------------------------------------------
6600..............................  Bronchitis, chronic.
6601..............................  Bronchiectasis.
6602..............................  Asthma, bronchial.
6603..............................  Emphysema, pulmonary.
6604..............................  Chronic obstructive pulmonary
                                     disease.
------------------------------------------------------------------------
                      Lungs and Pleura Tuberculosis
------------------------------------------------------------------------
Ratings for Pulmonary Tuberculosis (Chronic) Entitled on August 19,
 1968:
6701..............................  Active, far advanced.
6702..............................  Active, moderately advanced.
6703..............................  Active, minimal.
6704..............................  Active, advancement unspecified.
6721..............................  Inactive, far advanced.

[[Page 515]]

 
6722..............................  Inactive, moderately advanced.
6723..............................  Inactive, minimal.
6724..............................  Inactive, advancement unspecified.
------------------------------------------------------------------------
Ratings for Pulmonary Tuberculosis Initially Evaluated After August 19,
 1968:
6730..............................  Chronic, active.
6731..............................  Chronic, inactive.
6732..............................  Pleurisy, active or inactive.
------------------------------------------------------------------------
                         Nontuberculous Diseases
------------------------------------------------------------------------
6817..............................  Pulmonary Vascular Disease.
6819..............................  Neoplasms, malignant.
6820..............................  Neoplasms, benign.
------------------------------------------------------------------------
                    Bacterial Infections of the Lung
------------------------------------------------------------------------
6822..............................  Actinomycosis.
6823..............................  Nocardiosis.
6824..............................  Chronic lung abscess.
------------------------------------------------------------------------
                        Interstitial Lung Disease
------------------------------------------------------------------------
6825..............................  Fibrosis of lung, diffuse
                                     interstitial.
6826..............................  Desquamative interstitial
                                     pneumonitis.
6827..............................  Pulmonary alveolar proteinosis.
6828..............................  Eosinophilic granuloma.
6829..............................  Drug-induced, pneumonitis &
                                     fibrosis.
6830..............................  Radiation-induced, pneumonitis &
                                     fibrosis.
6831..............................  Hypersensitivity pneumonitis.
6832..............................  Pneumoconiosis.
6833..............................  Asbestosis.
------------------------------------------------------------------------
                          Mycotic Lung Disease
------------------------------------------------------------------------
6834..............................  Histoplasmosis.
6835..............................  Coccidioidomycosis.
6836..............................  Blastomycosis.
6837..............................  Cryptococcosis.
6838..............................  Aspergillosis.
6839..............................  Mucormycosis.
------------------------------------------------------------------------
                        Restrictive Lung Disease
------------------------------------------------------------------------
6840..............................  Diaphragm paralysis or paresis.
6841..............................  Spinal cord injury with respiratory
                                     insufficiency.
6842..............................  Kyphoscoliosis, pectus excavatum/
                                     carinatum.
6843..............................  Traumatic chest wall defect.
6844..............................  Post-surgical residual.
6845..............................  Pleural effusion or fibrosis.
6846..............................  Sarcoidosis.
6847..............................  Sleep Apnea Syndromes.
------------------------------------------------------------------------
                        THE CARDIOVASCULAR SYSTEM
                          Diseases of the Heart
------------------------------------------------------------------------
7000..............................  Valvular heart disease.
7001..............................  Endocarditis.
7002..............................  Pericarditis.
7003..............................  Pericardial adhesions.
7004..............................  Syphilitic heart disease.
7005..............................  Arteriosclerotic heart disease.
7006..............................  Myocardial infarction.
7007..............................  Hypertensive heart disease.
7008..............................  Hyperthyroid heart disease.
7010..............................  Supraventricular arrhythmias.
7011..............................  Ventricular arrhythmias.
7015..............................  Atrioventricular block.
7016..............................  Heart valve replacement.
7017..............................  Coronary bypass surgery.
7018..............................  Implantable cardiac pacemakers.
7019..............................  Cardiac transplantation.
7020..............................  Cardiomyopathy.
------------------------------------------------------------------------

[[Page 516]]

 
                   Diseases of the Arteries and Veins
------------------------------------------------------------------------
7101..............................  Hypertensive vascular disease.
7110..............................  Aortic aneurysm.
7111..............................  Aneurysm, large artery.
7112..............................  Aneurysm, small artery.
7113..............................  Arteriovenous fistula, traumatic.
7114..............................  Arteriosclerosis obliterans.
7115..............................  Thrombo-angiitis obliterans
                                     (Buerger's Disease).
7117..............................  Raynaud's syndrome.
7118..............................  Angioneurotic edema.
7119..............................  Erythromelalgia.
7120..............................  Varicose veins.
7121..............................  Post-phlebitic syndrome.
7122..............................  Cold injury residuals.
7123..............................  Soft tissue sarcoma.
------------------------------------------------------------------------
                          THE DIGESTIVE SYSTEM
------------------------------------------------------------------------
7200..............................  Mouth, injuries.
7201..............................  Lips, injuries.
7202..............................  Tongue, loss.
7203..............................  Esophagus, stricture.
7204..............................  Esophagus, spasm.
7205..............................  Esophagus, diverticulum.
7301..............................  Peritoneum, adhesions.
7304..............................  Ulcer, gastric.
7305..............................  Ulcer, duodenal.
7306..............................  Ulcer, marginal.
7307..............................  Gastritis, hypertrophic.
7308..............................  Postgastrectomy syndromes.
7309..............................  Stomach, stenosis.
7310..............................  Stomach, injury of, residuals.
7311..............................  Liver, injury of, residuals.
7312..............................  Liver, cirrhosis.
7314..............................  Cholecystitis, chronic.
7315..............................  Cholelithiasis, chronic.
7316..............................  Cholangitis, chronic.
7317..............................  Gall bladder, injury.
7318..............................  Gall bladder, removal.
7319..............................  Colon, irritable syndrome.
7321..............................  Amebiasis.
7322..............................  Dysentery, bacillary.
7323..............................  Colitis, ulcerative.
7324..............................  Distomiasis, intestinal or hepatic.
7325..............................  Enteritis, chronic.
7326..............................  Enterocolitis, chronic.
7327..............................  Diverticulitis.
7328..............................  Intestine, small, resection.
7329..............................  Intestine, large, resection.
7330..............................  Intestine, fistula.
7331..............................  Peritonitis.
7332..............................  Rectum & anus, impairment.
7333..............................  Rectum & anus, stricture.
7334..............................  Rectum, prolapse.
7335..............................  Ano, fistula in.
7336..............................  Hemorrhoids.
7337..............................  Pruritus ani.
7338..............................  Hernia, inguinal.
7339..............................  Hernia, ventral, postoperative.
7340..............................  Hernia, femoral.
7342..............................  Visceroptosis.
7343..............................  Neoplasms, malignant.
7344..............................  Neoplasms, benign.
7345..............................  Liver disease, chronic, without
                                     cirrhosis.
7346..............................  Hernia, hiatal.
7347..............................  Pancreatitis.
7348..............................  Vagotomy.
7351..............................  Liver transplant.
7354..............................  Hepatitis C.
------------------------------------------------------------------------
                        THE GENITOURINARY SYSTEM
------------------------------------------------------------------------
7500..............................  Kidney, removal.

[[Page 517]]

 
7501..............................  Kidney, abscess.
7502..............................  Nephritis, chronic.
7504..............................  Pyelonephritis, chronic.
7505..............................  Kidney, tuberculosis.
7507..............................  Nephrosclerosis, arteriolar.
7508..............................  Nephrolithiasis.
7509..............................  Hydronephrosis.
7510..............................  Ureterolithiasis.
7511..............................  Ureter, stricture.
7512..............................  Cystitis, chronic.
7515..............................  Bladder, calculus.
7516..............................  Bladder, fistula.
7517..............................  Bladder, injury.
7518..............................  Urethra, stricture.
7519..............................  Urethra, fistula.
7520..............................  Penis, removal of half or more.
7521..............................  Penis, removal of glans.
7522..............................  Penis, deformity, with loss of
                                     erectile power.
7523..............................  Testis, atrophy, complete.
7524..............................  Testis, removal.
7525..............................  Epididymo-orchitis, chronic only.
7527..............................  Prostate gland.
7528..............................  Malignant neoplasms.
7529..............................  Benign neoplasms.
7530..............................  Renal disease, chronic.
7531..............................  Kidney transplant.
7532..............................  Renal tubular disorders.
7533..............................  Kidneys, cystic diseases.
7534..............................  Atherosclerotic renal disease.
7535..............................  Toxic nephropathy.
7536..............................  Glomerulonephritis.
7537..............................  Interstitial nephritis.
7538..............................  Papillary necrosis.
7539..............................  Renal amyloid disease.
7540..............................  Disseminated intravascular
                                     coagulation.
7541..............................  Renal involvement in systemic
                                     diseases.
7542..............................  Neurogenic bladder.
------------------------------------------------------------------------
          GYNECOLOGICAL CONDITIONS AND DISORDERS OF THE BREAST
------------------------------------------------------------------------
7610..............................  Vulva or clitoris, disease or injury
                                     of (including vulvovaginitis).
7611..............................  Vagina, disease or injury.
7612..............................  Cervix, disease or injury.
7613..............................  Uterus, disease or injury.
7614..............................  Fallopian tube, disease or injury.
7615..............................  Ovary, disease or injury.
7617..............................  Uterus and both ovaries, removal.
7618..............................  Uterus, removal.
7619..............................  Ovary, removal.
7620..............................  Ovaries, atrophy of both.
7621..............................  Complete or incomplete pelvic organ
                                     prolapse due to injury or disease
                                     or surgical complications of
                                     pregnancy.
7624..............................  Fistula, rectovaginal.
7625..............................  Fistula, urethrovaginal.
7626..............................  Breast, surgery.
7627..............................  Malignant neoplasms of gynecological
                                     system.
7628..............................  Benign neoplasms of gynecological
                                     system.
7629..............................  Endometriosis.
7630..............................  Malignant neoplasms of the breast.
7631..............................  Benign neoplasms of the breast and
                                     other injuries of the breast.
7632..............................  Female sexual arousal disorder
                                     (FSAD).
------------------------------------------------------------------------
                  The Hematologic and Lymphatic Systems
------------------------------------------------------------------------
7700..............................  [Removed]
7702..............................  Agranulocytosis, acquired.
7703..............................  Leukemia.
7704..............................  Polycythemia vera.
7705..............................  Immune thrombocytopenia.
7706..............................  Splenectomy.
7707..............................  Spleen, injury of, healed.
7709..............................  Hodgkin's lymphoma.
7710..............................  Adenitis, tuberculous.
7712..............................  Multiple myeloma

[[Page 518]]

 
7714..............................  Sickle cell anemia.
7715..............................  Non-Hodgkin's lymphoma.
7716..............................  Aplastic anemia.
7717..............................  AL amyloidosis (primary
                                     amyloidosis).
7718..............................  Essential thrombocythemia and
                                     primary myelofibrosis.
7719..............................  Chronic myelogenous leukemia (CML)
                                     (chronic myeloid leukemia or
                                     chronic granulocytic leukemia).
7720..............................  Iron deficiency anemia.
7721..............................  Folic acid deficiency.
7722..............................  Pernicious anemia and Vitamin B12
                                     deficiency anemia.
7723..............................  Acquired hemolytic anemia.
7724..............................  Solitary plasmacytoma.
7725..............................  Myelodysplastic syndromes.
------------------------------------------------------------------------
                                THE SKIN
------------------------------------------------------------------------
7800..............................  Burn scar(s) of the head, face, or
                                     neck; scar(s) of the head, face, or
                                     neck due to other causes; or other
                                     disfigurement of the head, face, or
                                     neck.
7801..............................  Burn scar(s) or scar(s) due to other
                                     causes, not of the head, face, or
                                     neck that are associated with
                                     underlying soft tissue damage.
7802..............................  Burn scar(s) or scar(s) due to other
                                     causes, not of the head, face, or
                                     neck that are not associated with
                                     underlying soft tissue damage.
7804..............................  Scar(s), unstable or painful.
7805..............................  Scars, other; and other effects of
                                     scars evaluated under diagnostic
                                     codes 7800, 7801, 7802, or 7804.
7806..............................  Dermatitis or eczema.
7807..............................  Leishmaniasis, American (New World).
7808..............................  Leishmaniasis, Old World.
7809..............................  Discoid lupus erythematosus.
7811..............................  Tuberculosis luposa (lupus
                                     vulgaris).
7813..............................  Dermatophytosis.
7815..............................  Bullous disorders.
7816..............................  Psoriasis.
7817..............................  Erythroderma.
7818..............................  Malignant skin neoplasms.
7819..............................  Benign skin neoplasms.
7820..............................  Infections of the skin.
7821..............................  Cutaneous manifestations of collagen-
                                     vascular diseases not listed
                                     elsewhere.
7822..............................  Papulosquamous disorders not listed
                                     elsewhere.
7823..............................  Vitiligo.
7824..............................  Keratinization, diseases.
7825..............................  Chronic urticaria.
7826..............................  Vasculitis, primary cutaneous.
7827..............................  Erythema multiforme.
7828..............................  Acne.
7829..............................  Chloracne.
7830..............................  Scarring alopecia.
7831..............................  Alopecia areata.
7832..............................  Hyperhidrosis.
7833..............................  Malignant melanoma.
------------------------------------------------------------------------
                          THE ENDOCRINE SYSTEM
------------------------------------------------------------------------
7900..............................  Hyperthyroidism, including, but not
                                     limited to, Graves' disease.
7901..............................  Thyroid enlargement, toxic.
7902..............................  Thyroid enlargement, nontoxic.
7903..............................  Hypothyroidism.
7904..............................  Hyperparathyroidism.
7905..............................  Hypoparathyroidism.
7906..............................  Thyroiditis.
7907..............................  Cushing's syndrome.
7908..............................  Acromegaly.
7909..............................  Diabetes insipidus.
7911..............................  Addison's disease (adrenocortical
                                     insufficiency).
7912..............................  Polyglandular syndrome (multiple
                                     endocrine neoplasia, autoimmune
                                     polyglandular syndrome).
7913..............................  Diabetes mellitus.
7914..............................  Malignant neoplasm.
7915..............................  Benign neoplasm.
7916..............................  Hyperpituitarism.
7917..............................  Hyperaldosteronism.
7918..............................  Pheochromocytoma.
7919..............................  C-cell hyperplasia, thyroid.
------------------------------------------------------------------------

[[Page 519]]

 
            NEUROLOGICAL CONDITIONS AND CONVULSIVE DISORDERS
             Organic Diseases of the Central Nervous System
------------------------------------------------------------------------
8000..............................  Encephalitis, epidemic, chronic.
------------------------------------------------------------------------
                          Brain, New Growth of
------------------------------------------------------------------------
8002..............................  Malignant.
8003..............................  Benign.
8004..............................  Paralysis agitans.
8005..............................  Bulbar palsy.
8007..............................  Brain, vessels, embolism.
8008..............................  Brain, vessels, thrombosis.
8009..............................  Brain, vessels, hemorrhage.
8010..............................  Myelitis.
8011..............................  Poliomyelitis, anterior.
8012..............................  Hematomyelia.
8013..............................  Syphilis, cerebrospinal.
8014..............................  Syphilis, meningovascular.
8015..............................  Tabes dorsalis.
8017..............................  Amyotrophic lateral sclerosis.
8018..............................  Multiple sclerosis.
8019..............................  Meningitis, cerebrospinal, epidemic.
8020..............................  Brain, abscess.
------------------------------------------------------------------------
                        Spinal Cord, New Growths
------------------------------------------------------------------------
8021..............................  Malignant.
8022..............................  Benign.
8023..............................  Progressive muscular atrophy.
8024..............................  Syringomyelia.
8025..............................  Myasthenia gravis.
8045..............................  Residuals of traumatic brain injury
                                     (TBI).
8046..............................  Cerebral arteriosclerosis.
------------------------------------------------------------------------
                         Miscellaneous Diseases
------------------------------------------------------------------------
8100..............................  Migraine
8103..............................  Tic, convulsive.
8104..............................  Paramyoclonus multiplex.
8105..............................  Chorea, Sydenham's.
8106..............................  Chorea, Huntington's.
8107..............................  Athetosis, acquired.
8108..............................  Narcolepsy.
------------------------------------------------------------------------
                           The Cranial Nerves
------------------------------------------------------------------------
8205..............................  Fifth (trigeminal), paralysis.
8207..............................  Seventh (facial), paralysis.
8209..............................  Ninth (glossopharyngeal), paralysis.
8210..............................  Tenth (pneumogastric, vagus),
                                     paralysis.
8211..............................  Eleventh (spinal accessory, external
                                     branch), paralysis.
8212..............................  Twelfth (hypoglossal), paralysis.
8305..............................  Neuritis, fifth cranial nerve.
8307..............................  Neuritis, seventh cranial nerve.
8309..............................  Neuritis, ninth cranial nerve.
8310..............................  Neuritis, tenth cranial nerve.
8311..............................  Neuritis, eleventh cranial nerve.
8312..............................  Neuritis, twelfth cranial nerve.
8405..............................  Neuralgia, fifth cranial nerve.
8407..............................  Neuralgia, seventh cranial nerve.
8409..............................  Neuralgia, ninth cranial nerve.
8410..............................  Neuralgia, tenth cranial nerve.
8411..............................  Neuralgia, eleventh cranial nerve.
8412..............................  Neuralgia, twelfth cranial nerve.
------------------------------------------------------------------------
                            Peripheral Nerves
------------------------------------------------------------------------
8510..............................  Upper radicular group, paralysis.
8511..............................  Middle radicular group, paralysis.
8512..............................  Lower radicular group, paralysis.
8513..............................  All radicular groups, paralysis.
8514..............................  Musculospiral nerve (radial),
                                     paralysis.
8515..............................  Median nerve, paralysis.
8516..............................  Ulnar nerve, paralysis.

[[Page 520]]

 
8517..............................  Musculocutaneous nerve, paralysis.
8518..............................  Circumflex nerve, paralysis.
8519..............................  Long thoracic nerve, paralysis.
8520..............................  Sciatic nerve, paralysis.
8521..............................  External popliteal nerve (common
                                     peroneal), paralysis.
8522..............................  Musculocutaneous nerve (superficial
                                     peroneal), paralysis.
8523..............................  Anterior tibial nerve (deep
                                     peroneal), paralysis.
8524..............................  Internal popliteal nerve (tibial),
                                     paralysis.
8525..............................  Posterior tibial nerve, paralysis.
8526..............................  Anterior crural nerve (femoral),
                                     paralysis.
8527..............................  Internal saphenous nerve, paralysis.
8528..............................  Obturator nerve, paralysis.
8529..............................  External cutaneous nerve of thigh,
                                     paralysis.
8530..............................  Ilio-inguinal nerve, paralysis.
8540..............................  Soft-tissue sarcoma (Neurogenic
                                     origin).
8610..............................  Neuritis, upper radicular group.
8611..............................  Neuritis, middle radicular group.
8612..............................  Neuritis, lower radicular group.
8613..............................  Neuritis, all radicular group.
8614..............................  Neuritis, musculospiral (radial)
                                     nerve.
8615..............................  Neuritis, median nerve.
8616..............................  Neuritis, ulnar nerve.
8617..............................  Neuritis, musculocutaneous nerve.
8618..............................  Neuritis, circumflex nerve.
8619..............................  Neuritis, long thoracic nerve.
8620..............................  Neuritis, sciatic nerve.
8621..............................  Neuritis, external popliteal (common
                                     peroneal) nerve.
8622..............................  Neuritis, musculocutaneous
                                     (superficial peroneal) nerve.
8623..............................  Neuritis, anterior tibial (deep
                                     peroneal) nerve.
8624..............................  Neuritis, internal popliteal
                                     (tibial) nerve.
8625..............................  Neuritis, posterior tibial nerve.
8626..............................  Neuritis, anterior crural (femoral)
                                     nerve.
8627..............................  Neuritis, internal saphenous nerve.
8628..............................  Neuritis, obturator nerve.
8629..............................  Neuritis, external cutaneous nerve
                                     of thigh.
8630..............................  Neuritis, ilio-inguinal nerve.
8710..............................  Neuralgia, upper radicular group.
8711..............................  Neuralgia, middle radicular group.
8712..............................  Neuralgia, lower radicular group.
8713..............................  Neuralgia, all radicular groups.
8714..............................  Neuralgia, musculospiral nerve
                                     (radial).
8715..............................  Neuralgia, median nerve.
8716..............................  Neuralgia, ulnar nerve.
8717..............................  Neuralgia, musculocutaneous nerve.
8718..............................  Neuralgia, circumflex nerve.
8719..............................  Neuralgia, long thoracic nerve.
8720..............................  Neuralgia, sciatic nerve.
8721..............................  Neuralgia, external popliteal nerve
                                     (common peroneal).
8722..............................  Neuralgia, musculocutaneous nerve
                                     (superficial peroneal).
8723..............................  Neuralgia, anterior tibial nerve
                                     (deep peroneal).
8724..............................  Neuralgia, internal popliteal nerve
                                     (tibial).
8725..............................  Neuralgia, posterior tibial nerve.
8726..............................  Neuralgia, anterior crural nerve
                                     (femoral).
8727..............................  Neuralgia, internal saphenous nerve.
8728..............................  Neuralgia, obturator nerve.
8729..............................  Neuralgia, external cutaneous nerve
                                     of thigh.
8730..............................  Neuralgia, ilio-inguinal nerve.
------------------------------------------------------------------------
                             The Epilepsies
------------------------------------------------------------------------
8910..............................  Grand mal.
8911..............................  Petit mal.
8912..............................  Jacksonian and focal motor or
                                     sensory.
8913..............................  Diencephalic.
8914..............................  Psychomotor.
------------------------------------------------------------------------
                            Mental Disorders
------------------------------------------------------------------------
9201..............................  Schizophrenia.
9208..............................  Delusional disorder.
9210..............................  Other specified and unspecified
                                     schizophrenia spectrum and other
                                     psychotic disorders.
9211..............................  Schizoaffective Disorder.
9300..............................  Delirium.
9301..............................  Major or mild neurocognitive
                                     disorder due to HIV or other
                                     infections.

[[Page 521]]

 
9304..............................  Major or mild neurocognitive
                                     disorder due to traumatic brain
                                     injury.
9305..............................  Major or mild vascular
                                     neurocognitive disorder.
9310..............................  Unspecified neurocognitive disorder.
9312..............................  Major or mild neurocognitive
                                     disorder due to Alzheimer's
                                     disease.
9326..............................  Major or mild neurocognitive
                                     disorder due to another medical
                                     condition or substance/medication-
                                     induced major or mild
                                     neurocognitive disorder.
9400..............................  Generalized anxiety disorder.
9403..............................  Specific phobia; social anxiety
                                     disorder (social phobia).
9404..............................  Obsessive compulsive disorder.
9410..............................  Other specified anxiety disorder.
9411..............................  Posttraumatic stress disorder.
9412..............................  Panic disorder and/or agoraphobia.
9413..............................  Unspecified anxiety disorder.
9416..............................  Dissociative amnesia; dissociative
                                     identity disorder.
9417..............................  Depersonalization/derealization
                                     disorder.
9421..............................  Somatic symptom disorder.
9422..............................  Other specified somatic symptom and
                                     related disorder.
9423..............................  Unspecified somatic symptom and
                                     related disorder.
9424..............................  Conversion disorder (functional
                                     neurological symptom disorder).
9425..............................  Illness anxiety disorder.
9431..............................  Cyclothymic disorder.
9432..............................  Bipolar disorder.
9433..............................  Persistent depressive disorder
                                     (dysthymia).
9434..............................  Major depressive disorder.
9435..............................  Unspecified depressive disorder.
9440..............................  Chronic adjustment disorder.
9520..............................  Anorexia nervosa.
9521..............................  Bulimia nervosa.
------------------------------------------------------------------------
                       DENTAL AND ORAL CONDITIONS
------------------------------------------------------------------------
9900..............................  Maxilla or mandible, chronic
                                     osteomyelitis, osteonecrosis, or
                                     osteoradionecrosis of.
9901..............................  Mandible, loss of, complete.
9902..............................  Mandible loss of, including ramus,
                                     unilaterally or bilaterally.
9903..............................  Mandible, nonunion of, confirmed by
                                     diagnostic imaging studies.
9904..............................  Mandible, malunion.
9905..............................  Temporomandibular disorder (TMD).
9908..............................  Condyloid process.
9909..............................  Coronoid process.
9911..............................  Hard palate, loss of.
9913..............................  Teeth, loss of.
9914..............................  Maxilla, loss of more than half.
9915..............................  Maxilla, loss of half or less.
9916..............................  Maxilla, malunion or nonunion of.
9917..............................  Neoplasm, hard and soft tissue,
                                     benign.
9918..............................  Neoplasm, hard and soft tissue,
                                     malignant.
------------------------------------------------------------------------


[72 FR 12990, Mar. 20, 2007, as amended at 73 FR 54708, 54711, Sept. 23, 
2008; 74 FR 18467, Apr. 23, 2009; 77 FR 6467, Feb. 8, 2012; 79 FR 45102, 
Aug. 4, 2014; 82 FR 36085, Aug. 3, 2017; 82 FR 50807, Nov. 2, 2017; 83 
FR 15073, Apr. 9, 2018; 83 FR 15323, Apr. 10, 2018; 83 FR 32600, July 
13, 2018; 83 FR 54258, Oct. 29, 2018; 84 FR 28234, June 18, 2019; 85 FR 
76466, Nov. 30, 2020; 86 FR 8143, Feb. 4, 2021]



      Sec. Appendix C to Part 4--Alphabetical Index of Disabilities

------------------------------------------------------------------------
                                                            Diagnostic
                                                             code No.
------------------------------------------------------------------------
Abscess:
    Brain...............................................            8020
    Kidney..............................................            7501
    Lung................................................            6824
Acne....................................................            7828
Acromegaly..............................................            7908
Actinomycosis...........................................            6822
Addison's disease.......................................            7911
Agranulocytosis, acquired...............................            7702
AL amyloidosis..........................................            7717
Alopecia areata.........................................            7831
Amebiasis...............................................            7321
Amputation:
    Arm:
        Complete amputation, upper extremity............            5120

[[Page 522]]

 
        Above insertion of deltoid......................            5121
        Below insertion of deltoid......................            5122
    Digits, five of one hand............................            5126
    Digits, four of one hand:
        Thumb, index, long and ring.....................            5127
        Thumb, index, long and little...................            5128
        Thumb, index, ring and little...................            5129
        Thumb, long, ring and little....................            5130
        Index, long, ring and little....................            5131
    Digits, three of one hand:..........................
        Thumb, index and long...........................            5132
        Thumb, index and ring...........................            5133
        Thumb, index and little.........................            5134
        Thumb, long and ring............................            5135
        Thumb, long and little..........................            5136
        Thumb, ring and little..........................            5137
        Index, long and ring............................            5138
        Index, long and little..........................            5139
        Index, ring and little..........................            5140
        Long, ring and little...........................            5141
    Digits, two of one hand:
        Thumb and index.................................            5142
        Thumb and long..................................            5143
        Thumb and ring..................................            5144
        Thumb and little................................            5145
        Index and long..................................            5146
        Index and ring..................................            5147
        Index and little................................            5148
        Long and ring...................................            5149
        Long and little.................................            5150
        Ring and little.................................            5151
    Single finger:
        Thumb...........................................            5152
        Index finger....................................            5153
        Long finger.....................................            5154
        Ring finger.....................................            5155
        Little finger...................................            5156
    Forearm:
        Above insertion of pronator teres...............            5123
        Below insertion of pronator teres...............            5124
    Leg:
        With defective stump............................            5163
        Not improvable by prosthesis controlled by                  5164
         natural knee action............................
        At lower level, permitting prosthesis...........            5165
        Forefoot, proximal to metatarsal bones..........            5166
        Toes, all, amputation of, without metatarsal                5170
         loss or transmetatarsal, amputation of, with up
         to half of metatarsal loss.....................
        Toe, great......................................            5171
        Toe, other than great, with removal metatarsal              5172
         head...........................................
        Toes, three or more, without metatarsal                     5173
         involvement....................................
    Thigh:
        Complete amputation, lower extremity............            5160
        Upper third.....................................            5161
        Middle or lower thirds..........................            5162
Amyotrophic lateral sclerosis...........................            8017
Anatomical loss of:
    Both eyes...........................................            6061
One eye, with visual acuity of other eye:
        5/200 (1.5/60)..................................            6063
        10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)...            6064
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6065
        20/40 (6/12)....................................            6066
    Both feet...........................................            5107
    Both hands..........................................            5106
    One hand and one foot...............................            5108
    One foot and loss of use of one hand................            5105
    One hand and loss of use of one foot................            5104
Anemia:
    Acquired hemolytic anemia...........................            7723
    Folic acid deficiency...............................            7721
    Iron deficiency anemia..............................            7720
    Pernicious anemia and Vitamin B12 deficiency anemia.            7722
Aneurysm:

[[Page 523]]

 
    Aortic..............................................            7110
    Large artery........................................            7111
    Small artery........................................            7112
Angioneurotic edema.....................................            7118
Ankylosis:
    Ankle...............................................            5270
Digits, individual:
        Thumb...........................................            5224
        Index finger....................................            5225
        Long finger.....................................            5226
        Ring or little finger...........................            5227
    Elbow...............................................            5205
    Hand
Favorable:
    Five digits of one hand.............................            5220
    Four digits of one hand.............................            5221
    Three digits of one hand............................            5222
    Two digits of one hand..............................            5223
Unfavorable:
    Five digits of one hand.............................            5216
    Four digits of one hand.............................            5217
    Three digits of one hand............................            5218
    Two digits of one hand..............................            5219
Hip.....................................................            5250
Knee....................................................            5256
Scapulohumeral articulation.............................            5200
Subastragalar or tarsal joint...........................            5272
Wrist...................................................            5214
Ankylosing spondylitis..................................            5240
Aphakia.................................................            6029
Aphonia, organic........................................            6519
Aplastic anemia.........................................            7716
Arrhythmia:
    Supraventricular....................................            7010
    Ventricular.........................................            7011
Arteriosclerosis obliterans.............................            7114
Arteriosclerotic heart disease..........................            7005
Arteriovenous fistula...................................            7113
Arthritis:
    Degenerative, other than post-traumatic.............            5003
    Gonorrheal..........................................            5004
    Other specified forms (excluding gout)..............            5009
    Pneumococcic........................................            5005
    Post-traumatic......................................            5010
    Multi-joint (except post-traumatic and gout)........            5002
    Streptococcic.......................................            5008
    Syphilitic..........................................            5007
    Typhoid.............................................            5006
Arthropathy.............................................            5009
Asbestosis..............................................            6833
Aspergillosis...........................................            6838
Asthma, bronchial.......................................            6602
Astragalectomy..........................................            5274
Atherosclerotic renal disease...........................            7534
Athetosis...............................................            8107
Atrioventricular block..................................            7015
Avitaminosis............................................            6313
Bartonellosis...........................................            6306
Beriberi................................................            6314
Bladder:
    Calculus in.........................................            7515
    Fistula in..........................................            7516
    Injury of...........................................            7517
    Neurogenic..........................................            7542
Blastomycosis...........................................            6836
Blindness: see also Vision and Anatomical Loss
    Both eyes, only light perception....................            6062
    One eye, only light perception and other eye:
        5/200 (1.5/60)..................................            6067
        10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)...            6068
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6069
        20/40 (6/12)....................................            6070
Bones:

[[Page 524]]

 
    Neoplasm, benign....................................            5015
    Neoplasm, malignant, primary or secondary...........            5012
    Shortening of the lower extremity...................            5275
Brain:
    Abscess.............................................            8020
Breast surgery..........................................            7626
Bronchiectasis..........................................            6601
Bronchitis..............................................            6600
Brucellosis.............................................            6316
Buerger's disease.......................................            7115
Bulbar palsy............................................            8005
Bullous disorders.......................................            7815
Bursitis................................................            5019
Campylobacter jejuni infection..........................            6330
Cardiac:
    Pacemakers, implantable.............................            7018
    Transplantation.....................................            7019
Cardiomyopathy..........................................            7020
C-cell hyperplasia, thyroid.............................            7919
Cataract:
    Senile and others...................................            6028
    Traumatic...........................................            6027
Cerebral arteriosclerosis...............................            8046
Cervical strain.........................................            5237
Cervix disease or injury................................            7612
Chorea:
    Huntington's........................................            8106
    Sydenham's..........................................            8105
Chloracne...............................................            7829
Cholangitis, chronic....................................            7316
Cholecystitis, chronic..................................            7314
Cholelithiasis, chronic.................................            7315
Choroiditis.............................................            6005
Chronic Fatigue Syndrome (CFS)..........................            6354
Chronic lung abscess....................................            6824
Chronic obstructive pulmonary disease...................            6604
Coccidioidomycosis......................................            6835
Cold injury residuals...................................            7122
Colitis, ulcerative.....................................            7323
Compartment syndrome....................................            5331
Complete or incomplete pelvic organ prolapse due to                 7621
 injury or disease or surgical complications of
 pregnancy, including uterine or vaginal vault prolapse,
 cystocele, urethrocele, rectocele, enterocele, or
 combination............................................
Conjunctivitis:
    Trachomatous........................................            6017
    Other...............................................            6018
Coronary bypass surgery.................................            7017
Coxiella burnetii infection (Q Fever)...................            6331
Cryptococcosis..........................................            6837
Cushing's syndrome......................................            7907
Cutaneous manifestations of collagen-vascular diseases              7821
 not listed elsewhere...................................
Cyclitis................................................            6004
Cystitis, chronic.......................................            7512
Dacryocystitis..........................................            6031
Decompression illness...................................            5011
Dermatitis or eczema....................................            7806
Dermatophytosis.........................................            7813
Desquamative interstitial pneumonitis...................            6826
Diabetes:
    Insipidus...........................................            7909
    Mellitus............................................            7913
Diaphragm:
    Paralysis or paresis................................            6840
    Rupture.............................................            5324
Diplopia................................................            6090
Diplopia, limited muscle function, eye..................            6092
Disease:
    Addison's...........................................            7911
    Buerger's...........................................            7115
    Chronic obstructive pulmonary disease...............            6604
    Hodgkin's...........................................            7709
    Leprosy (Hansen's)..................................            6302
    Lyme................................................            6319
    Morton's............................................            5279

[[Page 525]]

 
    Parasitic...........................................            6320
Disfigurement of, head, face or neck....................            7800
Dislocated:
    Cartilage, semilunar................................            5258
    Lens, crystalline...................................            6033
Disseminated intravascular coagulation..................            7540
Distomiasis, intestinal or hepatic......................            7324
Diverticulitis..........................................            7327
Dysentery, bacillary....................................            7322
Ectropion...............................................            6020
Embolism, brain.........................................            8007
Emphysema, pulmonary....................................            6603
Encephalitis, epidemic, chronic.........................            8000
Endocarditis............................................            7001
Endometriosis...........................................            7629
Enteritis, chronic......................................            7325
Enterocolitis, chronic..................................            7326
Entropion...............................................            6021
Eosinophilic granuloma of lung..........................            6828
Epididymo-orchitis......................................            7525
Epilepsies:
    Diencephalic........................................            8913
    Grand mal...........................................            8910
    Jacksonian and focal motor or sensory...............            8912
    Petit mal...........................................            8911
    Psychomotor.........................................            8914
Epiphora................................................            6025
Erythema multiforme.....................................            7827
Erythroderma............................................            7817
Erythromelalgia.........................................            7119
Esophagus:
    Diverticulum........................................            7205
    Spasm...............................................            7204
    Stricture...........................................            7203
Fallopian tube..........................................            7614
Female sexual arousal disorder (FSAD)...................            7632
Fever:
    Relapsing...........................................            6308
    Rheumatic...........................................            6309
Fibrosis of lung, diffuse interstitial..................            6825
Fibromyalgia............................................            5025
Fistula in ano..........................................            7335
Fistula:
    Rectovaginal........................................            7624
    Urethrovaginal......................................            7625
Flatfoot, acquired......................................            5276
Gastritis, hypertrophic.................................            7307
Genu recurvatum.........................................            5263
Glaucoma:
    Congestive or inflammatory..........................            6012
    Simple, primary, noncongestive......................            6013
Glomerulonephritis......................................            7536
Gout....................................................            5017
Graves' disease.........................................            7900
Hallux:
    Rigidus.............................................            5281
    Valgus..............................................            5280
Hammer toe..............................................            5282
Heart valve replacement.................................            7016
Hematologic:
    Essential thrombocythemia and primary myelofibrosis.            7718
    Immune thrombocytopenia.............................            7705
    Multiple myeloma....................................            7712
    Myelodysplastic syndromes...........................            7725
    Solitary plasmacytoma...............................            7724
Hematomyelia............................................            8012
Hemorrhage:
    Brain...............................................            8009
    Intra-ocular........................................            6007
Hemorrhagic fevers, including dengue, yellow fever, and             6329
 others.................................................
Hemorrhoids.............................................            7336
Hepatitis C.............................................            7354
Hernia:

[[Page 526]]

 
    Femoral.............................................            7340
    Hiatal..............................................            7346
    Inguinal............................................            7338
    Muscle..............................................            5326
    Ventral.............................................            7339
Heterotopic ossification................................            5023
Hip:
    Flail joint.........................................            5254
Histoplasmosis..........................................            6834
HIV-Related Illness.....................................            6351
Hodgkin's disease.......................................            7709
Hodgkin's lymphoma......................................            7709
Hydronephrosis..........................................            7509
Hyperaldosteronism......................................            7917
Hyperhidrosis...........................................            7832
Hyperinfection syndrome or disseminated strongyloidiasis            6325
Hyperparathyroidism.....................................            7904
Hyperpituitarism........................................            7916
Hypersensitivity........................................            6831
Hypertensive:
    Heart disease.......................................            7007
    Vascular disease....................................            7101
Hyperthyroid heart disease..............................            7008
Hyperthyroidism.........................................            7900
Hypoparathyroidism......................................            7905
Hypothyroidism..........................................            7903
Impairment of:
    Humerus.............................................            5202
    Clavicle or scapula.................................            5203
    Elbow...............................................            5209
    Thigh...............................................            5253
    Femur...............................................            5255
    Knee, other.........................................            5257
    Field vision........................................            6080
    Tibia and fibula....................................            5262
    Rectum & anus.......................................            7332
    Ulna................................................            5211
Implantable cardiac pacemakers..........................            7018
Infections of the skin..................................            7820
Injury:
    Bladder.............................................            7517
    Breast..............................................            7631
    Eye, unhealed.......................................            6009
    Foot................................................            5284
    Gall bladder........................................            7317
    Lips................................................            7201
    Liver, residuals....................................            7311
    Mouth...............................................            7200
Muscle:
    Facial..............................................            5325
    Group I Function: Upward rotation of scapula........            5301
    Group II Function: Depression of arm................            5302
    Group III Function: Elevation and abduction of arm..            5303
    Group IV Function: Stabilization of shoulder........            5304
    Group V Function: Elbow supination..................            5305
    Group VI Function: Extension of elbow...............            5306
    Group VII Function: Flexion of wrist and fingers....            5307
    Group VIII Function: Extension of wrist, fingers,               5308
     thumb..............................................
    Group IX Function: Forearm muscles..................            5309
    Group X Function: Movement of forefoot and toes.....            5310
    Group XI Function: Propulsion of foot...............            5311
    Group XII Function: Dorsiflexion....................            5312
    Group XIII Function: Extension of hip and flexion of            5313
     knee...............................................
    Group XIV Function: Extension of knee...............            5314
    Group XV Function: Adduction of hip.................            5315
    Group XVI Function: Flexion of hip..................            5316
    Group XVII Function: Extension of hip...............            5317
    Group XVIII Function: Outward rotation of thigh.....            5318
    Group XIX Function: Abdominal wall and lower thorax.            5319
    Group XX Function: Postural support of body.........            5320
    Group XXI Function: Respiration.....................            5321
    Group XXII Function: Rotary and forward movements,              5322
     head...............................................
    Group XXIII Function: Movements of head.............            5323

[[Page 527]]

 
Pharynx.................................................            6521
Sacroiliac..............................................            5236
    Spinal cord.........................................            6841
    Stomach, residuals of...............................            7310
Iritis..................................................            6003
Interstitial nephritis..................................            7537
Intervertebral disc syndrome............................            5243
Intestine, fistula of...................................            7330
Irritable colon syndrome................................            7319
Keratinization, diseases of.............................            7824
Keratitis...............................................            6001
Keratoconus.............................................            6035
Kidney:
    Abscess.............................................            7501
    Cystic diseases.....................................            7533
    Removal.............................................            7500
    Transplant..........................................            7531
    Tuberculosis........................................            7505
Kyphoscoliosis, pectus excavatum / carinatum............            6842
Lagophthalmos...........................................            6022
Laryngectomy............................................            6518
Laryngitis:
    Tuberculous.........................................            6515
    Chronic.............................................            6516
Larynx, stenosis of.....................................            6520
Leishmaniasis:
    American (New World)................................            7807
    Old World...........................................            7808
Leprosy (Hansen's Disease)..............................            6302
Leukemia:
    Chronic myelogenous leukemia (CML) (chronic myeloid             7719
     leukemia or chronic granulocytic leukemia).........
    Leukemia............................................            7703
Limitation of extension:
    Forearm.............................................            5207
    Leg.................................................            5261
    Radius..............................................            5212
    Supination and pronation............................            5213
    Thigh...............................................            5251
Limitation of extension and flexion:
    Forearm.............................................            5208
Limitation of flexion:
    Forearm.............................................            5206
    Leg.................................................            5260
    Thigh...............................................            5252
Limitation of motion:
    Ankle...............................................            5271
    Arm.................................................            5201
    Index or long finger................................            5229
    Ring or little finger...............................            5230
    Temporomandibular...................................            9905
    Thumb...............................................            5228
    Wrist, limitation of motion.........................            5215
Liver:
    Disease, chronic, without cirrhosis.................            7345
    Transplant..........................................            7351
    Cirrhosis...........................................            7312
Loss of:
    Auricle.............................................            6207
    Condyloid process...................................            9908
    Coronoid process....................................            9909
    Eyebrows............................................            6023
    Eyelashes...........................................            6024
    Eyelids.............................................            6032
    Palate, hard........................................            9911
Mandible:
    Including ramus, unilaterally or bilaterally........            9902
Maxilla:
    More than half......................................            9914
    Less than half......................................            9915
Nose, part of, or scars.................................            6504
Skull, part of..........................................            5296
Smell, sense of.........................................            6275
Taste, sense of.........................................            6276

[[Page 528]]

 
Teeth, loss of..........................................            9913
Tongue, loss of whole or part...........................            7202
Loss of use of:
    Both feet...........................................            5110
    Both hands..........................................            5109
    Foot................................................            5167
    Hand................................................            5125
    One hand and one foot...............................            5111
Lumbosacral strain......................................            5237
Lupus:
    Erythematosus.......................................            6350
    Erythematosus, discoid..............................            7809
Lyme disease............................................            6319
Lymphatic filariasis, to include elephantiasis..........            6305
Malaria.................................................            6304
Malignant melanoma......................................            7833
Malunion:
    Mandible............................................            9904
    Os calcis or astragalus.............................            5273
Maxilla, malunion or nonunion...........................            9916
Maxilla or mandible, chronic osteomyelitis,                         9900
 osteonecrosis, or osteoradionecrosis of................
Melioidosis.............................................            6318
Meniere's syndrome......................................            6205
Meningitis, cerebrospinal, epidemic.....................            8019
Mental disorders:
    Anorexia nervosa....................................            9520
    Bipolar disorder....................................            9432
    Bulimia nervosa.....................................            9521
    Chronic adjustment disorder.........................            9440
    Conversion disorder (functional neurological symptom            9424
     disorder)..........................................
    Cyclothymic disorder................................            9431
    Delirium............................................            9300
    Delusional disorder.................................            9208
    Depersonalization/derealization disorder............            9417
    Dissociative amnesia; dissociative identity disorder            9416
    Generalized anxiety disorder........................            9400
    Illness anxiety disorder............................            9425
    Major depressive disorder...........................            9434
    Major or mild neurocognitive disorder due to                    9312
     Alzheimer's disease................................
    Major or mild neurocognitive disorder due to another            9326
     medical condition or substance/medication-induced
     major or mild neurocognitive disorder..............
    Major or mild neurocognitive disorder due to HIV or             9301
     other infections...................................
    Major or mild neurocognitive disorder due to                    9304
     traumatic brain injury.............................
    Major or mild vascular neurocognitive disorder......            9305
    Obsessive compulsive disorder.......................            9404
    Other specified and unspecified schizophrenia                   9210
     spectrum and other psychotic disorders.............
    Other specified anxiety disorder....................            9410
    Other specified somatic symptom and related disorder            9422
    Panic disorder and/or agoraphobia...................            9412
    Persistent depressive disorder (dysthymia)..........            9433
    Posttraumatic stress disorder.......................            9411
    Schizoaffective disorder............................            9211
    Schizophrenia.......................................            9201
    Somatic symptom disorder............................            9421
    Specific phobia; social anxiety disorder (social                9403
     phobia)............................................
    Unspecified somatic symptom and related disorder....            9423
    Unspecified anxiety disorder........................            9413
    Unspecified depressive disorder.....................            9435
    Unspecified neurocognitive disorder.................            9310
Metatarsalgia...........................................            5279
Migraine................................................            8100
Morton's disease........................................            5279
Mucormycosis............................................            6839
Multiple sclerosis......................................            8018
Myasthenia gravis.......................................            8025
Myelitis................................................            8010
Myocardial infarction...................................            7006
Myositis................................................            5021
Narcolepsy..............................................            8108
Neoplasms:
    Benign:
        Breast..........................................            7631
        Digestive system................................            7344

[[Page 529]]

 
        Ear.............................................            6209
        Endocrine.......................................            7915
        Genitourinary...................................            7529
        Gynecological...................................            7628
        Hard and soft tissue............................            9917
        Muscle..........................................            5328
        Respiratory.....................................            6820
        Skin............................................            7819
    Malignant:
        Breast..........................................            7630
        Digestive system................................            7343
        Ear.............................................            6208
        Endocrine.......................................            7914
        Genitourinary...................................            7528
        Gynecological...................................            7627
        Hard and soft tissue............................            9918
        Muscle..........................................            5327
        Respiratory.....................................            6819
        Skin............................................            7818
Nephritis, chronic......................................            7502
Nephrolithiasis.........................................            7508
Nephrosclerosis, arteriolar.............................            7507
Neuralgia:
    Cranial Nerves
        Fifth (trigeminal)..............................            8405
        Seventh (facial)................................            8407
        Ninth (glossopharyngeal)........................            8409
        Tenth (pneumogastric, vagus)....................            8410
        Eleventh (spinal accessory, external branch)....            8411
        Twelfth (hypoglossal)...........................            8412
    Peripheral Nerves
        Upper radicular group...........................            8710
        Middle radicular group..........................            8711
        Lower radicular group...........................            8712
        All radicular groups............................            8713
        Musculospiral (radial)..........................            8714
        Median..........................................            8715
        Ulnar...........................................            8716
        Musculocutaneous................................            8717
        Circumflex......................................            8718
        Long thoracic...................................            8719
        Sciatic.........................................            8720
        External popliteal (common peroneal)............            8721
        Musculocutaneous (superficial peroneal).........            8722
        Anterior tibial (deep peroneal).................            8723
        Internal popliteal (tibial).....................            8724
        Posterior tibial................................            8725
        Anterior crural (femoral).......................            8726
        Internal saphenous..............................            8727
        Obturator.......................................            8728
        External cutaneous nerve of thigh...............            8729
        Ilio-inguinal...................................            8730
Neuritis:
    Cranial nerves
        Fifth (trigeminal)..............................            8305
        Seventh (facial)................................            8307
        Ninth (glossopharyngeal)........................            8309
        Tenth (pneumogastric, vagus)....................            8310
        Eleventh (spinal accessory, external branch)....            8311
        Twelfth (hypoglossal)...........................            8312
    Optic...............................................            6026
    Peripheral Nerves
        Upper radicular group...........................            8610
        Middle radicular group..........................            8611
        Lower radicular group...........................            8612
        All radicular groups............................            8613
        Musculospiral (radial)..........................            8614
        Median..........................................            8615
        Ulnar...........................................            8616
        Musculocutaneous................................            8617
        Circumflex......................................            8618
        Long thoracic...................................            8619
        Sciatic.........................................            8620

[[Page 530]]

 
        External popliteal (common peroneal)............            8621
        Musculocutaneous (superficial peroneal).........            8622
        Anterior tibial (deep peroneal).................            8623
        Internal popliteal (tibial).....................            8624
        Posterior tibial................................            8625
        Anterior crural (femoral).......................            8626
        Internal saphenous..............................            8627
        Obturator.......................................            8628
        External cutaneous nerve of thigh...............            8629
        Ilio-inguinal...................................            8630
Neurogenic bladder......................................            7542
New growths:
    Benign
        Bones...........................................            5015
        Brain...........................................            8003
        Eye, orbit, and adnexa..........................            6015
        Spinal cord.....................................            8022
    Malignant
        Bones...........................................            5012
        Brain...........................................            8002
        Eye, orbit, and adnexa..........................            6014
        Spinal cord.....................................            8021
Nocardiosis.............................................            6823
Non-Hodgkin's lymphoma..................................            7715
Nontuberculosis mycobacterium infection.................            6312
Nontyphoid salmonella infection.........................            6333
Nonunion:
    Mandible, confirmed by diagnostic imaging studies...            9903
    Radius and ulna.....................................            5210
Nystagmus, central......................................            6016
Osteitis deformans......................................            5016
Osteomalacia, residuals of..............................            5014
Osteomyelitis...........................................            5000
Osteoporosis, residuals of..............................            5013
Otitis media:
    Externa.............................................            6210
    Nonsuppurative......................................            6201
    Suppurative.........................................            6200
Otosclerosis............................................            6202
Ovaries, atrophy of both................................            7620
Ovary:
    Disease or injury...................................            7615
    Removal.............................................            7619
Palsy, bulbar...........................................            8005
Pancreatitis............................................            7347
Papillary necrosis......................................            7538
Papulosquamous disorders................................            7822
Paralysis:
    Accommodation.......................................            6030
    Agitans.............................................            8004
    Complete, traumatic.................................            5244
Paralysis, nerve:
    Cranial nerves
        Fifth (trigeminal)..............................            8205
        Seventh (facial)................................            8207
        Ninth (glossopharyngeal)........................            8209
        Tenth (pneumogastric, vagus)....................            8210
        Eleventh (spinal accessory, external branch)....            8211
        Twelfth (hypoglossal)...........................            8212
    Peripheral Nerves:
        Upper radicular group...........................            8510
        Middle radicular group..........................            8511
        Lower radicular group...........................            8512
        All radicular groups............................            8513
        Musculospiral (radial)..........................            8514
        Median..........................................            8515
        Ulnar...........................................            8516
        Musculocutaneous................................            8517
        Circumflex......................................            8518
        Long thoracic...................................            8519
        Sciatic.........................................            8520
        External popliteal (common peroneal)............            8521
        Musculocutaneous (superficial peroneal).........            8522

[[Page 531]]

 
        Anterior tibial nerve (deep peroneal)...........            8523
        Internal popliteal (tibial).....................            8524
        Posterior tibial nerve..........................            8525
        Anterior crural nerve (femoral).................            8526
        Internal saphenous..............................            8527
        Obturator.......................................            8528
        External cutaneous nerve of thigh...............            8529
        Ilio-inguinal...................................            8530
Paramyoclonus multiplex.................................            8104
Parasitic disease.......................................            6320
Pellagra................................................            6315
Penis
    Deformity, with loss of erectile power..............            7522
    Removal of glans....................................            7521
    Removal of half or more.............................            7520
Pericardial adhesions...................................            7003
Pericarditis............................................            7002
Peripheral vestibular disorders.........................            6204
Peritoneum, adhesions...................................            7301
Peritonitis.............................................            7331
Pes cavus (Claw foot) acquired..........................            5278
Pheochromocytoma........................................            7918
Plague..................................................            6307
Plantar fasciitis.......................................            5269
Pleural effusion or fibrosis............................            6845
Pluriglandular syndrome.................................            7912
Pneumoconiosis..........................................            6832
Pneumonitis & fibrosis:
    Drug-induced........................................            6829
    Radiation-induced...................................            6830
Poliomyelitis, anterior.................................            8011
Polycythemia vera.......................................            7704
Polyglandular syndrome..................................            7912
Post-chiasmal disorders.................................            6046
Postgastrectomy syndromes...............................            7308
Post-phlebitic syndrome.................................            7121
Post-surgical residual..................................            6844
Progressive muscular atrophy............................            8023
Prostate gland..........................................            7527
Prosthetic implants:
    Ankle replacement...................................            5056
    Elbow replacement...................................            5052
    Hip, resurfacing or replacement.....................            5054
    Knee, resurfacing or replacement....................            5055
    Shoulder replacement................................            5051
    Wrist replacement...................................            5053
Psoriasis...............................................            7816
Pterygium...............................................            6034
Ptosis..................................................            6019
Pulmonary:
    Alveolar proteinosis................................            6827
    Vascular disease....................................            6817
Pruritus ani............................................            7337
Pyelonephritis, chronic.................................            7504
Raynaud's syndrome......................................            7117
Rectum:
    Rectum & anus, stricture............................            7333
    Prolapse............................................            7334
Removal:
    Cartilage, semilunar................................            5259
    Coccyx..............................................            5298
    Gall bladder........................................            7318
    Kidney..............................................            7500
    Penis glans.........................................            7521
    Penis half or more..................................            7520
    Ribs................................................            5297
    Testis..............................................            7524
    Ovary...............................................            7619
    Uterus..............................................            7618
    Uterus and both ovaries.............................            7617
Renal:
    Amyloid disease.....................................            7539
    Disease, chronic....................................            7530

[[Page 532]]

 
    Involvement in systemic diseases....................            7541
    Tubular disorders...................................            7532
Resection of intestine:
    Large...............................................            7329
    Small...............................................            7328
Retina detachment of....................................            6008
Retinal dystrophy (including retinitis pigmentosa, wet              6042
 or dry macular degeneration, early-onset macular
 degeneration, rod and/or cone dystrophy)...............
Retinopathy, diabetic...................................            6040
Retinopathy or maculopathy not otherwise specified......            6006
Rhabdomyolysis, residuals of............................            5330
Rhinitis:
    Allergic or vasomotor...............................            6522
    Bacterial...........................................            6523
    Granulomatous.......................................            6524
Rickettsial, ehrlichia, and anaplasma Infections........            6317
Sarcoidosis.............................................            6846
Scarring alopecia.......................................            7830
Scars:
    Burn scar(s) of the head, face, or neck; scar(s) of             7800
     the head, face, or neck due to other causes; or
     other disfigurement of the head, face, or neck.....
    Burn scar(s) or scar(s) due to other causes, not of             7801
     the head, face, or neck that are associated with
     underlying soft tissue damage......................
    Burn scar(s) or scar(s) due to other causes, not of             7802
     the head, face, or neck that are not associated
     with underlying soft tissue damage.................
    Retina..............................................            6011
    Scars, other; and other effects of scars evaluated              7805
     under diagnostic codes 7800, 7801, 7802, or 7804...
    Unstable or painful.................................            7804
Schistosomiasis.........................................            6326
Shigella infections.....................................            6334
Sinusitis:
    Ethmoid.............................................            6511
    Frontal.............................................            6512
    Maxillary...........................................            6513
    Pansinusitis........................................            6510
    Sphenoid............................................            6514
Sleep Apnea Syndrome....................................            6847
Soft tissue sarcoma:
    Muscle, fat, or fibrous connected...................            5329
    Neurogenic origin...................................            8540
    Vascular origin.....................................            7123
Spine:
    Degenerative arthritis, degenerative disc disease               5242
     other than intervertebral disc syndrome............
Spinal fusion...........................................            5241
Spinal stenosis.........................................            5238
Spleen, injury of, healed...............................            7707
Splenectomy.............................................            7706
Spondylolisthesis or segmental instability, spine.......            5239
Stomach, stenosis of....................................            7309
Symblepharon............................................            6091
Syndromes:
    Chronic Fatigue Syndrome (CFS)......................            6354
    Cushing's...........................................            7907
    Meniere's...........................................            6205
    Raynaud's...........................................            7117
    Sleep Apnea.........................................            6847
Syphilis................................................            6310
Syphilis:
    Cerebrospinal.......................................            8013
    Meningovascular.....................................            8014
Syphilitic heart disease................................            7004
Syringomyelia...........................................            8024
Tabes dorsalis..........................................            8015
Tarsal or metatarsal bones..............................            5283
Tenosynovitis, tendinitis, tendinosis or tendinopathy...            5024
Testis:
    Atrophy, complete...................................            7523
    Removal.............................................            7524
Thrombocytopenia........................................            7705
Thrombosis, brain.......................................            8008
Thyroid gland:..........................................
    Nontoxic thyroid enlargement........................            7902
    Toxic thyroid enlargement...........................            7901

[[Page 533]]

 
Thyroiditis.............................................            7906
Tic, convulsive.........................................            8103
Tinnitus, recurrent.....................................            6260
Toxic nephropathy.......................................            7535
Traumatic brain injury residuals........................            8045
Traumatic chest wall defect.............................            6843
Tuberculosis:
    Adenitis............................................            7710
    Bones and joints....................................            5001
    Eye.................................................            6010
    Kidney..............................................            7505
    Luposa (lupus vulgaris).............................            7811
    Miliary.............................................            6311
    Pleurisy, active or inactive........................            6732
Pulmonary:
    Active, far advanced................................            6701
    Active, moderately advanced.........................            6702
    Active, minimal.....................................            6703
    Active, advancement unspecified.....................            6704
    Active, chronic.....................................            6730
    Inactive, chronic...................................            6731
    Inactive, far advanced..............................            6721
    Inactive, moderately advanced.......................            6722
    Inactive, minimal...................................            6723
    Inactive, advancement unspecified...................            6724
Tuberculosis luposa (lupus vulgaris)....................            7811
Tympanic membrane.......................................            6211
Ulcer:
    Duodenal............................................            7305
    Gastric.............................................            7304
    Marginal............................................            7306
Ureter, stricture of....................................            7511
Ureterolithiasis........................................            7510
Urethra.................................................
    Fistula.............................................            7519
    Stricture...........................................            7518
    Urticaria, chronic..................................            7825
Uterus:
    And both ovaries, removal...........................            7617
    Disease or injury...................................            7613
    Prolapse............................................            7621
    Removal.............................................            7618
Uveitis.................................................            6000
Vagina, disease or injury...............................            7611
Vagotomy................................................            7348
Valvular heart disease..................................            7000
Varicose veins..........................................            7120
Vasculitis, primary cutaneous...........................            7826
Vertebral fracture or dislocation.......................            5235
Vibriosis (Cholera, Non-cholera)........................            6300
Visceral Leishmaniasis..................................            6301
Visceroptosis...........................................            7342
Vision: see also Blindness and Loss of
    One eye 5/200 (1.5/60), with visual acuity of other
     eye:
        5/200 (1.5/60)..................................            6071
        10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)...            6072
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6073
        20/40 (6/12)....................................            6074
    One eye 10/200 (3/60), with visual acuity of other
     eye:
        10/200 (3/60); 15/200 (4.5/60); 20/200 (6/60)...            6075
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6076
        20/40 (6/12)....................................            6077
    One eye 15/200 (4.5/60), with visual acuity of other
     eye:
        15/200 (4.5/60) or 20/200 (6/60)................            6075
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6076
        20/40 (6/12)....................................            6077
    One eye 20/200 (6/60), with visual acuity of other
     eye:
        20/200 (6/60)...................................            6075
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6076
        20/40 (6/12)....................................            6077
    One eye 20/100 (6/30), with visual acuity of other
     eye: and other eye:
        20/100 (6/30); 20/70 (6/21); 20/50 (6/15).......            6078
        20/40 (6/12)....................................            6079

[[Page 534]]

 
    One eye 20/70 (6/21), with visual acuity of other
     eye:
        20/70 (6/21) or 20/50 (6/15)....................            6078
        20/40 (6/12)....................................            6079
    One eye 20/50 (6/15), with visual acuity of other
     eye:
        20/50 (6/15)....................................            6078
        20/40 (6/12)....................................            6079
    Each eye 20/40 (6/12)...............................            6079
Vitiligo................................................            7823
Vulva or clitoris, disease or injury of.................            7610
Weak foot...............................................            5277
West Nile virus infection...............................            6335
------------------------------------------------------------------------


[72 FR 13003, Mar. 20, 2007, as amended at 73 FR 54708, 54712, Sept. 23, 
2008; 73 FR 69554, Nov. 19, 2008; 74 FR 18467, Apr. 23, 2009; 77 FR 
6467, Feb. 8, 2012; 79 FR 45103, Aug. 4, 2014; 82 FR 36085, Aug. 3, 
2017; 82 FR 50807, Nov. 2, 2017; 83 FR 15073, Apr. 9, 2018; 83 FR 15323, 
Apr. 10, 2018; 83 FR 32601, July 13, 2018; 83 FR 54259, Oct. 29, 2018; 
84 FR 28234, June 18, 2019; 85 FR 76467, Nov. 30, 2020; 85 FR 85523, 
Dec. 29, 2020; 86 FR 8143, Feb. 4, 2021]



PART 5_ADMINISTRATIVE PROCEDURES:GUIDANCE DOCUMENTS--Table of Contents



Sec.
5.0 Purpose.
5.10 Definitions relating to guidance documents.
5.15 Procedures for issuing guidance documents.
5.20 Procedures for petition for the withdrawal or modification of a 
          guidance document
5.25 Guidance website.

    Authority: 38 U.S.C. 501; E.O. 13891, 84 FR 55235.

    Effective Date Note: At 86 FR 30184, June 7, 2021, the authority 
citation for part 5 was revised, effective July 7, 2021. For the 
convenience of the user, the revised text is set forth as follows:
    Authority: 38 U.S.C. 501; E.O. 12866, 58 FR 51735, 3 CFR, 1993 
Comp., p. 638.

    Source: 85 FR 72570, Nov. 13, 2020, unless otherwise noted.



Sec.  5.0  Purpose.

    Sections 5.0 through 5.25 provide VA's processes and procedures for 
issuing and managing guidance documents in accordance with Executive 
Order 13891.

    Effective Date Note: At 86 FR 30184, June 7, 2021, Sec.  5.0 was 
revised, effective July 7, 2021. For the convenience of the user, the 
revised text is set forth as follows:



Sec.  5.0  Purpose.

    This part provides the Department of Veterans Affairs' (VA's) 
processes and procedures for issuing and managing guidance documents.



Sec.  5.10  Definitions relating to guidance documents.

    The following definitions apply to Sec. Sec.  5.0 through 5.25.
    Guidance document means an agency statement of general applicability 
(i.e., it applies to more than just one person, event, or transaction), 
that is intended to have a future effect on the behavior or actions of 
regulated parties (to include non-VA actors), and that sets forth a 
policy on a statutory, regulatory, or technical issue, or an 
interpretation of a statute or regulation. A guidance document does not 
include the following:
    (1) Rules promulgated pursuant to notice and comment under section 
553 of title 5, United States Code, or similar statutory provisions;
    (2) Rules exempt from rulemaking requirements under section 553(a) 
of title 5, United States Code;
    (3) Rules of agency organization, procedure, or practice;
    (4) Decisions of agency adjudications under section 554 of title 5, 
United States Code, or similar statutory provisions;
    (5) Internal guidance directed to the issuing agency or other 
agencies that is not intended to have substantial future effect on the 
behavior of regulated parties; or
    (6) Internal executive branch legal advice or legal opinions 
addressed to executive branch officials.
    Significant guidance document means a guidance document that the 
Administrator of the Office of Information and

[[Page 535]]

Regulatory Affairs determines is reasonably anticipated to:
    (1) Lead to an annual effect on the economy of $100 million or more 
or adversely affect in a material way the economy, a sector of the 
economy, productivity, competition, jobs, the environment, public health 
or safety, or State, local, or tribal governments or communities;
    (2) Create a serious inconsistency or otherwise interfere with an 
action taken or planned by another agency;
    (3) Materially alter the budgetary impact of entitlements, grants, 
user fees, or loan programs or the rights and obligations of recipients 
thereof; or
    (4) Raise novel legal or policy issues arising out of legal 
mandates, the President's priorities, or the principles of Executive 
Order 12866.
    VA means the Department of Veterans Affairs.



Sec.  5.15  Procedures for issuing guidance documents.

    (a) General. (1) Each guidance document must clearly and prominently 
state that it does not bind the public, except as authorized by law or 
as incorporated into a contract. Guidance documents may include the 
following or similar disclaimer language: The contents of this document 
do not have the force and effect of law and are not meant to bind the 
public in any way. This document is intended only to provide clarity to 
the public regarding existing requirements under the law or agency 
policies.
    (2) Each guidance document must include the following information in 
the published guidance document:
    (i) The term guidance;
    (ii) The agency or office issuing the document;
    (iii) To what and to whom the document applies;
    (iv) The date of issuance;
    (v) The title and unique identification number of the document;
    (vi) Citation to statutory or regulatory authority that the guidance 
document interprets or applies;
    (vii) A short summary of the subject matter covered at the beginning 
of the guidance document;
    (viii) The statement required under paragraph (a)(1) of this 
section; and
    (ix) As applicable, the guidance document being revised or replaced.
    (b) Significant guidance documents. We will refer to the 
Administrator of the Office of Information and Regulatory Affairs (OIRA) 
within the Office of Management and Budget, or the Administrator's 
designee, the question of whether a guidance document is significant. 
Significant guidance documents must follow the requirements provided in 
paragraph 5.15(a). Additionally, unless the Administrator of OIRA, 
pursuant to review under E.O. 12866, and VA agree that exigency, safety, 
health, or other compelling cause warrants an exemption, the following 
additional procedures apply:
    (1) VA will provide for a period of public notice and comment of at 
least 30 days before issuance of such significant guidance document and 
will provide a public response to major concerns raised in comments, 
except when VA for good cause finds (and incorporates such finding and a 
brief statement of reasons therefor into the guidance document) that 
notice and public comment thereon are impracticable, unnecessary, or 
contrary to the public interest.
    (2) The Secretary or a VA component head appointed by the President 
(with or without confirmation by the Senate), or by an official who is 
serving in an acting capacity as either of the foregoing, must approve 
any significant guidance document prior to issuance; pursuant to section 
4(a)(iii)(B) of Executive Order 13891, this approval authority is not 
delegable.
    (3) Significant guidance documents must be submitted to OIRA for 
review under Executive Order 12866 prior to issuance.
    (4) Significant guidance documents must comply with the applicable 
requirements for regulations or rules set forth in Executive Orders 
12866, 13563, 13609, 13771, and 13777.

    Effective Date Note: At 86 FR 30184, June 7, 2021, Sec.  5.15 was 
amended by revising the first sentence of paragraph (a)(1), revising the 
introductory text of paragraph (a)(2), revising paragraph (a)(2)(vii), 
removing paragraph (a)(2)(viii), redesignating paragraph (a)(2)(ix) as 
paragraph (a)(2)(viii), revising the introductory text of paragraph (b), 
removing paragraph (b)(1), redesignating paragraphs (b)(2) through 
(b)(4) as paragraphs

[[Page 536]]

(b)(1) through (3) and revising newly redesignated paragraphs (b)(1) and 
(3), effective July 7, 2021. For the convenience of the user, the 
revised text is set forth as follows:



Sec.  5.15  Procedures for issuing guidance documents.

    (a) General. (1) Each guidance document should clearly and 
prominently state that it does not bind the public, except as authorized 
by law or as incorporated into a contract. * * *
    (2) Each guidance document should include the following information 
in the published guidance document:

                                * * * * *

    (vii) A short summary of the subject matter covered at the beginning 
of the guidance document; and

                                * * * * *

    (b) Significant guidance documents. VA will refer to the 
Administrator of the Office of Information and Regulatory Affairs (OIRA) 
within the Office of Management and Budget, or the Administrator's 
designee, the question of whether a guidance document is significant. 
Significant guidance documents should contain the disclaimer and 
information described in paragraph (a) of this section. Additionally, 
unless the Administrator of OIRA, pursuant to review under E.O. 12866, 
and VA agree that exigency, safety, health, or other compelling cause 
warrants an exemption, the following additional procedures apply:
    (1) The Secretary or a VA component head appointed by the President 
(with or without confirmation by the Senate), or by an official who is 
serving in an acting capacity as either of the foregoing, must approve 
any significant guidance document prior to issuance. This approval 
authority is not delegable.

                                * * * * *

    (3) Significant guidance documents must comply with the applicable 
requirements set forth in Executive Orders 12866, 13563, and 13609.



Sec.  5.20  Procedures for petition for the withdrawal or modification 
of a guidance document.

    Petitions for withdrawal or modification of a guidance document. The 
following procedures apply for the public to petition for withdrawal or 
modification of a guidance document.
    (a) A member of the public wishing to petition for withdrawal or 
modification of a guidance document may submit such petition via email 
to: [email protected]. Petitions may also be mailed to the following 
address: Office of Policy and Interagency Collaboration, Office of 
Enterprise Integration, 810 Vermont Avenue NW, Washington, DC 20420.
    (b) A petition for withdrawal or modification of a guidance document 
must contain the following information:
    (1) The petitioner's name and address;
    (2) Information identifying the guidance document to which the 
petition pertains;
    (3) A statement of the reasons the petitioner believes the document 
should be withdrawn or modified.
    (c) VA will provide a response to a petition within 90 days of 
receipt of the request.

    Effective Date Note: At 86 FR 30184, June 7, 2021, Sec.  5.20 was 
amended by revising paragraph (c), effective July 7, 2021. For the 
convenience of the user, the revised text is set forth as follows:



Sec.  5.20  Procedures for petition for the withdrawal or modification 
          of a guidance document.

                                * * * * *

    (c) VA will seek to provide a response to a petition within 90 days 
of receipt of the request.



Sec.  5.25  Guidance website.

    VA has a guidance website that contains, or links to, guidance 
documents that are currently in effect. VA will not cite, use, or rely 
on any guidance document that is not posted on the website existing 
under Executive Order 13891, except to establish historical facts. The 
website can be found at the following address: www.VA.gov/guidance.

    Effective Date Note: At 86 FR 30184, June 7, 2021, Sec.  5.25 was 
amended revised, effective July 7, 2021. For the convenience of the 
user, the revised text is set forth as follows:



Sec.  5.25  Guidance website.

    VA has a guidance website that contains, or links to, guidance 
documents that are currently in effect. The website can be found at the 
following address: www.va.gov/orpm/va_guidance_documents.asp.

[[Page 537]]



PART 6_UNITED STATES GOVERNMENT LIFE INSURANCE--Table of Contents



                                   Age

Sec.
6.1 Misstatement of age.

                                Premiums

6.2 Premium rate.

                                Policies

6.3 Incontestability of United States Government life insurance.

         Beneficiary of United States Government Life Insurance

6.4 Proof of age, relationship and marriage.
6.5 Conditional designation of beneficiary.
6.6 Change of beneficiary.
6.7 Claims of creditors, taxation.

                           Optional Settlement

6.8 Selection, revocation and election.
6.9 Election of optional settlement by beneficiary.
6.10 Options.

                                Dividends

6.11 How dividends are paid.
6.12 Special dividends.

                                  Loans

6.13 Policy loans.

                               Cash Value

6.14 Cash value; other than special endowment at age 96 plan policy.
6.15 Cash value; special endowment at age 96 plan policy.
6.16 Payment of cash value in monthly installments.

                              Indebtedness

6.17 Collection of any indebtedness.

                   Total Permanent Disability Benefits

6.18 Other disabilities deemed to be total and permanent.

                             Death Benefits

6.19 Evidence to establish death of the insured.

    Determination of Liability Under Sections 302 and 313, World War 
 Veterans' Act, 1924, Sections 607 and 602(v)(2), National Service Life 
Insurance Act, 1940, as Amended, and Sections 1921 and 1957 of Title 38, 
                           United States Code

6.20 Jurisdiction.

                                 Appeals

6.21 Guardian: definition and authority.

    Authority: 38 U.S.C. 501, 1940-1963, 1981-1988, unless otherwise 
noted.

                                   Age



Sec.  6.1  Misstatement of age.

    If the age of the insured under a United States Government life 
insurance policy has been understated, the amount of the insurance 
payable under the policy shall be such exact amount as the premium paid 
would have purchased at the correct age; if overstated, the excess of 
premiums paid shall be refunded without interest. Guaranteed surrender 
and loan values will be modified accordingly. The age of the insured 
will be admitted by the Department of Veterans Affairs at any time upon 
satisfactory proof.

[13 FR 7089, Nov. 27, 1948. Redesignated at 61 FR 29024, June 7, 1996]

                                Premiums



Sec.  6.2  Premium rate.

    Effective January 1, 1983, United States Government Life Insurance 
policies, and total disability income provisions, on a premium paying 
status are paid-up and no premiums are required to maintain such 
policies and provisions in force.

[48 FR 1960, Jan. 17, 1983. Redesignated and amended at 61 FR 29024, 
29025, June 7, 1996]

                                Policies



Sec.  6.3  Incontestability of United States Government life insurance.

    Discharge or release of an insured from military or naval service 
for the reason of fraudulent enlistment shall not invalidate United 
States Government life insurance issued on the basis of such service 
unless the Secretary determines that the insured was mentally or legally 
incapable of entering into a contract of enlistment. In such case the 
United States Government life insurance so issued will be canceled as of 
the effective date of such insurance.

[13 FR 7091, Nov. 27, 1948, as amended at 17 FR 3162, Apr. 10, 1952; 24 
FR 7321, Sept. 11, 1959. Redesignated and amended at 61 FR 29024, 29025, 
June 7, 1996]

[[Page 538]]

         Beneficiary of United States Government Life Insurance



Sec.  6.4  Proof of age, relationship and marriage.

    Whenever it is necessary for a claimant to prove age, relationship 
or marriage, the provisions of 38 U.S.C. 103(c) and Part 3 this chapter 
will be followed.

[26 FR 1856, Mar. 3, 1961. Redesignated and amended at 61 FR 29024, 
29025, June 7, 1996]



Sec.  6.5  Conditional designation of beneficiary.

    If the insured by notice in writing to the Department of Veterans 
Affairs during his or her lifetime has provided that a designated 
beneficiary shall be entitled to the proceeds of United States 
Government life insurance only if such beneficiary shall survive him or 
her for such period (not more than 30 days), as specified by the 
insured, no right to the insurance shall vest as to such beneficiary 
during that period. In the event such beneficiary fails to survive the 
specified period, payment of the proceeds of United States Government 
life insurance will be made as if the beneficiary had predeceased the 
insured.

[14 FR 7175, Nov. 29, 1949, as amended at 46 FR 57043, Nov. 20, 1981. 
Redesignated at 61 FR 29024, June 7, 1996]



Sec.  6.6  Change of beneficiary.

    The insured under United States Government life insurance shall have 
the right at any time and from time to time and without the consent or 
knowledge of the beneficiary to change the beneficiary. A change of 
beneficiary must be made by written notice to the Department of Veterans 
Affairs over the signature of the insured and shall not be binding on 
the United States unless received by the Department of Veterans Affairs. 
A change of beneficiary must be forwarded to the Department of Veterans 
Affairs by the insured or his or her agent and must contain sufficient 
information to identify the insured. Whenever practicable, such notices 
shall be given on forms prescribed by the Department of Veterans 
Affairs. Upon receipt by the Department of Veterans Affairs, a change of 
beneficiary shall be deemed effective as of the date the insured signed 
the written notice. The United States shall be protected in all payments 
made to the beneficiary last of record and before receipt of notice of a 
change of beneficiary, and no payments so made shall be paid again to 
the changed beneficiary. The insured may exercise any right or privilege 
given under the provisions of a United States Government life insurance 
policy without the consent of the beneficiary. An original designation 
of a beneficiary may be made by the last will and testament, but no 
change of beneficiary may be made by the last will and testament. The 
provisions of the ``beneficiary'' clause in United States Government 
life insurance policies are hereby amended accordingly.

[17 FR 11071, Dec. 5, 1952, as amended at 46 FR 57043, Nov. 20, 1981. 
Redesignated at 61 FR 29024, June 7, 1996]



Sec.  6.7  Claims of creditors, taxation.

    (a) Effective January 1, 1958, payments of insurance to a 
beneficiary under a United States Government life insurance policy shall 
be subject to levy for taxes due the United States by such beneficiary.
    (b) The provisions of 38 U.S.C. 5301(b) which entitle the United 
States to collect by setoff out of benefits payable to any beneficiary 
under a United States Government life insurance policy do not apply to 
dividends being held to the credit of the insured for the payment of 
premiums under the provisions of section 1946 of title 38 U.S.C.

(Authority: 38 U.S.C. 5301)

[23 FR 681, Feb. 1, 1958, as amended at 24 FR 15, Jan. 1, 1959; 24 FR 
582, Jan. 27, 1959; 46 FR 57043, Nov. 20, 1981. Redesignated and amended 
at 61 FR 29024, 29025, June 7, 1996]

                           Optional Settlement



Sec.  6.8  Selection, revocation and election.

    The insured under a United States Government Life Insurance policy 
may, upon written notice, select an optional settlement. Such optional 
settlement may be revoked by written notice. If the insured does not 
select one of the optional settlements, as set out under the provisions 
of the policy, the insurance shall be payable in 240

[[Page 539]]

monthly installments unless the beneficiary elects in writing a 
different option.

[61 FR 29025, June 7, 1996]



Sec.  6.9  Election of optional settlement by beneficiary.

    If the insured has selected an optional settlement then at the death 
of the insured the designated beneficiary may elect to receive the 
proceeds of insurance in installments spread over a greater period of 
time than that selected by the insured and in accordance with the 
following provisions.


(Authority: 38 U.S.C. 1952)

    (a) If the insured has selected Option 1, the beneficiary may elect 
to receive payment under Option 2, 3, or 4.
    (b) If the insured has selected Option 2 with monthly installments 
not in excess of 120, the beneficiary may elect to receive payment in a 
greater number of installments under Option 2, or may elect to receive 
payment under Option 3 or 4.
    (c) If the insured has selected Option 2 with monthly installments 
in excess of 120, the beneficiary may elect to receive payment in a 
greater number of installments under Option 2, or may elect to receive 
payment under Option 3.
    (d) If the insured has selected Option 3, and named no contingent 
beneficiary, the beneficiary may elect to receive payment under Option 
4.
    (e) If the insured has selected Option 4, the beneficiary may elect 
to receive payment under Option 3.

If the insured has selected settlement under Option 1, a beneficiary who 
has elected to receive payment under Option 2, 3, or 4 may elect to 
receive the commuted value of any remaining unpaid installments certain 
(240 less the number paid in case of Option 3, or 120 less the number 
paid in the case of Option 4): Provided, That where the commutation is 
elected under Option 3 or 4 after payment under such option has 
commenced, and the beneficiary survives the period certain, such 
beneficiary shall be entitled to the resumption of monthly installments 
payable for life in accordance with the monthly income option previously 
selected by such beneficiary. The entitlement to the resumption of 
monthly installments will be effective as of the monthly payment date 
next following the expiration of the period certain. Settlement under 
any one of the options or payment to the beneficiary of said commuted 
value under Option 2 or payment of said commuted value under Options 3 
and 4 to the beneficiary who does not survive the period certain shall 
be in full and complete discharge of all liability under the contract. 
Any other change in the mode of settlement may, within the limitations 
set forth in paragraphs (a) through (e) of this section, be made by a 
beneficiary after payment has commenced, provided the change is made 
within 1 year of the original election and in those instances where 
Option 3 is changed to Option 1 or 2; or Option 4 is changed to Option 
1, 2, or 3, satisfactory proof is submitted to establish that the 
beneficiary's state of health is the same as it was at time of original 
election. The effective date of the original election for this purpose 
will be the date it was delivered to the Department of Veterans Affairs. 
If such election was forwarded by mail, properly addressed to the 
Department of Veterans Affairs, the postmark date will be taken as the 
date of delivery. Such change will be made on the premise that the new 
election was made initially, and the account will be adjusted 
accordingly. A condition precedent to any such change will be the 
repayment of any amount received by the beneficiary in excess of that 
which would have been due had the new election been made initially.

[32 FR 14274, Oct. 14, 1967, as amended at 48 FR 8069, Feb. 25, 1983. 
Redesignated and amended at 61 FR 29025, June 7, 1996]



Sec.  6.10  Options.

    Insurance will be payable in one sum only when selected by the 
insured during his or her lifetime or by his or her last will and 
testament.

[61 FR 29025, June 7, 1996]

                                Dividends



Sec.  6.11  How dividends are paid.

    (a) Regular annual dividends becoming payable on or after December 
31,

[[Page 540]]

1958, shall be payable on the date preceding the anniversary of the 
policy unless the Secretary shall declare them payable on some other 
date.
    (b) If the insured has a National Service Life Insurance policy or 
policies in force, dividends used to pay premiums in advance will be 
held to the credit of the insured, unless otherwise directed by the 
insured.
    (c) In the event premiums on more than one policy having the same 
premium due date are unpaid and the dividend credit of the insured for 
application to payment of premiums is not sufficient to keep all 
policies in force, in the absence of instructions to the contrary by the 
insured, such dividend credit will be applied to pay premiums in such 
manner as will provide the maximum amount of insurance protection.
    (d) Dividend credit of the insured held for payment of premiums as 
provided in section 1946 of title 38 U.S.C., may not be used to satisfy 
any indebtedness due the United States without the insured's consent. If 
the insured requests payment of such dividend credit, or any unused 
portion thereof, in cash, or requests that such credit be left to 
accumulate on deposit, then any indebtedness due the United States, such 
as described in Sec.  6.7 will be recovered therefrom.
    (e) Dividend credit of the insured held for payment of premiums or 
dividends left to accumulate on deposit may be applied to the payment of 
premiums in advance on any National Service Life Insurance policy upon 
written request of the insured made before default in payment of 
premium. Upon maturity of the policy, any unpaid dividend will be paid 
to the person(s) currently entitled to receive payments under the 
policy.

(Authority: 38 U.S.C. 1944)

[24 FR 15, Jan. 1, 1959, as amended at 25 FR 7369, Aug. 5, 1960; 28 FR 
12544, Nov. 23, 1963; 32 FR 13927, Oct. 6, 1967; 48 FR 1962, Jan. 17, 
1983. Redesignated and amended at 61 FR 29025, June 7, 1996]



Sec.  6.12  Special dividends.

    Any special U.S. Government Life Insurance dividend that may be 
declared shall be paid in cash. Such special dividends shall not be 
accepted to accumulate on deposit or as a dividend credit.

(Authority: 38 U.S.C. 1944)

[36 FR 368, Jan. 12, 1971, as amended at 48 FR 1963, Jan. 17, 1983. 
Redesignated at 61 FR 29025, June 7, 1996]

                                  Loans



Sec.  6.13  Policy loans.

    At any time after the first policy year and upon the execution of a 
loan agreement satisfactory to the Secretary the United States will lend 
to the insured on the sole security of his/her United States Government 
Life Insurance policy any amount which shall not exceed 94 percent of 
the cash value, and any indebtedness shall be deducted from the amount 
advanced on such loan. The loan shall bear interest at a rate not to 
exceed 5 percent per annum, payable annually, and the loan may be repaid 
in full or in amounts of $5 or more. Failure to pay either the amount of 
the loan or the interest thereon shall not void the policy unless the 
total indebtedness shall equal or exceed the cash value thereof. When 
the amount of the indebtedness equals or exceeds the cash value, the 
policy shall cease and become void.

(Authority: 38 U.S.C. 1944)

[48 FR 1963, Jan. 17, 1983. Redesignated and amended at 61 FR 29025, 
June 7, 1996]

                               Cash Value



Sec.  6.14  Cash value; other than special endowment at age 96 plan policy.

    Provisions for cash value shall become effective at the completion 
of the first policy year on any plan of United States Government Life 
Insurance other than the special endowment at age 96 plan policy; all 
values, reserves, and net single premiums being based on the American 
Experience Table of Mortality, with interest at the rate of 3\1/2\ 
percent per annum. The cash value shall be the reserve together with any 
dividend accumulations. For each month after the first policy year the 
reserve at the end of the preceding policy year shall be increased by 
one-twelfth of the increase in reserve for the current policy year. Upon 
written request therefor and upon complete

[[Page 541]]

surrender of the insurance with all claims thereunder made by the 
insured the United States will pay to the insured the cash value of the 
policy less any indebtedness. Unless otherwise requested by the insured, 
a surrender will be deemed completed as of the end of the month in which 
the application for cash surrender is delivered to the Department of 
Veterans Affairs, or as of the date of the check for the cash value, 
whichever is later. If the application is forwarded by mail, properly 
addressed, the postmark date will be taken as the date of delivery.

(Authority: 38 U.S.C. 1944)

[48 FR 1963, Jan. 17, 1983. Redesignated and amended at 61 FR 29025, 
June 7, 1996]



Sec.  6.15  Cash value; special endowment at age 96 plan policy.

    Provisions for cash value shall become effective at the completion 
of the first policy year; all values and net single premiums are as 
prescribed by the Secretary and published in VA Pamphlet 90-2A. The cash 
value at the end of the first policy year and at the end of any policy 
year thereafter shall be the reserve as set forth in the policy together 
with any dividend accumulations. For each month after the first policy 
year the reserve at the end of the preceding policy year shall be 
increased by one-twelfth of the increase in reserve for the current 
policy year. Upon written request therefor and upon complete surrender 
of the insurance with all claims thereunder made by the insured, the 
United States will pay to the insured the cash value of the policy less 
any indebtedness, provided the policy has been in force for at least 1 
year. Unless otherwise requested by the insured, a surrender will be 
deemed completed as of the end of the month in which the application for 
cash surrender is delivered to the Department of Veterans Affairs, or as 
of the date of the check for the cash value, whichever is later. If the 
application is forwarded by mail, properly addressed, the postmark date 
will be taken as the date of delivery. If it is forwarded through 
military channels, the date the application is placed in military 
channels will be taken as the date of delivery.

(Authority: 38 U.S.C. 1944)

[48 FR 1963, Jan. 17, 1983. Redesignated at 61 FR 29025, June 7, 1996]



Sec.  6.16  Payment of cash value in monthly installments.

    Effective January 1, 1971, in lieu of payment of cash value in one 
sum, the insured may elect to receive payment in monthly installments 
under option 2 as set forth in the insurance contract or as a refund 
life income option. If the insured dies before the agreed number of 
monthly installments have been paid, the remaining unpaid monthly 
installments will be payable to the designated beneficiary in one sum, 
unless the insured or such beneficiary has elected to continue the 
installments under the option selected by the insured. If no designated 
beneficiary survives, the present value of any remaining unpaid 
installments shall be paid to the estate of the insured, provided such 
payment would not escheat.

[61 FR 29025, June 7, 1996]

                              Indebtedness



Sec.  6.17  Collection of any indebtedness.

    At the maturity of a United States Government life insurance policy 
by total permanent disability or death, any indebtedness, unless paid 
off in cash, shall be liquidated by reducing the amount of each monthly 
installment in the proportion which the indebtedness bears to the 
commuted value of monthly installments as may then be payable under the 
policy, excluding dividend accumulations. If the policy is payable in 
one sum at death, any indebtedness shall be deducted from the amount 
payable under the policy.

[13 FR 7096, Nov. 27, 1948. Redesignated at 61 FR 29025, June 7, 1996]

                   Total Permanent Disability Benefits



Sec.  6.18  Other disabilities deemed to be total and permanent.

    (a) In addition to the conditions specified in 38 U.S.C. 1958, the 
following

[[Page 542]]

also will be deemed to be total and permanent disabilities: Organic loss 
of speech; permanently helpless or permanently bedridden.
    (b) Organic loss of speech will mean the loss of the ability to 
express oneself, both by voice and whisper, through the normal organs of 
speech if such loss is caused by organic changes in such organs. Where 
such loss exists, the fact that some speech can be produced through the 
use of an artificial appliance or other organs of the body will be 
disregarded.

[61 FR 29025, June 7, 1996]

                             Death Benefits



Sec.  6.19  Evidence to establish death of the insured.

    Whenever a claim is filed on account of the death of a person 
insured under yearly renewable term insurance or United States 
Government life insurance, the proof of death shall be established in 
accordance with the provisions of Part 3 of this chapter.

[26 FR 1856, Mar. 3, 1961. Redesignated and amended at 61 FR 29025, June 
7, 1996]

    Determination of Liability Under Sections 302 and 313, World War 
Veterans' Act, 1924, Sections 607 and 602 (v)(2), National Service Life 
Insurance Act, 1940, as Amended, and Sections 1921 and 1957 of Title 38 
                           United States Code



Sec.  6.20  Jurisdiction.

    The Insurance Claims Sections are vested with exclusive jurisdiction 
in determining the liability of the United States and the United States 
Government Life Insurance Fund for waiver of payment of premiums, 
payment of total, total permanent disability, and death insurance 
benefits under United States Government life insurance and to determine 
the liability of the United States and the National Service Life 
Insurance Fund for waiver of payment of premiums due to total 
disability, payment of total disability insurance benefits, and death 
insurance benefits under National Service life insurance.

(Authority: 38 U.S.C. 1944)

[27 FR 9604, Sept. 28, 1962, as amended at 48 FR 1965, Jan. 17, 1983. 
Redesignated at 61 FR 29025, June 7, 1996]

                                 Appeals



Sec.  6.21  Guardian: definition and authority.

    (a) Definition. For the purpose of this section, the term guardian 
includes any fiduciary certified by the appropriate Veterans Service 
Center Manager under Sec.  13.55 of this title to receive benefits in a 
fiduciary capacity for an insured or beneficiary.
    (b) Authority. For the purpose of this part, a guardian of an 
insured or beneficiary shall have authority to: Apply for conversion of 
a policy or change of plan; reinstate a policy; withdraw dividends held 
on deposit or credit; select or change a dividend option; obtain a 
policy loan; cash surrender a policy; authorize a deduction from 
benefits or allotment from military retired pay to pay premiums; apply 
for and receive payment of the proceeds on a matured policy; select or 
change the premium payment option; apply for waiver of premiums; select 
or change the settlement option for beneficiaries; assign a 
beneficiary's interest as provided under section 1953 of title 38 U.S.C.

(Authority: 38 U.S.C. 1944)

[56 FR 9627, Mar. 7, 1991. Redesignated at 61 FR 29025, June 7, 1996, as 
amended at 71 FR 28586, May 17, 2006]



PART 7_SOLDIERS' AND SAILORS' CIVIL RELIEF--Table of Contents



       Soldiers' and Sailors' Civil Relief Act Amendments of 1942

Sec.
7.2 Certification of military service.
7.3 The policy.
7.4 The premium.
7.5 Application.
7.6 Benefits.
7.7 Maturity.
7.8 Beneficiary or assignee.

    Authority: 50 U.S.C. app. 511, 540-547, unless otherwise noted.

    Source: 13 FR 7103, Nov. 27, 1948, unless otherwise noted.

[[Page 543]]

       Soldiers' and Sailors' Civil Relief Act Amendments of 1942



Sec.  7.2  Certification of military service.

    (a) A statement over the signature of the Commanding Officer or a 
commissioned officer of equal or higher rank than the insured, on the 
insured's application, may be accepted as a certification that the 
insured is a person in the military service.
    (b) If the insured is unavailable because of service, the 
application may be certified by the person who has custody of the 
insured's service record.
    (c) If an application is submitted by a person designated by the 
insured or by the insured's beneficiary, the Department of Veterans 
Affairs will obtain from the service department evidence that the 
insured is a person in the military service.

(Authority 50 U.S.C. app. 547)

[61 FR 29026, June 7, 1996]



Sec.  7.3  The policy.

    (a) Any provision in a policy that may limit or eliminate a benefit 
other than the primary death benefit will not, because of such 
provision, place the policy outside the protection of the Act if it is 
otherwise eligible for protection.
    (b) An annuity contract, if it provides payment of a substantial 
death benefit in the nature of life insurance, may be included within 
the provisions of the Act if otherwise eligible. Group insurance will 
not be included unless an individual and separate contract of insurance 
is completely released to the insured and thereafter comes within the 
provisions of the Act as a policy.
    (c) The phrase Face amount of insurance as used in the regulations 
in this part will mean the amount of insurance payable as a death 
benefit; Provided, That any indebtedness, or any accruals (such as paid-
up additions, dividend accumulations, etc.) that may be added to or 
taken from the amount payable as the death benefits will not be used in 
calculating the face amount of a policy.

[13 FR 7103, Nov. 27, 1948, as amended at 21 FR 7297, Sept. 25, 1956. 
Redesignated and amended at 61 FR 29026, June 7, 1996]



Sec.  7.4  The premium.

    The term premium as defined under 50 U.S.C. app. 540(b) shall 
include membership dues and assessments in an association.
    (a) The premium on a policy will be calculated on an annual basis, 
and if the annual premium is not stated on the policy, the insurer will 
make a calculation of the premiums for payment in advance and discounted 
at not less than 3\1/2\ percent, subject to approval by the Department 
of Veterans Affairs.
    (b) Premiums will not be guaranteed for benefits additional to the 
primary death benefit if, when combined with the amount of the primary 
death benefit, the total benefit would result in a payment in excess of 
$10,000 or if liability for such benefits is excluded or restricted by 
military service or any activity which the insured may be called upon to 
perform in connection with military service. In the event that premiums 
for the primary and additional benefits are not separable under the 
terms of the policy the entire policy will be guaranteed, if the policy 
is otherwise eligible for protection under the law.

[13 FR 7103, Nov. 27, 1948. Redesignated and amended at 61 FR 29026, 
June 7, 1996]



Sec.  7.5  Application.

    (a) The benefits of the Act are not available except upon 
application. The insured may designate any person, firm, or corporation 
to submit an application on his or her behalf. The designation must be 
in writing, signed by the insured and attached to the application.
    (b) When an application for benefits is received by an insurer, a 
report thereof will be made within 30 days to the Department of Veterans 
Affairs Regional Office and Insurance Center at Philadelphia, 
Pennsylvania. The insurer may submit with the report a statement setting 
forth any additional information deemed necessary to the adjudication of 
the application, and any facts and reasoning as to why the

[[Page 544]]

policy should or should not be protected under the Act.

[13 FR 7103, Nov. 27, 1948, as amended at 26 FR 11802, Dec. 8, 1961; 27 
FR 656, Jan. 23, 1962. Redesignated and amended at 61 FR 29026, June 7, 
1996]



Sec.  7.6  Benefits.

    Any policy found to be entitled to protection under the provisions 
of the Act will not lapse or otherwise terminate or be forfeited for the 
nonpayment of a premium or the nonpayment of any indebtedness or 
interest during the period of military service of the insured and two 
years after the expiration of such service. If the insured reenters 
military service during the two-year period following separation from 
such service and the policy is under the protection of the Act on the 
date of reentry, such reentrance shall be deemed to be a continuation of 
the previous military service. In such case, in the absence of written 
instruction from the insured to the contrary, the protection under the 
Act will continue during the period of military service of the insured 
and two years after the expiration of such service, but the guarantee 
will not extend for more than two years after the date when the Act 
ceases to be in force.
    (a) For the period during which a policy is protected by the 
provisions of the Act, any dividends, return of premiums, or other such 
monetary benefits arising out of the contract or by reason thereof, will 
be held subject to disposal or to be applied as may be approved by the 
Department of Veterans Affairs.
    (b) A policy will not be removed from the protection of the Act by 
reason of a payment made to the insurer by or on behalf of the insured, 
but any tender of a premium (in whole or in part) shall be applied on 
the indebtedness established under authority of the Act against the 
policy: Provided, That nothing herein shall prevent an insured from 
continuing payment to the insurer of premiums to cover any additional 
benefits (such as double indemnity, waiver of premium, etc.) where such 
premiums may not be included in the amount guaranteed by the Government.

[13 FR 7103, Nov. 27, 1948, as amended at 27 FR 2287, Mar. 9, 1962. 
Redesignated and amended at 61 FR 29026, June 7, 1996]



Sec.  7.7  Maturity.

    (a) The phrase maturity of a policy as a death claim or otherwise 
(SSCRA, as amended) will not include a termination or maturity of a 
policy as a disability claim, and the policy will continue under the 
provisions of the Act as if there had been no maturity, but the 
Government shall not be liable for any premiums that the insured would 
have been relieved of paying under any provisions for payment of 
premiums in the policy.
    (b) Upon the expiration of the period of protection, the insurer 
will submit to the Department of Veterans Affairs a complete statement 
of the account on each policy, which will show the amount of 
indebtedness by reason of the premiums with interest and the credits, if 
any, then available and will be subject to audit and approval by the 
Department of Veterans Affairs. The statement of account will include 
the rate of interest charged on all indebtedness, the date of debit and 
credit entries, and such other information as may be deemed necessary in 
making an audit of the account.

[13 FR 7103, Nov. 27, 1948, as amended at 27 FR 656, Jan. 23, 1962. 
Redesignated and amended at 61 FR 29026, June 7, 1996]



Sec.  7.8  Beneficiary or assignee.

    The consent of a beneficiary, assignee, or any other person who may 
have a right or interest in the proceeds of the policy is not a 
prerequisite for placing a policy under the protection of the Act.

[61 FR 29026, June 7, 1996]



PART 8_NATIONAL SERVICE LIFE INSURANCE--Table of Contents



                              Applications

Sec.
8.0 Definitions of terms used in connection with title 38 CFR, part 8, 
          National Service Life Insurance.

[[Page 545]]

                             Effective Date

8.1 Effective date for an insurance policy issued under section 1922(a) 
          of title 38 U.S.C. (Service-Disabled Veterans' Insurance).

                                Premiums

8.2 Payment of premiums.
8.3 Revival of insurance.
8.4 Deduction of insurance premiums from compensation, retirement pay, 
          or pension.
8.5 Authorization for deduction of premiums from compensation, 
          retirement pay, or pension.

                       Calculation of Time Period

8.6 Calculation of time period.

                              Reinstatement

8.7 Reinstatement of National Service Life Insurance except insurance 
          issued pursuant to section 1925 of title 38 U.S.C.
8.8 Health requirements.
8.9 Application and medical evidence.

                                Dividends

8.10 How paid.

                       Cash Value and Policy Loan

8.11 Cash value and policy loan.
8.12 Payment of the cash value of National Service Life Insurance in 
          monthly installments under section 1917(e) of title 38 U.S.C.
8.13 Policy loans.

                   Extended Term and Paid-Up Insurance

8.14 Provision for extended term insurance--other than 5-year level 
          premium term or limited convertible 5-year level premium term 
          policies.
8.15 Provision for paid-up insurance; other than 5-year level premium 
          term or limited convertible 5-year level premium term 
          policies.

                             Change in Plan

8.16 Conversion of a 5-year level premium term policy as provided for 
          under Sec.  1904 of title 38 U.S.C.

                  Premium Waivers and Total Disability

8.17 Discontinuance of premium waiver.
8.18 Total disability--speech.

                              Beneficiaries

8.19 Beneficiary and optional settlement changes.

                  Proof of Death, Age, or Relationship

8.20 Proof of death, age, relationship and marriage.

                                   Age

8.21 Misstatement of age.

                              Examinations

8.22 Examination of applicants for insurance or reinstatement.
8.23 Examination in connection with total disability benefits.
8.24 Expenses incident to examinations for insurance purposes.

                          Optional Settlements

8.25 Options.

                        Renewal of Term Insurance

8.26 Renewal of National Service Life Insurance on the 5-year level 
          premium term plan.

       Settlement of Insurance Maturing on or After August 1, 1946

8.27 Conditional designation of beneficiary.
8.28 Application for reinstatement of total disability income provision.

                 National Service Life Insurance Policy

8.29 Policy provisions.

                                 Appeals

8.30 Review of Decisions and Appeal to Board of Veterans' Appeals.
8.31 Total disability for twenty years or more.
8.32 Authority of the guardian.
8.33 Cash value for term-capped policies.
8.34 Ineligibility for insurance under 38 U.S.C. 1922A (supplemental 
          Service-Disabled Veterans' Insurance) if person insured under 
          38 U.S.C. 1922(b).

    Authority: 38 U.S.C. 501, 1901-1929, 1981-1988, unless otherwise 
noted.

                              Applications



Sec.  8.0  Definitions of terms used in connection with title 38 CFR,
part 8, National Service Life Insurance.

    (a) What does the term ``good health'' mean? The term good health 
means that the applicant is, from clinical or other evidence, free from 
any condition that would tend to:
    (1) Weaken normal physical or mental functions; or
    (2) Shorten life.

    Note to paragraph (a): Conditions that would affect ``good health'' 
are diseases or injuries or residuals of diseases or injuries. A 
``residual'' is a disability that remains following the original disease 
or injury.

    (b) What does the term ``good health criteria'' mean? The term good 
health

[[Page 546]]

criteria means the underwriting standards that determine whether a 
person is in good health. ``Good health criteria'' are based whenever 
possible, as far as practicable, on general insurance usage. 
``Underwriting'' is the process that sets the terms, conditions, and 
prices for an insurance policy, by rating an applicant's mortality risk.
    (c) What does the term ``organic loss of speech'' mean? The term 
organic loss of speech means the loss of the ability to express oneself, 
both by voice and whisper, through the normal organs of speech if the 
loss is caused by physical changes in such organs. The fact that some 
speech can be produced through the use of artificial appliance or other 
organs of the body will not impact this definition.
    (d) What does the term ``disease or injury traceable to the extra 
hazards of the military service'' mean? The term disease or injury 
traceable to the extra hazards of the military service means a disease 
or injury that was either caused by or can be traced back to the 
performance of duty in the active military, naval, or air service.
    (e) What does the term ``guardian'' mean? The term guardian means 
any representative certified by the appropriate Veterans Service Center 
Manager, under Sec.  13.55 of this chapter, to receive benefits in a 
fiduciary capacity on behalf of the insured or the beneficiary, or to 
take the actions listed in Sec.  8.32.

[67 FR 54738, Aug. 26, 2002]

                             Effective Date



Sec.  8.1  Effective date for an insurance policy issued under section 1922(a)
of title 38 U.S.C. (Service-Disabled Veterans' Insurance).

    (a) What is the effective date of the policy? The effective date is 
the date policy coverage begins. Benefits due under the policy are 
payable any time after the effective date.
    (b) How is the effective date established? The effective date is the 
date you deliver both of the following to VA:
    (1) A valid application.
    (2) A premium payment.

    Note 1 to paragraph (b): If your valid application and premium are 
mailed to VA, the postmark date will be the date of delivery.
    Note 2 to paragraph (b): If a postmark date is not available, the 
date of delivery will be the date your valid application and premium are 
received by VA.

    (c) Can you have a different effective date? Yes, if you would like 
an effective date other than the date of delivery as described in 
paragraph (b) of this section, you may choose one of the following three 
options as an effective date:
    (1) The first day of the month in which you deliver your valid 
application and premium payment to VA. For example, if VA receives your 
application and premium payment on August 15, you may request an 
effective date of August 1.
    (2) The first day of the month following the month in which you 
deliver your valid application and premium payment. For example, if VA 
receives your application and premium payment on August 15, you may 
request an effective date of September 1.
    (3) The first day of any month up to six months prior to the month 
in which you deliver your valid application and premium payment. For 
example, if VA receives your application and premium payment on August 
15, you may request an effective date of February 1 or the first day of 
any month following up to August 1. However, you must pay the following:
    (i) The insurance reserve amount for the time period for each month 
starting with the requested effective date up to the first day of the 
month prior to the month in which you delivered your application to VA; 
and
    (ii) The premium for the month in which you delivered your 
application to VA.

    Note to paragraph (c): For example, if your postmark date is August 
15 and you request an effective date of February 1, you must pay the 
insurance reserve amount for February 1 through July 31, and also pay 
the August premium.

[67 FR 54738, Aug. 26, 2002]

[[Page 547]]

                                Premiums



Sec.  8.2  Payment of premiums.

    (a) What is a premium? A premium is a payment that a policyholder is 
required to make for an insurance policy.
    (b) How can policyholders pay premiums? Premiums can be paid by:
    (1) Cash, check, or money order directly to VA.
    (2) Allotment from service or retirement pay.
    (3) Automatic deduction from VA benefits (pension, compensation or 
insurance dividends (see Sec.  8.4)).
    (4) Pre-authorized debit from a checking account.
    (c) When should policyholders pay premiums? (1) Unless premiums are 
paid in advance, policyholders must pay premiums on the effective date 
shown on the policy and on the same date of each following month. This 
is called the ``due date.''
    (2) Policyholders may pay premiums quarterly, semi-annually, or 
annually in advance.
    (d) What happens if a policyholder does not pay a premium on time? 
(1) When a policyholder pays a premium within 31 days from the ``due 
date,'' the policy remains in force. This 31-day period is called a 
``grace period.'' If the insured dies within the 31-day grace period, VA 
deducts the unpaid premium from the amount of insurance payable.
    (2) If a policyholder pays a premium after the 31-day grace period, 
VA will not accept the payment and the policy lapses effective the date 
the premium was due; Except that VA will accept a premium paid after the 
31-day grace period as a timely payment if:
    (i) The policyholder pays the premium within 61 days of the due 
date; and
    (ii) The policyholder is alive at the time the payment is mailed.
    (3) When a policyholder pays the premium by mail, the postmark date 
is the date of payment.
    (4) When a policyholder pays a premium by check or money order which 
is not honored and it is shown by satisfactory evidence that:

------------------------------------------------------------------------
The bank did not pay the check or money
           order because of:                          Then:
------------------------------------------------------------------------
An error by the bank...................  The policyholder has an
                                          additional 31 days (from the
                                          date stamped on VA's
                                          notification letter) to pay
                                          the premium and any other
                                          premiums due through the
                                          current month.
An error in the check or money order...  The policyholder has an
                                          additional 31 days (same as
                                          above).
Lack of funds..........................  The premium is considered not
                                          paid.
------------------------------------------------------------------------


[65 FR 7437, Feb. 15, 2000]



Sec.  8.3  Revival of insurance.

    (a) If the sole reason death or total disability benefits under a 
policy of National Service life insurance cannot be granted is that the 
policy had lapsed, the insurance will be considered in force under 
premium-paying conditions on the date of death or the date of 
commencement of total disability if,
    (1) On the date of lapse there were accrued dividends, not then 
payable, resulting from premiums paid since the last anniversary date of 
the policy and such dividends were equal to or greater in amount than 
the total of the monthly premiums which have become due from and 
including the date of lapse to the date of death or date of commencement 
of total disability, and/or
    (2) At the end of the grace period for the unpaid premium causing 
lapse there were due and payable to the policyholder unpaid dividends, 
refundable premiums, pure insurance risk credits, other refundable 
credits or total disability benefit payments arising from the 
policyholder's U.S. Government or National Service life insurance which 
are equal to or greater in amount than the total of the monthly premiums 
which have become due from and including the date of lapse to the date 
of death or date of commencement of total disability.
    (3) For purposes of this section amounts under paragraphs (a)(1) and 
(2) of this section may be combined. In that case, the amount, if any, 
of dividend accrued under paragraph (a)(1) of

[[Page 548]]

this section will first be determined and the amount available under 
paragraph (a)(2) of this section, if any, will be added thereto for the 
purpose of determining if the total amount thus available is equal to or 
greater than the total of monthly premiums which have become due.
    (4) In determining the amount of monthly premiums which have become 
due under paragraphs (a)(1) and (2) of this section a shortage of 10 
percent per monthly premium may be allowed for a period not to exceed 3 
months.
    (5) In determining the monthly premiums which have become due for 
adjustment purposes under paragraphs (a)(1) and (2) of this section, the 
premium for the monthly due date immediately preceding the date of death 
or date of commencement of total disability may be omitted because of 
the coverage provided by the allowable grace period (Sec.  8.2(d)) and 
if the conditions of paragraph (b) of this section are met, the premium 
for the second due date immediately preceding the date of death or date 
of commencement of total disability may be omitted.
    (6) When a policy is deemed in force under premium-paying conditions 
by operation of this section, the amount of any shortage included in the 
calculation and the premium for any monthly due date omitted in the 
calculation will become a lien against the policy.
    (7) The provisions of this section may be applied if, on the date of 
death, the insurance is in force under the extended term insurance 
provision (Sec.  8.14) and a policy loan was outstanding on the date of 
lapse or a dividend deposit balance was included in the cash value as 
determined at time of lapse.
    (8) If accrued dividends under paragraph (a)(1) of this section and/
or amounts due and payable under paragraph (a)(2) of this section exist 
in connection with more than one policy of the same veteran and one or 
more policies lapsed prior to the date of death or date of commencement 
of total disability, the amounts available will be related first to the 
policy or policies on which they arose if such policy or policies are 
lapsed. Any amount available under paragraphs (a)(1) and (2) of this 
section which is not required to place in force the policy upon which it 
arose or which is insufficient to place in force the policy upon which 
it arose, may be combined with similar amounts available on any other 
policy whenever the total of such amounts is sufficient to place another 
policy in force.
    (9) Where more than one policy is involved and credits are not 
needed or are insufficient to revive the policy on which the credits 
arose, the credits will be used insofar as they are sufficient to revive 
the policy or policies under which the most insurance is payable.
    (10) No total disability income provision will be considered in 
force under this section unless it lapsed at the same time as the life 
insurance contract and both the life insurance and total disability 
income provision can be considered in force through the same date and 
benefits are payable under the total disability income provision. An 
exception will be a paid-in-full limited pay contract on which total 
disability income provision premiums are due and payable to age 65.
    (11) When a total disability income provision lapsed at the same 
time as the life insurance, the premium for the provision will be 
considered separately in determining if the amounts available are equal 
to or in excess of the monthly premiums which have become due. In such a 
case if the amounts available are sufficient, both the life insurance 
and the provision will be revived. If the amounts are insufficient for 
that purpose, they will be applied to revive the policy or policies with 
the greatest amount payable in death cases or the policy or policies 
providing the greatest life insurance and total disability benefit in 
total disability cases.
    (12) Accrued dividends and/or credits on any policy of National 
Service or U.S. Government life insurance held by the policyholder may 
be considered for the purpose of this section.
    (b) If the sole reason death or total disability benefits under a 
policy of National Service life insurance cannot be granted is that the 
policy had lapsed, the insurance will be considered in force on the date 
of death or date of commencement of total disability if,
    (1) The policyholder died or became totally disabled within 61 days 
of the due date of the unpaid premiums, and

[[Page 549]]

    (2) The policy prior to the lapse had been in force for 5 years or 
more. In determining in-force status under this subparagraph if the 
original effective date of the insurance (when necessary, include 
predecessor contracts involving renewal, conversion or replacement/
reinstatement under 38 U.S.C. 1981) is 5 years or more earlier than the 
date of death or date of total disability and during the 5 years 
immediately preceding the date of lapse the insurance has not been 
lapsed at any one time in excess of 6 months, the requirement will be 
satisfied. When insurance is considered in force under this section the 
amount of the monthly premium due on the date of lapse and the following 
monthly premium(s) will become a lien against the policy.
    (3) The provisions of this section may be applied if, on the date of 
death, the insurance is in force under the extended term insurance 
provision (Sec.  8.14) and a policy loan was outstanding on the date of 
lapse or a dividend deposit balance was included in the cash value as 
determined at time of lapse.

[33 FR 17915, Dec. 3, 1968. Redesignated and amended at 61 FR 29290, 
29291, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000; 65 FR 
19658, Apr. 12, 2000]



Sec.  8.4  Deduction of insurance premiums from compensation, retirement
pay, or pension.

    The insured under a National Service life insurance policy which is 
not lapsed may authorize the monthly deduction of premiums from 
disability compensation, death compensation, dependency and indemnity 
compensation, retirement pay, disability pension, or death pension that 
may be due and payable to him under any laws administered by the 
Department of Veterans Affairs in accordance with the following 
provisions.
    (a) The authorization may be made by an insured or the insured's 
legal representative. If the authorization is made by the insured's 
legal representative, it must be in writing over the signature of the 
representative and forwarded to the Department of Veterans Affairs along 
with a copy of the document which evidences the individual's authority 
to act on behalf of the insured. If an insured is incompetent and has no 
legal representative and has a spouse to whom benefits are being paid 
pursuant to Part 13 of this chapter, the spouse may authorize payment of 
insurance premiums through the deduction system. If an insured is 
incompetent and has no legal representative and an institutional award 
has been made in his or her behalf, the authorization may be executed by 
the Director of the field facility in which the insured is hospitalized 
or receiving domiciliary care, and in appropriate cases by the chief 
officers of State hospitals or other institutions to whom similar awards 
may have been approved.
    (b) The monthly disability compensation, death compensation, 
dependency and indemnity compensation, retirement pay, disability 
pension, or death pension so due and payable must be equal to, or in 
excess of, the amount of the insurance premium figured on a monthly 
basis.
    (c) The authorization may be cancelled by the insured at any time. 
Such cancellation will be effective on the first day of the month 
following the month in which it is received by the Department of 
Veterans Affairs.
    (d) If the benefits payable to the insured are apportioned under the 
regulations of the Department of Veterans Affairs now in effect or 
hereafter issued, the deduction authorized by the insured shall be from 
that portion awarded to the insured under such regulations.
    (e) The deduction authorized by a policyholder issued insurance 
under 38 U.S.C. 1925 will be automatically adjusted by the Department of 
Veterans Affairs to take cognizance of any premium adjustment made by 
the Secretary on such insurance provided the benefit payments due and 
payable to the insured are of an amount sufficient to pay the monthly 
insurance premium.

(Authority: 38 U.S.C. 1908)

[13 FR 7110, Nov. 27, 1948, as amended at 14 FR 5241, Aug. 24, 1949; 24 
FR 7327, Sept. 9, 1959; 28 FR 1542, Feb. 19, 1963; 30 FR 3645, Mar. 19, 
1965; 54 FR 46231, Nov. 2, 1989. Redesignated and amended at 61 FR 
29290, 29291, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]

[[Page 550]]



Sec.  8.5  Authorization for deduction of premiums from compensation,
retirement pay, or pension.

    Deductions from benefits for the payment of premiums shall be 
effective on the month the authorization for such deduction is received 
by the Department of Veterans Affairs or on any successive month 
specified by the insured. Such deduction shall be applied to the premium 
due in the succeeding calendar month and shall continue monthly so long 
as the benefit payments are due and payable to the insured and the 
amount is sufficient to pay the premium or until such authorization is 
revoked by the veteran or otherwise terminated. When premium deductions 
are authorized by the insured, the premium will be treated as paid for 
purposes of preventing lapse of the insurance, so long as there is due 
and payable to the insured a benefit amount sufficient to provide the 
premium payment. If authorization was executed by the Director of a VA 
hospital or domiciliary or chief officer of a State hospital or other 
institution to make deductions from an institutional award, the 
authorization will cease and terminate at the termination of the 
institutional award and the insurance shall lapse unless another 
authorization for deduction from monthly benefit payments is executed by 
the insured. The insured will be notified by letter directed to the last 
address of record of the termination of the authorization to deduct 
premiums, but failure to give such notice shall not prevent lapse.

[61 FR 29291, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]

                       Calculation of Time Period



Sec.  8.6  Calculation of time period.

    If the last day of a time period specified in Sec. Sec.  8.2 or 8.3 
or allowed for filing an application for National Service life insurance 
or for applying for reinstatement thereof, or paying premiums due 
thereon, falls on a Saturday, Sunday, or legal holiday, the time period 
will be extended to include the following workday.

[33 FR 17916, Dec. 3, 1968. Redesignated and amended at 61 FR 29290, 
29291, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000; 65 FR 
19659, Apr. 12, 2000]

                              Reinstatement



Sec.  8.7  Reinstatement of National Service Life Insurance except insurance
issued pursuant to section 1925 of title 38 U.S.C.

    (a) Any policy which lapses and which is not surrendered for a cash 
value or for paid-up insurance, may be reinstated upon written 
application signed by the applicant, payment of all premiums in arrears, 
and evidence of good health as required under Sec.  8.8 (a) or (b), 
whichever is applicable. If a policy is not reinstated within 6 months 
from the due date of the premium in default, interest must be paid in 
addition to premiums for all months in arrears from their respective due 
dates at the rate of 5 percent per annum, compounded annually. The 
payment or reinstatement of any indebtedness against a policy must be 
made upon application for reinstatement, and any excess of indebtedness 
and interest over the reserve of the policy must be paid at that time. A 
lapsed National Service Life Insurance policy which is in force under 
extended term insurance may be reinstated within 5 years from the date 
extended insurance would expire upon application and payment of all 
premiums in arrears with the required interest. In any case in which the 
extended insurance under an endowment policy provides protection to the 
end of the endowment period, the policy may be reinstated at any time 
before maturity upon application and payment of the premiums with the 
required interest. A policy on the level term premium plan may be 
reinstated within 5 years of the date of lapse upon written application 
signed by the insured, evidence of insurability and payment of two 
monthly premiums, one for the month of the lapse, the other for the 
month of reinstatement.
    (b) Reinstatement of insurance issued under section 1925, title 38 
U.S.C. Any policy of insurance issued under 38 U.S.C. 1925 which has 
been lapsed for

[[Page 551]]

not more than 5 years shall be reinstated under the same provisions of 
paragraph (a) of this section.
    (c) Effective date of reinstatements. Reinstatement is effected on 
the date an acceptable application and the required monetary payments 
are delivered to the Department of Veterans Affairs. If application for 
reinstatement is submitted by mail, properly addressed to the Department 
of Veterans Affairs, the postmark date shall be the date of delivery. 
The effective date of reinstatement of the insurance shall be the last 
monthly premium due date prior to the delivery or postmark date of the 
application for reinstatement, except where reinstatement is effected on 
the due date of a premium, then in such case that date shall be the 
reinstatement date.
    (d) Inquiry during the grace period. When the insured makes inquiry 
prior to the expiration of the grace period disclosing a clear intent to 
continue insurance protection, such as a request for information 
concerning premium rates or conversion privileges, etc., an additional 
reasonable period not exceeding 60 days may be granted for payment of 
premiums due; but the premiums in any such case must be paid during the 
lifetime of the insured.

[61 FR 29291, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000; 
65 FR 19659, Apr. 12, 2000]



Sec.  8.8  Health requirements.

    National Service life insurance on any plan may be reinstated if 
application and tender of premiums are made:
    (a) Within 6 premium months including the premium month for which 
the unpaid premium was due, provided the applicant be in as good health 
on the date of application and tender of premiums as he or she was on 
the last day of the grace period of the premium in default and furnishes 
satisfactory evidence thereof.
    (b) After expiration of the 6-month period mentioned in paragraph 
(a) of this section, provided applicant is in good health (Sec.  8.0) on 
the date of application and tender of premiums and furnishes 
satisfactory evidence. If the insurance to be reinstated was issued 
under 38 U.S.C. 1922(a), 1925(b), or 1925(c) and application is made 
within 1 year of the date of lapse, any service-connected disability 
existing at the time the insurance was issued will be waived for the 
purpose of reinstatement (including natural progression of the condition 
since time of issuance). If the insurance to be reinstated was issued 
under 38 U.S.C. 1925(a) and application is made within 1 year of the 
date of lapse, any nonservice-connected disability, or service-connected 
disability which combined with a non-service-connected disability 
rendered the insured uninsurable as of October 13, 1964, will be waived 
for the purpose of reinstatement (including natural progression).

[33 FR 365, Jan. 10, 1968, as amended at 33 FR 12002, Aug. 23, 1968; 47 
FR 11657, Mar. 18, 1982. Redesignated and amended at 61 FR 29290, 29292, 
June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]



Sec.  8.9  Application and medical evidence.

    The applicant for reinstatement of National Service Life Insurance, 
during his or her lifetime, and within 5 years after the date of lapse 
if the insurance was issued under 38 U.S.C. 1925, must submit a written 
application signed by him or her and furnish satisfactory evidence of 
health as required in Sec.  8.8 at the time of application. Applicant's 
own statement of comparative health may be accepted as proof of 
insurability for the purpose of reinstatement under Sec.  8.8(a), but, 
whenever deemed necessary in any such case, report of physical 
examination may be required. Applications for reinstatement submitted 
after expiration of the applicable period mentioned in Sec.  8.8(a) must 
be accompanied by satisfactory evidence of good health. If the insurance 
becomes a claim after the tender of the amount necessary to meet 
reinstatement requirements but before full compliance with the 
requirements of this section, and the applicant was in a required state 
of health at the date that he or she made the tender of the amount 
necessary to meet reinstatement requirements, and that there is 
satisfactory reason for his or her noncompliance, the Assistant Director 
for Insurance, VA Center, Philadelphia, Pennsylvania may, if the 
applicant be dead, waive any or all requirements of

[[Page 552]]

this section (except payment of the necessary premiums) or, if the 
applicant be living, allow compliance with this section as of the date 
the required amount necessary to reinstate was received by the 
Department of Veterans Affairs.

(Authority: 38 U.S.C. 1925)

[47 FR 11657, Mar. 18, 1982. Redesignated and amended at 61 FR 29290, 
29292, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000; 65 FR 
19659, Apr. 12, 2000]

                                Dividends



Sec.  8.10  How paid.

    (a) Except as hereinafter provided in this paragraph, a National 
Service Life Insurance policy shall participate in and receive such 
dividends from gains and savings as may be determined by the Secretary 
of Veterans Affairs. Dividends becoming payable after January 1, 1952, 
shall be payable on the date preceding the anniversary of the policy 
unless the Secretary shall declare them payable on some other date. 
Dividends are not payable on insurance:
    (1) Issued or reinstated under the provisions of section 602(c)(2) 
of the National Service Life Insurance Act, as amended, where the 
requirements of good health were waived at the time of such issue or 
reinstatement;
    (2) Issued under sections 620 and 621 of the National Service Life 
Insurance Act, as amended;
    (3) Issued under sections 1904(c) and 1922(a) of title 38 U.S.C.;


(Authority: 38 U.S.C. 1923(b) and 725)

    (4) Issued on the ordinary life plan under section 1904(d) of title 
38 U.S.C., to replace the amount of insurance reduced under a modified 
life plan policy issued under 38 U.S.C. 1904(c); and
    (5) On which premiums are waived, in whole or in part, under the 
provisions of section 622 of the National Service Life Insurance Act, as 
amended, and 38 U.S.C. 1924 for the period during which such premium 
waiver is in effect.
    (b) Unless and until VA receives a written request from the insured 
that National Service Life Insurance dividends be paid in cash, or that 
they be used to pay an insurance indebtedness, or that they be placed on 
deposit or be used to pay premiums in advance, or that they be used to 
pay the premiums on a particular policy or policies, or that they be 
used to purchase paid-up additions, any such dividends shall be held to 
the credit of the insured to be applied to pay monthly premiums becoming 
due and unpaid after the date such dividends are payable on any National 
Service or United States Government Life Insurance policy or policies 
held by the insured: Provided, That such dividend credits will be 
applied as of the due date of any unpaid premium. Dividend credits will 
earn interest at such rate and in such manner as the Secretary may 
determine.


(Authority: 38 U.S.C. 1907(a))

    (c) In the event premiums on more than one policy having the same 
premium due date are unpaid and the dividend credit of the insured for 
application to payment of premiums is not sufficient to keep all 
policies in force, in the absence of instructions to the contrary by the 
insured, such dividend credit will be applied to pay premiums in such 
manner as will provide the maximum amount of insurance protection.
    (d) At the expiration of any term period, dividend credit of the 
insured held for payment of premiums will be applied to pay the required 
premium for renewal of term insurance unless the insured requests 
otherwise in writing prior to the expiration of the term period.
    (e) A request for payment of dividends in cash or for other 
disposition will be effective as of the date the request is delivered to 
the Department of Veterans Affairs: If forwarded by mail, properly 
addressed, the postmark date will be taken as the date of delivery: If 
forwarded through military channels by the insured while in military 
service, the date the request is placed in military channels will be 
accepted as the date of delivery. Unless otherwise stipulated by the 
insured, such request will remain in force until revoked in writing 
signed by the insured and delivered to the Department of Veterans 
Affairs.
    (f) Dividend credit of the insured held for payment of premiums may 
not be used to satisfy any indebtedness due

[[Page 553]]

the United States without the insured's consent. If the insured requests 
payment of such dividend credit, or any unused portion thereof, in cash, 
or requests that such credit be left to accumulate on deposit, as 
provided in paragraph (g) of this section, then any indebtedness due the 
United States, such as described in Sec.  5301 of title 38 U.S.C. will 
be recovered therefrom.
    (g) At the written request of the insured, National Service life 
insurance dividends may be left to accumulate on deposit at interest 
which will be credited in such manner and at such rate as the Secretary 
may determine: Provided, That the policy is in force on a basis other 
than extended term insurance or level premium term insurance. Dividend 
credit of the insured held for payment of premiums or dividends left to 
accumulate on deposit as provided in this paragraph may be applied to 
the payment of premiums in advance upon written request of the insured 
made before default in payment of a premium. Dividends on deposit under 
the provisions of this paragraph will be used in addition to the reserve 
on the policy for the purpose of computing the period of extended term 
insurance or the amount of paid-up insurance as provided in Sec. Sec.  
8.14 and 8.15, respectively. Any dividend credit of a person who no 
longer has insurance in force by payment or waiver of premiums will be 
paid in cash to such person. If a person has a dividend credit option on 
a lapsed level premium term policy or a permanent plan policy on which 
extended term insurance has expired and such person has another policy 
in force by payment or waiver of premiums, any dividend credit or unpaid 
dividends on the lapsed policy, in the absence of instructions from the 
insured to the contrary, will be transferred to the policy which is in 
force and will be held on such policy as a dividend credit. Such 
dividend credit will be deemed to have accrued on the policy which is in 
force. Upon maturity of the policy, any dividend on deposit, any unpaid 
dividend payable in cash, and any dividend credit accruing from such 
policy which cannot be used to pay premiums will be paid to the person 
currently entitled to receive payments under the policy. If the policy 
is not in force at death, any such unpaid dividends and dividend credits 
will be paid to the insured's estate.
    (h) Any insured receiving an annual dividend in cash may return such 
dividend check or an equivalent amount of money in order to have the 
dividend retained under the deposit or credit option. The return of such 
dividend must be made during the lifetime of the insured and before the 
end of the calendar year during which the dividend was paid. Dividends 
returned under this provision are not available for the payment of 
premiums, receipt of interest, or calculation of cash value prior to the 
postmark date of the returned check.

[17 FR 2362, Mar. 19, 1952, as amended at 18 FR 3715, June 30, 1953; 24 
FR 5021, June 20, 1959; 25 FR 7369, Aug. 5, 1960; 28 FR 12545, Nov. 23, 
1963; 30 FR 3646, Mar. 19, 1965; 32 FR 13927, Oct. 6, 1967; 37 FR 3352, 
Feb. 15, 1972; 46 FR 57043, Nov. 20, 1981; 50 FR 12252, Mar. 28, 1985. 
Redesignated and amended at 61 FR 29290, 29292, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000; 65 FR 19659, Apr. 12, 2000]

                       Cash Value and Policy Loan



Sec.  8.11  Cash value and policy loan.

    (a) Provisions for cash value, paid-up insurance, and extended term 
insurance, except as provided in Sec.  8.14(b), shall become effective 
at the completion of the first policy year on any plan of National 
Service Life Insurance other than the 5-year level premium term plan. 
The cash value at the end of the first policy year and at the end of any 
policy year thereafter, for which premiums have been paid in full, shall 
be the reserve with any dividend accumulations, where applicable.
    (b) Upon written request and upon complete surrender of the 
insurance and all claims thereunder, the United States will pay to the 
insured the cash value of the policy less any indebtedness, provided the 
policy has been in force by payment or waiver of the premiums for at 
least 1 year. Paid-up additions do not have to be in force for 1 year 
before they have cash values. Unless otherwise requested by the insured, 
a surrender will be deemed completed as of the end of the premium month 
in which the application for cash surrender is delivered to the 
Department of Veterans Affairs, or as of

[[Page 554]]

the date of the check for the cash value, whichever is later. If the 
application is forwarded by mail, properly addressed, the postmark date 
will be taken as the date of delivery. If it is forwarded through 
military channels, the date the application is placed in military 
channels will be taken as the date of delivery.
    (c) All values, reserves and net single premiums on participating 
National Service Life Insurance, other than as provided in paragraph (e) 
of this section, shall be based on the American Experience Table of 
Mortality, with interest at the rate of 3 percent per annum. For each 
month after the first policy year for which month a premium has been 
paid or waived, the reserve at the end of the preceding policy year 
shall be increased by one-twelfth of the increase in reserve for the 
current policy year.


(Authority: 38 U.S.C. 1902, 1906)

    (d) All values on insurance, reserves, and net single premiums 
issued under the provisions of section 1922(a) of title 38 U.S.C., and 
on modified life and ordinary life plans of insurance issued under 
section 1904(c), (d), and (e), respectively, shall be based on the 
Commissioners 1941 Standard Ordinary Table of Mortality with interest at 
the rate of 2\1/4\ percent per annum. Values between policy years shall 
be proportionally adjusted.


(Authority: 38 U.S.C. 1904, 1906)

    (e) All values on insurance, reserves, and net single premiums 
issued under the provisions of section 1923(b) of title 38 U.S.C., and 
on modified life and ordinary life plans of such insurance issued under 
section 1904 (c), (d), and (e), respectively, shall be based on table X-
18 (1950-54 Intercompany Table of Mortality) with interest at the rate 
of 2\1/2\ percent per annum. Values between policy years shall be 
proportionally adjusted.


(Authority: 38 U.S.C. 1904, 1923)

    (f) All values, reserves, and net single premiums on 
nonparticipating insurance on which the requirements of good health were 
waived under the provisions of section 602(c)(2) of the National Service 
Life Insurance Act, as amended (``H'' Insurance), and on the modified 
life and ordinary life plans of such ``H'' insurance issued under 
section 1904 (c), (d), and (e), respectively, of title 38 U.S.C. shall 
be based on the American Experience Table of Mortality, with interest at 
the rate of 3 percent per annum. Values between policy years shall be 
proportionally adjusted. The provisions of the ``Net Cash Value'' clause 
in National Service Life Insurance policies are hereby amended 
accordingly.
    (g) All values, reserves, and net single premiums on participating 
modified life and ordinary life plan insurance issued under section 1904 
(b), (d), and (e), respectively, of title 38 U.S.C. shall be based on 
the 1958 Commissioners Standard Ordinary Basic Table of Mortality and 
interest at the rate of 3 percent per annum. Values between policy years 
shall be proportionally adjusted.
    (h) All values, reserves, and net single premiums on insurance 
issued under the provisions of section 1925(b) of title 38 U.S.C, and on 
modified life and ordinary life plans of such insurance issued under 
section 1904 (c), (d), and (e), respectively, shall be based on the 1958 
Commissioners Standard Ordinary Basic Mortality Table and interest at 
the rate of 3\1/2\ percent per annum. Values between policy years shall 
be proportionally adjusted.
    (i) All values, reserves, and net single premiums on insurance 
issued under the provisions of section 1925(c) of title 38 U.S.C., and 
on modified life, ordinary life, 20-payment life and 30-payment life 
plans, where appropriate, of such insurance issued under section 1904 
(c), (d), and (e), respectively, shall be based on the American 
Experience Table of Mortality and interest at the rate of 3\1/2\ percent 
per annum. Values between policy years shall be proportionally adjusted.

(Authority: 38 U.S.C. 1906)

[61 FR 29292, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000; 
65 FR 19659, Apr. 12, 2000]

[[Page 555]]



Sec.  8.12  Payment of the cash value of National Service Life Insurance in
monthly installments under section 1917(e) of title 38 U.S.C.

    (a) Effective January 1, 1971, in lieu of payment of the cash 
surrender value in one sum the insured may elect to receive payment in 
monthly installments under option 2 or as a refund life income. If the 
insured dies before the agreed number of monthly installments have been 
paid, the remaining unpaid monthly installments will be payable as 
provided in title 38 U.S.C. 1917. Unless otherwise requested by the 
insured, a surrender under this section will be deemed completed as of 
the premium month in which the application for cash surrender is 
delivered to the Department of Veterans Affairs, or as of the date of 
the first check released thereunder, whichever is later.
    (b) [Reserved]

[36 FR 4384, Mar. 5, 1971. Redesignated and amended at 61 FR 29290, 
29292, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]



Sec.  8.13  Policy loans.

    (a) At any time after the premiums for the first policy year have 
been paid and earned and before default in payment of any subsequent 
premium, and upon the execution of a loan agreement satisfactory to the 
Secretary, the United States will lend to the insured on the security of 
his or her National Service Life Insurance policy, any amount which will 
not exceed 94 percent of the reserve, and any indebtedness on the policy 
shall be deducted from the amount advanced on such loan. At any time 
before default in the payment of the premium, the loan may be repaid in 
full or in amounts of $5 or more. Failure to pay either the amount of 
the loan or the interest thereon shall not make the policy voidable 
unless the total indebtedness shall equal or exceed the cash value. When 
the amount of the indebtedness equals or exceeds the cash value, the 
policy shall become voidable. On loans applied for before the effective 
date of this regulation (November 2, 1987) and not exchanged pursuant to 
paragraph (b) of this section, the policy loan interest rate in effect 
when the loan was applied for shall not be increased for the term of the 
loan.
    (b) Loans applied for or exchanged on and after the effective date 
of this regulation (November 2, 1987) shall bear interest at a rate 
which may be varied during the term of the loan, not more frequently 
than once a year, as provided by paragraphs (c) and (d) of this section. 
After October 1, 1988, the policy loan rate shall not be varied more 
frequently than once a year. Notification of the initial rate of 
interest on new loans will be forwarded at the time the loan is made. 
Policyholders with existing variable rate loans will be forwarded 
reasonable advance notice of any increase in the rate. Reasonable 
advance notice of any change in the variable loan rate will be published 
in the Federal Register. A notice pertaining to variable loans which is 
sent to the policyholder's last address of record will constitute 
sufficient evidence of notice.
    (c) Subject to the provisions of paragraph (d) of this section, loan 
rates established pursuant to paragraph (b) of this section shall equal 
the yield on the Ten-Year Constant Maturities Index for U.S. Treasury 
Securities for the month of June of the year of calculation rounded down 
to the next whole percentage. Such loan rate shall be effective on the 
date on or after the first day of October on which the rate change is 
made in the insurance automatic data processing system, and shall remain 
in effect for not less than one year after the date of establishment. 
The prevailing variable loan rate shall apply to all loans granted under 
paragraph (b) of this section.
    (d) Notwithstanding any other provisions of this section, the 
variable loan rate shall not exceed 12 percent or be lower than 5 
percent per annum.

(Authority: 38 U.S.C. 1906)

[52 FR 39626, Oct. 2, 1987, as amended at 53 FR 17466, May 17, 1988; 59 
FR 65717, Dec. 21, 1994. Redesignated at 61 FR 29290, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000]

[[Page 556]]

                   Extended Term and Paid-Up Insurance



Sec.  8.14  Provision for extended term insurance--other than 5-year
level premium term or limited convertible 5-year level premium term
policies.

    (a) After the expiration of the first policy year and upon default 
in the payment of a premium within the grace period, if a permanent plan 
National Service Life Insurance policy other than the modified life plan 
has not been surrendered for cash or for paid-up insurance, the policy 
shall be extended automatically as term insurance. The extended term 
insurance shall be for an amount of the insurance equal to the face 
value of the policy less any indebtedness for such time from the due 
date of the premium in default as the cash value less any indebtedness 
and a charge for administrative cost for insurance issued under 38 
U.S.C. 1925, will purchase when applied as a net single premium at the 
attained age of the insured. For this purpose the attained age is the 
age on the birthday anniversary nearest to the effective date of the 
policy plus the number of years and months from that date to the date 
the extended term insurance becomes effective. The extended term 
insurance shall not have a loan value, but shall have a cash value.
    (b) Upon default in payment of a premium within the grace period on 
any permanent plan of National Service Life Insurance other than the 
modified life plan and any plan of insurance issued under 38 U.S.C. 
1925, if the policy has been in force by payment or waiver of premiums 
for not less than 3 months nor more than 11 months, the policy shall be 
extended automatically as term insurance. The extended term insurance 
shall be for an amount of insurance equal to the face value of the 
policy less any indebtedness for such time from the due date of the 
premium in default as the reserve of the policy less any indebtedness 
will purchase when applied as a net single premium at the attained age 
of the insured. For this purpose the attained age is the age on the 
birthday anniversary nearest to the effective date of the policy plus 
the number of months from that date to the date extended term insurance 
becomes effective. Extended term insurance under this provision shall 
not have a cash or loan value. This paragraph shall be effective from 
and after August 2, 1948.
    (c) Upon default in payment of a premium within the grace period, if 
a modified life plan of National Service Life Insurance has not been 
surrendered for cash or paid-up insurance and if the policy has been in 
force by payment or waiver of premiums for not less than 3 months, or 
for not less than 1 year for insurance issued under 38 U.S.C. 1925, the 
policy shall be extended automatically as of insurance equal to (1) the 
Initial Face Amount of Insurance (face amount of policy in force prior 
to insured's 65th birthday) less any indebtedness, for lapses which 
occur prior to the insured's 65th birthday, or (2) the Ultimate Face 
Amount of Insurance (face amount of policy in force on or after 
insured's 65th birthday) less any indebtedness, for lapses which occur 
on or after the insured's 65th birthday. The extended term insurance 
shall be for an amount of insurance equal to:
    (i) The initial face amount of insurance (face amount of policy in 
force prior to the insured's 65th or 70th birthday, depending on the 
plan of insurance), less any indebtedness, for lapses which occur prior 
to the insured's 65th or 70th birthday, depending on the plan of 
insurance, or
    (ii) The ultimate face amount of insurance (face amount of policy in 
force on or after insured's 65th or 70th birthday, depending on the plan 
of insurance) less any indebtedness, for lapses which occur on or after 
the insured's 65th or 70th birthday, depending on the plan of insurance. 
If a modified life plan policy is on extended term insurance at the end 
of the day preceding the insured's 65th or 70th birthday, depending on 
the plan of insurance, the amount of extended term insurance in effect 
under such policy shall be automatically reduced by one-half thereof. If 
the policy lapsed prior to the end of the first policy year, the 
extended term insurance shall not have a cash or loan value. If the 
policy lapsed after the

[[Page 557]]

first policy year, the extended term insurance shall not have a loan 
value, but shall have a cash value.

(Authority: 38 U.S.C. 1906)

[30 FR 3647, Mar. 19, 1965, as amended at 47 FR 11658, Mar. 18, 1982. 
Redesignated at 61 FR 29290, June 10, 1996. Redesignated at 65 FR 7437, 
Feb. 15, 2000]



Sec.  8.15  Provision for paid-up insurance; other than 5-year level 
premium term or limited convertible 5-year level premium term policies.

    If a National Service Life Insurance policy on any plan other than 
5-year level premium term or limited convertible 5-year level premium 
term plan has not been surrendered for cash, upon written request of the 
insured and complete surrender of the insurance with all claims 
thereunder, after the expiration of the first policy year and while the 
policy is in force under premium-paying conditions, the United States 
will issue paid-up insurance for such amount as the cash value less any 
indebtedness, and a charge for administrative cost for insurance issued 
under 38 U.S.C. 1925, will purchase when applied as a net single premium 
at the attained age of the insured. For this purpose the attained age is 
the age on the birthday anniversary nearest to the effective date of the 
policy plus the number of years and months from that date to the date 
the paid-up insurance becomes effective. Such paid-up insurance will be 
effective as of the expiration of the period for which premiums have 
been paid and earned; and, any premiums paid in advance for months 
subsequent to that in which the application for paid-up insurance is 
made shall be refunded to the insured. The paid-up insurance, if 
eligible to participate in and to receive dividends, shall be with the 
right to dividends. The insured may at any time surrender the paid-up 
policy for its cash value or obtain a loan on such paid-up insurance.

[30 FR 3648, Mar. 19, 1965. Redesignated and amended at 61 FR 29290, 
29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]

                             Change in Plan



Sec.  8.16  Conversion of a 5-year level premium term policy as provided
for under Sec.  1904 of title 38 U.S.C.

    National Service Life Insurance on the level premium term plan which 
is in force may be exchanged for a permanent plan policy upon written 
application by the insured and the payment of the current monthly 
premium at the attained age for the plan of insurance selected (except 
where premium waiver under 38 U.S.C. 1912 is effective). The reserve (if 
any) on the policy will be allowed as a credit on the current monthly 
premium except where premium waiver is effective. Conversion to an 
endowment plan may not be made while the insured is totally disabled. 
The conversion will be made without medical examination, except when 
deemed necessary to determine whether an applicant for conversion to an 
endowment plan is totally disabled, and upon complete surrender of the 
term insurance while in force by payment or waiver of premium.

(Authority: 38 U.S.C. 1904)

[61 FR 29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]

                  Premium Waivers and Total Disability



Sec.  8.17  Discontinuance of premium waiver.

    (a) The Secretary may require proof of continuance of total 
disability at any time the Secretary may deem same necessary. In the 
event it is found that an insured is no longer totally disabled, the 
waiver of premiums shall cease as of the date of such finding, and the 
insurance may be continued by payment of premiums, the due date of the 
first premium payable being the next regular monthly due date of the 
premium under the policy. The insurance shall not lapse prior to the 
date of expiration of the grace period allowed for the payment of such 
premium or prior to the expiration of 31 days after date of notice to 
the insured of the termination of the premium waiver, whichever is the 
later date. Such notice shall be sent by registered mail or by certified 
mail and sufficient notice will be deemed to have been given

[[Page 558]]

when such letter has been placed in the mails by the Department of 
Veterans Affairs: Provided, That the Secretary may grant an additional 
period of not more than 31 days for payment of the premiums in any case 
in which it is shown that the failure to make payment within 31 days 
after notice as defined in this paragraph was due to circumstances 
beyond the insured's control; but the premiums in any such case must be 
paid during the lifetime of the insured. The failure of the insured to 
furnish a correct current address at which mail will reach him or her 
promptly shall not be grounds for a further extension of time for 
payment of premiums under this section.
    (b) In the event a finding that insured is no longer totally 
disabled is made at the same time a finding is made of total disability 
entitling the insured to a waiver of premiums while so disabled, the 
waiver of premiums shall cease as of the date on which total disability 
ceased and continuance of the insurance in such cases shall be subject 
to the timely payment of the premiums as they become or have become due 
and payable. The due date of the first premium payable subsequent to the 
date total disability ceased is the next regular due date of the premium 
under the policy, and if such premium was not paid within 31 days after 
the due date, the insurance lapsed.
    (c) If the insured shall fail to cooperate with the Secretary in 
securing any evidence he may require to determine whether total 
disability has continued, the premium waiver shall cease effective as of 
the date finding is made of such failure to cooperate, and the insurance 
may be continued by payment of the premiums within 31 days after notice 
of termination as provided in paragraph (a) of this section.

[13 FR 7114, Nov. 27, 1948, as amended at 25 FR 8776, Sept. 13, 1960; 47 
FR 11658, Mar. 18, 1982. Redesignated at 61 FR 29290, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000]



Sec.  8.18  Total disability--speech.

    The organic loss of speech shall be deemed to be total disability 
under National Service Life Insurance.

[67 FR 54738, Aug. 26, 2002]

                              Beneficiaries



Sec.  8.19  Beneficiary and optional settlement changes.

    The insured shall have the right at any time, and from time to time, 
and without the knowledge or consent of the beneficiary to cancel or 
change a beneficiary and/or optional settlement designation. A change of 
beneficiary or optional settlement to be effective must be made by 
notice in writing signed by the insured and forwarded to the Department 
of Veterans Affairs by the insured or designated agent, and must contain 
sufficient information to identify the insured. A beneficiary 
designation and an optional settlement selection, but not a change of 
beneficiary, may be made by last will and testament duly probated. Upon 
receipt by the Department of Veterans Affairs, a valid designation or 
change of beneficiary or option shall be deemed to be effective as of 
the date of execution. Any payment made before proper notice of 
designation or change of beneficiary has been received in the Department 
of Veterans Affairs shall be deemed to have been properly made and to 
satisfy fully the obligations of the United States under such insurance 
policy to the extent of such payments.

[61 FR 29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]

                  Proof of Death, Age, or Relationship



Sec.  8.20  Proof of death, age, relationship and marriage.

    Whenever it is necessary for a claimant to prove death, age, 
relationship or marriage, the provisions found in Part 3 of this chapter 
will be followed.

[26 FR 1856, Mar. 3, 1961. Redesignated and amended at 61 FR 29290, 
29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000]

                                   Age



Sec.  8.21  Misstatement of age.

    If the age of the insured under a National Service life insurance 
policy has been understated, the amount of the insurance payable under 
the policy shall be such exact amount as the premium paid would have 
purchased at the correct age; if overstated, the excess of premiums paid 
shall be refunded

[[Page 559]]

without interest. Guaranteed surrender and loan values will be modified 
accordingly. The age of the insured will be admitted by the Department 
of Veterans Affairs at any time upon satisfactory proof.

[13 FR 7115, Nov. 27, 1948. Redesignated at 61 FR 29290, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000]

                              Examinations



Sec.  8.22  Examination of applicants for insurance or reinstatement.

    Where physical or mental examination is required of an applicant for 
National Service Life Insurance or of an applicant for reinstatement of 
National Service Life Insurance, such examination may be made by a 
medical officer of the United States Army, Navy, Air Force, or Public 
Health Service, or may be made free of charge to him or her by a full-
time or part-time salaried physician or a physician's assistant at a 
regional office or medical facility of the Department of Veterans 
Affairs. Such examination may also be made, at the applicant's own 
expense, by a physician duly licensed for the practice of medicine by a 
State, possession of the United States, Commonwealth of Puerto Rico, or 
the District of Columbia, or by a duly licensed osteopathic physician 
who is a graduate of a recognized and approved college of osteopathy and 
who is listed in the current directory of the American Osteopathic 
Association. Such examination may be made by a physician or osteopath 
who is not related to the applicant by blood or marriage, associated 
with him or her in business, or pecuniarily interested in the insurance 
or reinstatement of the policy. Examinations made in a foreign country 
by a physician duly licensed for the practice of medicine and otherwise 
acceptable may be accepted if submitted through the American consul. The 
Secretary of Veterans Affairs may require such further medical 
examination or additional medical evidence as may be deemed necessary 
and proper to establish the physical and mental condition of the 
applicant at the time of the application.

(Authority: 38 U.S.C. 1904 and 1905)

[30 FR 3650, Mar. 19, 1965, as amended at 47 FR 11659, Mar. 18, 1982. 
Redesignated and amended at 61 FR 29290, 29293, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000]



Sec.  8.23  Examination in connection with total disability benefits.

    Physical examination in connection with claim for total disability 
benefits may be made by a medical officer of the United States Army, 
Navy, Air Force, or Public Health Service, or may be made at Government 
expense by a full-time or part-time salaried physician or physician's 
assistant at a regional office or medical facility of the Department of 
Veterans Affairs. If an insured is unable to travel, because of physical 
or mental condition, the Director of a regional office or of a medical 
facility may, on his or her own initiative or at the request of the 
Insurance activity concerned, authorize at Government expense 
examination at the residence of the insured. The Secretary of Veterans 
Affairs may require such further medical examination or such additional 
medical evidence as may be deemed necessary and proper to establish the 
physical and mental condition of the insured.

(Authority: 38 U.S.C. 1912(b))

[47 FR 11659, Mar. 18, 1982. Redesignated at 61 FR 29290, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000]



Sec.  8.24  Expenses incident to examinations for insurance purposes.

    Except as provided in Sec.  8.22, necessary transportation expenses 
incident to physical or mental examinations for insurance purposes at 
regional offices or medical facilities shall be furnished when the 
insured is ordered to report for examination at the specific request of 
the insurance activity concerned, or the Director of a regional office 
or of a medical facility. Such expenses will be borne by the United 
States and will be paid from the applicable appropriation of the 
Veterans Health Services and Research Administration. Transportation, 
meal and lodging requests in connection with reporting to and returning 
from the place of examination

[[Page 560]]

may be furnished the applicant, or the applicant may travel at his or 
her own expense and claim reimbursement for such travel on a mileage 
basis, provided prior authority has been given for the travel. Travel 
incident to such an examination by salaried employees of the Department 
of Veterans Affairs will be in accordance with the Federal Travel 
Regulations. If such an examination is made by a medical examiner on a 
fee basis, payment will be made at a fee not in excess of the schedule 
of fees in effect and approved by the Department of Veterans Affairs for 
medical and professional services in the State in which the examination 
is made. Where no approved State fee schedule is in effect or where a 
fee for the type of examination authorized is not listed in the approved 
State fee schedule in effect, such examinations will be furnished at a 
fee not in excess of that listed in the ``Guide for Charges for Medical 
and Ancillary Services'' of the Veterans Health Services and Research 
Administration in effect at the time the examination is authorized. If 
the particular examination is not covered by a schedule in effect and/or 
the said guide, a fee not in excess of what is reasonable and 
customarily charged in the community concerned may be allowed.

[30 FR 3650, Mar. 19, 1965, as amended at 47 FR 11659, Mar. 18, 1982. 
Redesignated and amended at 61 FR 29290, 29293, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000; 65 FR 19659, Apr. 12, 2000]

                          Optional Settlements



Sec.  8.25  Options.

    Insurance will be paid in a lump sum only when selected by the 
insured during his or her lifetime or by his or her last will and 
testament.

[61 FR 29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000, 
and further redesignated at 67 FR 54739, Aug. 26, 2002]

                        Renewal of Term Insurance



Sec.  8.26  Renewal of National Service Life Insurance on the 5-year level
premium term plan.

    (a) Effective July 23, 1953, all or any part of National Service 
Life Insurance on the 5-year level premium term plan, in any multiple of 
$500 and not less than $1,000, which is not lapsed at the expiration of 
any 5-year term period, shall be automatically renewed without 
application or medical examination for a successive 5-year period at the 
applicable level premium term rate for the then attained age of the 
insured: Provided, That on or after September 1, 1984, National Service 
Life Insurance ``V'' 5-year level premium term rates shall not exceed 
the renewal age 70 term premium rate, or that on or after (the date the 
regulation is published as final), Veterans Special Life Insurance 
``RS'' five-year level premium term rates shall not exceed the renewal 
age 70 ``RS'' term premium rate: Provided further, That in any case in 
which the insured is shown by satisfactory evidence to be totally 
disabled at the expiration of the term period of his or her insurance 
under conditions which would entitle the insured to continued insurance 
protection but for such expiration, such insurance, if subject to 
renewal under this paragraph shall be automatically renewed for an 
additional period of 5 years at the applicable premium rate. The renewal 
of insurance for any successive 5-year period will become effective as 
of the day following the expiration of the preceding term period, and 
the premium for such renewal will be the applicable level premium term 
rate on that day: Provided further, That no insurance is subject to 
renewal if the policyholder has exercised the insured's right to change 
to another plan of insurance.


(Authority: 38 U.S.C. 1905, 1906)

    (b) Effective June 25, 1970, a 5-year level premium term policy 
which lapsed for nonpayment of the premium due and subsequently expired 
may be renewed subsequently to the expiration of the old term period 
provided the insured within 5 years of the date of lapse:
    (1) Submits written application for reinstatement of the insurance.
    (2) Tenders two monthly premiums, one for the month of lapse at the 
rate for the expired term and the other for the month of reinstatement 
at the rate for the new term.

[[Page 561]]

    (3)(i) If application for reinstatement is submitted and the 
premiums tendered within 6 premium months after lapse, including the 
premium month for which the unpaid premium was due, insurance will be 
reinstated provided the applicant be in as good health on the date of 
application and tender of premiums as he was on the last day of the 
grace period of the premium in default and furnishes satisfactory 
evidence thereof.
    (ii) If application for reinstatement is submitted and the premiums 
tendered after expiration of the 6-month period mentioned in subdivision 
(i) of this subparagraph, insurance will be reinstated provided 
applicant is in good health (Sec.  8.0) on the date of application and 
tender of premiums and furnishes satisfactory evidence thereof.

[21 FR 6544, Aug. 30, 1956, as amended at 24 FR 21, Jan. 1, 1959; 30 FR 
3652, Mar. 19, 1965; 33 FR 365, Jan. 10, 1968; 36 FR 4384, Mar. 5, 1971; 
49 FR 34484, Aug. 31, 1984; 54 FR 5931, Feb. 7, 1989. Redesignated and 
amended at 61 FR 29290, 29293, June 10, 1996. Redesignated at 65 FR 
7437, Feb. 15, 2000, and further redesignated at 67 FR 54739, Aug. 26, 
2002]

       Settlement of Insurance Maturing on or After August 1, 1946



Sec.  8.27  Conditional designation of beneficiary.

    If the insured by notice in writing to the Department of Veterans 
Affairs during his lifetime has provided that a designated beneficiary 
shall be entitled to the proceeds of National Service life insurance 
only if such beneficiary shall survive him for such period (not more 
than 30 days), as specified by the insured, no right to the insurance 
shall vest as to such beneficiary during that period. In the event such 
beneficiary fails to survive the specified period, payment of the 
proceeds of National Service life insurance will be made as if the 
beneficiary had predeceased the insured.

[14 FR 7175, Nov. 29, 1949. Redesignated at 61 FR 29290, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000, and further redesignated at 
67 FR 54739, Aug. 26, 2002]



Sec.  8.28  Application for reinstatement of total disability income
provision.

    A total disability income provision which is lapsed may be 
reinstated if the insured meets the same requirements as those for 
reinstatement of the policy to which the total disability income 
provision is attached; except that in no event shall the requirement of 
a health statement or other medical evidence be waived in connection 
with the reinstatement of the total disability income provision.

[61 FR 29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000, 
and further redesignated at 67 FR 54739, Aug. 26, 2002]

                 National Service Life Insurance Policy



Sec.  8.29  Policy provisions.

    Contracts of insurance authorized to be made in accordance with the 
terms and conditions set forth in the forms and policy plans are subject 
in all respects to the applicable provisions of title 38 U.S.C., 
amendments and supplements thereto, and applicable Department of 
Veterans Affairs regulations promulgated pursuant thereto, all of which 
together with the insured's application, required evidence of health, 
including physical examination, if required, and tender of premium shall 
constitute the contract.

[61 FR 29293, June 10, 1996. Redesignated at 65 FR 7437, Feb. 15, 2000, 
and further redesignated at 67 FR 54739, Aug. 26, 2002]

                                 Appeals



Sec.  8.30  Review of Decisions and Appeal to Board of Veterans' Appeals.

    (a) Decisions. This section pertains to insurance decisions 
involving questions arising under parts 6, 7, 8, and 8a of this chapter, 
to include the denial of applications for insurance, total disability 
income provision, or reinstatement; disallowance of claims for insurance 
benefits; and decisions holding fraud or imposing forfeiture. The 
applicant or claimant and his or her representative, if any, will be 
notified in writing of such a decision, which must include, in the 
notice letter or enclosures or a combination thereof, all of the 
following elements:
    (1) Identification of the issues adjudicated.
    (2) A summary of the evidence considered.

[[Page 562]]

    (3) A summary of the applicable laws and regulations relevant to the 
decision.
    (4) Identification of findings that are favorable to the claimant.
    (5) For denials, identification of the element(s) not satisfied that 
led to the denial.
    (6) An explanation of how to obtain or access the evidence used in 
making the decision.
    (7) A summary of the applicable review options available for the 
claimant to seek further review of the decision.
    (b) Favorable findings. Any finding favorable to the claimant or 
applicant is binding on all subsequent agency of original jurisdiction 
and Board of Veterans' Appeals adjudicators, unless rebutted by evidence 
that identifies a clear and unmistakable error in the favorable finding.
    (c) Review of decisions. Within one year from the date on which the 
agency of original jurisdiction issues notice of an insurance decision 
as outlined in paragraph (a) of this section, applicants or claimants 
may elect one of the following administrative review options by timely 
filing the appropriate form prescribed by the Secretary:
    (1) Supplemental claim review. The nature of this review will accord 
with Sec.  3.2501 of this title to the extent the terms used therein 
apply to insurance matters.
    (2) Request for a higher-level review. The nature of this review 
will accord with Sec.  3.2601 of this title to the extent the terms used 
therein apply to insurance matters. Higher-level reviews will be 
conducted by an experienced adjudicator who did not participate in the 
prior decision. Selection of a higher-level adjudicator to conduct a 
higher-level review is at VA's discretion.
    (3) Appeal to Board of Veterans' Appeals. See 38 CFR part 20.
    (d) Part 3 provisions. See Sec.  3.2500(b) through (d) of this 
chapter for principles that generally apply to a veteran's election of 
review of an insurance decision.
    (e) Applicability. This section applies where notice of an insurance 
decision was provided to an applicant or claimant on or after the 
effective date of the modernized review system as provided in Sec.  
19.2(a) of this chapter, or where an applicant or claimant has elected 
review of a legacy claim under the modernized review system as provided 
in Sec.  3.2400(c) of this title.
    (f) Unpaid premiums. When a claimant or applicant elects a review 
option under paragraph (c) of this section, any unpaid premiums, 
normally due under the policy from effective date of issue or 
reinstatement (as appropriate), will become an interest-bearing lien, 
enforceable as a legal debt due the United States and subject to all 
available collection procedures in the event of a favorable result for 
the claimant or applicant.
    (g) Premium payments. Despite a claimant's or applicant's election 
of a review option under paragraph (c) of this section, where the agency 
of original jurisdiction's decision involved a change in or addition to 
insurance currently in force, premium payments must be continued on the 
existing contract.
    (h) Section 1984. Nothing in this section shall limit an applicant's 
or claimant's right to pursue actions under 38 U.S.C. 1984.

(Authority: 38 U.S.C. 501, 1901-1929, 1981-1988)

[84 FR 173, Jan. 18, 2019]



Sec.  8.31  Total disability for twenty years or more.

    Where the Disability Insurance Claims activity has made a finding of 
total disability for insurance purposes and it is found that such 
disability remained continuously in effect for 20 or more years, the 
finding will not be discontinued thereafter, except upon a showing that 
such a determination was based on fraud. The 20-year period will be 
computed from the date the continuous total disability commenced, as 
determined by the Disability Insurance Claims activity.

[27 FR 11893, Dec. 1, 1962. Redesignated at 61 FR 29290, June 10, 1996. 
Redesignated at 65 FR 7437, Feb. 15, 2000, and further redesignated at 
67 FR 54739, Aug. 26, 2002]



Sec.  8.32  Authority of the guardian.

    What actions does a guardian have the authority to take for 
insurance purposes? The guardian of an insured or beneficiary has the 
authority to take the following actions:

[[Page 563]]

    (a) Apply for insurance or for conversion of a policy or change of 
plan;
    (b) Reinstate a policy;
    (c) Withdraw dividends held on deposit or credit;
    (d) Select or change a dividend option;
    (e) Obtain a policy loan;
    (f) Cash surrender a policy;
    (g) Authorize a deduction from benefits or allotment from military 
retired pay to pay premiums;
    (h) Apply for and receive payment of proceeds on a matured policy;
    (i) Select or change the premium payment option;
    (j) Apply for waiver of premiums and total disability income 
benefits;
    (k) Select or change settlement options for beneficiaries; and
    (l) Assign a beneficiary's interest as provided under section 1918 
of title 38 U.S.C.

(Authority: 38 U.S.C. 1906)

[67 FR 54739, Aug. 26, 2002]



Sec.  8.33  Cash value for term-capped policies.

    (a) What is a term-capped policy? A term-capped policy is a National 
Service Life Insurance policy prefixed with ``V'' or Veterans Special 
Life Insurance policy prefixed with ``RS,'' issued on a 5-year level 
premium term plan in which premiums have been capped (frozen) at the 
renewal age 70 rate.
    (b) How can a term-capped policy accrue cash value? Normally, a 
policy issued on a 5-year level premium term plan does not accrue cash 
value (see section 8.14). However, notwithstanding any other provisions 
of this part, reserves have been established to provide for cash value 
for term-capped policies.
    (c) On what basis have the reserve values been established? Reserve 
values have been established based upon the 1980 Commissioners Standard 
Ordinary Basic Table and interest at five per centum per annum in 
accordance with accepted actuarial practices.
    (d) How much cash value does a term-capped policy have? The cash 
value for each policy will depend on the age of the insured, the type of 
policy, and the amount of coverage in force and will be calculated in 
accordance with accepted actuarial practices. For illustrative purposes, 
below are some examples of cash values based upon a $10,000 policy at 
various attained ages for an NSLI ``V'' policy and a VSLI ``RS'' policy:

------------------------------------------------------------------------
                                                 Cash value   Cash value
                      Age                          ``V''        ``RS''
------------------------------------------------------------------------
75............................................       $1,494       $1,716
80............................................        3,212        3,358
85............................................        4,786        4,818
90............................................        6,249        6,217
95............................................        8,887        7,286
------------------------------------------------------------------------

    (e) What can be done with this cash value? Upon cancellation or 
lapse of the policy, a policyholder may receive the cash value in a lump 
sum or may use the cash value to purchase paid-up insurance. If a term-
capped policy is kept in force, cash values will continue to grow.
    (f) How much paid-up insurance can be obtained for the cash value? 
The amount of paid-up insurance that can be purchased will depend on the 
amount of cash value that the policy has accrued and will be calculated 
in accordance with accepted actuarial practices. For illustrative 
purposes, below are some examples of paid-up insurance that could be 
purchased by the cash value of a ``V'' and an ``RS'' $10,000 policy at 
various attained ages:

------------------------------------------------------------------------
                                                  Paid-up      Paid-up
                      Age                          ``V''        ``RS''
                                                 insurance    insurance
------------------------------------------------------------------------
75............................................       $2,284       $2,625
80............................................        4,452        4,654
85............................................        6,109        6,149
90............................................        7,421        7,115
95............................................        9,331        7,650
------------------------------------------------------------------------

    (g) If the policy lapses due to non-payment of the premium, does the 
policyholder nonetheless have a choice of receiving the cash value or 
paid-up insurance? Yes, the policyholder will have that choice, along 
with the option to reinstate the policy (see section 8.10 for 
reinstatement of a policy). However, if a policyholder does not make a 
selection, VA will apply the cash value to purchase paid-up insurance. 
Paid-up insurance may be surrendered for cash at any time.
    (h) If a policyholder elects to receive either the cash surrender or 
paid-up insurance due to lapse or voluntary cancellation of a term-
capped policy, may the original term-capped policy be reinstated?

[[Page 564]]

Yes, the term-capped policy may be reinstated but the policyholder, in 
addition to meeting the reinstatement requirements of term policies, 
must also pay the current reserve value of the reinstated policy.

[65 FR 54799, Sept. 11, 2000. Redesignated at 67 FR 54739, Aug. 26, 
2002]



Sec.  8.34  Ineligibility for insurance under 38 U.S.C. 1922A 
(supplemental Service-Disabled Veterans' Insurance) if person insured
under 38 U.S.C. 1922(b).

    A person who is granted Service-Disabled Veterans' Insurance under 
38 U.S.C. 1922(b) is not eligible for supplemental Service-Disabled 
Veterans' Insurance under 38 U.S.C. 1922A.

[83 FR 18422, Apr. 27, 2018]



PART 8a_VETERANS MORTGAGE LIFE INSURANCE--Table of Contents



Sec.
8a.1 Definitions.
8a.2 Maximum amount of insurance.
8a.3 Effective date.
8a.4 Coverage.

    Authority: 38 U.S.C. 501, and 2101 through 2106, unless otherwise 
noted.

    Source: 37 FR 282, Jan. 8, 1972, unless otherwise noted.



Sec.  8a.1  Definitions.

    (a) The term housing unit means a family dwelling or unit, together 
with the necessary land therefor, that has been or will be purchased, 
constructed, or remodeled with a grant to meet the needs of an eligible 
individual and of his or her family, and is or will be owned and 
occupied by the eligible individual as his or her home, or a family 
dwelling or unit, including the necessary land therefor, acquired by an 
eligible individual to be used as his or her residence after selling or 
otherwise disposing of title to the housing unit for which his or her 
grant was made.
    (b) The term Veterans Mortgage Life Insurance (VMLI) means the 
mortgage protection life insurance authorized for individuals under 38 
U.S.C. 2106.
    (c) The term initial amount of insurance means the amount of 
insurance selected by the insured, which may be less than the statutory 
maximum of $200,000 and less than the amount necessary to pay the 
mortgage indebtedness in full.
    (d) The term mortgage loan means any loan, lien, or other 
indebtedness incurred by an eligible individual to buy, build, remodel, 
or enlarge a housing unit, the payment of which loan, lien, or 
indebtedness is secured by a mortgage lien, or other equivalent security 
of record, on the housing unit in the usual legal form employed in the 
community in which the property is situated. The term also includes 
refinancing of such an indebtedness to avoid a default, to consolidate 
liens, to renew or extend the time for payment of the indebtedness, and 
in cases where the housing unit is being bought, built, remodeled, or 
enlarged by increasing the amount of such an indebtedness.
    (e) The term owned means the eligible individual has or will acquire 
an interest in the housing unit which is:
    (1) A fee simple estate, or
    (2) A leasehold estate, the unexpired term of which, including 
renewals at the option of the lessee, is not less than 50 years, or
    (3) An interest in a residential unit in a cooperative or a 
condominium type development which in the judgment of the Under 
Secretary for Benefits or the Director, Loan Guaranty Service, provides 
a right of occupancy for a period of not less than 50 years: Provided, 
The title to such estate or interest is or shall be such as is 
acceptable to prudent lending institutions, informed buyers, title 
companies, and attorneys, generally, in the community.
    (f) The term eligible individual means a person who has been 
determined by the Secretary to be eligible for benefits pursuant to 38 
U.S.C. chapter 21.

(Authority: 38 U.S.C. 501, 2101, 2101A, 2106)

[37 FR 282, Jan. 8, 1972, as amended at 42 FR 43835, Aug. 31, 1977; 61 
FR 29027, June 7, 1996; 82 FR 48631, Oct. 19, 2017]



Sec.  8a.2  Maximum amount of insurance.

    (a) Each eligible individual is authorized an initial amount of 
insurance up to a maximum of $200,000 in VMLI to insure his or her life 
during periods he or she is obligated under a mortgage loan, except 
that, as to an individual

[[Page 565]]

housing unit, whenever there is a reduction in the actual amount of 
insurance in force as provided for in Sec.  8a.4(a) the amount of VMLI 
thereafter available to insure the life of the same individual on the 
same housing unit is permanently reduced by a like amount.
    (b) The maximum amount of insurance in force on any one life at one 
time shall not exceed the lesser of the following amounts:
    (1) $200,000.
    (2) For insurance issued prior to December 24, 1987, the reduced 
maximum amount of insurance then available to an eligible individual.
    (3) The amount of the unpaid principal of the mortgage loan 
outstanding on the date of approval of the grant on a housing unit then 
owned and occupied by the eligible individual, or on a housing unit 
being or to be constructed or remodeled for the eligible individual, and 
such initial amount of insurance may be adjusted upward, subject to the 
maximum insurance available to the eligible individual, or downward, 
depending upon the amount of the mortgage loans outstanding on the date 
of full disbursement of the grant, or on the date of final settlement of 
the purchase, construction, or remodeling agreement, whichever date is 
the later date.
    (4) Where an eligible individual ceases to own the housing unit 
which was subject to a mortgage loan that resulted in his or her life 
being insured under VMLI, and becomes obligated under a mortgate loan on 
another housing unit occupied or to be occupied by the eligible 
individual, the amount of the unpaid principal outstanding on the 
mortgage loan on the newly acquired housing unit on the date insurance 
hereunder is placed in effect.
    (5) Where an eligible individual incurs or refinances a mortgage 
loan, subject to the provisions of paragraph (a) of this section, the 
amount of the incurred or refinanced mortgage loan.
    (6) If title to an undivided interest in a housing unit is or will 
be vested in a person other than the spouse of an eligible individual, 
the amount of VMLI or his or her life shall be computed to be such part 
of the total of the unpaid principal of the loan outstanding on the 
housing unit as is proportionate to the undivided interest of the 
individual in the entire property.
    (7) All claims, arising out of the deaths of insured individuals 
occurring prior to October 1, 1976, shall be subject to the $30,000 
lifetime maximum amount of insurance then in effect. All claims, arising 
out of the deaths of insured individuals occurring on or after October 
1, 1976, but prior to December 1, 1992, shall be subject to the $40,000 
lifetime maximum amount of insurance then in effect.
    (8) All claims, arising out of the deaths of insured individuals 
occurring prior to December 24, 1987, shall be subject to the provisions 
of paragraph (a) of this section then in effect which limited the amount 
of VMLI coverage to a lifetime maximum per eligible individual.
    (c) Any eligible individual who prior to October 1, 1976, was 
covered by $30,000 VMLI and who on that date became eligible to have his 
or her coverage increased may elect to retain the lesser amount of 
coverage he or she had in effect prior to that date.

(Authority: 38 U.S.C. 501, 2101, 2101A, 2106)

[52 FR 48682, Dec. 24, 1987, as amended at 59 FR 59921, Nov. 21, 1994; 
61 FR 29027, June 7, 1996; 82 FR 48631, Oct. 19, 2017]



Sec.  8a.3  Effective date.

    (a) Where the grant was approved prior to August 11, 1971, VMLI 
shall be effective August 11, 1971, if on that date, the eligible 
individual was obligated under a mortgage loan, and any such eligible 
individual is automatically insured, unless he or she elects in writing 
not to be insured, or fails to respond within 60 days after the date a 
final request is made or mailed to the eligible individual for 
information on which his or her premium can be based.
    (b) Where the grant is approved on or after August 11, 1971, VMLI 
shall be effective on the date of approval of the grant, if on that date 
the eligible individual is obligated under a mortgage loan, and any such 
eligible individual is automatically insured, unless he or she elects in 
writing not to be insured, or fails to respond within 60 days after the 
date a final request is made or mailed to the eligible individual for 
information on which his or her premium can be based.

[[Page 566]]

    (c) In any case in which an individual would have been eligible for 
VMLI on August 11, 1971, or on the date of approval of his or her grant, 
whichever date is the later date, but such insurance did not become 
effective because he or she was not obligated under a mortgage loan on 
that date, or because he or she elected in writing not to be insured, or 
failed to timely respond to a request for information on which his or 
her premium could be based, the insurance will be effective on a date 
agreed upon by the individual and the Secretary, but only if the 
individual files an application in writing with the Department of 
Veterans Affairs for such insurance, submits evidence that he or she 
meets the health requirements of the Secretary, together with 
information on which his or her premiums can be based, and is or becomes 
obligated under a mortgage loan upon the date agreed upon as the 
effective date of his or her insurance.
    (d) In any case in which an eligible individual disposes of the 
housing unit purchased, constructed or remodeled in part with a grant, 
or a subsequently acquired housing unit, and becomes obligated under a 
mortgage loan on another housing unit occupied or to be occupied by the 
eligible individual, the insurance will be effective upon a date 
requested by the individual and agreed to by the Secretary, but only if 
the eligible individual files an application for such insurance, submits 
evidence that he or she meets the health requirements of the Secretary, 
furnishes information on which his or her premium can be based, and is 
or becomes obligated under a mortgage loan on the date the insurance is 
to become effective.
    (e) In any case where an eligible individual insured under VMLI, 
refinances the mortgage loan which is the basis for such insurance on 
his or her life, any increase in the amount of insurance or any delay in 
the rate of reduction of insurance will be effective only if the 
eligible individual files an application for insurance, submits evidence 
that he or she meets the health requirements of the Secretary, and 
furnishes information on which his or her premium can be based.

(Authority: 38 U.S.C. 501, 2101, 2101A, 2106)

[42 FR 43835, Aug. 31, 1977, as amended at 61 FR 29027, June 7, 1996; 82 
FR 48631, Oct. 19, 2017]



Sec.  8a.4  Coverage.

    (a) The amount of VMLI in force on his or her life at any one time 
shall be reduced simultaneously (1) with the reduction in the principal 
of the mortgage loan, whether or not the mortgage loan is amortized, and 
(2) in addition, if the mortgage loan is amortized, according to the 
schedule for the reduction of the principal of the mortgage loan whether 
or not the schedule payments are timely made.
    (b) If the amount of the mortgage loan exceeds $200,000, or the 
reduced maximum amount of insurance selected by an eligible individual, 
whichever amount is the lesser, the amount of insurance in force on the 
life of the individual shall remain at a constant level until the 
principal amount of the mortgage loan which is basis for establishing 
the amount of insurance is reduced to $200,000, or to the amount of the 
reduced maximum amount of insurance selected by the individual, at which 
time the amount of insurance in force on his or her life shall be 
reduced in accordance with the schedule for the reduction of the 
principal of the mortgage loan, and whether or not the scheduled 
payments are timely made.
    (c) Subject to the $200,000 maximum amount of insurance, and to the 
reduced maximum amount of insurance selected by the eligible individual, 
he or she is entitled to be insured under VMLI or to apply for such 
insurance as often as he or she becomes obligated under a mortgage loan 
or a refinanced mortgage loan on a housing unit or a successor housing 
unit owned and occupied by the eligible individual. Where an individual 
who is not automatically insured under VMLI applies for such insurance, 
he or she shall be required to meet the health standards and other

[[Page 567]]

conditions established by the Secretary for such insureds.

(Authority: 38 U.S.C. 501, 2101, 2101A, 2106)

[37 FR 282, Jan. 8, 1972, as amended at 42 FR 43836, Aug. 31, 1977; 52 
FR 48682, Dec. 24, 1987; 59 FR 59921, Nov. 21, 1994; 61 FR 29027, June 
7, 1996; 82 FR 48631, Oct. 19, 2017]



PART 9_SERVICEMEMBERS' GROUP LIFE INSURANCE AND VETERANS' GROUP LIFE
INSURANCE--Table of Contents



Sec.
9.1 Definitions.
9.2 Effective date; applications.
9.3 Waiver or reduction of coverage.
9.4 Beneficiaries and options.
9.5 Payment of proceeds.
9.6 Assignments.
9.7 Administrative decisions.
9.8 Termination of coverage.
9.9 Conversion privilege.
9.10 Health standards.
9.11 Criteria for reinsurers and converters.
9.12 Reinsurance formula.
9.13 Actions on the policy.
9.14 Accelerated Benefits.
9.20 Traumatic injury protection.
9.21 VA's access to records maintained by the insurer, reinsurer(s), and 
          their successors.
9.22 Submission of certain applications and forms affecting entitlement 
          to Servicemembers' Group Life Insurance and Veterans' Group 
          Life Insurance.
9.24 Insurable dependents who become eligible members, and eligible 
          members who marry eligible members.

    Authority: 38 U.S.C. 501, 1965-1980A, unless otherwise noted.

    Source: 40 FR 4135, Jan. 28, 1975, unless otherwise noted.

    Editorial Note: Nomenclature changes to part 9 appear at 62 FR 
35970, July 3, 1997, and 62 FR 45733, Sept. 9, 1997.



Sec.  9.1  Definitions.

    The following definitions are in addition to those definitions in 38 
U.S.C. 101 and 1965:
    (a) The term policy means Group Policy No. G-32000, which was 
effective September 29, 1965, purchased from the insurer pursuant to 38 
U.S.C. 1966, executed and attested on December 30, 1965, and amended 
thereafter.
    (b) The term administrative office means the Office of 
Servicemembers' Group Life Insurance, located at 80 Livingston Avenue, 
Roseland, New Jersey 07068.
    (c) The term insurer means the commercial life insurance company or 
companies selected under 38 U.S.C. 1966 to provide insurance coverage 
specified in the policy.
    (d) The term reinsurer means any life insurance company meeting all 
the criteria set forth in Sec.  9.10 which reinsures a portion of the 
total amount of insurance covered by the policy and issues individual 
life insurance policies to members under the provisions of 38 U.S.C. 
1968(b) and 1977(e).
    (e) The term converter means any life insurance company meeting all 
the criteria set forth in Sec.  9.10 which issues individual life 
insurance policies to members under the provisions of 38 U.S.C. 1968(b) 
and 1977(e).
    (f) The term coverage means Servicemembers' Group Life Insurance or 
Veterans' Group Life Insurance payable while the member is insured under 
the policy.
    (g) The term termination of duty means (1) In the case of active 
duty or active duty for training being performed under a call or order 
that does not specify a period of less than 31 days-discharge, release 
or separation from such duty.
    (2) In the case of other duty--the member's release from his or her 
obligation to perform any duty in his or her uniformed service (active 
duty, or active duty for training or inactive duty training) whether 
arising from limitations included in a contract of enlistment or similar 
form of obligation or arising from resignation, retirement or other 
voluntary action by which the obligation to perform such duty ceases.
    (h) The term break in service means the situation(s) in which: (1) A 
member terminates duty or obligation to perform duty in one service and 
enters on duty or assumes the obligation to perform duty in another 
uniformed service, regardless of the length of time intervening.
    (2) A member reenters on duty or resumes an obligation to perform 
duty as a Reserve in the same uniformed service and 1 calendar day or 
more has elapsed following termination of the prior period of duty or 
obligation to perform duty.

[[Page 568]]

    (i) The term disability means any type of injury or disease whether 
mental or physical.
    (j) The term total disability means any impairment of mind or body 
which continuously renders it impossible for the insured to follow any 
substantially gainful occupation. Without prejudice to any other cause 
of disability, the permanent loss of the use of both feet, of both 
hands, or of both eyes, or of one foot and one hand, or of one foot and 
one eye, or of one hand and one eye, or the total loss of hearing of 
both ears, or the organic loss of speech shall be deemed to be total 
disability. Organic loss of speech will mean the loss of the ability to 
express oneself, both by voice and whisper, through the normal organs of 
speech if such loss is caused by organic changes in such organs. Where 
such loss exists, the fact that some speech can be produced through the 
use of an artificial appliance or other organs of the body will be 
disregarded.
    (k)(1) The term member's stillborn child means a member's biological 
child--
    (i) Whose death occurs before expulsion, extraction, or delivery; 
and
    (ii) Whose--
    (A) Fetal weight is 350 grams or more; or
    (B) Duration in utero is 20 completed weeks of gestation or more, 
calculated from the date the last normal menstrual period began to the 
date of expulsion, extraction, or delivery.
    (l) The term member of the family as used in Sec.  9.5(e)(2) means 
an individual with any of the following relationships to a person who is 
convicted of intentionally and wrongfully killing the decedent or 
determined in a civil proceeding to have intentionally and wrongfully 
killed the decedent:
    (1) Spouse;
    (2) Biological, adopted, or step child;
    (3) Biological, adoptive, or step parent;
    (4) Biological, adopted, or step sibling; or
    (5) Biological, adoptive, or step grandparent or grandchild.

(Authority: 38 U.S.C. 501(a), 1980A)

[40 FR 4135, Jan. 28, 1975, as amended at 53 FR 17698, May 18, 1988; 61 
FR 20135, May 6, 1996; 67 FR 52413, Aug. 12, 2002; 70 FR 75946, Dec. 22, 
2005; 73 FR 71930, Nov. 26, 2008; 74 FR 59479, Nov. 18, 2009; 74 FR 
62706, Dec. 1, 2009; 77 FR 60306, Oct. 3, 2012; 77 FR 70376, Nov. 26, 
2012; 85 FR 14802, Mar. 16, 2020]



Sec.  9.2  Effective date; applications.

    (a) The effective date of Servicemembers' Group Life Insurance will 
be in accordance with provisions set forth in 38 U.S.C. 1967.
    (b) The effective date of Veterans' Group Life Insurance will be as 
follows:
    (1) For members whose Servicemembers' Group Life Insurance coverage 
ceases under 38 U.S.C. 1968 (a)(1)(A) and 38 U.S.C. 1968(a)(4), the 
effective date shall be the 121st day after termination of duty. An 
application and the initial premium must be received by the 
administrative office within 120 days following termination of duty or 
separation or release from such assignment.
    (2) For members whose Servicemembers' Group Life Insurance coverage 
was extended because of total disability, the effective date shall be 
the day following the end of the 2-year period of extended coverage or 
the day following the end of the total disability, whichever is the 
earlier date, but in no event before the 121st day following termination 
of duty. An application and the initial Veterans' Group Life Insurance 
premium must be received by the administrative office within 1 year 
following termination of SGLI coverage.
    (3) For members who qualify for coverage under 38 U.S.C. 1967(b), 
the effective date shall be the 121st day after termination of duty. An 
application, the initial premium, and proof of disability must be 
received by the administrative office within 120 days following 
termination of duty.
    (4) For members of the Individual Ready Reserve or the Inactive 
National Guard, the effective date shall be the date an application and 
the initial premium are received by the administrative office. The 
application and initial

[[Page 569]]

premium must be received by the administrative office within 120 days of 
becoming a member of either organization.
    (5) Pursuant to 38 U.S.C. 1977(a)(3), former members under the age 
of 60 can elect to increase their Veterans' Group Life Insurance 
coverage by $25,000, up to the existing Servicemembers' Group Life 
Insurance maximum. The insured's first opportunity to elect to increase 
coverage is on the one-year Veterans' Group Life Insurance coverage 
anniversary date. Thereafter, the insured could elect to increase 
coverage on the five-year anniversary date of the first VGLI coverage 
increase election opportunity and subsequently every five years from the 
anniversary date of the insured's last VGLI coverage increase election 
opportunity. Increases of less than $25,000 are only available when 
existing Veterans' Group Life Insurance coverage is within less than 
$25,000 of the Servicemembers' Group Life Insurance maximum and any 
increases of less than $25,000 must be only in the amount needed to 
bring the insurance coverage up to the statutory maximum allowable 
amount of Servicemembers' Group Life Insurance. The eligible former 
members must apply for the increased coverage through the administrative 
office, within 120 days of invitation prior to the initial one-year 
anniversary date or within 120 days prior to each subsequent five-year 
coverage anniversary date from the first VGLI coverage increase election 
opportunity. The increased coverage will be effective from the 
anniversary date immediately following the election.


(Authority: 38 U.S.C. 1977)

    (c) If either an application or the initial premium has not been 
received by the administrative office within the time limits set forth 
above, Veterans' Group Life Insurance coverage may still be granted if 
an application, the initial premium, and evidence of insurability are 
received by the administrative office within 1 year and 120 days 
following termination of duty, except that evidence of insurability is 
not required during the initial 240 days following termination of duty.
    (d) The effective date for Servicemembers' Group Life Insurance or 
Veterans' Group Life Insurance in any case not otherwise covered under 
this section or under 38 U.S.C. 1967(a) shall be the date an application 
and the initial premium are received by the administrative office.
    (e) For purposes of this section, an application, an initial 
premium, and any evidence necessary to effect Servicemembers' Group Life 
Insurance or Veterans' Group Life Insurance coverage will be considered 
to have been received by the administrative office if:
    (1) They are properly addressed to the administrative office, and
    (2) The proper postage is affixed, and
    (3) They are legibly postmarked within the time limit required for 
receipt by the administrative office.
    (f)(1) If an application, initial premium, or evidence of 
insurability (as the case may be) has not been received by the 
administrative office within the time limits set forth in paragraph (c) 
of this section, Veterans' Group Life Insurance coverage may still be 
granted if an application, the initial premium, and evidence of 
insurability are received by the administrative office within 1 year and 
210 days following termination of duty, except that evidence of 
insurability is not required during the initial 330 days following 
termination of duty.
    (2) Paragraph (f)(1) of this section shall not apply to an 
application or initial premium received after December 11, 2021.
    (g) Except as provided in Sec.  9.24, the effective date of 
enrollment, re-enrollment, or an increase in coverage under 38 U.S.C. 
1967(a)(1) shall be the date the uniformed service receives an 
application and proof of the insurable spouse's good health:
    (1) For an insurable spouse who was eligible for coverage under 38 
U.S.C. 1967(a)(1)(A)(ii) or (C)(ii) but was not so insured or was 
insured at a reduced rate and who became a member; and
    (2) For a member-spouse covered under 38 U.S.C. 1967(a)(1)(A)(i) and 
who was also eligible for coverage under 38 U.S.C. 1967(a)(1)(A)(ii) or 
(C)(ii) but who was not so insured or was insured at a

[[Page 570]]

reduced amount by reason of an election made by a member.

(Authority: 38 U.S.C. 501, 1967, 1968, 1977)

[61 FR 20135, May 6, 1996, as amended at 62 FR 35970, July 3, 1997; 77 
FR 66071, Nov. 1, 2012; 79 FR 44299, July 31, 2014; 83 FR 65528, Dec. 
21, 2018; 85 FR 35563, June 11, 2020; 85 FR 78559, Nov. 27, 2020; 86 FR 
30543, June 9, 2021]



Sec.  9.3  Waiver or reduction of coverage.

    (a) Full-time coverage which is in effect will terminate or be 
reduced at midnight of the last day of the month a member's written 
notice requesting such termination or reduction is received by his or 
her uniformed service. In the case of a member paying premiums directly 
to the administrative office, full-time coverage will terminate or be 
reduced as of the last day of the month for which the last full premium 
was paid. Termination or reduction of coverage is effective for the 
entire remaining period of active duty unless the member reinstates his 
or her coverage under the provisions of 38 U.S.C. 1967(c). If, following 
termination of duty, a member reenters duty (in the same or another 
uniformed service), a waiver or reduction for the previous period of 
duty will not apply to the subsequent period of duty.
    (b) Part-time coverage will terminate or be reduced at the end of 
the last day of the period of duty then being performed if the member is 
on active duty or active duty for training when the waiver or reduction 
is filed; at the end of the period of inactive duty training then being 
performed if the member is on inactive duty training when the waiver or 
reduction is filed; or on the date the waiver or reduction is received 
by his or her uniformed service if the member is not on active duty, 
active duty for training; or inactive duty training on the date the 
waiver or reduction is filed.
    (1) When a member insured under part-time coverage waives his or her 
right to group coverage or elects a reduced amount of insurance, such 
waiver or election, unless changed, is effective throughout the period 
of the member's continuous reserve obligation in the same uniformed 
service. If, following termination of duty, the member reenters duty or 
resumes the obligation to perform duty (in the same or another uniformed 
service), the waiver or reduction will not apply to the subsequent 
period of duty or obligation.
    (2) If a reservist insured under part-time coverage is called or 
ordered to active duty or active duty for training under a call or order 
that does not specify a period of less than 31 days and is separated or 
released from such duty and then resumes his or her reserve obligation, 
any waiver or election of reduced coverage made while eligible for part-
time coverage, unless changed, shall be effective throughout the entire 
period of part-time coverage, the active duty or active duty for 
training period and 120 days thereafter and the period of immediately 
resumed reserve obligation.
    (3) If a member, other than a member referred to in paragraph (b)(2) 
of this section, upon termination of duty qualifying him or her for 
full-time coverage assumes an obligation to perform duty as a reservist, 
any waiver or election previously made by the member shall not apply to 
coverage arising from his or her reservist obligation. Furthermore, 
during the 120 days following termination of such duty the full-time 
coverage shall not be reduced by any waiver or election made by a member 
as a reservist.

[40 FR 4135, Jan. 28, 1975, as amended at 48 FR 8070, Feb. 25, 1983; 53 
FR 17698, May 18, 1988. Redesignated and amended at 61 FR 20135, May 6, 
1996]



Sec.  9.4  Beneficiaries and options.

    Any designation of beneficiary or election of settlement options is 
subject to the provisions of 38 U.S.C. 1970 and 1977 and the following 
provisions:
    (a) Any designation of beneficiary or settlement option election 
made by any member insured under Servicemembers' Group Life Insurance 
for full-time coverage or part-time coverage will remain in effect until 
properly changed by the member or canceled automatically for any of the 
following reasons:
    (1) The insurance terminates following separation or release from 
all duty in a uniformed service.
    (2) The member enters on duty in another uniformed service.
    (3) The member reenters on duty in the same uniformed service more 
than

[[Page 571]]

1 calendar day after separation or release from all duty in that 
uniformed service.
    (b) A change of beneficiary may be made at any time and without the 
knowledge or consent of the previous beneficiary.
    (c) Until and unless otherwise changed, a beneficiary designation 
and settlement option election of record on the date a statutory 
increase in coverage takes effect shall be considered to be a 
beneficiary and optional settlement election for the increased amount as 
well, and any beneficiary named therein shall be entitled to the same 
percentage (%) share of the new total coverage amount as that 
beneficiary was entitled to prior to the statutory increase in coverage.

(Authority: 38 U.S.C. 501)

[40 FR 4135, Jan. 28, 1975, as amended at 53 FR 17699, May 18, 1988. 
Redesignated and amended at 61 FR 20135, 20136, May 6, 1996]



Sec.  9.5  Payment of proceeds.

    Proceeds shall be paid in accordance with provisions set forth in 38 
U.S.C. 1970 and the following provisions:
    (a) If proceeds are to be paid in installments, the first 
installment will be payable as of the date of death. The amount of each 
installment will be computed so as to include interest on the unpaid 
balance at the then effective rate.
    (b) If, following the death of an insured member who has designated 
both principal and contingent beneficiaries and elected to have payment 
made in 36 equal monthly installments, the principal beneficiary dies 
before all 36 installments have been paid, the remaining installments 
will be paid as they fall due to the contingent beneficiary. At the 
death of such a contingent beneficiary, and in other instances of a 
beneficiary's death, where there is no contingent beneficiary, the value 
of any unpaid installments, discounted to the date of his or her death 
at the same rate used for inclusion of interest in the computation of 
installments will be paid, without further accrual of interest, in one 
sum to the estate of the beneficiary or continent beneficiary last 
receiving payment.
    (c) In instances where payment in installments is made at the 
election of the beneficiary, upon his or her request, the value of such 
installments as remain unpaid will be discounted to the date of payment 
at the same rate used for inclusion of interest in the computation of 
installments and paid to him or her in one sum.
    (d) If a member whose coverage is extended due to total disability 
converts the group insurance to an individual policy which is effective 
before he or she ceases to be totally disabled or before the end of 2 
years following termination of duty, whichever is earlier, and dies 
while group insurance would be in effect, except for such conversion, 
the group insurance will be payable, provided the individual policy is 
surrendered for a return of premiums and without further claim. When 
there is no such surrender, any amount of group insurance in excess of 
the amount of the individual policy will be payable.
    (e)(1) The proceeds payable because of the death of an individual 
insured under Servicemembers' Group Life Insurance or Veterans' Group 
Life Insurance (``decedent'') shall not be payable to any person 
described in paragraph (e)(2) of this section. A Servicemembers' Group 
Life Insurance Traumatic Injury Protection benefit payable under Sec.  
9.20(j)(3) shall not be payable to any person described in paragraph 
(e)(2) of this section.
    (2) The persons described in this paragraph are:
    (i) A person who is convicted of intentionally and wrongfully 
killing the decedent or determined in a civil proceeding to have 
intentionally and wrongfully killed the decedent;
    (ii) A person who is convicted of assisting or aiding, or determined 
in a civil proceeding to have assisted or aided, a person described in 
paragraph (e)(2)(i) of this section; and
    (iii) A member of the family of a person described in paragraph 
(e)(2)(i) or (e)(2)(ii) of this section who is not related to the 
decedent by blood, legal adoption, or marriage.
    (3) The Servicemembers' Group Life Insurance or Veterans' Group Life 
Insurance proceeds or Servicemembers' Group Life Insurance Traumatic 
Injury Protection benefit not payable under paragraph (e)(1) of this 
section to any

[[Page 572]]

person described in paragraph (e)(2) of this section is not payable to 
such persons even though the criminal conviction or civil determination 
is pending appeal.
    (4)(i) Servicemembers' Group Life Insurance or Veterans' Group Life 
Insurance proceeds or a Servicemembers' Group Life Insurance Traumatic 
Injury Protection benefit not payable under paragraphs (e)(1) and (e)(2) 
of this section shall be payable to the first person or persons listed 
in paragraphs (e)(4)(i)(A) through (F) of this section who are surviving 
on the date of the decedent's death in the following order of 
precedence:
    (A) To the next eligible beneficiary designated by the decedent in a 
writing received by the appropriate office of the applicable uniformed 
service before the decedent's death in the uniformed services in the 
case of Servicemembers' Group Life Insurance proceeds or a 
Servicemembers' Group Life Insurance Traumatic Injury Protection 
benefit, or in a writing received by the administrative office defined 
in Sec.  9.1(b) of this part before the decedent's death in the case of 
Veterans' Group Life Insurance proceeds;
    (B) To the decedent's widow or widower;
    (C) To the decedent's child or children, in equal shares, and 
descendants of deceased children by representation;
    (D) To the decedent's parents, in equal shares, or to the survivor 
of them;
    (E) To the duly appointed executor or administrator of the 
decedent's estate;
    (F) To other next of kin of the decedent as determined by the 
insurer (defined in Sec.  9.1(c) of this part) under the laws of the 
domicile of the decedent at the time of the decedent's death.
    (ii) Payment of Servicemembers' Group Life Insurance or Veterans' 
Group Life Insurance proceeds or a Servicemembers' Group Life Insurance 
Traumatic Injury Protection benefit to any person under paragraph 
(e)(4)(i) of this section shall bar recovery of those proceeds or that 
benefit by any other person.
    (f) If a stillborn child is otherwise eligible to be insured by the 
Servicemembers' Group Life Insurance coverage of more than one member, 
the child shall be insured by the coverage of the child's insured 
biological mother.

(Authority: 38 U.S.C. 501(a), 1965(10), 1967(a)(4)(B))

[40 FR 4135, Jan. 28, 1975, as amended at 50 FR 12252, Mar. 28, 1985. 
Redesignated and amended at 61 FR 20135, 20136, May 6, 1996; 77 FR 
60306, Oct. 3, 2012; 77 FR 70376, Nov. 26, 2012; 79 FR 44299, July 31, 
2014]



Sec.  9.6  Assignments.

    Servicemembers' Group Life Insurance, Veterans' Group Life Insurance 
and benefits thereunder are not assignable.

[40 FR 4135, Jan. 28, 1975. Redesignated at 61 FR 20135, May 6, 1996]



Sec.  9.7  Administrative decisions.

    (a) Determinations of the Department of Veterans Affairs are 
conclusive under the policy with respect to the following:
    (1) The status of any person being within the term member and 
whether or not he or she is covered at any point of time under the 
policy including traveltime under 38 U.S.C. 1967(b) and death within 120 
days thereafter from a disability incurred or aggravated while on duty.
    (2) The fact and date of a member's termination of active duty, or 
active duty for training, and the fact, date and hours of a member's 
performance of inactive duty training.
    (3) The fact and dates with respect to a member's absence without 
leave, confinement by civilian authorities under a sentence adjudged by 
a civil court, or confinement by military authorities under a court-
martial sentence involving total forfeiture of pay and allowances.
    (4) The operation of the forfeiture provision provided in 38 U.S.C. 
1973 with respect to any member.
    (5) The existence of total disability or insurability at standard 
premium rates under 38 U.S.C. 1968.
    (b) When determination is required on a claim that a member who 
waived coverage, or whose coverage was forfeited for one of the offenses 
listed under 38 U.S.C. 1973 was in fact insured,

[[Page 573]]

or that a member who elected to be insured was insured for an amount 
greater than the amount shown in the record, and there is no record of 
an application to be insured or to increase the amount of insurance as 
required under 38 U.S.C. 1967(c):
    (1) The person making the claim will be required to submit all 
evidence available concerning the member's actions and intentions with 
respect to Servicemembers' Group Life Insurance or Veterans' Group Life 
Insurance.
    (2) Request will be made to the member's uniformed service and any 
other likely source of information considered necessary, for whatever 
evidence in the form of copies of payroll or personnel records, 
statements of persons having knowledge of the facts, etc., is essential 
to a decision in the matter.

Based on the evidence obtained, a formal determination will be made as 
to whether the member involved is deemed to have applied to be insured, 
or to be insured for an amount other than the amount shown in the 
record. The determination will include a finding as to the member's 
health status for insurance purposes based on the evidence available.


(Authority: 38 U.S.C. 1967)

    (c) In making the determination required under paragraph (b) of this 
section, the following will be considered:
    (1) The possibility that due to widespread geographic distribution, 
inadequate means of communication and the nature of the group insurance 
program, members may not be adequately and accurately informed, 
especially in time of war or military emergency, about the detailed 
requirements for obtaining insurance protection.
    (2) Payroll deductions made without objection by a member, following 
waiver or termination of coverage, representing premiums for insurance 
or additional insurance, may, by virtue of continuity or the 
circumstances surrounding their initiation, be indicative that the 
member did apply. Such deductions without a formal application of record 
may be considered as evidence that the member's application was not in 
proper form or misplaced. They may also be considered as evidence that 
an application was not made solely because of erroneous or incomplete 
counseling or absence of counseling on the part of the responsible 
personnel of the uniformed service.
    (d) Questions for determination under this section as well as those 
involving coverage of groups and classes of members and other questions 
are properly referable to the Assistant Director for Insurance. 
Authority to make any determinations required under this section is 
delegated to the Under Secretary for Benefits and Assistant Director for 
Insurance.

[40 FR 4135, Jan. 28, 1975, as amended at 53 FR 17699, May 18, 1988. 
Redesignated and amended at 61 FR 20135, 20136, May 6, 1996]



Sec.  9.8  Termination of coverage.

    Termination of coverage will be in accordance with the provisions of 
38 U.S.C. 1968 and Sec.  9.3 of this part and the following provisions:
    (a) In the case of a member whose coverage is forfeited under 38 
U.S.C. 1973, coverage terminates at the end of the day preceding the day 
on which the act or omission forming the basis for such forfeiture 
occurred.
    (b) In the event of discontinuance of the group policy, coverage 
terminates at the end of the day preceding the date of the 
discontinuance of the policy except for those members who are insured 
under Veterans' Group Life Insurance in which event coverage terminates 
at the expiration of the day preceding the anniversary of the effective 
date of such insurance which first occurs, 90 days or more after the 
discontinuance of the group policy.

[40 FR 4135, Jan. 28, 1975, as amended at 48 FR 8071, Feb. 25, 1983; 53 
FR 17699, May 18, 1988; 57 FR 11910, Apr. 8, 1992. Redesignated and 
amended at 61 FR 20135, 20136, May 6, 1996; 62 FR 35970, July 3, 1997]



Sec.  9.9  Conversion privilege.

    (a) With respect to a member on active duty or active duty for 
training under a call or order to duty that specifies a period of less 
than 31 days, and a member insured during inactive duty training 
scheduled in advance by competent authority there shall be no right of 
conversion unless the insurance is continued in force under 38

[[Page 574]]

U.S.C. 1967(b) or 1968(a) for 120 days following a period of such duty, 
as the result of a disability incurred or aggravated during such a 
period of duty.
    (b) The individual policy of life insurance to which an insured may 
convert under 38 U.S.C. 1968(b) or 1977(e) shall not have disability or 
other supplementary benefits and shall not be term insurance or any 
policy which does not provide for cash values. Term riders providing 
level or decreasing insurance for which an additional premium is charged 
may be attached to an eligible basic conversion policy, but the rider 
will be excluded from the conversion pool agreement under the policy.
    (c) The insurer will establish a conversion pool in cooperation with 
the reinsurers and converters in accordance with the terms of the 
policy. Its purpose will be to provide for the determination and 
maintenance of appropriate charges arising from excess mortality under 
individual conversion policies issued in accordance with this section 
and provide for the appropriate distribution of the risk of loss due to 
such excess mortality among the reinsurers and converters.

[40 FR 4135, Jan. 28, 1975, as amended at 53 FR 17699, May 18, 1988. 
Redesignated and amended at 61 FR 20135, 20136, May 6, 1996]



Sec.  9.10  Health standards.

    (a) For the purpose of determining if a member who incurred a 
disability or aggravated a preexisting disability during a period of 
active duty or active duty for training under a call to duty specifying 
a period of less than 31 days or during a period of inactive duty was 
rendered uninsurable at standard premium rates, the underwriting 
criteria used by the insurer in determining good health for persons 
applying to it for life insurance in amounts not exceeding the maximum 
amount of coverage then available under 38 U.S.C. 1967 will be used.


(Authority: 38 U.S.C. 1967)

    (b) For all other purposes of determining if a member meets the 
necessary health requirements except paragraph (a) of this section, the 
underwriting criteria used by the insurer in determining good health for 
group life insurance purposes will be used.

[40 FR 4135, Jan. 28, 1975, as amended at 53 FR 17699, May 18, 1988. 
Redesignated at 61 FR 20135, May 6, 1996]



Sec.  9.11  Criteria for reinsurers and converters.

    The following criteria will control eligibility for reinsuring and 
converting companies:
    (a) The company must be a legal reserve life insurance company as 
classified by the insurance supervisory authorities of the State of 
domicile. Qualified fraternal organizations are included.
    (b) The company must have been in the life insurance business for a 
continuous period of 5 years prior to October 1, 1965, or the December 
31 preceding any redeterminations of the allocations. In the event of a 
merger, the 5-year requirement may be satisfied by either the surviving 
company or by one of the absorbed companies. Upon joint application by a 
subsidiary of a participating company, together with the parent company, 
the 5-year requirement may be waived provided such parent company owns 
more than 50 percent of the outstanding stock of the subsidiary and has 
been a legal reserve life insurance company for a period of 10 years or 
more.
    (c) The company must be licensed to engage in life insurance in at 
least one State of the United States or the District of Columbia.
    (d) The company will not be one: (1) Certified by the Department of 
Defense as being under suspension for cause for purpose of allotment or 
on-base solicitation privileges.
    (2) That solicits life insurance applications as conversion or other 
replacement of Servicemembers' Group Life Insurance or Veterans' Group 
Life Insurance coverage in jurisdictions in which it is not licensed.
    (3) That fails to take effective action to correct an improper 
practice followed by it or its agents within 30 days after written 
receipt of notice issued by the insurer or the Assistant Director for 
Insurance. Improper practice includes:
    (i) The use for solicitation purposes of lists of names and 
addresses of

[[Page 575]]

former members without obtaining reasonable assurance that such lists 
have not been obtained contrary to regulations of the Department of 
Defense or other uniformed service;
    (ii) Failure to reveal sources and copies of mailing lists upon 
proper request or to otherwise cooperate in an authorized investigation 
of a reported improper practice;
    (iii) The use of written or oral representations which may mislead 
the person addressed as to the true role of the company or its 
representatives as one of the participating companies;
    (iv) The use of written or oral representations which may mislead 
the person addressed as to rights, privileges, coverage, premiums, or 
similar matters under Servicemembers' Group Life Insurance, Veterans' 
Group Life Insurance, or any policy issued or proposed to be issued as a 
conversion or other replacement coverage;
    (v) Violation of regulations of a uniformed service concerning 
solicitation of life insurance; and
    (vi) The use of written or oral references to Servicemembers' Group 
Life Insurance, Veterans' Group Life Insurance or conversions of 
Servicemembers' Group Life Insurance or Veterans' Group Life Insurance 
in connection with the attempted sale of an insurance policy which would 
not be, in fact, a conversion policy or a policy issued in lieu of a 
conversion, if those references might lead a person addressed to believe 
there is a connection between the policy being sold and coverage under 
Servicemembers' Group Life Insurance, Veterans' Group Life Insurance or 
a conversion of it.
    (e) Each reinsuring and converting company must agree to issue 
conversion policies to any qualified applicant regardless of race, 
color, religion, sex, or national origin, under terms and conditions 
established by the primary insurer.

[40 FR 4135, Jan. 28, 1975. Redesignated at 61 FR 20135, May 6, 1996]



Sec.  9.12  Reinsurance formula.

    The allocation of insurance to the insurer and each reinsurer will 
be based upon the following:
    (a) An amount of the total life insurance in force under the policy 
in proportion to the company's total life insurance in force in the 
United States where:

    The first $100 million in force is counted in full,
    The second $100 million in force is counted at 75 percent,
    The third $100 million in force is counted at 50 percent,
    The fourth $100 million in force is counted at 25 percent,
    And any amount above $400 million in force is counted at 5 percent.

    (b) The allocation will be redetermined at the beginning of each 
policy year for the primary insurer and the companies then reinsuring, 
with the portion as set forth in paragraph (a) of this section based 
upon the corresponding in force (excluding the Servicemembers' Group 
Life Insurance in force) as of the preceding December 31.
    (c) Any life insurance company, which is not initially participating 
in reinsurance or conversions, but satisfies the criteria set forth in 
Sec.  9.11, may subsequently apply to the primary insurer to reinsure 
and convert, or to convert only. The participation of such company will 
be effective as of the beginning of the policy year following the date 
on which application is approved by the insurer.

[40 FR 4135, Jan. 28, 1975. Redesignated and amended at 61 FR 20135, 
20136, May 6, 1996]



Sec.  9.13  Actions on the policy.

    The Assistant Director for Insurance will furnish the name and 
address of the insuring company upon written request of a member of the 
uniformed services or his or her beneficiary. Actions at law or in 
equity to recover on the policy, in which there is not alleged any 
breach of any obligation undertaken by the United States, should be 
brought against the insurer.

[40 FR 4135, Jan. 28, 1975. Redesignated and amended at 61 FR 20135, 
20136, May 6, 1996]



Sec.  9.14  Accelerated Benefits.

    (a) What is an Accelerated Benefit? An Accelerated Benefit is a 
payment of a portion of your Servicemembers' Group Life Insurance or 
Veterans' Group Life Insurance to you before you die.
    (b) Who is eligible to receive an Accelerated Benefit? You are 
eligible to receive

[[Page 576]]

an Accelerated Benefit if you have a valid written medical prognosis 
from a physician of 9 months or less to live, and otherwise comply with 
the provisions of this section.
    (c) Who can apply for an Accelerated Benefit? Only you, the insured 
member, can apply for an Accelerated Benefit. No one can apply on your 
behalf.
    (d) How much can you request as an Accelerated Benefit? (1) You can 
request as an Accelerated Benefit an amount up to a maximum of 50% of 
the face value of your insurance coverage.
    (2) Your request for an Accelerated Benefit must be $5,000 or a 
multiple of $5000 (for example, $10,000, $15,000).
    (e) How much can you receive as an Accelerated Benefit? You can 
receive as an Accelerated Benefit the amount you request up to a maximum 
of 50% of the face value of your insurance coverage.
    (f) How do you apply for an Accelerated Benefit? (1) You can obtain 
an application form by writing the Office of Servicemembers' Group Life 
Insurance, 80 Livingston Avenue, Roseland, New Jersey 07068-1733; 
calling the Office of Servicemembers' Group Life Insurance toll-free at 
1-800-419-1473; or downloading the form from the Internet at 
www.insurance.va.gov. You must submit the completed application form to 
the Office of Servicemembers' Group Life Insurance, 80 Livingston 
Avenue, Roseland, New Jersey 07068-1733.
    (2) As stated on the application form, you will be required to 
complete part of the application form and your physician will be 
required to complete part of the application form. If you are an active 
duty servicemember, your branch of service will also be required to 
complete part of the form.

________________________________________________________________________

                       To Be Completed by Insured

                     Claim for Accelerated Benefits

Your name:______________________________________________________________
Social Security Number:_________________________________________________
Your home address:______________________________________________________
Date of birth:__________________________________________________________
Branch of Service (if covered under SGLI):______________________________
Your mailing address (if different from above):_________________________
Amount of SGLI coverage: $______________________________________________
Amount of claim (can be no more than one-half of coverage in increments 
of $5,000):_____________________________________________________________
Type of coverage (check one):
    SGLI (circle one of the following): Active Duty Ready Reserve Army 
or Air National Guard Separated or Discharged
    VGLI

    Note: If you checked SGLI, you must also have your military unit 
complete the attached form.

    I acknowledge that I have read all of the attached information about 
the accelerated benefit. I understand that I can get this benefit only 
once during my lifetime and that I can use it for any purpose I choose. 
I further understand that the face amount of my coverage will reduce by 
the amount of accelerated benefit I choose to receive now.

Your signature:_________________________________________________________
Date:___________________________________________________________________

                Authorization To Release Medical Records

    To all physicians, hospitals, medical service providers, 
pharmacists, employers, other insurance companies, and all other 
agencies and organizations:
    You are authorized to release a copy of all my medical records, 
including examinations, treatments, history, and prescriptions, to the 
Office of Servicemembers' Group Life Insurance (OSGLI) or its 
representatives.

Printed name:___________________________________________________________
Signature:______________________________________________________________
Date:___________________________________________________________________
    A photocopy of this authorization will be considered as effective 
and valid as the original.
    Valid for one year from date signed.

________________________________________________________________________

                      To Be Completed by Physician

                   Attending Physician's Certification

Patient's name:_________________________________________________________
Patient's Social Security Number:_______________________________________
Diagnosis:______________________________________________________________
ICD-9-CM Disease Code *:________________________________________________
Description of present medical condition (please attach results of x-
rays, E.K.G. or other tests):___________________________________________

    Is the patient capable of handling his/her own affairs? ____ Yes__ 
No__
    The patient applied for an accelerated benefit under his/her 
government life insurance coverage. To qualify, the patient must have a 
life expectancy of nine (9) months or less.
    Does your patient meet this requirement? ____ Yes__ No__

Attending Physician's name (please print):______________________________
State in which you are licensed to practice:____________________________
Specialty:______________________________________________________________
Mailing address:________________________________________________________
Telephone number:_______________________________________________________
Fax Number:_____________________________________________________________
Signature:______________________________________________________________
Date:___________________________________________________________________


[[Page 577]]

________________________________________________________________________
    *ICD-9-CM is an acronym for International Classification of 
Diseases, 9th revision, Clinical Modification.

________________________________________________________________________

       To Be Completed by Personnel Office of Servicemember's Unit

(Complete this form only if the applicant for Accelerated Benefits is 
covered under SGLI.)

                       Branch of Service Statement

Servicemember's name:___________________________________________________
Social Security Number:_________________________________________________
Branch of Service:______________________________________________________
Amount of SGLI coverage: $______________________________________________
Monthly premium amount: $_______________________________________________
Name of person completing this form:____________________________________
Telephone Number:_______________________________________________________
Fax Number:_____________________________________________________________
Title of person completing this form:___________________________________
Duty Station and address:_______________________________________________
Signature of person completing this form:_______________________________
Date:___________________________________________________________________

    Notice: It is fraudulent to complete these forms with information 
you know to be false or to omit important facts. Criminal and/or civil 
penalties can result from such acts.

    (g) Who decides whether or not an Accelerated Benefit will be paid 
to you? The Office of Servicemembers' Group Life Insurance will review 
your application and determine whether you meet the requirements of this 
section for receiving an Accelerated Benefit.
    (1) They will approve your application if the requirements of this 
section are met.
    (2) If the Office of Servicemembers' Group Life Insurance determines 
that your application form does not fully and legibly provide the 
information requested by the application form, they will contact you and 
request that you or your physician submit the missing information to 
them. They will not take action on your application until the 
information is provided.
    (h) How will an Accelerated Benefit be paid to you? An Accelerated 
Benefit will be paid to you in a lump sum.
    (i) What happens if you change your mind about an application you 
filed for Accelerated Benefits? (1) An election to receive the 
Accelerated Benefit is made at the time you have cashed or deposited the 
Accelerated Benefit. After that time, you cannot cancel your request for 
an Accelerated Benefit. Until that time, you may cancel your request for 
benefits by informing the Office of Servicemembers' Group Life Insurance 
in writing that you are canceling your request and by returning the 
check if you have received one. If you want to change the amount of 
benefits you requested or decide to reapply after canceling a request, 
you may file another application in which you request either the same or 
a different amount of benefits.
    (2) If you die before cashing or depositing an Accelerated Benefit 
payment, the payment must be returned to the Office of Servicemembers' 
Group Life Insurance. Their mailing address is 290 W. Mt. Pleasant 
Avenue, Livingston, New Jersey 07039.
    (j) If you have cashed or deposited an Accelerated Benefit, are you 
eligible for additional Accelerated Benefits? No.

(Approved by the Office of Management and Budget under control number 
2900-0618)

(Authority: 38 U.S.C. 1965, 1966, 1967, 1980)

[67 FR 52413, Aug. 12, 2002; 79 FR 44299, July 31, 2014]



Sec.  9.20  Traumatic injury protection.

    (a) What is traumatic injury protection? Traumatic injury protection 
provides for the payment of a specified benefit amount to a member 
insured by Servicemembers' Group Life Insurance who sustains a traumatic 
injury directly resulting in a scheduled loss.
    (b) What is a traumatic event? (1) A traumatic event is the 
application of external force, violence, chemical, biological, or 
radiological weapons, or accidental ingestion of a contaminated 
substance causing damage to a living being occurring on or after October 
7, 2001.
    (2) A traumatic event does not include a medical or surgical 
procedure in and of itself.
    (c) What is a traumatic injury? (1) A traumatic injury is physical 
damage to a living body that is caused by a traumatic event as defined 
in paragraph (b) of this section.
    (2) For purposes of this section, the term ``traumatic injury'' does 
not include damage to a living body caused by--
    (i) A mental disorder; or
    (ii) A mental or physical illness or disease, except if the physical 
illness or

[[Page 578]]

disease is caused by a pyogenic infection, biological, chemical, or 
radiological weapons, or accidental ingestion of a contaminated 
substance.
    (3) For purposes of this section, all traumatic injuries will be 
considered to have occurred at the same time as the traumatic event.
    (d) What are the eligibility requirements for payment of traumatic 
injury protection benefits? You must meet all of the following 
requirements in order to be eligible for traumatic injury protection 
benefits.
    (1) You must be a member of the uniformed services who is insured by 
Servicemembers' Group Life Insurance under section 1967(a)(1)(A)(i), (B) 
or (C)(i) of title 38, United States Code, on the date you sustained a 
traumatic injury, except if you are a member who experienced a traumatic 
injury on or after October 7, 2001, through and including November 30, 
2005. (For this purpose, you will be considered a member of the 
uniformed services until midnight on the date of termination of your 
duty status in the uniformed services that established your eligibility 
for Servicemembers' Group Life Insurance, notwithstanding an extension 
of your Servicemembers' Group Life Insurance coverage under section 
1968(a) of title 38, United States Code.)
    (2) You must suffer a scheduled loss that is a direct result of a 
traumatic injury and no other cause.
    (3) You must survive for a period not less than seven full days from 
the date of the traumatic injury. The seven day period begins on the 
date and Zulu (Greenwich Meridean) time of the traumatic injury and ends 
168 full hours later.
    (4) You must suffer a scheduled loss under paragraph (e)(7) of this 
section within two years of the traumatic injury.
    (5) You must suffer a traumatic injury before midnight on the date 
of termination of your duty status in the uniformed services that 
established eligibility for Servicemembers' Group Life Insurance. For 
purposes of this section, the scheduled loss may occur after the date of 
termination of your duty status in the uniformed services that 
established eligibility for Servicemembers' Group Life Insurance.
    (e) What is a scheduled loss and what amount will be paid because of 
that loss? (1) The term ``scheduled loss'' means a condition listed in 
the schedule in paragraph (e)(7) of this section if directly caused by a 
traumatic injury. A scheduled loss is payable at the amount specified in 
the schedule.
    (2) The maximum amount payable under the schedule for all losses 
resulting from traumatic events occurring within a seven-day period is 
$100,000. We will calculate the seven-day period beginning with the day 
on which the first traumatic event occurs.
    (3) A benefit will not be paid if a scheduled loss is due to a 
traumatic injury--
    (i) Caused by--
    (A) The member's attempted suicide, while sane or insane;
    (B) An intentionally self-inflicted injury or an attempt to inflict 
such injury;
    (C) Diagnostic procedures, preventive medical procedures such as 
inoculations, medical or surgical treatment for an illness or disease, 
or any complications arising from such procedures or treatment;
    (D) Willful use of an illegal substance or a controlled substance 
unless administered or consumed on the advice of a medical professional; 
or
    (ii) Sustained while a member was committing or attempting to commit 
a felony.
    (4) A benefit will not be paid for a scheduled loss resulting from--
    (i) A physical or mental illness or disease, whether or not caused 
by a traumatic injury, other than a pyogenic infection or physical 
illness or disease caused by biological, chemical, or radiological 
weapons or accidental ingestion of a contaminated substance; or
    (ii) A mental disorder whether or not caused by a traumatic injury.
    (5) Amount Payable under the Schedule of Losses. (i) The maximum 
amount payable for all scheduled losses resulting from a single 
traumatic event is limited to $100,000. For example, if a traumatic 
event on April 1, 2006, results in the immediate total and permanent 
loss of sight in both eyes, and the loss of one foot on May 1, 2006, as

[[Page 579]]

a direct result of the same traumatic event, the member will be paid 
$100,000.
    (ii) If a member suffers more than one scheduled loss from separate 
traumatic events occurring more than seven full days apart, the 
scheduled losses will be considered separately and a benefit will be 
paid for each loss up to the maximum amount according to the schedule. 
For example, if a member suffers the loss of one foot at or above the 
ankle on May 1, 2006, from one event, the member will be paid $50,000. 
If the same member suffers loss of sight in both eyes from an event that 
occurred on November 1, 2006, the member will be paid an additional 
$100,000.
    (6) Definitions. For purposes of this paragraph (e)(6)--
    (i) The term quadriplegia means the complete and irreversible 
paralysis of all four limbs.
    (ii) The term paraplegia means the complete and irreversible 
paralysis of both lower limbs.
    (iii) The term hemiplegia means the complete and irreversible 
paralysis of the upper and lower limbs on one side of the body.
    (iv) The term uniplegia means the complete and irreversible 
paralysis of one limb of the body.
    (v) The term complete and irreversible paralysis means total loss of 
voluntary movement resulting from damage to the spinal cord or 
associated nerves, or to the brain, that is deemed clinically stable and 
unlikely to improve.
    (vi) The term inability to carry out activities of daily living 
means the inability to independently perform at least two of the six 
following functions:
    (A) Bathing.
    (B) Continence.
    (C) Dressing.
    (D) Eating.
    (E) Toileting.
    (F) Transferring in or out of a bed or chair with or without 
equipment.
    (vii) The term pyogenic infection means a pus-producing infection.
    (viii) The term contaminated substance means food or water made 
unfit for consumption by humans because of the presence of chemicals, 
radioactive elements, bacteria, or organisms.
    (ix) The term chemical weapon means chemical substances intended to 
kill, seriously injure, or incapacitate humans through their 
physiological effects.
    (x) The term biological weapon means biological agents or 
microorganisms intended to kill, seriously injure, or incapacitate 
humans through their physiological effects.
    (xi) The term radiological weapon means radioactive materials or 
radiation-producing devices intended to kill, seriously injure, or 
incapacitate humans through their physiological effects.
    (xii) The term medical professional means a licensed practitioner of 
the healing arts acting within the scope of his or her practice. Some 
examples include a licensed physician, optometrist, nurse practitioner, 
registered nurse, physician assistant, or audiologist.
    (xiii) The term hospitalization means an inpatient stay in a 
facility that is:
    (A)(1) Accredited by the Joint Commission or its predecessor, the 
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 
or accredited or approved by a program of the qualified governmental 
unit in which such institution is located if the Secretary of Health and 
Human Services has found that the accreditation or comparable approval 
standards of such qualified governmental unit are essentially equivalent 
to those of the Joint Commission or JCAHO;
    (2) Used primarily to provide, by or under the supervision of 
physicians, to inpatients diagnostic services and therapeutic services 
for medical diagnosis, treatment, and care of injured, disabled, or sick 
persons;
    (3) Requires every patient to be under the care and supervision of a 
physician; and
    (4) Provides 24-hour nursing services rendered or supervised by a 
registered professional nurse and has a licensed practical nurse or 
registered nurse on duty at all times; or
    (B) Any Armed Forces medical facility that is authorized to provide 
inpatient and/or ambulatory care to eligible service members.
    (xiv) The term total and permanent loss of sight means:

[[Page 580]]

    (A) Visual acuity in the eye of 20/200 or less (worse) with 
corrective lenses lasting at least 120 days;
    (B) Visual acuity in the eye of greater (better) than 20/200 with 
corrective lenses and a visual field of 20 degrees or less lasting at 
least 120 days; or
    (C) Anatomical loss of the eye.
    (xv) The term total and permanent loss of speech means organic loss 
of speech or the ability to express oneself, both by voice and whisper, 
through normal organs for speech, notwithstanding the use of an 
artificial appliance to simulate speech. Loss of speech must be 
clinically stable and unlikely to improve.
    (xvi) The term total and permanent loss of hearing means average 
hearing threshold sensitivity for air conduction of at least 80 
decibels, based on hearing acuity measured at 500, 1,000, and 2,000 
Hertz, that is clinically stable and unlikely to improve.
    (xvii) The term burns means 2nd degree (partial thickness) or worse 
burns covering at least 20 percent of the body, including the face and 
head, or 20 percent of the face alone. Percentage of the body burned may 
be measured using the Rule of Nines or any means generally accepted 
within the medical profession.
    (xviii) The term coma means a state of profound unconsciousness that 
is measured at a Glasgow Coma Score of 8 or less.
    (xix) The term limb salvage means a series of operations designed to 
save an arm or leg with all of its associated parts rather than amputate 
it. For purposes of this section, a surgeon must certify that the option 
of amputation of the limb(s) was a medically justified alternative to 
salvage, and the patient chose to pursue salvage.
    (xx) The term amputation means the severance or removal of a limb or 
genital organ or part of a limb or genital organ resulting from trauma 
or surgery. With regard to limbs an amputation above a joint means a 
severance or removal that is closer to the body than the specified joint 
is.
    (xxi) The term anatomical loss of the penis is defined as amputation 
of the glans penis or any portion of the shaft of the penis above the 
glans penis (i.e. closer to the body) or damage to the glans penis or 
shaft of the penis that requires reconstructive surgery.
    (xxii) The term permanent loss of use of the penis is defined as 
damage to the glans penis or shaft of the penis that results in complete 
loss of the ability to perform sexual intercourse that is reasonably 
certain to continue throughout the lifetime of the member.
    (xxiii) The term anatomical loss of the testicle(s) is defined as 
the amputation of, or damage to, one or both testicles that requires 
testicular salvage, reconstructive surgery, or both.
    (xxiv) The term permanent loss of use of both testicles is defined 
as damage to both testicles resulting in the need for hormonal 
replacement therapy that is medically required and reasonably certain to 
continue throughout the lifetime of the member.
    (xxv) The term anatomical loss of the vulva, uterus, or vaginal 
canal is defined as the complete or partial amputation of the vulva, 
uterus, or vaginal canal or damage to the vulva, uterus, or vaginal 
canal that requires reconstructive surgery.
    (xxvi) The term permanent loss of use of the vulva or vaginal canal 
is defined as damage to the vulva or vaginal canal that results in 
complete loss of the ability to perform sexual intercourse that is 
reasonably certain to continue throughout the lifetime of the member.
    (xxvii) The term anatomical loss of the ovary(ies) is defined as the 
amputation of one or both ovaries or damage to one or both ovaries that 
requires ovarian salvage, reconstructive surgery, or both.
    (xxviii) The term permanent loss of use of both ovaries is defined 
as damage to both ovaries resulting in the need for hormonal replacement 
therapy that is medically required and reasonably certain to continue 
throughout the lifetime of the member.
    (xxix) The term total and permanent loss of urinary system function 
is defined as damage to the urethra, ureter(s), both kidneys, bladder, 
or urethral sphincter muscle(s) that requires urinary diversion and/or 
hemodialysis, either of which is reasonably certain to continue 
throughout the lifetime of the member.
    (f) Schedule of Losses.

[[Page 581]]



------------------------------------------------------------------------
 
------------------------------------------------------------------------
For losses listed in paragraphs (f)(1) through
 (19) of this section, multiple losses resulting
 from a single traumatic event may be combined for
 purposes of a single payment (except where noted
 otherwise); however, the total payment amount may
 not exceed $100,000 for losses resulting from a
 single traumatic event.
Payments for losses listed in paragraphs (f)(20)
 through (21) of this section may not be made in
 addition to payments for losses under paragraphs
 (f)(1) through (19)--only the higher amount will
 be paid. The total payment amount may not exceed
 $100,000 for losses resulting from a single
 traumatic event.
------------------------------------------------------------------------
If the loss is--                                         Then the amount
                                                    payable for the loss
                                                                    is--
------------------------------------------------------------------------
(1) Total and permanent loss of sight:
     For each eye...............               $50,000
(2) Total and permanent loss of hearing:
     For one ear................               $25,000
     For both ears..............              $100,000
(3) Total and permanent loss of speech............               $50,000
(4) Quadriplegia..................................              $100,000
(5) Hemiplegia....................................              $100,000
(6) Paraplegia....................................              $100,000
(7) Uniplegia:
     For each limb*.............               $50,000
*Note: Payment for uniplegia of arm cannot be
 combined with loss 9, 10, or 14 for the same arm.
 Payment of uniplegia of leg cannot be combined
 with loss 11, 12, 13, or 15 for the same leg.
(8) Burns.........................................              $100,000
(9) Amputation of a hand at or above the wrist:
     For each hand*.............               $50,000
*Note: Payment for loss 9 cannot be made in
 additional to payment for loss 10 for the same
 hand.
(10) Amputation at or above the
 metacarpophalangeal joint(s) of either the thumb
 or the other 4 fingers on 1 hand:
     For each hand*.............               $50,000
*Note: Payment for loss of the thumb cannot be
 made in addition to payment for loss of the other
 4 fingers for the same hand.
(11) Amputation of a foot at or above the ankle:
     For each foot.*............               $50,000
*Note: Payment for loss 11 cannot be made in
 addition to payments for losses 12 or 13 for the
 same foot.
(12) Amputation at or above the
 metatarsophalangeal joints of all toes on 1 foot:
     For each foot*.............               $50,000
*Note: Payment for loss 12 cannot be made in
 addition to payments for loss 13 for the same
 foot.
(13) Amputation at or above the
 metatarsophalangeal joint(s) of either the big
 toe, or the other 4 toes on 1 foot
     For each foot..............               $25,000
(14) Limb salvage of arm:
     For each arm*..............               $50,000
*Note: Payment for loss 14 cannot be made in
 addition to payments for losses 9 or 10 for the
 same arm.
(15) Limb salvage of leg:
     For each leg*..............               $50,000
*Note: Payment for loss 15 cannot be made in
 addition to payments for losses 11, 12 or 13 for
 the same leg.

[[Page 582]]

 
(16) Facial Reconstruction:
     Jaw--surgery to correct                   $75,000
     discontinuity loss of the upper or lower jaw.
     Nose--surgery to correct                  $50,000
     discontinuity loss of 50% or more of the
     cartilaginous nose...........................
     Lips--surgery to correct
     discontinuity loss of 50% or more of the
     upper or lower lip
        --For one lip.............................               $50,000
        --For both lips...........................               $75,000
     Eyes--surgery to correct
     discontinuity loss of 30% or more of the
     periorbita.
        --For each eye............................               $25,000
     Facial Tissue--surgery to
     correct discontinuity loss of the tissue in
     50% or more of any of the following facial
     subunits: forehead, temple, zygomatic,
     mandibular, infraorbital or chin.
        --For each facial subunit.................               $25,000
Note 1: Losses due to facial reconstruction may be
 combined with each other, but the maximum benefit
 for facial reconstruction may not exceed $75,000.
Note 2: Any injury or combination of losses under
 facial reconstruction may also be combined with
 other losses in paragraphs 9.20(f)(1)-(18) and
 treated as one loss, provided that all losses are
 the result of a single traumatic event. However,
 the total payment amount may not exceed $100,000.
(17) Coma from traumatic injury AND/OR Traumatic
 Brain injury resulting in inability to perform at
 least 2 Activities of Daily Living (ADL):
     at 15th consecutive day of                $25,000
     coma or ADL loss*............................
     at 30th consecutive day of          an additional
     coma or ADL loss*............................               $25,000
     at 60th consecutive day of          an additional
     coma or ADL loss*............................               $25,000
    ; at 90th consecutive day of         an additional
     coma or ADL loss*............................               $25,000
Note 1: Duration of coma and inability to perform
 ADLs includes date of onset of coma or inability
 to perform ADLs and the first date on which
 member is no longer in a coma or is able to
 perform ADLs.
(18) Hospitalization due to traumatic brain
 injury:*
     at 15 consecutive day of                  $25,000
     hospitalization**............................
*Note: Payment for hospitalization replaces period
 in loss 17.
**Note: Duration of hospitalization includes dates
 on which member is transported from the injury
 site to a facility described in Sec.
 9.20(e)(6)(xiii), admitted to the facility,
 transferred between facilities, and discharged
 from the facility.
(19) Genitourinary Losses:
     Anatomical loss of the                    $50,000
     penis........................................
     Permanent loss of use of                  $50,000
     the penis....................................
     Anatomical loss of one                    $25,000
     testicle.....................................
     Anatomical loss of both testicles............               $50,000
     Permanent loss of use of                  $50,000
     both testicles...............................
     Anatomical loss of the                    $50,000
     vulva, uterus, or vaginal canal..............
     Permanent loss of use of                  $50,000
     the vulva or vaginal canal...................
     Anatomical loss of one                    $25,000
     ovary........................................
     Anatomical loss of both                   $50,000
     ovaries......................................
     Permanent loss of use of                  $50,000
     both ovaries.................................
     Total and permanent loss of               $50,000
     urinary system function......................
Note 1: Losses due to genitourinary injuries may
 be combined with each other, but the maximum
 benefit for genitourinary losses may not exceed
 $50,000.
Note 2: Any genitourinary loss may be combined
 with other injuries listed in Sec.   9.20(f)(1)
 through (18) and treated as one loss, provided
 that all losses are the result of a single
 traumatic event. However, the total payment may
 not exceed $100,000.

[[Page 583]]

 
(20) Traumatic injury, other than traumatic brain
 injury, resulting in inability to perform at
 least 2 Activities of Daily Living (ADL):
     at 30th consecutive day of                $25,000
     ADL loss*....................................
     at 60th consecutive day of          an additional
     ADL loss*....................................               $25,000
     at 90th consecutive day of          an additional
     ADL loss*....................................               $25,000
     at 120th consecutive day of         an additional
     ADL loss*....................................               $25,000
*Note: Duration of inability to perform ADLs
 includes date of onset of inability to perform
 ADLs and the first date on which member is able
 to perform ADLs.
(21) Hospitalization due to traumatic injury other
 than traumatic brain injury:*
     at 15th consecutive day of                $25,000
     hospitalization**............................
*Note: Payment for hospitalization replaces the
 first payment period in loss 19.
**Note: Duration of hospitalization includes dates
 on which member is transported from the injury
 site to a facility described in Sec.
 9.20(e)(6)(xiii), admitted to the facility,
 transferred between facilities, and discharged
 from the facility.
------------------------------------------------------------------------

    (g) Who will determine eligibility for traumatic injury protection 
benefits? Each uniformed service will certify its own members for 
traumatic injury protection benefits based upon section 1032 of Public 
Law 109-13, section 501 of Public Law 109-233, and this section. The 
uniformed service will certify whether you were at the time of the 
traumatic injury insured under Servicemembers' Group Life Insurance and 
whether you have sustained a qualifying loss.
    (h) How does a member make a claim for traumatic injury protection 
benefits? (1)(i) A member who believes he or she qualifies for traumatic 
injury protection benefits must complete Part A of the Application for 
TSGLI Benefits Form and sign the form.
    (ii) If a member is unable to sign the Application for TSGLI 
Benefits Form due to the member's physical or mental incapacity, the 
form must be signed by the member's guardian; if none, the member's 
agent or attorney acting under a valid Power of Attorney; if none, the 
member's military trustee.
    (iii) If a member suffered a scheduled loss as a direct result of 
the traumatic injury, survived seven full days from the date of the 
traumatic event, and then died before the maximum benefit for which the 
service member qualifies is paid, the beneficiary or beneficiaries of 
the member's Servicemembers' Group Life Insurance policy should complete 
an Application for TSGLI Benefits Form.
    (2) If a member seeks traumatic injury protection benefits for a 
scheduled loss occurring after submission of a completed Application for 
TSGLI Benefits Form for a different scheduled loss, the member must 
submit a completed Application for TSGLI Benefits Form for the new 
scheduled loss and for each scheduled loss that occurs thereafter and 
for each increment of a scheduled loss that occurs thereafter. For 
example, if a member seeks traumatic injury protection benefits for a 
scheduled loss due to coma from traumatic injury and/or the inability to 
carry out activities of daily living due to traumatic brain injury 
(Sec.  9.20(f)(17)), or the inability to carry out activities of daily 
living due to loss directly resulting from a traumatic injury other than 
an injury to the brain (Sec.  9.20(f)(19)), a completed Application for 
TSGLI Benefits Form must be submitted for each increment of time for 
which TSGLI is payable. Also, for example, if a service member suffers a 
scheduled loss due to a coma, a completed Application for TSGLI Benefits 
Form should be filed after the 15th consecutive day that the member is 
in the coma, for which $25,000 is payable. If the member remains in a 
coma for another 15 days, another completed Application for TSGLI 
Benefits Form should be submitted and another $25,000 will be paid.

[[Page 584]]

    (i) How does a member or beneficiary appeal an adverse eligibility 
determination? (1) Notice of a decision regarding a member's eligibility 
for traumatic injury protection benefits will include an explanation of 
the procedure for obtaining review of the decision. An appeal of an 
eligibility determination, such as whether the loss occurred within 365 
days of the traumatic injury, whether the injury was self-inflicted or 
whether a loss of hearing was total and permanent, must be in writing. 
An appeal must be submitted by a member or a member's legal 
representative or by the beneficiary or the beneficiary's legal 
representative, within one year of the date of a denial of eligibility, 
to the office of the uniformed service identified in the decision 
regarding the member's eligibility for the benefit.
    (2) An appeal regarding whether a member was insured under 
Servicemembers' Group Life Insurance when the traumatic injury was 
sustained must be in writing. An appeal must be submitted by a member or 
a member's legal representative or by the beneficiary or the 
beneficiary's legal representative within one year of the date of a 
denial of eligibility to the Office of Servicemembers' Group Life 
Insurance.
    (3) Nothing in this section precludes a member from pursuing legal 
remedies under 38 U.S.C. 1975 and 38 CFR 9.13.
    (j) Who will be paid the traumatic injury protection benefit? The 
injured member who suffered a scheduled loss will be paid the traumatic 
injury protection benefit in accordance with title 38 U.S.C. 1980A 
except under the following circumstances:
    (1) If a member is legally incapacitated, the member's guardian or 
agent or attorney acting under a valid Power of Attorney will be paid 
the benefit on behalf of the member.
    (2) If no guardian, agent, or attorney is authorized to act as the 
member's legal representative, a military trustee who has been appointed 
under the authority of 37 U.S.C. 602 will be paid the benefit on behalf 
of the member. The military trustee will report the receipt of the 
traumatic injury benefit payment and any disbursements from that payment 
to the Department of Defense.
    (3) If a member dies before payment is made, the beneficiary or 
beneficiaries who will be paid the benefit will be determined in 
accordance with 38 U.S.C. 1970(a).
    (k) The Traumatic Servicemembers' Group Life Insurance program will 
be administered in accordance with this rule, except to the extent that 
any regulatory provision is inconsistent with subsequently enacted 
applicable law.

(Authority: 37 U.S.C. 602, 603; 38 U.S.C. 501(a), 1980A)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0671)

[70 FR 75946, Dec. 22, 2005, as amended at 72 FR 10365, Mar. 8, 2007; 73 
FR 71930, Nov. 26, 2008; 76 FR 75460, Dec. 2, 2011; 79 FR 44299, July 
31, 2014]



Sec.  9.21  VA's access to records maintained by the insurer, reinsurer(s),
and their successors.

    (a) In order to perform oversight responsibilities designed to 
protect the legal and financial rights of the Government and persons 
affected by the activities of the Department of Veterans Affairs and its 
agents and to ensure that the policy and the related program benefits 
and services are managed effectively and efficiently as required by law, 
the Secretary of Veterans Affairs shall have complete and unrestricted 
access to the records of any insurer, reinsurer(s), and their successors 
with respect to the policy and related benefit programs or services that 
are derived from the policy. This access includes access to:
    (1) Any records relating to the operation and administration of 
benefit programs derived from the policy, which are considered to be 
Federal records created under the policy;
    (2) Records related to the organization, functions, policies, 
decisions, procedures, and essential transactions, including financial 
information, of the insurer, reinsurer(s), and their successors; and
    (3) Records of individuals insured under the policy or utilizing 
other related program benefits and services or who may be entitled to 
benefits derived through the Servicemembers' and Veterans' Group Life 
Insurance programs,

[[Page 585]]

including personally identifiable information concerning such 
individuals and their beneficiaries.
    (b) Complete access to these records shall include the right to have 
the originals of such records sent to the Secretary of Veterans Affairs 
or a representative of the Secretary at the Secretary's direction. The 
records shall be available in either hard copy or readable electronic 
media. At the Secretary's option, copies may be provided in lieu of 
originals where allowed by the Federal Records Act, 44 U.S.C. chapter 
31.

[79 FR 48072, Aug. 15, 2014]



Sec.  9.22  Submission of certain applications and forms affecting entitlement
to Servicemembers' Group Life Insurance and Veterans' Group Life Insurance.

    (a)(1) For purposes of this section, the terms in writing and 
written mean an intentional recording of words in visual form and 
include:
    (i) Hard-copy applications and forms containing a person's name or 
mark written or made by that person; and
    (ii) Applications and forms submitted through a VA approved 
electronic means that include an electronic or digital signature that 
identifies and authenticates a particular person as the source of the 
electronic message and indicates such person's approval of the 
information submitted through such means.
    (2) With regard to the following actions, applications or forms that 
satisfy the definition in paragraph (a)(1) of this section will be 
deemed to satisfy the requirement in the referenced statutes that an 
application, election, or beneficiary designation be ``in writing'' or 
``written'':
    (i) Decline Servicemembers' Group Life Insurance for the member or 
Family Servicemembers' Group Life Insurance for the member's insurable 
spouse (38 U.S.C. 1967(a)(2)(A) or (B));
    (ii) Insure the member under Servicemembers' Group Life Insurance or 
the member's spouse under Family Servicemembers' Group Life Insurance in 
an amount less than the maximum amount of such insurance (38 U.S.C. 
1967(a)(3)(B));
    (iii) Restore or increase coverage under Servicemembers' Group Life 
Insurance for the member or under Family Servicemembers' Group Life 
Insurance for the member's insurable spouse (38 U.S.C. 1967(c));
    (iv) Designate one or more beneficiaries for the member's 
Servicemembers' Group Life Insurance or former member's Veterans' Group 
Life Insurance (38 U.S.C. 1970(a)); and
    (v) Increase the amount of coverage under Veterans' Group Life 
Insurance (38 U.S.C. 1977(a)(3)).
    (b) Applications or forms that satisfy the definition in paragraph 
(a)(1) of this section may be utilized to--
    (1) Apply for Veterans' Group Life Insurance; and
    (2) Reinstate Veterans' Group Life Insurance.

[83 FR 10623, Mar. 12, 2018]



Sec.  9.24  Insurable dependents who become eligible members, and eligible 
members who marry eligible members.

    (a) A Servicemembers' Group Life Insurance-covered member (member) 
who marries another Servicemembers' Group Life Insurance eligible member 
(member spouse) after January 1, 2013, or is married to a person who 
becomes a Servicemembers' Group Life Insurance eligible member after 
January 1, 2013, shall receive Family Servicemembers' Group Life 
Insurance spousal coverage at the statutory maximum amount or a lesser 
amount, or receive increased existing spousal coverage on their member 
spouse, upon an election of such coverage if made within 240 days 
following the member's marriage to another member, or the member's 
spouse entering service, without having to provide proof of the member 
spouse's good health. If a member does not elect coverage for a member 
spouse within 240 days following the member's marriage to another 
member, or the member's spouse entering service, then the member may 
still receive spousal coverage at the statutory maximum amount or a 
lesser amount, or increase existing spousal coverage, by applying and 
submitting proof of the member spouse's good health.

[[Page 586]]

    (b) A spouse shall remain eligible to be covered by any existing 
Family Servicemembers' Group Life Insurance spousal coverage without the 
member electing such coverage or applying for such coverage with proof 
of the member spouse's good health in a case where the spouse is 
enrolled in coverage under 38 U.S.C. 1967(a)(1)(A)(ii) or (C)(ii) prior 
to becoming a member married to another member.
    (c) A member's spouse who was insured under the member's Family 
Servicemembers' Group Life Insurance at the time the spouse separates 
from service will continue to be covered under the spousal Family 
Servicemembers' Group Life Insurance carried while in service, and the 
member will not need to elect such coverage. If a member seeks to enroll 
a former member spouse who did not have such spousal insurance coverage 
when the former member spouse separates from service, or seeks to 
increase existing spousal coverage on their former member spouse, the 
member shall receive such spousal coverage on their former member 
spouse, upon an election of such coverage if made within 240 days 
following the former member spouse's separation from service, without 
having to provide proof of the former member spouse's good health. If a 
member does not elect coverage for a former member spouse within 240 
days following the former member spouse's separation from service, then 
the member may still receive spousal coverage at the statutory maximum 
amount or a lesser amount, or increase existing spousal coverage, by 
applying and submitting proof of the former member spouse's good health.
    (d) After January 1, 2013, an insurable child who is a member at the 
time a parent's Servicemembers' Group Life Insurance coverage commences 
is not eligible for automatic dependent coverage under 38 U.S.C. 
1967(a)(1)(A)(ii) or (C)(ii). Dependent coverage in effect for an 
insurable child prior to becoming a member shall remain in effect so 
long as the child remains an insurable dependent. If an insurable child 
was not covered prior to becoming a member, the child cannot be covered 
under 38 U.S.C. 1967(a)(1)(A)(ii) or (C)(ii) after the child becomes a 
member.

[85 FR 78559, Nov. 27, 2020]



PART 10_ADJUSTED COMPENSATION--Table of Contents



                     Adjusted Compensation; General

Sec.
10.0 Adjusted service pay entitlements.
10.1 Issuance of duplicate adjusted service certificate without bond.
10.2 Evidence required of loss, destruction or mutilation of adjusted 
          service certificate.
10.3 Issuance of duplicate adjusted service certificate with bond.
10.4 Loss, destruction, or mutilation of adjusted service certificate 
          while in possession of Department of Veterans Affairs.
10.15 Designation of more than one beneficiary under an adjusted service 
          certificate.
10.16 Conditions requisite for change in designation of beneficiary.
10.17 Designation of beneficiary subsequent to cancellation of previous 
          designation.
10.18 Approval of application for change of beneficiary heretofore made.
10.20 ``Demand for payment'' certification.
10.22 Payment to estate of decedent.
10.24 Payment of death claim on lost, destroyed or mutilated adjusted 
          service certificate with bond.
10.25 Payment of death claim on adjusted service certificate without 
          bond.
10.27 Definitions.
10.28 Proof of death evidence.
10.29 Claims for benefits because of elimination of preferred dependent.
10.30 Proof of remarriage.
10.31 Dependency of mother or father.
10.32 Evidence of dependency.
10.33 Determination of dependency.
10.34 Proof of age of dependent mother or father.
10.35 Claim of mother entitled by reason of unmarried status.
10.36 Proof of marital cohabitation under section 602 or section 312 of 
          the Act.
10.37 Claim of widow not living with veteran at time of veteran's death.
10.38 Proof of age of veteran's child.
10.39 Mental or physical defect of child.
10.40 Payment on account of minor child.
10.41 Definition of ``child''.
10.42 Claim of child other than legitimate child.
10.43 Claim by guardian of child of veteran.
10.44 Evidence required to support claim of mother or father.
10.45 Definition of ``widow''.
10.46 Authentication of statements supporting claims.

[[Page 587]]

10.47 Use of prescribed forms.

                                Payments

10.50 Section 601 and section 603 payments made on first day of calendar 
          quarter.
10.51 Payments to minor child.
10.52 Duplication of payments prohibited.
10.53 Payment on duplicate certificate.

    Authority: 72 Stat. 1114; 38 U.S.C. 501. Rights and benefits are 
continued in effect by sec. 12(b), 72 Stat. 1264, 38 U.S.C. note prec. 
Part 1.

    Source: 13 FR 7122, Nov. 27, 1948, unless otherwise noted.

                     Adjusted Compensation; General



Sec.  10.0  Adjusted service pay entitlements.

    A veteran entitled to adjusted service pay is one whose adjusted 
service credit does not amount to more than $50 as distinguished from a 
veteran whose adjusted service credit exceeds $50 and who therefore is 
entitled to an adjusted service certificate.



Sec.  10.1  Issuance of duplicate adjusted service certificate without
bond.

    If the veteran named in an adjusted service certificate issued 
pursuant to the provisions of section 501 of the World War Adjusted 
Compensation Act, without bad faith, has not received such certificate, 
or if prior to receipt by the veteran such certificate was destroyed 
wholly or in part or was so defaced as to impair its value, or, if after 
delivery it was partially destroyed or defaced so as to impair its value 
but can be identified to the satisfaction of the Secretary, a duplicate 
adjusted service certificate will be issued upon application and a bond 
of indemnity will not be required: Provided, That if the adjusted 
service certificate was destroyed in part or so defaced as to impair its 
value, the veteran or person entitled to payment thereon will be 
required to surrender to the Department of Veterans Affairs the original 
certificate or so much thereof as may remain.



Sec.  10.2  Evidence required of loss, destruction or mutilation of adjusted
service certificate.

    The veteran named in an adjusted service certificate issued pursuant 
to the provisions of section 501 of the World War Adjusted Compensation 
Act, or the person entitled to payment thereon will be required to 
furnish evidence of the nonreceipt of the adjusted service certificate, 
or of its receipt in a mutilated or defaced condition, or of the loss or 
destruction in whole or in part of defacement of the certificate after 
its receipt, as the case may be. The evidence must be sufficient to 
establish to the satisfaction of the Secretary that neither the veteran 
nor the person entitled to payment thereon, or any person for or on 
their behalf, received the adjusted service certificate, or that at the 
time of its receipt it was mutilated or defaced to such an extent as to 
impair its value, or that after receipt of the certificate it was lost 
or destroyed in whole or in part or defaced, but without bad faith on 
the part of the veteran, and that every effort has been made to recover 
the lost certificate. Unless determination is otherwise made by the 
Secretary the evidence must be in the form of a written statement sworn 
to by the veteran or person entitled to payment thereon and witnessed by 
at least two persons who shall state, under oath that they personally 
know the affiant, that they have read his or her statement and that it 
is true to the best of their knowledge and belief. These statements 
should be supplemented by affidavits of any persons having personal 
knowledge of additional facts and circumstances concerning the matter, 
and the Secretary may require any additional evidence deemed necessary.



Sec.  10.3  Issuance of duplicate adjusted service certificate with bond.

    An indemnity bond will be required as a prerequisite to the issuance 
of a duplicate adjusted service certificate in all cases where the 
certificate was lost after receipt by the veteran, or after receipt by 
the veteran was defaced or mutilated and cannot be identified to the 
satisfaction of the Secretary, provided the loss, defacement, or 
mutilation was without bad faith on the part of the veteran or the 
person entitled to payment thereon. The bond must be in the manner and 
form prescribed by the Department of Veterans Affairs and for an amount 
equal to the face value of the certificate, with surety or sureties 
residents of the United

[[Page 588]]

States and satisfactory to the Secretary, with condition to indemnify 
and save harmless the United States from any claim on account of such 
certificate. If the certificate was defaced or mutilated the veteran or 
person entitled to payment thereon will be required to surrender to the 
Department of Veterans Affairs the certificate or so much thereof as may 
remain.



Sec.  10.4  Loss, destruction, or mutilation of adjusted service certificate
while in possession of Department of Veterans Affairs.

    A new adjusted service certificate will be issued without bond in 
lieu of the certificate which has been lost or destroyed, or has been 
mutilated, defaced or damaged so as to impair its value, while in 
possession of the Department of Veterans Affairs.



Sec.  10.15  Designation of more than one beneficiary under an adjusted
service certificate.

    A veteran to whom an adjusted service certificate has been issued 
pursuant to the provisions of section 501 of the World War Adjusted 
Compensation Act may name more than one beneficiary to receive the 
proceeds of his adjusted service certificate, and may from time to time 
with the approval of the Secretary change such beneficiaries. The 
designated beneficiaries shall share equally unless otherwise specified 
by the veteran. Wherever the word beneficiary appears in the law and 
Department of Veterans Affairs regulations it shall be interpreted to 
include beneficiaries.



Sec.  10.16  Conditions requisite for change in designation of beneficiary.

    A change of beneficiary of an adjusted service certificate to be 
valid must be made:
    (a) By notice signed by the veteran or his duly authorized agent, 
and delivered or properly mailed to the Department of Veterans Affairs 
during the lifetime of the veteran. Such change shall not take effect 
until approved by the Secretary and after such approval the change shall 
be deemed to have been made as of the date the veteran signed said 
written notice and change, whether the veteran be living at the time of 
said approval or not.
    (b) Or by last will and testament of the veteran, duly probated. 
Such change shall not be effective until received by the Department of 
Veterans Affairs and approved by the Secretary and after such approval 
the change shall be deemed to have been made as of the date of death of 
the veteran: Provided, That a change of beneficiary signed subsequent to 
the date upon which the will was executed and delivered in accordance 
with paragraph (a) of this section shall if approved in accordance with 
regulations take precedence over the designation by will.

Provided, however, That any payment made to a beneficiary of record, 
before notice of change of beneficiary has been received in the 
Department of Veterans Affairs and approved by the Secretary, shall not 
be made again to the changed beneficiary.



Sec.  10.17  Designation of beneficiary subsequent to cancellation of
previous designation.

    The designation of a beneficiary made subsequent to the cancellation 
of a previous designation of beneficiary, shall be considered as a 
change in beneficiary, and shall be subject to the approval of the 
Secretary and subject to the conditions and requirements respecting 
change in beneficiary as outlined in Sec.  10.16.



Sec.  10.18  Approval of application for change of beneficiary heretofore
made.

    Any application for a change of beneficiary heretofore made may be 
approved if it meets the requirements set out in Sec. Sec.  10.16 and 
10.17.



Sec.  10.20  ``Demand for payment'' certification.

    Certification to the execution of demand for payment forms appearing 
on the reverse side of adjusted service certificates issued pursuant to 
the World War Adjusted Compensation Act, as amended, is required in 
accordance with instructions printed on said forms. Such certification 
if made in the United States or possessions will be

[[Page 589]]

accepted if made by and bearing the official seal of a United States 
postmaster, an executive officer of an incorporated bank or trust 
company, notary public, or any person who is legally authorized to 
administer oaths in a State, Territory, District of Columbia or in a 
Federal judicial district of the United States. If the demand for 
payment be executed in a foreign country, the same shall be certified by 
an American consul, a recognized representative of an American embassy 
or legation or by a person authorized to administer oaths under the laws 
of the place where execution of demand is made, provided there be 
attached to the certificate of such latter officer a proper 
certification by an accredited official of the State Department of the 
United States that the officer certifying to the execution of the demand 
for payment was authorized to administer oaths in the place where 
certification was made.



Sec.  10.22  Payment to estate of decedent.

    Wherever the face value of an adjusted service certificate, issued 
pursuant to the World War Adjusted Compensation Act, as amended, becomes 
payable to the estate of any decedent and the amount thereof is not over 
$500 and an administrator has not been or is not to be appointed, such 
amount will be paid to such person or persons as would, under the laws 
of the State of residence of the decedent, be entitled to his personal 
property in case of intestacy.



Sec.  10.24  Payment of death claim on lost, destroyed or mutilated adjusted
service certificate with bond.

    If the veteran named in an adjusted service certificate, issued 
pursuant to the provisions of section 501 of the World War Adjusted 
Compensation Act, is deceased, and if, after receipt by the veteran, the 
adjusted service certificate was lost, destroyed, or so defaced as to 
impair its value and cannot be identified to the satisfaction of the 
Secretary of Veterans Affairs, the person entitled to payment thereon 
will be required to furnish an indemnity bond in the manner and form 
prescribed by the Department of Veterans Affairs and for an amount equal 
to the face value of the certificate, with surety or sureties residents 
of the United States and satisfactory to the Secretary of Veterans 
Affairs with condition to indemnify and save harmless the United States 
from any claim on account of such certificate, before payment will be 
made of the proceeds of the certificate and a duplicate adjusted service 
certificate will not be issued.



Sec.  10.25  Payment of death claim on adjusted service certificate without
bond.

    If the veteran named in the adjusted service certificate, issued 
pursuant to the provisions of section 501 of the World War Adjusted 
Compensation Act, is deceased, and if the certificate was lost or 
destroyed wholly or in part or was so defaced as to impair its value 
prior to receipt by the veteran, or was partially destroyed or defaced 
after receipt by the veteran, but can be identified to the satisfaction 
of the Secretary of Veterans Affairs, payment will be made of the 
proceeds of the certificate, a bond of indemnity will not be required, 
and a duplicate adjusted service certificate will not be issued: 
Provided, The person entitled to payment thereon surrenders the defaced 
or mutilated certificate or so much thereof as may remain.



Sec.  10.27  Definitions.

    For the purpose of Sec. Sec.  10.28 to 10.47, the word Act as used 
herein refers to the World War Adjusted Compensation Act, as amended; 
the word Veteran refers to that term as defined in section 2 of title I 
of said Act; the word Director refers to the Secretary of Veterans 
Affairs.



Sec.  10.28  Proof of death evidence.

    Evidence required in establishing proof of death under the act, as 
amended, shall conform with the requirements set forth in the 
regulations of the Department of Veterans Affairs.



Sec.  10.29  Claims for benefits because of elimination of preferred 
dependent.

    A dependent, in subsequent position in the order of preference as 
defined in section 601 of title VI of the Act, as amended, who makes 
claim for the benefits of the Act in consequence of the

[[Page 590]]

death of a dependent who made application and who stood in preferential 
position as defined in section 601 of the act, as amended, shall be 
required to furnish, in support of such claim, proof of death of said 
dependent. Proof of death of said dependent shall be in accordance with 
the requirements for proof of death as outlined in the regulations of 
Department of Veterans Affairs. A dependent who makes claim for the 
benefits of the act because of remarriage of a widow who did not make 
and file application before remarriage shall be required to furnish in 
support of such claim proof of remarriage of said widow. Proof of 
remarriage of said widow shall be in accordance with the requirements 
for proof of marriage as outlined in regulations of the Department of 
Veterans Affairs.



Sec.  10.30  Proof of remarriage.

    A dependent who is receiving payments under section 601 of title VI 
of the Act, as amended, and who remarries after making and filing 
application, shall be required to furnish proof of remarriage in 
accordance with the requirements for proof of remarriage as outlined in 
regulations of the Department of Veterans Affairs.



Sec.  10.31  Dependency of mother or father.

    Claims of a mother or father for the benefits to which either may be 
entitled under the World War Adjusted Compensation Act, as amended, 
shall be supported by a statement of fact of dependency made under oath 
by the claimant and witnessed by two persons.



Sec.  10.32  Evidence of dependency.

    Evidence of a whole or entire dependency shall not be required. The 
mother or father shall be considered dependent for the purposes of the 
act when it is established as a fact that the mother or father of a 
deceased veteran did not have sufficient means from all sources for a 
reasonable livelihood at the time of the death of the veteran or at any 
time thereafter and on or before January 2, 1935. In those cases where 
because of continued and unexplained absence for seven years the veteran 
is declared deceased under section 312(a) of the Act as amended May 29, 
1928, the mother or father shall be considered dependent when it is 
established that the mother or father did not have sufficient means from 
all sources for a reasonable livelihood at the beginning of such 7-year 
period or at any time thereafter and before the expiration of such 
period.



Sec.  10.33  Determination of dependency.

    A determination of the existence of the alleged dependency will be 
made upon consideration of all facts relating to dependency, and upon 
such investigation of such facts as may be warranted. The following 
facts as existing at the time of the death of the veteran, or at any 
time thereafter and on or before January 2, 1935, or where it is 
established that the veteran is deceased as provided in section 312(a), 
at the beginning of such 7-year period or at any time thereafter and 
before the expiration of such period, shall be taken into consideration 
in determining dependency in a given case:
    (a) Claimant's age.
    (b) Amount contributed to claimant by deceased veteran.
    (c) Value of all real and personal property owned by claimant.
    (d) Total monthly expenses of the claimant and total monthly income.
    (e) The fact that claimant did or did not receive an allotment of 
pay or allowance during the veteran's military or naval service.
    (f) Incapability of self-support by reason of mental or physical 
defect.
    (g) Any other fact or facts pertinent to the determination of 
dependency.



Sec.  10.34  Proof of age of dependent mother or father.

    The mother or father of a veteran to be entitled to the presumption 
of dependency within the meaning of section 602(c) or section 312(c) of 
the Act, as amended, shall be required to submit proof of age in 
accordance with the requirements as set forth in regulations of the 
Department of Veterans Affairs.



Sec.  10.35  Claim of mother entitled by reason of unmarried status.

    Claim of a mother for the benefits to which she may be entitled by 
reason of her unmarried status as outlined in

[[Page 591]]

section 202(c) or section 312(c)3 of the Act, as amended, shall be 
supported by a statement of fact, under oath, of such status, together 
with one of the following:
    (a) Certified copy of public record of death of the husband.
    (b) Certified copy of court record of divorce decree.



Sec.  10.36  Proof of marital cohabitation under section 602 or 
section 312 of the Act.

    In order to prove marital cohabitation within the meaning of that 
term as used in section 602(a) or section 312(c)1 of the Act, as 
amended, claimant shall be required to establish:
    (a) A valid marriage, such marriage to be shown by the best evidence 
obtainable in accordance with the provisions of regulations of the 
Department of Veterans Affairs.
    (b) The fact of living together as man and wife, with such fact to 
be established by:
    (1) Statement of the widow or widower showing that he or she and the 
veteran lived together as man and wife and also showing the place or 
places of residence during such marital cohabitation and the approximate 
time of such residence; or
    (2) Statement of two competent persons showing that they personally 
knew the claimant and veteran and that they had personal knowledge that 
said claimant and veteran lived together as man and wife and were 
recognized as such.
    (c) The fact that the marital status existed at the time of the 
death of the veteran or where it is established that the veteran is 
deceased, as provided in section 312(a)1 of the Act, as amended, at the 
beginning of such 7-year period, such fact to be established by:
    (1) Statement by claimant that he or she and the veteran had not 
been divorced and that there had been no annulment of the marriage.
    (2) Statement of claimant that he or she was not remarried at the 
time of making application.
    (3) Statement of two competent persons showing that they personally 
knew the claimant and the veteran; that they personally knew of the 
marriage relationship between claimant and veteran; that to the best of 
their knowledge and belief there had been no divorce and no annulment of 
the marriage and that claimant was not remarried at the time of making 
and filing application.



Sec.  10.37  Claim of widow not living with veteran at time of 
veteran's death.

    If a veteran and widow were not living together at the time of the 
death of the veteran the widow will be required to establish:
    (a) That the living apart was not due to her willful act, and
    (b) Actual dependency upon the veteran at the time of his death or 
at any time thereafter and before January 2, 1935.
    (1) A determination of what shall constitute a willful act, as used 
in section 602(a) of the Act, as amended, will be made upon 
consideration of all facts relating to such act and upon such 
investigation of such facts as may be deemed warranted. For the purpose 
of this section, the fact that a veteran lived apart from the widow 
because of any act by the widow involving desertion or moral turpitude 
will be construed as the willful act of the widow. Cause of separation 
and time and duration of separation at the time of the death of the 
veteran shall be taken into consideration in determining a willful act.
    (2) A determination of the existence of actual dependency will be 
made under the criteria set forth in Sec. Sec.  10.32 and 10.33 with 
respect to dependency of a mother or father.



Sec.  10.38  Proof of age of veteran's child.

    A child of a veteran shall be required to submit proof of age in 
accordance with the requirements set forth in the regulations of the 
Department of Veterans Affairs.



Sec.  10.39  Mental or physical defect of child.

    If claim is made under section 602(b), (2), of title IV of the Act 
as amended, alleging that a child over 18 years of age was incapable of 
self-support at the death of the veteran or that he became incapable of 
self-support subsequent to

[[Page 592]]

the death of the veteran but on or before January 2, 1935, or that he 
was incapable of self-support at the disappearance of the veteran or 
became incapable of self-support after the disappearance of the veteran 
and before the expiration of the period of seven years mentioned in 
section 312(c), (2), of the Act, it will be necessary to furnish 
evidence as to the mental or physical condition of the child at the time 
it is alleged he became incapable of self-support.
    (a) Where incapability of self-support by reason of the mental 
defect of the child is alleged, the following evidence will be required:
    (1) Certified copy of court order or decree declaring the child to 
be mentally incompetent; or
    (2) A report of a licensed physician setting forth all of the facts 
as to the child's mental condition; or
    (3) The affidavit of the person having custody and control of the 
child, setting forth all of the available information as to the child's 
mental condition. The affidavit must be substantiated by two competent 
disinterested persons who shall state that they personally know the 
child, that they have read the affidavit made by the person having 
custody and control of the child, and that the information therein set 
forth is true to the best of their knowledge and belief.
    (b) Where incapability of self-support by reason of physical defect 
of the child is alleged, the following evidence will be required:
    (1) Report of a licensed physician setting forth all of the facts as 
to the child's physical condition; and
    (2) Affidavit of the child regarding his physical condition and the 
affidavits of two competent disinterested persons, who shall state that 
they personally know the claimant, that they have read his affidavit and 
that the same is true to the best of their knowledge and belief.



Sec.  10.40  Payment on account of minor child.

    Payments to a minor child shall be made to the legally constituted 
guardian, curator or conservator, or to the person found by the director 
to be otherwise legally vested with the care of the child.



Sec.  10.41  Definition of ``child''.

    The term child as used in the regulations in this part includes:
    (a) A legitimate child;
    (b) A child legally adopted;
    (c) A stepchild if a member of the veteran's household at the time 
of the death of the veteran, or
    (d) An illegitimate child but as to the father only if acknowledged 
in writing signed by him, or if he has been judicially ordered or 
decreed to contribute to such child's support or has been judicially 
decreed to be the putative father of such child.



Sec.  10.42  Claim of child other than legitimate child.

    A claim of a child legally adopted by the veteran upon whose service 
the claim is based shall be supported by a certified copy of the court 
record of such adoption. A claim of a stepchild of a veteran shall be 
supported by an affidavit of his or her legal guardian, stating that at 
the time of the death of the veteran said stepchild was a member of the 
veteran's household. The fact, as stated in such affidavit, and the 
signature of the guardian thereto, shall be attested by the court having 
jurisdiction over the guardian, or by two competent persons to whom the 
child was personally known at the time of the death of the veteran. A 
claim of an illegitimate child of a veteran upon whose service claim is 
based, shall be supported by:
    (a) A statement by the veteran in writing acknowledging his 
parentage of such child; or
    (b) Certified copy of order or decree of a court ordering the 
veteran to contribute to such child's support; or
    (c) Certified copy of a decree of a court holding the veteran to be 
the putative father of such child.



Sec.  10.43  Claim by guardian of child of veteran.

    A claim made by a legal guardian on behalf of his or her ward, a 
child of a veteran, shall be supported by an affidavit of said guardian, 
in the capacity of guardian, setting forth the names,

[[Page 593]]

ages, and addresses of all living children of the deceased veteran, or, 
if there be no living child other than the claimant child, statement of 
that fact shall be made. The signature of the guardian to such required 
affidavit shall be attested by the court having jurisdiction of the 
guardian and ward, or by two competent persons to whom the child is 
personally known.



Sec.  10.44  Evidence required to support claim of mother or father.

    The term mother and father as referred to in the order of preference 
as outlined in section 601 of the Act, as amended, includes stepmothers, 
stepfathers, mothers and fathers through adoption, and persons who, for 
a period of not less than one year, have stood in the place of a mother 
or father to the veteran at any time prior to the beginning of his 
service. In addition to the evidence of dependency required from a 
natural mother or father, a claim of a stepmother or stepfather shall be 
supported by evidence of marriage to the natural parent of the veteran. 
This evidence shall be in accordance with the requirements of proof of 
marriage as set forth in regulations of the Department of Veterans 
Affairs. A claim of a mother or father through adoption shall be 
supported by a certified copy of the court record of such adoption. A 
claim by a person who claims to have stood in the place of a mother or 
father shall be supported by evidence of such relationship satisfactory 
to the Department of Veterans Affairs. Such evidence shall comprise:
    (a) An affidavit of the claimant containing a complete detailed 
statement of the alleged relationship and
    (b) Affidavits of two competent witnesses to whom claimant was 
personally known at the time of the death of the veteran, said witnesses 
certifying to the truth of the statement as made by the claimant.



Sec.  10.45  Definition of ``widow''.

    The term widow as used in the regulations in this part includes 
widower.



Sec.  10.46  Authentication of statements supporting claims.

    All statements, except those of licensed examining physicians under 
Sec.  10.39 (a)(2) and (b)(1), required by Sec. Sec.  10.28 to 10.44 
shall be subscribed and sworn to before an officer vested with authority 
to administer oaths, in the place where such statements are made. 
Signatures executed in foreign countries or places shall be certified by 
an American consul, a recognized representative of an American consul, a 
recognized representative of an American embassy or legation or by a 
person authorized to administer oaths under the laws of the place where 
such statements are made, provided there be attached to the certificate 
of such latter officer a proper certification by an accredited official 
of the State Department of the United States that the officer certifying 
to the execution of the signature was authorized to administer oaths in 
the place where certification was made.



Sec.  10.47  Use of prescribed forms.

    Statements required by the regulations in this part should be 
submitted on forms provided by the Department of Veterans Affairs, when 
conveniently available.

                                Payments



Sec.  10.50  Section 601 and section 603 payments made on first day of
calendar quarter.

    Cash payments and the first installment of installment payments 
authorized in sections 601 and 603, respectively of title VI of the 
World War Adjusted Compensation Act, as amended, will be made as of the 
first day of the calendar quarter following the finding by the director 
that the applicant is a dependent entitled to the benefits of the act, 
but in no case shall any such payments be made before March 1, 1925: 
Provided, however, That payments authorized by section 608 of title VI 
of the Act, as amended, shall be paid in a lump sum to the preferred 
dependent without reference to payments under section 603 of title VI of 
the Act, as amended.



Sec.  10.51  Payments to minor child.

    Payments to minor child through legal guardian, natural guardian, or 
self. (See Sec.  10.40.)

[[Page 594]]



Sec.  10.52  Duplication of payments prohibited.

    Duplication of payments shall not be made in case of change of 
beneficiary. (See Sec.  10.16.)



Sec.  10.53  Payment on duplicate certificate.

    Issuance of duplicate adjusted service certificates and payment of 
claims based upon lost, destroyed, or mutilated, adjusted service 
certificates. (See Sec. Sec.  10.1 to 10.4, 10.24 and 10.25, 
respectively.)



PART 11_LOANS BY BANKS ON AND PAYMENT OF ADJUSTED SERVICE CERTIFICATES-
-Table of Contents



Loans by Banks on Adjusted Service Certificates Under Section 502 of the 
                   World War Adjusted Compensation Act

Sec.
11.75 Certificates.
11.76 To whom loan may be made.
11.77 By whom loans may be made.
11.80 Sale or discount of note by holding bank.
11.81 Rediscounts with Federal Reserve Banks.
11.83 Additional loans by reason of 50 percent loan value.
11.84 Redemption because of veteran's death.
11.85 Condition requisite for redemption.

  Disposition of Notes Secured by Adjusted Certificates Redeemed from 
  Banks by the Department of Veterans Affairs Under Section 502 of the 
   World War Adjusted Compensation Act, as Amended (Pub. L. 120, 68th 
                                 Cong.)

11.88 Cancellation of note.
11.89 Notification of veteran.
11.91 Repayment of loans.
11.93 Failure to redeem.

 Department of Veterans Affairs Loans on Adjusted Service Certificates 
Under Section 502 of the World War Adjusted Compensation Act, as Amended

11.96 By whom loans may be made.
11.99 Identification.
11.100 Form of note.
11.102 Term of note.
11.104 Disposition of notes and certificates.

   Application for Payment of Adjusted Service Certificate Under the 
    Adjusted Compensation Payment Act, 1936 (Pub. L. 425, 74th Cong.)

11.109 Settlement of unmatured adjusted service certificates.
11.110 Who may make application for final settlement.
11.111 Form of application.
11.114 Identification.
11.115 Where to file application.
11.116 Death of veteran before final settlement.
11.117 Missing applications.

Application for Payment of Adjusted Service Certificate Under the World 
   War Adjusted Compensation Act, as Amended (Pub. L. 120, 68th Cong.)

11.125 Settlement of matured adjusted service certificates.
11.126 Form of application.
11.127 Identification.
11.128 Veteran dies without having filed application for final 
          settlement.
11.129 Form of application for payment of deceased veteran's 
          certificate.
11.130 Where to file applications.

    Authority: 72 Stat. 1114; 38 U.S.C. 501. Rights and benefits are 
continued in effect by sec. 12(b), 72 Stat. 1264, 38 U.S.C. note prec. 
Part 1, unless otherwise noted.

Loans by Banks on Adjusted Service Certificates Under Section 502 of the 
                   World War Adjusted Compensation Act

    Source: 13 FR 7125, Nov. 27, 1948, unless otherwise noted.



Sec.  11.75  Certificates.

    Adjusted service certificates are dated as of the 1st day of the 
month in which the applications were filed, but no certificates are 
dated prior to January 1, 1925. Loans on the security of such 
certificates may be made at any time after the date of the certificate. 
The fact that a certificate is stamped or marked ``duplicate'' does not 
destroy its value as security for a loan.



Sec.  11.76  To whom loan may be made.

    Only the veteran named in the certificate can lawfully obtain a loan 
on his adjusted service certificate and neither the beneficiary nor any 
other person than the veteran has any rights in this respect. The person 
to whom the loan is made must be known to the lending bank to be the 
veteran named

[[Page 595]]

in the certificate securing such note. The consent of the beneficiary is 
not required, the act providing that a loan on the security of the 
certificate may be made ``with or without the consent of the beneficiary 
thereof.'' Loans may be made to veterans adjudged incompetent only 
through the guardians of such veterans and pursuant to specific order of 
the court having jurisdiction. Certified copy of court order must be 
submitted if note be presented for redemption by the Department of 
Veterans Affairs.



Sec.  11.77  By whom loans may be made.

    Any national bank or any bank or trust company incorporated under 
the laws of any State, Territory, possession, or the District of 
Columbia, hereinafter referred to as any bank, is authorized to loan to 
any veteran upon his promissory note secured by his Adjusted Service 
Certificate any amount not in excess of the loan value of the 
certificate at the date the loan is made. Each certificate contains on 
its face a table for determining the loan value of the certificate, but 
it is provided by amendment to the World War Adjusted Compensation Act 
dated February 27, 1931, that the loan value of any certificate shall at 
no time be less than 50 percent of the face value. Upon the making of 
such loan, the lending bank shall promptly notify the Department of 
Veterans Affairs of the name of the veteran, the A-number shown 
immediately after the name, the number of the certificate, the amount, 
the rate of interest, and date of loan: However, this requirement may be 
waived by the Secretary of Veterans Affairs.



Sec.  11.80  Sale or discount of note by holding bank.

    Any bank holding a note secured by an Adjusted Service Certificate 
may sell the note to any bank authorized to make a loan to a veteran and 
deliver the certificate to such bank. In case a note secured by an 
Adjusted Service Certificate is sold or transferred, the bank selling, 
discounting or rediscounting the note is required by law to notify the 
veteran promptly by mail at his last known post office address. No 
Adjusted Service Certificate is negotiable or assignable, or may serve 
as security for a loan, except as provided in section 502 of the World 
War Adjusted Compensation Act, as amended. Any negotiation, assignment 
or loan made in violation of section 502 of the World War Adjusted 
Compensation Act is void. In case of sale, discount or rediscount by the 
bank which made the loan, the note or notes should be accompanied by the 
affidavit required by Sec.  11.85.



Sec.  11.81  Rediscounts with Federal Reserve Banks.

    Upon the endorsement of any bank, which shall be deemed a waiver of 
demand, notice and protest by such bank as to its own endorsement 
exclusively, and subject to regulations to be prescribed by the Federal 
Reserve Board, any such note secured by an Adjusted Service Certificate 
and held by a bank is made eligible for discount or rediscount by the 
Federal reserve bank of the Federal reserve district in which such bank 
is located, whether or not the bank offering the note for discount or 
rediscount is a member of the Federal Reserve System and whether or not 
it acquired the note in the first instance from the veteran or acquired 
it by transfer upon the endorsement of any other bank: Provided, That at 
the time of discount or rediscount such note has a maturity not in 
excess of 9 months, exclusive of days of grace, and complies in all 
other respects with the provisions of the law, the regulations of the 
Federal Reserve Board and the regulations in this part.



Sec.  11.83  Additional loans by reason of 50 percent loan value.

    (a) It will be the policy of the Department of Veterans Affairs to 
redeem all loans made in accordance with the law and regulations made 
pursuant thereto, when such loans are made in good faith to the veteran 
to whom the certificate was issued. If, while his certificate is held by 
a bank as security for a loan, the veteran applies for the increased 
loan value authorized by the amendment to the World War Adjusted 
Compensation Act dated February 27, 1931, whether or not the loan has 
matured, the veteran and the bank will be informed fully of the 
provisions of this section and that the bank may make

[[Page 596]]

the loan for the additional amount or, upon request of the veteran, may 
send the note and certificate to the Secretary of Veterans' Affairs. The 
Secretary shall, if the loan was legally made, accept such certificate 
and note, and pay to the bank in full satisfaction of its claim the 
amount of the unpaid principal due it and the unpaid interest at the 
rate authorized by the World War Adjusted Compensation Act, as amended, 
up to the date of the check issued to the bank. If the veteran has not 
filed application for final settlement of his adjusted service 
certificate under the provisions of the Adjusted Compensation Payment 
Act, 1936, and demand is made upon the bank to present the note and 
certificate for redemption prior to the maturity date of the loan and 
during the lifetime of the veteran, interest will be payable up to the 
date the check is issued to the bank, or, if demanded by the bank, up to 
the maturity date of the loan.
    (b) If, however, an application for final settlement is filed and 
the bank is notified to present the note and certificate to the 
Secretary and does so within 15 days after the mailing of such notice 
interest will be payable to the date the check is issued to the bank. If 
the bank fails to forward the note and certificate within 15 days after 
the mailing of the notice, interest shall be paid only up to the 
fifteenth day after the mailing of such notice.



Sec.  11.84  Redemption because of veteran's death.

    If the veteran dies before the maturity of the loan, the amount of 
the unpaid principal and the unpaid interest shall be immediately due 
and payable. In such case, or if the veteran dies on the day the loan 
matures or within six months thereafter, the bank holding the note and 
certificate shall, upon notice of the death, present them to the 
Secretary, who shall pay to the bank, in full satisfaction of its claim 
the amount of the unpaid principal and unpaid interest, at the rate 
authorized by the World War Adjusted Compensation Act, as amended, 
accrued up to the date of the check issued to the bank; except that if, 
prior to the payment, the bank is notified of the death by the Secretary 
and fails to present the certificate and note to the Secretary within 15 
days after the notice such interest shall be paid only up to the 
fifteenth day after such notice.



Sec.  11.85  Condition requisite for redemption.

    In order to be eligible for redemption by the Department of Veterans 
Affairs, the note and certificate must be accompanied by an affidavit of 
a duly authorized officer (the capacity in which the officer serves must 
be shown) of the lending bank showing that the said bank has not charged 
or collected, or attempted to charge or collect, directly or indirectly, 
any fee or other compensation in respect of the loan, or any other loan 
made by the bank under the provisions of section 502 of the World War 
Adjusted Compensation Act, except the rate of interest specified in the 
section of the Act cited; that the person who obtained the loan is known 
to the lending bank to be the person named in the Adjusted Service 
Certificate; and that notice required by Sec.  11.77 was promptly given. 
In case the note was sold or discounted by the lending bank, there 
should be incorporated in the affidavit a statement that the veteran was 
notified promptly of the transfer by mail to his last known address. In 
case the note was resold or rediscounted by any other bank, affidavit 
shall be made by a duly authorized officer of such bank that proper 
notice of such resale or rediscount was promptly mailed to the veteran 
at his last known address. The proper execution of the appropriate 
affidavit on Form 6615 or 6615a will be considered as a compliance with 
the requirements of this section. A single affidavit setting forth the 
full particulars may be accepted to cover any number of veterans' notes 
submitted for redemption at one time. The affidavit must be executed 
before a judge of the United States court, a United States commissioner, 
a United States district attorney, a United States marshal, a collector 
of internal revenue, a collector of customs, a United States postmaster, 
a clerk of court of record under the seal of the court, an executive 
officer of an incorporated bank or trust company, under his official 
designation and the seal of the bank or trust company, or a notary

[[Page 597]]

public under his seal, or a diplomatic or consular officer of the United 
States, under his official seal.

  Disposition of Notes Secured by Adjusted Certificates Redeemed from 
  Banks by the Department of Veterans Affairs Under Section 502 of the 
   World War Adjusted Compensation Act, as Amended (Pub. L. 120, 68th 
                                 Cong.)

    Source: 13 FR 7126, Nov. 27, 1948, unless otherwise noted.



Sec.  11.88  Cancellation of note.

    When a veteran's note is redeemed by the Department of Veterans 
Affairs, the note will be canceled and both the note and certificate 
will be retained in the files of the Department of Veterans Affairs 
until such time as settlement is made.



Sec.  11.89  Notification of veteran.

    When a note is redeemed notification will be sent to the veteran at 
his last known address, advising him that the Department of Veterans 
Affairs holds his note, and outlining the conditions governing 
repayment.



Sec.  11.91  Repayment of loans.

    Should the veteran so desire, he may repay the amount due on his 
note in full or in installments.



Sec.  11.93  Failure to redeem.

    (a) If the veteran fails to redeem his certificate before its 
maturity there will be deducted from the face value of the certificate 
the amount of the unpaid principal of the note of the veteran and the 
unpaid interest thereon through September 30, 1931.
    (b) If the veteran failed to redeem his certificate and died prior 
to January 27, 1936, there will be deducted from the face value of the 
certificate the amount of the unpaid principal of the veteran's note and 
the unpaid interest thereon to the date of his death. If the veteran 
died on or after January 27, 1936, the amount to be deducted when making 
settlement will be the unpaid principal of the veteran's note and the 
unpaid interest thereon through September 30, 1931.

 Department of Veterans Affairs Loans on Adjusted Service Certificates 
Under Section 502 of the World War Adjusted Compensation Act, as Amended

    Source: 13 FR 7126, Nov. 27, 1948, unless otherwise noted.



Sec.  11.96  By whom loans may be made.

    Loans will be made by the Department of Veterans Affairs, 
Washington, DC, to any veteran, upon his promissory note secured by his 
adjusted service certificate, in any amount in even dollars not less 
than $10 and not in excess of the loan value of the certificate at the 
date the loan is made. Each certificate contains on its face a table for 
determining the loan value of the certificate but at no time is the loan 
value less than fifty per centum of the face value.



Sec.  11.99  Identification.

    Before a loan is made on an adjusted service certificate, the person 
applying therefor will be identified as the person entitled to the 
certificate offered as security. Such identification will be made in 
accordance with Sec.  11.114.

[19 FR 5086, Aug. 12, 1954]



Sec.  11.100  Form of note.

    The form of note used in making loans secured by adjusted service 
certificates shall follow Form 1185.



Sec.  11.102  Term of note.

    All loans will be for a period of one year and if not paid will be 
automatically extended from year to year for periods of one year in the 
amount of the principal plus interest accrued to the end of the 
immediately preceding expired loan year, which total amount shall 
automatically become a new principal each year provided a loan may be 
paid off at any time by the payment of principal and accrued interest, 
but in no event will interest accruing after September 30, 1931, be 
deducted in final settlement of a certificate except as provided in 
Sec.  11.93(b).

[[Page 598]]



Sec.  11.104  Disposition of notes and certificates.

    All notes and certificates shall be held in the custody of the 
Department of Veterans Affairs, Washington, DC 20420.

[13 FR 7126, Nov. 27, 1948, as amended at 54 FR 34982, Aug. 23, 1989]

   Application for Payment of Adjusted Service Certificate Under the 
    Adjusted Compensation Payment Act, 1936 (Pub. L. 425, 74th Cong.)



Sec.  11.109  Settlement of unmatured adjusted service certificates.

    Where an application for final settlement of an adjusted service 
certificate is received in the Department of Veterans Affairs prior to 
the maturity date of the certificate, payment will be made under the 
terms of the Adjusted Compensation Payment Act, 1936. This act provides 
for payment of the amount due on the certificate, after deducting any 
unpaid loans with interest through September 30, 1931, in adjusted 
service bonds. These bonds will be issued by the Treasury Department in 
denominations of $50, in the name of the veteran only, and will bear 
interest at the rate of 3 percent per annum from June 15, 1936, to June 
15, 1945. Any excess amount not sufficient to purchase a $50 bond will 
be paid by check.

[19 FR 5087, Aug. 12, 1954]



Sec.  11.110  Who may make application for final settlement.

    A mentally competent veteran to whom an adjusted service certificate 
has been issued.
    (a) A legally appointed guardian of an incompetent veteran. An 
application submitted by a legally appointed guardian must be 
accompanied by letters of guardianship showing the fiduciary 
relationship, provided such papers are not already on file in the 
Department of Veterans Affairs.
    (b) A representative of a physically incapacitated veteran. Where 
application is made by a representative of a physically incapacitated 
veteran, the representative must attach a statement describing the 
veteran's incapacity. The correctness of such statement must be 
certified by an officer as designated in Sec.  11.114.
    (c) A superintendent or other bonded officer designated by the 
Secretary of the Interior to receive funds under the provision of Pub. 
L. No. 373, 72d Congress, may make application for an incompetent adult 
or minor Indian who is a recognized ward of the Government. The 
application must be accompanied by a certification from the 
superintendent or other bonded officer showing: (1) That the said 
beneficiary is a ward of the Government; (2) that no guardian or other 
fiduciary has been appointed; (3) that the officer making application 
has been designated by the Secretary of the Interior in accordance with 
Pub. L. No. 373, 72d Congress; (4) that he is properly bonded; and (5) 
that he will receive, handle, and account for such benefits in 
accordance with existing law and regulations of the Department of 
Interior.
    (d) A manager of a Department of Veterans Affairs hospital, or a 
manager or superintendent of a contract hospital or State institution 
where the veteran is a patient may make application as custodian for the 
veteran. Such application must be made with the approval of the regional 
chief attorney.

[19 FR 5087, Aug. 12, 1954]



Sec.  11.111  Form of application.

    Application must be made on Department of Veterans Affairs Adjusted 
Compensation Form 1701.

[13 FR 7127, Nov. 27, 1948]



Sec.  11.114  Identification.

    Before settlement is made on an adjusted service certificate, the 
person applying therefor will be identified as the person entitled to 
the settlement for which an application is made. If made in the United 
States or possessions, certification will be accepted if made by a 
United States postmaster or assistant postmaster over an impression of 
the post office cancellation stamp; a commissioned officer of the 
regular establishment of the Army, Navy, or Marine Corps; a member of 
the United States Senate or the House of Representatives; an officer, 
over his official title, of a post, chapter, or

[[Page 599]]

other comparable unit of an organization recognized under Veterans 
Regulation No. 10 (38 U.S.C. ch. 12A), or an officer over his official 
title, of the State or national body of such organization, or any person 
who is legally authorized to administer oaths in a State, Territory, 
possession, District of Columbia, or in a Federal judicial district, of 
the United States. If identification is made in a foreign country, it 
will be certified by an American consul, a recognized representative of 
an American Embassy or Legation, or by a person authorized to administer 
oaths under the laws of the place where identification is made; 
provided, there be attached to the certificate of such latter officer a 
proper certification by an accredited official of the State Department 
of the United States that such officer was authorized to administer 
oaths in the place where certification was made. A manager of a 
Department of Veterans Affairs hospital is authorized to identify 
patients, members, or employees of the hospital over which he has 
charge. An employee of the Department of Veterans Affairs who has been 
specifically designated in writing to do so may identify applicants 
during official hours and on the premises of the Department of Veterans 
Affairs using for this purpose, if necessary, the official records of 
the Department of Veterans Affairs. Field station finance employees may 
not be designated for this purpose.
    (a) Fingerprint impressions shall be required on the application and 
shall be imprinted thereon in the presence of the persons identifying 
the veteran. In the case of veterans who are mentally incapacitated and 
application is being executed by a representative of the veteran, the 
veterans' fingerprints will be obtained if possible. If this cannot be 
done, as also in the case of an individual whose fingers are all 
missing, a statement of explanation will be required.
    (b) [Reserved]

[13 FR 7127, Nov. 27, 1948, as amended at 19 FR 5087, Aug. 12, 1954]



Sec.  11.115  Where to file application.

    The application for final settlement, accompanied by the veteran's 
adjusted service certificate, unless the certificate is being held in 
the Department of Veterans Affairs as collateral for a loan, must be 
forwarded to the Manager, Veterans Benefits Office, Washington, DC 
20421.

[19 FR 5087, Aug. 12, 1954]



Sec.  11.116  Death of veteran before final settlement.

    If the veteran dies after making application under the Adjusted 
Compensation Payment Act, 1936, but before it is filed, it may be filed 
by any person and will be considered valid if found to bear the bona-
fide signature of the applicant, discloses an intention to claim 
benefits under the Act, and is filed before the maturity of the 
certificate and before payment is made to the beneficiary. An 
application made by the veteran or his legal representative shall 
evidence his intention to claim the benefits of this Act; no other 
evidence shall be acceptable.
    (a) If the veteran's death occurs after the application is filed but 
before payment is received under this Act, or if the application is 
filed after death occurs but before the maturity of the certificate and 
before payment is made to the beneficiary under section 501 of the World 
War Adjusted Compensation Act, as amended, payment under this act shall 
be made to the estate of the veteran irrespective of any beneficiary 
designation.
    (b) If the veteran dies without filing a valid application under 
this Act, no payment under this Act shall be made. In such case, payment 
of the certificate will be made under the World War Adjusted 
Compensation Act, as amended, in accordance with Sec.  11.128; however, 
in making any settlement there shall be deducted from the face value of 
the certificate the amount of any outstanding loans and so much of the 
unpaid interest as accrued prior to October 1, 1931.

[19 FR 5087, Aug. 12, 1954]



Sec.  11.117  Missing applications.

    Where the records of the Department of Veterans Affairs show that an 
application, disclosing an intention to claim the benefits of this Act, 
has been filed and the application cannot be found, such application 
shall be presumed, in

[[Page 600]]

the absence of affirmative evidence to the contrary, to have been valid 
when originally filed. The determination of the correctness of this 
assumption shall be made by the Manager, Veterans Benefits Office, 
Washington, DC, or his designee.

[19 FR 5087, Aug. 12, 1954]

Application for Payment of Adjusted Service Certificate Under the World 
   War Adjusted Compensation Act, as Amended (Pub. L. 120, 68th Cong.)

    Source: 19 FR 5087, Aug. 12, 1954, unless otherwise noted.



Sec.  11.125  Settlement of matured adjusted service certificates.

    Where an application for final settlement of an adjusted service 
certificate is received in the Department of Veterans Affairs subsequent 
to the date of maturity of the certificate, payment will be made under 
the terms of the World War Adjusted Compensation Act, as amended. This 
Act provides for payment of the face value of the certificate less any 
outstanding indebtedness for loans obtained on the certificate; however, 
interest accrued on the loans subsequent to September 30, 1931, and 
unpaid will be canceled insofar as the veteran is concerned.



Sec.  11.126  Form of application.

    Either demand for payment (Form 1748) of application (Form 1701) may 
be used by the veteran or his legal representative in applying for final 
settlement of a matured certificate.



Sec.  11.127  Identification.

    Before payment may be made on the adjusted service certificate, the 
person applying therefor will be identified as the person entitled to 
payment for which application is made. Such identification will be 
accepted if made by an authorized person as stated in Sec.  11.114; 
also, fingerprint impressions shall be placed in the space provided on 
the application in accordance with Sec.  11.114(a).



Sec.  11.128  Veteran dies without having filed application for final
settlement.

    If the veteran dies without having filed application for final 
settlement under the Adjusted Compensation Payment Act, 1936, and the 
certificate has not matured, payment will be made to the last designated 
beneficiary or, if no beneficiary, to his estate. If the certificate has 
matured, payment will be made to the veteran's estate regardless of any 
beneficiary designation. Payment of the amount due on a deceased 
veteran's certificate will be made only on an approved award based upon 
receipt in the Department of Veterans Affairs of an application properly 
executed by the person or persons entitled.



Sec.  11.129  Form of application for payment of deceased veteran's
certificate.

    Demand for payment (VA Form 8-582) is the proper form for use in 
applying for payment of the amount due on a deceased veteran's 
certificate.



Sec.  11.130  Where to file applications.

    Application for payment of a matured certificate or a deceased 
veteran's certificate, accompanied by the adjusted service certificate, 
unless it is held in the Department of Veterans Affairs as collateral 
for a loan, must be forwarded to the Manager, Veterans Benefits Office, 
Washington, DC, 20421.



PART 12_DISPOSITION OF VETERAN'S PERSONAL FUNDS AND EFFECTS-
-Table of Contents



  Disposition of Veteran's Personal Funds and Effects on Facility Upon 
 Death, or Discharge, or Unauthorized Absence, and of Funds and Effects 
                            Found on Facility

Sec.
12.0 Definitions.
12.1 Designee cases; competent veterans.
12.2 Designee cases; incompetent veterans.
12.3 Deceased veteran's cases.
12.4 Disposition of effects and funds to designee; exceptions.
12.5 Nondesignee cases.
12.6 Cases of living veterans.
12.7 Cases not applicable to provisions of Sec. Sec.  12.0 to 12.6.
12.8 Unclaimed effects of veterans.

[[Page 601]]

12.9 Rights of designate; sales instruction; transportation charges.
12.10 Proceeds of sale.
12.12 Miscellaneous provisions.
12.13 Posting of notice of the provisions of Pub. L. No. 734, 75th 
          Congress (38 U.S.C. 16-16j).

  Disposition of Personal Funds and Effects Left Upon Premises of the 
 Department of Veterans Affairs by Non-Veteran Patients, Employees and 
                     Other Persons, Known or Unknown

12.15 Inventory of property.
12.16 Action on inventory and funds.
12.17 Unclaimed effects to be sold.
12.18 Disposition of funds and effects left by officers and enlisted men 
          on the active list of the Army, Navy or Marine Corps of the 
          United States.

Under Pub. L. 382, 77th Congress, December 26, 1941, Amending the Act of 
                      June 25, 1910 (24 U.S.C. 136)

12.19 Provisions of Pub. L. 382 (38 U.S.C. 17-17j).
12.20 Posting of notice provisions of Pub. L. 382.
12.21 Action upon death of veteran.
12.22 Disposition of personal property.
12.23 Recognition of valid claim against the General Post Fund.

                   Operation of Lost and Found Service

12.24 Operation of lost and found service.

    Authority: 38 U.S.C. 501, 8501-8528.

  Disposition of Veteran's Personal Funds and Effects on Facility Upon 
 Death, or Discharge, or Unauthorized Absence, and of Funds and Effects 
                            Found on Facility



Sec.  12.0  Definitions.

    (a) As used in respect to the disposition of property of veterans 
dying at Department of Veterans Affairs medical centers or other field 
facilities, or who are discharged or who elope, or are absent without 
leave therefrom, and in respect to property found thereat, the term 
funds means all types of United States currency and coin, checks payable 
to the decedent except checks drawn on the Treasurer of the United 
States which have never been negotiated, and includes deposits to the 
credit of the veteran in the account ``Personal Funds of Patients,'' and 
each competent veteran will be so advised. The term effects means and 
embraces all other property of every description, including insurance 
policies, certificates of stock, bonds and notes the obligation of the 
United States or of others, and all other papers of every character 
except checks drawn on the Treasurer of the United States, as well as 
clothing, jewelry and other forms of property, or evidences of interest 
therein. Checks drawn on the Treasurer of the United States which have 
never been negotiated will be returned to the issuing office for 
disposition.
    (b) Field facilities as used in Sec. Sec.  12.1 to 12.13 includes 
hospitals, centers, domiciliary activities, supply depots, and other 
offices over which the Department of Veterans Affairs has direct and 
exclusive administrative jurisdiction, and excludes State, county, city, 
private, and contract hospitals and hospitals or other institutions 
operated by the United States through agencies other than the Department 
of Veterans Affairs. At institutions other than field facilities as 
herein defined funds or effects as defined in paragraph (a) of this 
section, except for funds derived from VA benefits and deposited by the 
Department of Veterans Affairs in the account Personal Funds of Patients 
for incompetent veterans, will be disposed of under the laws governing 
such institutions. In any case where the veteran died intestate without 
heirs or next of kin his or her personal property vests in the United 
States. Disposition of the property will be made in accordance with the 
provisions of Sec. Sec.  12.19 to 12.23.

[13 FR 7127, Nov. 27, 1948, as amended at 25 FR 1612, Feb. 25, 1960; 79 
FR 68129, Nov. 14, 2014]



Sec.  12.1  Designee cases; competent veterans.

    (a) Designees--general. (1) Upon admission to a VA field facility, 
VA will request and encourage a competent veteran to designate in 
writing, on the relevant VA form, an individual to whom VA will deliver 
the veteran's funds and effects in the event of the veteran's death in 
such VA field facility. The individual named by the veteran is referred 
to in this part as the designee.
    (2) The veteran may change or revoke a designation in writing, on 
the relevant VA form, at any time.

[[Page 602]]

    (3) If the veteran does not name a designee or if a designee is 
unable or unwilling to accept delivery of funds or effects, Sec.  12.5 
Nondesignee cases, applies.
    (4) The designee may not be a VA employee unless such employee is a 
member of the veteran's family. For purposes of this section, a family 
member includes the spouse, parent, child, step family member, extended 
family member or an individual who lives with the veteran but is not a 
member of the veteran's family.
    (5) To be effective, a completed form must be received by the 
facility head or facility designee prior to the veteran's death.
    (b) Delivery of funds and effects. The delivery of the veteran's 
funds or effects to the designee is only a delivery of possession. Such 
delivery of possession does not affect in any manner:
    (1) The title to such funds or effects; or
    (2) The person legally entitled to ownership of such funds or 
effects.
    (c) Veteran becomes incompetent. If a veteran is determined to be 
incompetent pursuant to an order of a state court or is determined to be 
unable to manage monetary VA benefits by a VA clinician after the 
veteran is admitted to a VA field facility, the VA field facility staff 
will contact the Veterans Benefits Administration for the application of 
38 CFR 3.353, regarding an incompetency rating as to whether the veteran 
is able to manage monetary VA benefits, and, if appropriate, 38 CFR 
13.55, regarding VA fiduciary appointments. If the Veterans Benefits 
Administration determines that a veteran is incompetent to manage 
monetary VA benefits, any designation by the veteran under paragraph (a) 
of this section will cease with respect to VA benefits that are 
deposited by VA into the Personal Funds of Patients. The veteran's 
designation will not change with respect to disposition of funds and 
personal effects derived from non-VA sources, unless a court-appointed 
guardian or conservator changes or revokes the existing designation.
    (d) Retention of funds and effects by a veteran. Upon admission to a 
VA field facility, VA will encourage a competent veteran to:
    (1) Place articles of little or no use to the veteran during the 
period of care in the custody of a family member or friend; and
    (2) Retain only such funds and effects that are actually required 
and necessary for the veteran's immediate convenience.
    (The information collection is pending Office of Management and 
Budget approval.)

(Authority: 38 U.S.C. 8502)

(The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-0817

[79 FR 68129, Nov. 14, 2014]



Sec.  12.2  Designee cases; incompetent veterans.

    (a) An incompetent veteran will not be informed concerning the 
designation of a person to receive funds or effects; but if he or she 
has a guardian the guardian will be requested to make such designation 
of himself or herself or another person to receive possession of the 
funds and effects (other than funds deposited by VA in Personal Funds of 
Patients that were derived from VA benefits) upon the incompetent's 
death. The guardian will sign the letter designating himself or herself 
or another person with the veteran's name ``By _____, guardian of his or 
her estate''.
    (b) No effort will be made to obtain a designation by or on behalf 
of an incompetent veteran who has no guardian.

[13 FR 7128, Nov. 27, 1948, as amended at 25 FR 1613, Feb. 25, 1960; 79 
FR 68129, Nov. 14, 2014]



Sec.  12.3  Deceased veteran's cases.

    (a) Immediately upon the death or the absence without leave of any 
beneficiary at a field facility, as defined in Sec.  12.0(b), a survey 
and inventory of the funds and effects of such beneficiary will be taken 
in the following manner:
    (1) If the death or absence without leave occurred during 
hospitalization, a complete inventory (VA Form 10-2687, Inventory of 
Funds and Effects)

[[Page 603]]

will be made of all personal effects (including those in the custody of 
the hospital, jewelry being worn by the deceased person, or jewelry and 
other effects in pockets of clothing he or she may have been wearing) 
and all funds found and moneys on deposit in Personal Funds of Patients. 
In the case of death of incompetent veterans after November 30, 1959, 
the inventory will be completed to show separately those funds deposited 
by VA in Personal Funds of Patients that were derived from VA benefits. 
For purpose of determining the source of funds, expenditures from the 
account will be considered as having been made from VA benefits, not to 
exceed the extent of deposits of such benefits. In the event death 
occurred during other than official working hours, the officer of the 
day and/or a representative of Nursing Service will collect and 
inventory all funds and personal effects on the person of the deceased 
beneficiary and on the ward, will carefully safeguard such property and, 
upon completion of the tour of duty, will turn the funds and effects 
over to the properly designated employees.
    (2) If the death or absence without leave occurred while the 
beneficiary was assigned to a domiciliary section, or while receiving 
hospitalization and at time of death or absence without leave any 
effects are in the section, a like inventory will be made by 
representatives of the Chief, Domiciliary Operations and/or Medical 
Administration Division.
    (3) The inventory report will be executed in triplicate, original 
and two copies. All will be signed by the employee making the inventory, 
and disposed of as provided for in pertinent procedural instructions.
    (4) Personally owned clothing or other effects (such as tooth 
brushes, false teeth not containing gold, etc.), which are unserviceable 
by reason of wear or tear or insanitary condition, and clothing that had 
been supplied by the Government, will not be included in this inventory; 
instead, the unserviceable personally owned articles will be listed on a 
separate list, with their condition briefly described, and their 
disposition recommended in a separate report to the facility head. The 
facility head, if approving this recommendation, will order destruction 
or utilization in occupational therapy, or as wipe rags, etc., of such 
unserviceable articles and, when they are so destroyed or utilized, will 
have entered on the papers the date and nature of the disposition. The 
completed papers will then be placed in the correspondence file of the 
beneficiary. Clothing that had been supplied by the Government will be 
reconditioned if possible and returned to stock for issue to other 
eligible beneficiaries. When Government-owned clothing cannot be 
reconditioned it will be disposed of.
    (5) When the nearest relative requests that the deceased beneficiary 
be clad for burial in clothing he or she personally owned, instead of 
burial clothing to be supplied under the contract for mortuary services, 
such request will be honored. A receipt in such cases will be obtained 
from the undertaker, specifying the articles of clothing so used. 
Adjustment of the undertaker's bill in the case will correspondingly be 
made.
    (6) In accomplishing such inventories, detailed description will be 
given of items of material value or importance, for example:

Watch--Yellow metal (make, movement, and case number, if available 
without damage to watch).
Ring--Yellow metal (probably gold-plated or stamped 14-K., setting if 
any).
Discharge certificate.
Adjusted service certificate (number).
Bonds or stocks (name of company, registered or nonregistered, 
identifying number, recited par value, if any).
Bank books or other asset evidence (name of bank or other obligor, 
apparent value, identifying numbers, etc.).
Clothing (brief description and statement of condition). Etc.

    (b) Upon completion of the survey and inventory, the effects will be 
turned over to the designated employee for safekeeping. Any funds found 
in excess of $100 which apparently were the property of the deceased 
will be turned over to the details clerk and delivered immediately to 
the agent cashier, who shall deposit same in the account ``Personal 
Funds of Patients''. Unendorsed checks other than Treasury checks and 
funds not in excess of $100 will be considered personal effects

[[Page 604]]

and not funds and will be handled accordingly.

[13 FR 7128, Nov. 27, 1948, as amended at 25 FR 1613, Feb. 25, 1960; 29 
FR 17904, Dec. 17, 1964; 36 FR 5911, Mar. 31, 1971; 79 FR 68129, Nov. 
14, 2014]



Sec.  12.4  Disposition of effects and funds to designee; exceptions.

    (a) Upon authorization by the facility head or his or her designated 
representative, all funds, as defined in Sec.  12.0 (except funds 
deposited by VA in Personal Funds of Patients that were derived from VA 
benefits where the veteran was incompetent at time of death), and 
effects will be delivered or sent to the designee of the deceased 
veteran if request therefor be made after death and within 90 days 
following the mailing of notice to such designee (see Sec.  12.9(a)), 
unless:
    (1) The executor or administrator of the estate of the deceased 
veteran shall have notified the facility head or his or her designated 
representative of his or her desire and readiness to receive such funds 
or effects, in which event the facility head or his or her designated 
representative will authorize delivery of all funds and effects to such 
executor or administrator upon receipt of appropriate documentary 
evidence of his or her qualifications and in exchange for appropriate 
receipts, or
    (2) An heir capable of inheriting the personal property of the 
veteran makes claim for the funds and effects prior to delivery to the 
designee.
    (3) Subsequent to the naming of a designee the veteran became 
incompetent and his or her guardian revoked such designation, in which 
event the facility head or his or her designated representative will 
deliver all funds and effects to his guardian in exchange for 
appropriate receipts subject to the limitation contained in paragraph 
(d) of this section, or
    (4) Designee was the wife (or husband) of the veteran at the time of 
designation, and information at the disposal of the field facility 
indicates that she (or he) was thereafter divorced and the veteran was 
incompetent at or subsequent to the time of divorce, or
    (5) Notwithstanding there is a designee, it is probable that title 
would pass to the United States under the provisions of Sec. Sec.  12.19 
to 12.23 issued pursuant to 38 U.S.C. 5502(e) and 38 U.S.C. 8520(a), or
    (6) The facility head or his or her designated representative 
determines that there is reasonable ground to believe that the transfer 
of such possession to the designee probably would be contrary to the 
interests of the person legally entitled to the personal property, or 
there are any other special circumstances raising a serious doubt as to 
the propriety of such delivery to the designee.

In any case in which the facility head does not deliver the funds and 
effects, because of the provisions of paragraphs (a)(3), (4), and (5) of 
this section, he or she will develop all facts and refer the matter to 
the Chief Attorney of the regional office having jurisdiction over the 
area where the hospital is located, for advice as to the disposition 
which legally should be made of such funds and effects.
    (b) When authorized by the facility head or his or her designated 
representative, the effects will be delivered or shipped to the 
designee. If shipped at Government expense, the shipment shall be made 
in the most economical manner but in no case at a cost in excess of $25. 
If such expenses will exceed $25, the excess amount shall be paid by the 
consignee to the facility head in advance. There will be no obligation 
on the Government, initially or otherwise, to pay such expenses in 
excess of $25.
    (c) When possession of funds or effects is transferred to a 
designee, the attention of the designee will again be directed to the 
fact that possession only has been transferred to him or her and that 
such transfer does not of itself affect title thereto and that such 
designee will be accountable to the owner of said funds and effects 
under applicable laws.
    (d) Upon receipt from the proper Chief Attorney of an appropriate 
certification that the guardianship was in full force and effect at the 
time of the veteran's death and that the guardian's bond is adequate, 
funds (other than funds deposited by VA in Personal Funds of Patients 
that were derived

[[Page 605]]

from VA benefits) and effects of an incompetent veteran may be 
immediately delivered or sent to such guardian, inasmuch as the guardian 
had a right to possession, and he or she will be accountable therefor to 
the party entitled to receive the decedent's estate. If, however, it 
appears probable that decedent died without a valid will and left no 
person surviving entitled to inherit, the funds will not be paid to the 
former guardian but will be disposed of as provided in Sec.  12.19(a). 
The effects will be sold, used, or destroyed, at the discretion of the 
facility head or his designated representative.

[25 FR 1613, Feb. 25, 1960, as amended at 29 FR 17904, Dec. 17, 1964; 79 
FR 68129, Nov. 14, 2014]



Sec.  12.5  Nondesignee cases.

    (a) If there exists no designee at the time of death at a hospital, 
domiciliary, or regional office of a veteran admitted as competent, or 
the designee fails or refuses to claim the funds and effects as defined 
in Sec.  12.0(a) within 90 days following the mailing of notice to such 
designee, the facility head will take appropriate action to dispose of 
the effects to the person or persons legally entitled thereto, i.e., the 
executor or administrator of the decedent, or, if no notice of such an 
appointment has been received, to the decedent's widow, child, 
grandchild, mother, father, grandmother, grandfather, brother, or 
sister, in the order named. Subject to the applicable provisions of 
Sec. Sec.  12.3 and 12.4, such delivery may be made at any time before 
the sale contemplated by Sec.  12.9 to the designee or other person 
entitled under the facts of the case. Delivery will be made to the 
person entitled to priority as prescribed in this paragraph, unless such 
person waives right to possession, in which event delivery will be to 
the person, if any, in whose favor such prior entitled person waives 
right to possession. If the waiver is not in favor of a particular 
person or class, delivery will be to the person or persons next in order 
of priority under this paragraph. If in any case there be more than one 
person in the class entitled to priority, initially or by reason of 
waiver, delivery will be made only to their joint designated agent (who 
may, but need not, be one of the class), or to one of such class in his 
or her own behalf upon written waiver of all others of the class 
entitled thereto. The guardian of a minor or incompetent may waive his 
or her ward's prior right to possession.
    (b) Except where delivery is made to a designee, executor, or 
administrator, funds of veterans who were competent at time of death 
will be released to the person or persons who would ultimately be 
entitled to distribution under the laws of the State of the decedent's 
domicile. The person or persons entitled may waive in writing his or her 
right to the funds in favor of another heir or next of kin.
    (c) Funds of veterans who were incompetent at time of death 
occurring after November 30, 1959, if derived from sources other than 
funds deposited by VA in Personal Funds of Patients that were derived 
from VA benefits, will be disposed of in the same manner as for 
competent veterans.
    (d) Funds deposited by the Department of Veterans Affairs in 
Personal Funds of Patients, at any office, for veterans who were 
incompetent at time of death occurring after November 30, 1959 and which 
were derived from VA benefits, will be paid upon receipt of proper 
application to the following persons living at the time of settlement, 
and in the order named: the surviving spouse, the children (without 
regard to age or marital status) in equal parts, and the dependent 
parents of such veteran, in equal parts. Any funds derived from VA 
benefits not disposed of in accordance with this paragraph shall be 
deposited to the credit of the applicable current appropriation; except 
that there may be paid only so much of such funds as may be necessary to 
reimburse a person (other than a political subdivision of the United 
States) who bore the expenses of last sickness or burial of the veteran 
for such expenses.
    (e) No payment shall be made under paragraph (d) of this section 
unless claim therefor is filed with the Department of Veterans Affairs 
within 5 years after the death of the veteran, except that, if any 
person so entitled under such regulation is under legal disability at 
the time of death of the veteran, such 5-year period of limitation

[[Page 606]]

shall run from the termination or removal of the legal disability.

[18 FR 1854, Apr. 3, 1953 and 25 FR 1614, Feb. 25, 1960, as amended at 
29 FR 17904, Dec. 17, 1964; 79 FR 68129, Nov. 14, 2014]



Sec.  12.6  Cases of living veterans.

    (a) Except as provided in Sec.  12.8, effects of veterans absent 
without leave or who have been discharged or have eloped (and who are 
not to be returned to the field facility) will be disposed of as 
follows:
    (1) To the owner if competent, or if deceased to his or her 
administrator or executor or as directed in writing by such owner, or 
his or her executor or administrator.
    (2) To the guardian of the owner if the latter be incompetent, or if 
deceased to his or her administrator or executor, or as directed in 
writing by such guardian, executor or administrator.
    (3) To the incompetent owner if he or she has no guardian; delivery, 
however, to the incompetent owner may be withheld and may be made to the 
person who is caring for such incompetent if, in the judgment of the 
facility head or his or her designated representative, such delivery is 
to the incompetent's best interest.

    Note: The Government will not pay expense of transportation of 
effects of competent or incompetent veterans discharged, on trail visit, 
absent without leave, or who have eloped, except that personal effects 
of a beneficiary discharged or on trail visit, or of a beneficiary being 
transferred to another facility at Government expense, which are not 
available at time of discharge, beginning of trail visit, or transfer of 
the beneficiary, due to the articles being in custody of the Government, 
may be shipped at Government expense.

    (b) Funds of veterans absent without leave or who have been 
discharged or have eloped (and who are not to be returned to the 
station) will be disposed of in accordance with the provisions of 
current Department of Veterans Affairs procedures.

[13 FR 7129, Nov. 27, 1948, as amended at 17 FR 1687, Feb. 26, 1952; 19 
FR 9330, Dec. 30, 1954; 29 FR 17904, Dec. 17, 1964]



Sec.  12.7  Cases not applicable to provisions of Sec. Sec.  12.0 to 12.6.

    The provisions of Sec. Sec.  12.0 to 12.6 shall be inapplicable to 
property known to be that of any person dying in or discharged or absent 
without leave from a Department of Veterans Affairs field facility other 
than a veteran admitted as such to such field facility.

[13 FR 7129, Nov. 27, 1948]



Sec.  12.8  Unclaimed effects of veterans.

    (a) In the case of any property of a veteran who was in receipt of 
hospital or domiciliary care, heretofore or hereafter left at a 
Department of Veterans Affairs field facility, the owner of which is 
discharged or absent without leave or who has eloped and is not to be 
returned to a Department of Veterans Affairs field facility, or has died 
after departure therefrom, or in case the whereabouts or identity of any 
owner of any property thereat be unknown, such property, unless it shall 
be disposed of under the provisions of Sec. Sec.  12.4 and 12.6 shall be 
sold, used, destroyed or otherwise disposed of as the manager or his or 
her designated representative shall determine the circumstances in the 
case may warrant. Any sale of such property shall be conditioned upon 
the 90-day notice provided in section 6 of the Act of June 25, 1938 (38 
U.S.C. 5-16e).
    (b) If the circumstances are such that retention of any property as 
is mentioned in paragraph (a) of this section, or of any property of 
unknown ownership found on the premises would endanger the health or 
life of patients or others on the premises (by reason of contagion, 
infection, or otherwise) such property shall be forthwith destroyed on 
order of the manager or his or her designated representative, and proper 
record of the action taken will be made.
    (c) If there be no known claimant of any such property and if it may 
be used at the field facility for the benefit of the members or patients 
for such purposes as the General Post Fund is intended to serve, and if 
the value is inconsequential, the manager or his or her designated 
representative may authorize the retention and use of such property at 
the field facility.

[[Page 607]]

    (d) Any such property which is not destroyed or used as provided in 
paragraphs (b) and (c) of this section shall be sold in the manner 
provided in Sec. Sec.  12.9 and 12.10, after notice as therein provided 
unless, prior to sale, claim be made for any such property by someone 
legally entitled thereto.

[13 FR 7129, Nov. 27, 1948]



Sec.  12.9  Rights of designate; sales instruction; transportation charges.

    (a) Upon death of a veteran admitted as such to a field facility, 
the Manager or his or her designated representative will cause notice 
(parts I and V of VA Form 10-1171) to be sent to the designate: 
Provided, however, That if the Manager or his or her designated 
representative has information of the death of the primary designate, 
notice shall be sent to the alternate designate and all of the 
provisions of the regulations in this part respecting the designate will 
be deemed to apply to the alternate. If the designate is a minor or a 
person known to be incompetent, delivery of the funds or effects will be 
made only to the designate's guardian or custodian upon qualification. 
The right of the designate to receive possession ceases when he or she 
refuses to accept delivery or if he or she fails to respond within 90 
days after VA Form 10-1171 was mailed. When the right of a designate 
ceases, VA Form 10-1171 will be forwarded immediately to the alternate 
designate, whose rights then become identical with those forfeited by 
the first designate, and the rights of the alternate designate shall 
terminate at the expiration of 90 days after VA Form 10-1171 was mailed 
to him or her. Delivery will not be made to a designate until he or she 
submits a signed statement to the effect that he or she understands that 
the delivery of such funds and effects constitutes a delivery of 
possession only and that such delivery is not intended to affect in any 
manner the title thereto. Such notice shall fully identify the decedent 
and state the fact that he or she designated the addressee to receive 
possession of such property; that the right to receive possession 
thereof does not affect the ownership but that the designate will be 
responsible for the ultimate disposition thereof to those who, under 
applicable law, are entitled to the decedent's property; and will 
request prompt advice as to whether the designate will accept such 
property and that, if he or she will, he or she furnish shipping 
instructions, upon receipt of which the property will be shipped at the 
expense of the Government. However, prior to dispatching such notice, it 
will be definitely determined that the shipping expense will not exceed 
$25. If such expense will exceed $25, the excess cost will be 
ascertained, and the notice will include a statement of the amount of 
such excess shipping cost with request that the amount thereof be 
remitted at the time shipping instructions are furnished. In estimating 
the shipping expense, it will be assumed that shipment to the designate 
will be to the same address as that to which the notice is sent. Each 
notice, however, shall contain a statement that in no event will the 
Government pay shipping expense in excess of $25. The notice will 
include a copy of the inventory of the property which it is proposed to 
deliver to the designate.
    (b) Upon receipt of appropriate shipping instructions the property 
will be shipped, transportation charges prepaid, by mail, express, or 
freight as may be appropriate under the circumstances and most 
economical to the Government. The expense of such shipment, chargeable 
to the Government, in no case to exceed $25.00, is payable the same as 
other administrative expenses of the Department of Veterans Affairs.
    (c) The living owner of any property left or found at a field 
facility will be promptly notified thereof. Except as provided in Sec.  
12.6(a), transportation charges on property shipped to a living veteran 
will not be paid by the Government. In such cases, shipment shall be 
made as requested by the owner of the property (or his or her guardian) 
upon receipt of necessary transportation charges, which will be prepaid, 
unless the owner requests shipment with charges collect and the carrier 
will accept such shipment without liability for such charges, contingent 
or otherwise, upon the Government.
    (d) If the designate refuses or, upon the lapse of 90 days, has 
failed to take

[[Page 608]]

possession or request shipment of decedent's property (paragraph (a) of 
this section), or if 90 days have elapsed after the finding of any 
property and the owner (known or unknown) has failed to request same, 
the manager or his or her designated representative will authorize 
destruction, use or sale.
    (e) If sale of the property is authorized the manager will take 
necessary action to ascertain the names and addresses, of the owners; 
or, in the event of the owner's decease, of his or her executor or 
administrator, widow, child, grandchild, mother, father, grandmother, 
grandfather, brother, or sister.
    (f) When in possession of the necessary information the manager will 
cause proper notice of sale (Form 4-1171) to be mailed. Such notice in 
all cases shall disclose the identity, if known, of the decedent whose 
property is to be sold and contain a copy of the inventory of such 
property. A copy of such notice (Form 4-1171), after parts I, IV, and V 
thereof are completed, shall be mailed to the owner, if known, or if 
deceased to the decedent's executor or administrator, if known, and also 
to the widow (or widower), child, grandchild, mother, father, 
grandmother, grandfather, brother and sister, if known. If more than one 
relative of the degree named is known, copy will be mailed to each. If 
the owner is living, parts IV and V only of Form 4-1171 will be 
completed.
    (g) Copy of such notice (Form 4-1171, parts IV and V) will also be 
posted by a responsible employee more than 21 years of age at:
    (1) The field facility where the death occurred or property shall 
have been found,
    (2) The place where property is situated at the time such notice is 
posted, and
    (3) The place where probate notices are posted in the county wherein 
the sale is to be had.
    (h) In addition to showing the name of the owner, if known (alive or 
deceased), and the inventory of the property to be sold, such notice 
shall state the hour and day when and the precise place where the sale 
will occur and that the same will be at public auction for cash upon 
delivery without warranty, express or implied, and that such sale is 
pursuant to the act of June 25, 1938 (38 U.S.C. 16-16j); and shall also 
state that any person legally entitled to said property may claim the 
same at any time prior to sale thereof and in the event of such claim by 
a proper person the property will not be sold but will be delivered to 
the person lawfully entitled thereto. Said notice shall also contain a 
statement substantially to the effect that if sold the net proceeds of 
sale may be claimed by the person who is legally entitled at any time 
within 5 years after the date of notice; or in case of property the 
ownership of which was not originally known, within 5 years after its 
finding; otherwise such proceeds will be retained in the General Post 
Fund, subject to disbursement for the purposes of such fund.
    (i) The person (or persons) posting said notice of sale (Form 4-
1171) shall make appropriate affidavit on a copy thereof as to his or 
her action in that respect and the manager or his or her designated 
representative will also certify on the same copy as to the persons to 
whom copies of such notice were mailed and the mailing dates. The copy 
on which appear the affidavit and certificate as to service of the 
notice will be retained in the facility file pertaining to the 
disposition of such property.

[13 FR 7129, Nov. 27, 1948, as amended at 15 FR 663, Feb. 7, 1950; 23 FR 
5, Jan. 1, 1958]



Sec.  12.10  Proceeds of sale.

    After proper notice as prescribed, sale of any such property which 
it is proper to sell, will be made by public auction by the manager (or 
any employee designated by him or her) at the time and place stated in 
the notice of sale. The property will be sold to the highest bidder (no 
employee except member employees of the Department of Veterans Affairs 
shall purchase any of this property) and forthwith delivered and the 
amount of the bid collected and deposited to the credit of ``General 
Post Fund, Department of Veterans Affairs.'' Care will be taken to 
segregate the property of each owner and separate account will be 
maintained as to the proceeds of sale thereof. Property not disposed of 
by public auction will be included in the next sale or will be used or 
destroyed

[[Page 609]]

as the value thereof warrants at the discretion of the manager.

[13 FR 7130, Nov. 27, 1948]



Sec.  12.12  Miscellaneous provisions.

    If it is shown that some person other than the veteran has title to 
property in a veteran's possession at the time of death, nothing 
contained in Sec. Sec.  12.0 to 12.12 shall be construed as prohibiting 
delivery of such property to the owner. A life insurance policy may be 
delivered to the beneficiary therein named if the insured is deceased, 
notwithstanding the veteran has designated a person to whom possession 
of his or her property at the field facility is to be transferred. In no 
case will funds or effects be delivered to a minor, or to an incompetent 
person other than as provided in Sec.  12.9 (a) and (c), but where any 
such person is entitled to title or possession delivery may be made to 
his or her guardian.

[13 FR 7130, Nov. 27, 1948]



Sec.  12.13  Posting of notice of the provisions of Pub. L. No. 734, 
75th Congress (38 U.S.C. 16-16j).

    In order that all persons who bring property on premises of the 
Department of Veterans Affairs may be advised of the existence of the 
act of June 25, 1938 (38 U.S.C. 16-16j), and that it affects such 
property, notice thereof (Form 4-1182), shall be permanently posted in 
at least one prominent place on the premises of each field facility 
where persons are likely to see such notice.

[13 FR 7130, Nov. 27, 1948]

  Disposition of Personal Funds and Effects Left Upon Premises of the 
 Department of Veterans Affairs By Non-Veteran Patients, Employees and 
                     Other Persons, Known or Unknown



Sec.  12.15  Inventory of property.

    Immediately upon the death at a Department of Veterans Affairs field 
facility of a person who was not admitted as a veteran, or immediately 
after it is ascertained that any such person has absented himself or 
herself from such field facility, a survey and inventory of the personal 
funds and effects of such deceased or absent person will be made in the 
manner prescribed in Sec.  12.3(a).

[13 FR 7130, Nov. 27, 1948]



Sec.  12.16  Action on inventory and funds.

    (a) The manager will dispose of the personal funds and effects as 
promptly as possible. No expense will be incurred by the Government for 
shipment of the effects.
    (b) In making disposition of funds and effects the manager will 
release the funds to the owner if living and will release the effects to 
him or her or as directed by him or her, provided that if he or she is 
incompetent and has a guardian the funds and effects will be released to 
such guardian. If the owner is deceased, and left a last will and 
testament probated under the laws of the place of his or her last legal 
domicile or under the laws of the State, territory, insular possession, 
or dependency, within which the field facility may be, the personal 
property of such decedent situated upon such premises will be released 
to the executor. If such person left on said premises funds or effects 
not disposed of by a will probated in accordance with the provisions of 
this paragraph, such property shall be released to the administrator, if 
one has been appointed.
    (c) In those cases where there is neither an administrator nor an 
executor the funds and effects will be released to the person entitled 
to inherit the personal property of the decedent under the intestacy 
laws of the State where the decedent was last domiciled.
    (d) Where disposition of the funds and effects cannot be 
accomplished under the provisions of paragraphs (b) and (c) of this 
section, the funds, at the expiration of 90 days will be deposited to 
the General Post Fund and the effects will be disposed of in accordance 
with the provisions of Sec. Sec.  12.8, 12.9, and 12.10.

[13 FR 7131, Nov. 27, 1948, as amended at 14 FR 4726, July 28, 1949]



Sec.  12.17  Unclaimed effects to be sold.

    (a) Personal effects of persons referred to in Sec.  12.15 which 
remain unclaimed for 90 days after the death or departure of the owner 
shall be sold in the manner provided by Sec.  12.8. The

[[Page 610]]

owner, his or her personal representative, or next of kin may reclaim 
any such property upon request therefor at any time prior to the sale.
    (b) Any unclaimed funds and the proceeds of any effects sold as 
unclaimed will be deposited to the General Post Fund subject to be 
reclaimed within five years after notice of sale, by or on behalf of any 
person or persons who, if known, would have been entitled to the 
property prior to the sale.

[13 FR 7131, Nov. 27, 1948, as amended at 14 FR 4726, July 28, 1949]



Sec.  12.18  Disposition of funds and effects left by officers and
enlisted men on the active list of the Army, Navy or Marine Corps of
the United States.

    (a) The manager will notify the commanding officer of the death or 
absence of such patient and will deliver to the commanding officer, 
without expense to the Department of Veterans Affairs, the funds and 
effects of the deceased or absent officer, or enlisted man procuring a 
receipt therefor.
    (b) If the funds and effects are not delivered to the commanding 
officer within seven days after the death or absence without leave of an 
officer, or enlisted man, the funds will be deposited in the Personal 
Funds of Patients. If not disposed of at the expiration of 90 days after 
the date of death or absence, the funds will be transferred to the 
General Post Fund and the effects will be handled in accordance with 
regulations governing the disposition of unclaimed effects left by 
veterans. The funds and the proceeds derived from the sale of the 
personal effects will be paid to the person lawfully entitled thereto, 
providing claim is made within five years from the date of notice of 
sale, or in the case of legal disability within five years after 
termination of legal disability.

[13 FR 7131, Nov. 27, 1948, as amended at 14 FR 4726, July 28, 1949]

Under Pub. L. 382, 77th Congress, December 26, 1941, Amending the Act of 
                      June 25, 1910 (24 U.S.C. 136)



Sec.  12.19  Provisions of Pub. L. 382 (38 U.S.C. 17-17j).

    (a) Whenever any veteran (admitted as a veteran) shall die in any 
Department of Veterans Affairs hospital, center, or domiciliary activity 
or in any Federal, State, or private hospital or other institution, 
while being furnished care or treatment therein by the Department of 
Veterans Affairs, without leaving a will and without leaving any spouse, 
heirs, or next of kin entitled to his or her personal property, all such 
property, except funds on deposit in Personal Funds of Patients to the 
credit of an incompetent beneficiary, derived from payments of 
compensation, automatic or term insurance, emergency officers' 
retirement pay or pension, shall immediately vest in and become the 
property of the United States as trustee for the sole use and benefit of 
the General Post Fund, subject to claim as elsewhere provided. Funds to 
the credit of an incompetent beneficiary derived from payments of 
compensation, automatic or term insurance, emergency officers' 
retirement pay or pension will be deposited to the credit of the current 
appropriations provided for the payment of compensation, insurance or 
pension.
    (b) Personal property as used in this section shall include cash, 
funds on deposit in Personal Funds of Patients, bank accounts, 
certificates of stock, bonds, and notes, the obligation of the United 
States or of others, money orders, checks, insurance policies the 
proceeds of which are payable to the veteran or his or her estate, 
postal savings certificates, money and choses in action, and all other 
papers of every character; also clothing, jewelry, and all other forms 
of personalty, or evidences of interest therein.

[19 FR 9330, Dec. 30, 1954]



Sec.  12.20  Posting of notice provisions of Pub. L. 382.

    (a) VA Form 10-P-10, Application for Hospital Treatment or 
Domiciliary Care, includes notice to the applicant that the acceptance 
of care or treatment by any veteran shall constitute acceptance of the 
provisions of the act. Similar notice shall be given to each veteran 
receiving care as of March 26, 1942, by posting notice in a prominent 
place in each building wherein patients or members are housed. Such 
notices shall be posted immediately and kept posted.

[[Page 611]]

    (b) Since the provisions of the law are applicable to all veterans 
receiving care at the expense of the Department of Veterans Affairs 
(whether in contract, Federal, State or private hospital) it shall be 
the responsibility of the Department of Veterans Affairs officer 
authorizing admission of a veteran to other than a Department of 
Veterans Affairs hospital, center or home, to cause the chief officer of 
such institution to post in a conspicuous place, in all buildings where 
veterans are housed, the provisions of Sec.  12.19(a), or if he or she 
declines to post such provisions, notify the patients individually and 
supply a statement from each acknowledging notice. Such provisions 
supersede in part the provisions of Form 10-P-10, executed prior to 
March 26, 1942.

[13 FR 7131, Nov. 27, 1948, as amended at 14 FR 243, Jan. 18, 1949]



Sec.  12.21  Action upon death of veteran.

    Upon the death of a veteran at a Department of Veterans Affairs 
hospital, center or domiciliary activity while receiving care or 
treatment therein, and who it is believed leaves no will or heirs or 
next of kin entitled to his or her personal property, regardless of 
whether VA Form 10-P-10, executed by the veteran, names a designee, an 
inventory of the funds and effects, VA Form 10-2687, will be promptly 
prepared and supplemented by all information or evidence available as to 
personal property owned by the veteran in addition to that left at the 
place of death; similar action will be taken when the death of such a 
veteran hospitalized by the Department of Veterans Affairs occurs at a 
contract hospital, Army, Navy, Marine or other hospital. Such 
inventories and information together with any bank books, stocks, bonds, 
or other valuable paper as enumerated in Sec.  12.19(b), left in the 
effects of the veteran, will be delivered to the manager of the 
Department of Veterans Affairs hospital, center, or domiciliary activity 
having jurisdiction, for disposition in accordance with existing 
regulations.

[14 FR 243, Jan. 18, 1949]



Sec.  12.22  Disposition of personal property.

    Any assets heretofore or hereafter accruing to the benefit of the 
General Post Fund, including stocks, bonds, checks, bank deposits, 
savings certificates, money orders, and similar assets, will be sold or 
otherwise converted into cash, except that articles of personal 
adornment which are obviously of sentimental value shall, if unclaimed, 
be retained for 5 years from the date of death of the veteran, unless 
for sanitary or other reasons their retention is deemed unsafe. 
Possession of effects other than those located on the premises of the 
Department of Veterans Affairs will be obtained, except that if 
transportation, storage, etc., is involved, determination will be made 
as to whether expenditure therefor is warranted. Proceeds from the 
conversion or sale will be deposited to the credit of the General Post 
Fund. Funds on deposit in Personal Funds of Patients will be transferred 
to the General Post Fund. Any claims against the estate of the deceased 
veteran will be adjudicated and paid, if valid.

[33 FR 1073, Jan. 27, 1968]



Sec.  12.23  Recognition of valid claim against the General Post Fund.

    Effective December 26, 1941, the assets of the estate of a veteran 
theretofore or thereafter deposited to the General Post Fund are subject 
to the valid claims of creditors presented to the Department of Veterans 
Affairs within 1 year from the date of death or otherwise as provided by 
any applicable law. Any heir, next of kin, legatee, or other person 
found to be legally entitled to the personal property of the veteran may 
claim same within 5 years from the date of the veteran's death. If 
claimant is under any legal disability (as a minor, incompetent, etc.) 
at the date of the veteran's death, the 5-year period begins upon the 
termination of removal of legal disability. Such claims are for 
settlement by the field facility which had originally made the deposit. 
In the event of doubt as to entitlement or the necessity of legal 
proceedings to obtain assets for the benefit of the General Post Fund, 
the case will be referred to the Chief Attorney

[[Page 612]]

of jurisdiction for advice and/or appropriate action. Any necessary 
court costs or expenses will be paid from the appropriation, General 
Operating Expenses, Department of Veterans Affairs.

[33 FR 1073, Jan. 27, 1968]

                   Operation of Lost and Found Service



Sec.  12.24  Operation of lost and found service.

    Unless maintained by the Public Buildings Service, the lost and 
found service will be maintained by an employee designated by the 
Manager to be known as the lost and found custodian. VA Form 3771, 
Record of Lost or Found Article, will be used for recording articles of 
any personal property lost or found. Every effort will be made to 
determine rightful ownership of found articles and to recover items 
which have been reported lost. Currency, including readily negotiable 
instruments, found and delivered to the lost and found custodian will 
not be retained beyond the official closing hour. The currency or 
negotiable instruments will be delivered to the agent cashier before the 
close of business. Individuals claiming found articles will furnish 
complete identification and satisfy the facility authority of rightful 
ownership. Where more than one individual claims ownership the matter 
will be referred to the Manager for decision. All articles of personal 
property remaining unclaimed for 90 days or more will be disposed of in 
accordance with Sec.  12.8.

[21 FR 3875, June 6, 1956]



PART 13_FIDUCIARY ACTIVITIES--Table of Contents



Sec.
13.10 Purpose and applicability of other regulations.
13.20 Definitions.
13.30 Beneficiary rights.
13.40 Representation of beneficiaries in the fiduciary program.
13.50 Suspension of benefits.
13.100 Fiduciary appointments.
13.110 Supervised direct payment.
13.120 Field examinations.
13.130 Bars to serving as a fiduciary.
13.140 Responsibilities of fiduciaries.
13.200 Fiduciary accounts.
13.210 Fiduciary investments.
13.220 Fiduciary fees.
13.230 Protection of beneficiary funds.
13.240 Funds of beneficiaries less than the age of majority.
13.250 Funds of deceased beneficiaries.
13.260 Personal funds of patients.
13.270 Creditors' claims.
13.280 Accountings.
13.300 Onsite reviews.
13.400 Misuse of benefits.
13.410 Reissuance and recoupment of misused benefits.
13.500 Removal of fiduciaries.
13.510 Fiduciary withdrawals.
13.600 Appeals.

    Authority: 38 U.S.C. 501, 5502, 5506-5510, 6101, 6106-6108, and as 
noted in specific sections.

    Source: 83 FR 32738, July 13, 2018, unless otherwise noted.



Sec.  13.10  Purpose and applicability of other regulations.

    (a) Purpose. The regulations in this part implement the Department 
of Veterans Affairs' (VA) fiduciary program, which is authorized by 38 
U.S.C. chapters 55 and 61. The purpose of the fiduciary program is to 
protect certain VA beneficiaries who, as a result of injury, disease, or 
infirmities of advanced age, or by reason of being less than the age of 
majority, cannot manage their VA benefits. Under this program, VA 
oversees these vulnerable beneficiaries to ensure their well-being, and 
appoints and oversees fiduciaries who manage these beneficiaries' 
benefits.
    (b) Applicability of other regulations. Fiduciary matters arise 
after VA has determined that a beneficiary is entitled to benefits, and 
decisions on fiduciary matters are not decisions on claims for VA 
monetary benefits. Accordingly, VA's regulations governing the 
adjudication of claims for benefits, see 38 CFR part 3, do not apply to 
fiduciary matters unless VA has prescribed applicability in this part.

(Authority: 38 U.S.C. 501)



Sec.  13.20  Definitions.

    The following definitions apply to this part:
    Dependent means a beneficiary's spouse as defined by this section, a 
beneficiary's child as defined by Sec.  3.57 of this chapter, or a 
beneficiary's parent as defined by Sec.  3.59 of this chapter, who does 
not have an income sufficient for reasonable maintenance and who

[[Page 613]]

obtains support for such maintenance from the beneficiary.
    Fiduciary means an individual or entity appointed by VA to receive 
VA benefits on behalf of a beneficiary for the use and benefit of the 
beneficiary and the beneficiary's dependents.
    Hub Manager means the individual who has authority to oversee the 
activities of a VA Fiduciary Hub or the Veterans Service Center Manager 
of the Manila, Philippines, VA Regional Office.
    In the fiduciary program means, with respect to a beneficiary, that 
the beneficiary:
    (1) Has been rated by VA as incapable of managing his or her own VA 
benefits as a result of injury, disease, or the infirmities of advanced 
age;
    (2) Has been determined by a court with jurisdiction as being unable 
to manage his or her own financial affairs; or
    (3) Is less than the age of majority.
    Rating authority means VA employees who have authority under Sec.  
3.353 of this chapter to determine whether a beneficiary can manage his 
or her VA benefits.
    Relative means a person who is an adopted child or is related to a 
beneficiary by blood or marriage, as defined by this chapter.
    Restricted withdrawal agreement means a written contract between VA, 
a fiduciary, and a financial institution in which the fiduciary has VA 
benefit funds under management for a beneficiary, under which certain 
funds cannot be withdrawn without the consent of the Hub Manager.
    Spouse means a husband or wife whose marriage, including common law 
marriage and same-sex marriage, meets the requirements of 38 U.S.C. 
103(c).
    VA benefit funds under management means the combined value of the VA 
funds maintained in a fiduciary account or accounts managed by a 
fiduciary for a beneficiary under Sec.  13.200 and any VA funds invested 
by the fiduciary for the beneficiary under Sec.  13.210, to include any 
interest income and return on investment derived from any account.
    Written notice means that VA will provide to the beneficiary and the 
beneficiary's representative and legal guardian, if any, a written 
decision in a fiduciary matter that is appealable under Sec.  13.600. 
Such notice will include:
    (1) A clear statement of the decision,
    (2) The reason(s) for the decision,
    (3) A summary of the evidence considered in reaching the decision, 
and
    (4) The necessary procedures and time limits to initiate an appeal 
of the decision.

(Authority: 38 U.S.C. 501)



Sec.  13.30  Beneficiary rights.

    Except as prescribed in this part, a beneficiary in the fiduciary 
program is entitled to the same rights afforded any other VA 
beneficiary.
    (a) General policy. Generally, a beneficiary has the right to manage 
his or her own VA benefits. However, due to a beneficiary's injury, 
disease, or infirmities of advanced age or by reason of being less than 
the age of majority, VA may determine that the beneficiary is unable to 
manage his or her benefits without VA supervision or the assistance of a 
fiduciary. Or a court with jurisdiction might determine that a 
beneficiary is unable to manage his or her financial affairs. Under any 
of these circumstances, VA will apply the provisions of this part to 
ensure that VA benefits are being used to maintain the well-being of the 
beneficiary and the beneficiary's dependents.
    (b) Specific rights. The rights of beneficiaries in the fiduciary 
program include, but are not limited to, the right to:
    (1) Receive direct payment of recurring monthly benefits until VA 
appoints a fiduciary if the beneficiary reaches the age of majority or 
older;
    (2) Receive written notice regarding VA's appointment of a fiduciary 
or any other decision on a fiduciary matter that affects VA's provision 
of benefits to the beneficiary;
    (3) Appeal to the Board of Veterans' Appeals VA's appointment of a 
fiduciary;
    (4) Be informed of the fiduciary's name, telephone number, mailing 
address, and email address;
    (5) Contact his or her fiduciary and request a disbursement of funds 
for

[[Page 614]]

current or foreseeable needs or consideration for payment of previously 
incurred expenses, account balance information, or other information or 
assistance consistent with the responsibilities of the fiduciary 
prescribed in Sec.  13.140;
    (6) Obtain from his or her fiduciary a copy of the fiduciary's VA-
approved annual accounting;
    (7) Have VA reissue benefits misused by a fiduciary if VA is 
negligent in appointing or overseeing the fiduciary or if the fiduciary 
who misused the benefits meets the criteria prescribed in Sec.  13.410;
    (8) Appeal to the Board of Veterans' Appeals VA's determination 
regarding its own negligence in misuse and reissuance of benefits 
matters;
    (9) Submit to VA a reasonable request for appointment of a successor 
fiduciary. For purposes of this paragraph, reasonable request means a 
good faith effort to seek replacement of a fiduciary, if:
    (i) The beneficiary's current fiduciary receives a fee deducted from 
the beneficiary's account under Sec.  13.220 and the beneficiary 
requests an unpaid volunteer fiduciary who ranks higher in the order of 
preference under Sec.  13.100(e);
    (ii) The beneficiary requests removal of his or her fiduciary under 
Sec.  13.500(a)(1)(iii) and supervised direct payment of benefits under 
Sec.  13.110; or
    (iii) The beneficiary provides credible information that the current 
fiduciary is not acting in the beneficiary's interest or is unable to 
effectively serve the beneficiary due to a personality conflict or 
disagreement and VA is not able to obtain resolution;
    (10)(i) Be removed from the fiduciary program and receive direct 
payment of benefits without VA supervision provided that the 
beneficiary:
    (A) Is rated by VA as able to manage his or her own benefits; or
    (B) Is determined by a court with jurisdiction as able to manage his 
or her financial affairs if the beneficiary is in the fiduciary program 
as a result of a court order and not a decision by VA's rating agency; 
or
    (C) Attains the age of majority;
    (ii) Have a fiduciary removed and receive direct payment of benefits 
with VA supervision as prescribed in Sec.  13.110 regarding supervised 
direct payment and Sec.  13.500 regarding removal of fiduciaries 
generally, provided that the beneficiary establishes the ability to 
manage his or her own benefits with limited and temporary VA 
supervision; and
    (11) Be represented by a VA-accredited attorney, claims agent, or 
representative of a VA-recognized veterans service organization. This 
includes the right to have a representative present during a field 
examination and the right to be represented in the appeal of a fiduciary 
matter under Sec.  13.600.

(Authority: 38 U.S.C. 501)

(Approved by the Office of Management and Budget under control number 
2900-0017)



Sec.  13.40  Representation of beneficiaries in the fiduciary program.

    The provisions of 38 CFR 14.626 through 14.629 and 14.631 through 
14.637 regarding accreditation and representation of VA claimants and 
beneficiaries in proceedings before VA are applicable to representation 
of beneficiaries before VA in fiduciary matters governed by this part.
    (a) Accreditation. Only VA-accredited attorneys, claims agents, and 
accredited representatives of VA-recognized veterans service 
organizations who have complied with the power-of-attorney requirements 
in Sec.  14.631 of this chapter may represent beneficiaries before VA in 
fiduciary matters.
    (b) Standards of conduct. Accredited individuals who represent 
beneficiaries in fiduciary matters must comply with the general and 
specific standards of conduct prescribed in Sec.  14.632(a) through (c) 
of this chapter, and attorneys must also comply with the standards 
prescribed in Sec.  14.632(d). For purposes of this section:
    (1) A fiduciary matter is not a claim for VA benefits. However, the 
term claimant in Sec.  14.632 of this chapter includes VA beneficiaries 
who are in the fiduciary program, and the term claim in Sec.  14.632 
includes a fiduciary matter that is pending before VA.
    (2) The provisions of Sec.  14.632(c)(7) through (9) of this chapter 
mean that an accredited individual representing a beneficiary in a 
fiduciary matter may not:

[[Page 615]]

    (i) Delay or refuse to cooperate in the processing of a fiduciary 
appointment or any other fiduciary matter, including but not limited to 
a field examination prescribed by Sec.  13.120 and the investigation of 
a proposed fiduciary prescribed by Sec.  13.100;
    (ii) Mislead, threaten, coerce, or deceive a beneficiary in the 
fiduciary program or a proposed or current fiduciary regarding payment 
of benefits or the rights of beneficiaries in the fiduciary program; or
    (iii) Engage in, or counsel or advise a beneficiary or proposed or 
current fiduciary to engage in, acts or behavior prejudicial to the fair 
and orderly conduct of administrative proceedings before VA.
    (3) The Hub Manager will submit a written report regarding an 
alleged violation of the standards of conduct prescribed in this section 
to the VA Chief Counsel who administers the accreditation program for a 
determination regarding further action, including suspension or 
cancellation of accreditation under Sec.  14.633 of this chapter, and 
notification to any agency, court, or bar to which the attorney, agent, 
or representative is admitted to practice.
    (c) Fees. Except as prescribed in paragraphs (c)(1)(i) through (iii) 
of this section, an accredited attorney or claims agent may charge a 
reasonable fixed or hourly fee for representation services provided to a 
beneficiary in a fiduciary matter, provided that the fee meets the 
requirements of Sec.  14.636 of this chapter.
    (1) The following provisions of Sec.  14.636 of this chapter do not 
apply in fiduciary matters:
    (i) Fees under Sec.  14.636(e) of this chapter, to the extent that 
the regulation authorizes a fee based on a percentage of benefits 
recovered;
    (ii) The presumptions prescribed by Sec.  14.636(f) of this chapter 
based upon a percentage of a past-due benefit amount. In fiduciary 
matters, the reasonableness of a fixed or hourly-rate fee will be 
determined based upon application of the reasonableness factors 
prescribed in Sec.  14.636(e); and
    (iii) Direct payment of fees by VA out of past-due benefits under 
Sec.  14.636(g)(2) and (h) of this chapter.
    (2) An accredited attorney or claims agent who wishes to charge a 
fee for representing a beneficiary in a fiduciary matter must comply 
with the fee agreement filing requirement prescribed in Sec.  
14.636(g)(3) of this chapter.
    (3) VA, the beneficiary, or the beneficiary's fiduciary may 
challenge the reasonableness of a fee charged by an accredited attorney 
or claims agent using the procedures prescribed in Sec.  14.636(i) of 
this chapter.

(Authority: 38 U.S.C. 501, 38 U.S.C. chapter 59)



Sec.  13.50  Suspension of benefits.

    (a) Notwithstanding the beneficiary rights prescribed in Sec.  
13.30, the Hub Manager will temporarily suspend payment of benefits and 
hold such benefits in the U.S. Treasury to the credit of the beneficiary 
or take other action that the Hub Manager deems appropriate to prevent 
exploitation of VA benefit funds or to ensure that the beneficiary's 
needs are being met, if:
    (1) The beneficiary or the beneficiary's attorney, claims agent, or 
representative withholds cooperation in any of the appointment and 
oversight procedures prescribed in this part; or
    (2) VA removes the beneficiary's fiduciary for any reason prescribed 
in Sec.  13.500(b) and is unable to appoint a successor fiduciary before 
the beneficiary has an immediate need for disbursement of funds.
    (b) All or any part of the funds held in the U.S. Treasury to the 
beneficiary's credit under paragraph (a) of this section will be 
disbursed under the order and in the discretion of the VA Regional 
Office Director who has jurisdiction over the fiduciary hub or regional 
office for the benefit of the beneficiary or the beneficiary's 
dependents.

(Authority: 38 U.S.C. 501, 512, 5502, 5504)



Sec.  13.100  Fiduciary appointments.

    (a) Authority. Except as prescribed in paragraph (b) of this 
section, the Hub Manager will appoint a fiduciary for a beneficiary who:
    (1) Has been rated by VA as being unable to manage his or her VA 
benefits,

[[Page 616]]

    (2) Has been determined by a court with jurisdiction as being unable 
to manage his or her financial affairs, or
    (3) Has not reached age of majority.
    (b) Exceptions. The Hub Manager will not appoint a fiduciary for a 
beneficiary who:
    (1) Is eligible for supervised direct payment under Sec.  13.110, or
    (2) Is not a beneficiary described in paragraph (a)(1) or (a)(2) of 
this section and has not reached age of majority, but
    (i) Is serving in the Armed Forces of the United States, or
    (ii) Has been discharged from service in the Armed Forces of the 
United States, or
    (iii) Qualifies for survivors' benefits as a surviving spouse.
    (c) Retroactive benefit payments. The Hub Manager will withhold any 
retroactive, one-time, or other lump-sum benefit payment awarded to a 
beneficiary described in paragraph (a) of this section until the Hub 
Manager has appointed a fiduciary for the beneficiary and, if 
applicable, the fiduciary has obtained a surety bond under Sec.  13.230.
    (d) Initial appointment. In appointing a fiduciary, the Hub Manager 
will make every effort to appoint the person, agency, organization, or 
institution that will best serve the interest of the beneficiary. The 
Hub Manager will consider the results of a field examination, which will 
include a face-to-face meeting with the beneficiary and the 
beneficiary's dependents at their residence when practicable, and will 
conduct the investigation prescribed in paragraph (f) of this section. 
The Hub Manager will also consider whether:
    (1) VA benefits can be paid directly to the beneficiary with limited 
and temporary supervision by VA, as prescribed in Sec.  13.110;
    (2) The circumstances require appointment of a temporary fiduciary 
under paragraph (h) of this section; and
    (3) The proposed fiduciary is complying with the responsibilities of 
a fiduciary prescribed in Sec.  13.140 with respect to all beneficiaries 
in the fiduciary program currently being served by the proposed 
fiduciary and whether the proposed fiduciary can handle an additional 
appointment without degrading service for any other beneficiary.
    (e) Order of preference in appointing a fiduciary. The Hub Manager 
will consider individuals and entities for appointment in the following 
order of preference, provided that the proposed fiduciary is qualified 
and willing to serve and the appointment would serve the beneficiary's 
interest:
    (1) The preference stated by the beneficiary in the fiduciary 
program, if the beneficiary has the capacity to state such a preference. 
If the beneficiary has a legal guardian appointed to handle his or her 
affairs, the Hub Manager will presume that the beneficiary does not have 
the capacity to state a preference and will consider individuals and 
entities in the order of preference prescribed in paragraphs (e)(2) 
through (10) of this section;
    (2) The beneficiary's spouse;
    (3) A relative who has care or custody of the beneficiary or his or 
her funds;
    (4) Any other relative of the beneficiary;
    (5) Any friend, acquaintance, or other person who is willing to 
serve as fiduciary for the beneficiary without a fee;
    (6) The chief officer of a public or private institution in which 
the beneficiary receives care or which has custody of the beneficiary;
    (7) The bonded officer of an Indian reservation, if applicable;
    (8) An individual or entity who has been appointed by a court with 
jurisdiction to handle the beneficiary's affairs;
    (9) An individual or entity who is not willing to serve without a 
fee; or
    (10) A temporary fiduciary, if necessary.
    (f) Investigation of a proposed fiduciary. Except as prescribed in 
paragraph (f)(3) of this section, before appointing a fiduciary for a 
beneficiary in the fiduciary program, the Hub Manager will conduct an 
investigation regarding the proposed fiduciary's qualifications.
    (1) The investigation will include:
    (i) To the extent practicable, a face-to-face interview of the 
proposed fiduciary;
    (ii) A review of a credit report on the proposed fiduciary issued by 
a credit reporting agency no more than 30 days

[[Page 617]]

prior to the date of the proposed appointment;
    (iii) A criminal background check to determine whether the proposed 
fiduciary has been convicted of any offense which would be a bar to 
serving as a fiduciary under Sec.  13.130 or which the Hub Manager may 
consider and weigh under the totality of the circumstances regarding the 
proposed fiduciary's qualifications;
    (iv) Obtaining proof of the proposed fiduciary's identity and 
relationship to the beneficiary, if any; and
    (v) A determination regarding the need for surety bond under Sec.  
13.230 and the proposed fiduciary's ability to obtain such a bond.
    (2) The Hub Manager may, at any time after the initial appointment 
or reappointment of the fiduciary for a beneficiary, repeat all or part 
of the investigation prescribed by paragraph (f)(1) of this section to 
ensure that the fiduciary continues to meet the qualifications for 
service and there is no current bar to service under Sec.  13.130.
    (3) The Hub Manager must conduct the requirements of paragraphs 
(f)(1)(i),(ii) and (iii) for every subsequent appointment of the 
fiduciary for each beneficiary.
    (4) VA will not conduct the investigation prescribed by paragraph 
(f) of this section if the proposed fiduciary is an entity, such as the 
trust department of a bank that provides fiduciary services.
    (g) Expedited appointment. The Hub Manager may waive the 
requirements of paragraphs (f)(1)(i) through (iii) of this section and 
expedite the appointment of a proposed fiduciary if the Hub Manager 
determines that an expedited appointment would be in the beneficiary's 
interest and:
    (1) The proposed fiduciary is:
    (i) The beneficiary's parent (natural, adopted, or step-parent) and 
the beneficiary is less than the age of majority, or
    (ii) The beneficiary's spouse; or
    (2) The annual amount of VA benefits the proposed fiduciary would 
manage for the beneficiary does not exceed the amount specified in 38 
U.S.C. 5507(c)(2)(D), as adjusted by VA pursuant to 38 U.S.C. 5312.
    (h) Temporary fiduciary appointments. (1) The Hub Manager may 
appoint a temporary fiduciary for a period not to exceed 120 days in any 
of the following circumstances:
    (i) VA has removed a fiduciary for cause under Sec.  13.500 and 
cannot expedite the appointment of a successor fiduciary, and the 
beneficiary has an immediate need for fiduciary services; or
    (ii) The Hub Manager determines that the beneficiary has an 
immediate need for fiduciary services and it would not be in the 
beneficiary's or the beneficiary's dependents' interest to pay benefits 
to the beneficiary until a fiduciary is appointed.
    (2) Any temporary fiduciary appointed under this paragraph (h) must 
be:
    (i) An individual or entity that has already been subject to the 
procedures for appointment in paragraphs (d) and (f) of this section, 
and
    (ii) Performing satisfactorily as a fiduciary for at least one other 
VA beneficiary for whom the fiduciary has submitted an annual accounting 
that VA has approved.
    (i) Authorization for disclosure of information. The Hub Manager 
will:
    (1) Obtain from every proposed fiduciary who is an individual a 
written authorization for VA to disclose to the beneficiary information 
regarding any fiduciary matter that may be appealed under Sec.  13.600, 
including but not limited to the fiduciary's qualifications for 
appointment under Sec.  13.100 or misuse of benefits under Sec.  13.400. 
Such disclosures may occur in VA's correspondence with the beneficiary, 
in a VA fiduciary appointment or misuse of benefits decision, in a 
statement of the case for purposes of appeal under Sec.  13.600, or upon 
request by the beneficiary, the beneficiary's guardian, or the 
beneficiary's accredited attorney, claims agent, or representative;
    (2) Notify the proposed fiduciary that the disclosed information may 
be used by the beneficiary in appealing a VA appointment or misuse 
decision to the Board of Veterans' Appeals under Sec.  13.600; and
    (3) Terminate consideration of a proposed fiduciary if the 
individual refuses to provide the authorization prescribed in paragraph 
(i)(1) of this section. Such

[[Page 618]]

refusal is a bar to serving as a fiduciary for a beneficiary under Sec.  
13.130(b).

(Authority: 38 U.S.C. 501, 5502, 5506, 5507)



Sec.  13.110  Supervised direct payment.

    (a) Authority. The Hub Manager may authorize the payment of VA 
benefits directly to an adult beneficiary in the fiduciary program who 
has reached the age of majority if the Hub Manager determines, based 
upon a field examination, that the beneficiary can manage his or her VA 
benefits with limited and temporary VA supervision. In making this 
determination, the Hub Manager will consider:
    (1) Whether the beneficiary is aware of his or her monthly income;
    (2) Whether the beneficiary is aware of his or her fixed monthly 
expenses such as rent, mortgage, utilities, clothing, food, and medical 
bills;
    (3) The beneficiary's ability to:
    (i) Allocate appropriate funds to fixed monthly expenses and 
discretionary items;
    (ii) Pay monthly bills in a timely manner; and
    (iii) Conserve excess funds; and
    (4) Any other information that demonstrates the beneficiary's actual 
ability to manage his or her VA benefits with limited VA supervision.
    (b) Supervision. The limited and temporary supervision of 
beneficiaries receiving direct payment under paragraph (a) of this 
section will consist of:
    (1) Assistance in the development of a budget regarding the 
beneficiary's income and expenses,
    (2) Assistance with creating a fund usage report to aid the 
beneficiary in tracking his or her income and expenses, and
    (3) Periodic reviews of the beneficiary's fund usage report, as 
required by the Hub Manager.
    (c) Reassessment. The Hub Manager will reassess the beneficiary's 
ability to manage his or her VA benefits at or before the end of the 
first 12-month period of supervision. Based upon a field examination, an 
evaluation of the factors listed in paragraph (a) of this section, and 
the results of the supervision prescribed in paragraph (b) of this 
section, the Hub Manager will determine whether the beneficiary can 
manage his or her benefits without VA supervision.
    (1) If the beneficiary demonstrates the ability to manage his or her 
VA benefits without supervision, the Hub Manager will prepare a report 
that summarizes the findings and refer the matter with a recommendation 
and supporting evidence to the rating authority for application of Sec.  
3.353(b)(3) of this chapter regarding reevaluation of ability to manage 
VA benefits and Sec.  3.353(d) of this chapter regarding the presumption 
of ability to manage VA benefits without restriction.
    (2) If the beneficiary does not demonstrate the ability to manage 
his or her VA benefits without VA supervision, the Hub Manager will:
    (i) Appoint a fiduciary, or
    (ii) Continue supervised direct payment for not longer than one 
additional 12-month period based upon evidence that additional 
supervision might assist the beneficiary in developing the ability to 
manage his or her own VA benefits. At the conclusion of the additional 
period of supervised direct payment, the Hub Manager will conduct the 
reassessment prescribed by paragraph (c) of this section and either 
recommend reevaluation under paragraph (c)(1) of this section or appoint 
a fiduciary under paragraph (c)(2)(i) of this section.

(Authority: 38 U.S.C. 501, 5502)



Sec.  13.120  Field examinations.

    (a) Authority. The Hub Manager will order a field examination 
regarding fiduciary matters within the Hub Manager's jurisdiction for 
any of the reasons prescribed in paragraph (c) of this section. For 
purposes of this section, field examination means the inquiry, 
investigation, or monitoring activity conducted by designated fiduciary 
hub or other qualified VA personnel who are authorized to:
    (1) Interview beneficiaries, dependents, and other interested 
persons regarding fiduciary matters;
    (2) Interview proposed fiduciaries and current fiduciaries regarding 
their qualifications, performance, or compliance with VA regulations;
    (3) Conduct investigations and examine witnesses regarding any 
fiduciary matter;

[[Page 619]]

    (4) Take affidavits;
    (5) Administer oaths and affirmations;
    (6) Certify copies of public or private documents; and
    (7) Aid claimants and beneficiaries in the preparation of claims for 
VA benefits or other fiduciary or claim-related material.
    (b) Scope of field examinations. Field examinations may include, but 
are not limited to:
    (1) Assessing a beneficiary's and the beneficiary's dependents' 
welfare and physical and mental well-being, environmental and social 
conditions, and overall financial situation, based upon visiting the 
beneficiary's current residence and conducting a face-to-face interview 
of the beneficiary and the beneficiary's dependents, when practicable;
    (i) The Hub Manager will waive the requirements of paragraph (b)(1) 
of this section if the Veterans Health Administration (VHA) has approved 
the fiduciary as the beneficiary's family caregiver, and VHA's status 
report regarding the beneficiary indicates the beneficiary is in an 
excellent situation.
    (ii) The provisions of paragraph (b)(1)(i) of this section do not 
apply when the Hub Manager has information that a fiduciary, who is also 
the beneficiary's VHA-designated family caregiver, is misusing a 
beneficiary's VA funds under management, is neglecting a beneficiary, or 
has failed to comply with the requirements of Sec.  13.140, or there is 
insufficient evidence to determine the beneficiary's well-being.
    (2) Assessing the beneficiary's ability to manage his or her own VA 
benefits with only limited VA supervision (see Sec.  13.110 regarding 
supervised direct payment);
    (3) Collecting and reviewing financial documentation, including 
income and expenditure information;
    (4) Providing any necessary assistance to the beneficiary with 
issues affecting current or additional VA benefits, claims, and non-VA 
matters that may affect or conflict with VA benefits;
    (5) Making appropriate referrals in cases of actual or suspected 
physical or mental abuse, neglect, or other harm to a beneficiary;
    (6) Investigating, when necessary, allegations that a beneficiary's 
fiduciary has engaged in misconduct or misused VA benefits to include 
but not limited to allegations regarding:
    (i) Theft or misappropriation of funds,
    (ii) Failure to comply with the responsibilities of a fiduciary as 
prescribed in Sec.  13.140,
    (iii) Other allegations of inappropriate fund management by a 
fiduciary, and
    (iv) Other special circumstances which require a visit with or 
onsite review of the fiduciary, such as a change in an award of benefits 
or benefit status, or non-fiduciary program matters.
    (c) Reasons for conducting field examinations. A Hub Manager will 
order a field examination to:
    (1) Determine whether benefits should be paid directly to a 
beneficiary under Sec.  13.110 or to a fiduciary appointed for the 
beneficiary under Sec.  13.100;
    (2) Determine whether benefit payments should continue to be made 
directly to a beneficiary under Sec.  13.110 or to a fiduciary on behalf 
of a beneficiary; or
    (3) Ensure the well-being of a beneficiary in the fiduciary program 
or to protect a beneficiary's VA benefit funds.

(Authority: U.S.C. 501, 512, 5502, 5506, 5507, 5711)


(Approved by the Office of Management and Budget under control numbers 
2900-0815 and 2900-0803)



Sec.  13.130  Bars to serving as a fiduciary.

    (a) An individual or entity may not serve as a fiduciary for a VA 
beneficiary if the individual or entity:
    (1) Misused or misappropriated a beneficiary's VA benefits while 
serving as the beneficiary's fiduciary;
    (2) Has been convicted of a felony offense. For purposes of this 
paragraph, felony offense means a criminal offense for which the minimum 
period of imprisonment is 1 year or more, regardless of the actual 
sentence imposed or the actual time served. However, such conviction is 
not a bar to serving as a fiduciary for a beneficiary if all of the 
following conditions are met:

[[Page 620]]

    (i) The conviction occurred more than 10 years preceding the 
proposed date of appointment;
    (ii) The conviction did not involve any of the following offenses:
    (A) Fraud;
    (B) Theft;
    (C) Bribery;
    (D) Embezzlement;
    (E) Identity theft;
    (F) Money laundering;
    (G) Forgery;
    (H) The abuse of or neglect of another person; or
    (I) Any other financial crime;
    (iii) There is no other person or entity who is willing and 
qualified to serve; and
    (iv) The Hub Manager determines that the nature of the conviction is 
such that appointment of the individual poses no risk to the beneficiary 
and is in the beneficiary's interest.
    (b) An individual may not serve as a fiduciary for a VA beneficiary 
if the individual:
    (1) Refuses or neglects to provide the authorization for VA 
disclosure of information prescribed in Sec.  13.100(i);
    (2) Is unable to manage his or her own Federal or state benefits and 
is in a Federal or state agency's fiduciary, representative payment, or 
similar program;
    (3) Has been adjudicated by a court with jurisdiction as being 
unable to manage his or her own financial affairs;
    (4) Is incarcerated in a Federal, state, local, or other penal 
institution or correctional facility, sentenced to home confinement, 
released from incarceration to a half-way house, or on house arrest or 
in custody in any facility awaiting trial on pending criminal charges;
    (5) Has felony charges pending;
    (6) Has been removed as legal guardian by a state court for 
misconduct;
    (7) Is under the age of majority; or
    (8) Knowingly violates or refuses to comply with the regulations in 
this part.

(Authority: 38 U.S.C. 501, 5502, 5506, 5507, 6101, 6106)



Sec.  13.140  Responsibilities of fiduciaries.

    Any individual or entity appointed by VA as a fiduciary to receive 
VA benefit payments on behalf of a beneficiary in the fiduciary program 
must fulfill certain responsibilities associated with the services of a 
fiduciary. These responsibilities include:
    (a) General. (1) Fiduciaries appointed by VA to manage the VA funds 
of a beneficiary are also responsible for monitoring the beneficiary's 
well-being and using available funds to ensure that the beneficiary's 
needs are met. Fiduciaries owe VA and beneficiaries the duties of good 
faith and candor and must administer a beneficiary's funds under 
management in accordance with paragraph (b) of this section. In all 
cases, the fiduciary must disburse or otherwise manage funds according 
to the best interests of the beneficiary and the beneficiary's 
dependents and in light of the beneficiary's unique circumstances, 
needs, desires, beliefs, and values.
    (2) The fiduciary must take all reasonable precautions to protect 
the beneficiary's private information contained in the fiduciary's paper 
and electronic records.
    (i) For purposes of this section:
    (A) Reasonable precautions means protecting against any unauthorized 
access to or use of the beneficiary's private information that may 
result in substantial harm or inconvenience to the beneficiary; and
    (B) Private information means a beneficiary's first name and last 
name or first initial and last name in combination with any one or more 
of the following data elements that relate to such beneficiary: VA claim 
number, Social Security number, date of birth, address, driver's license 
number or state-issued identification card number, or financial account 
number or credit card or debit card number, with or without any required 
security code, access code, personal identification number, or password, 
that would permit access to the beneficiary's account.
    (ii) At a minimum, fiduciaries must place reasonable restrictions 
upon access to paper records containing the beneficiary's private 
information, including storage of such records in locked facilities, 
storage areas, or containers.

[[Page 621]]

    (iii) For electronic records containing the beneficiary's private 
information, the fiduciary must:
    (A) Use unique identifications and passwords, which are not vendor-
supplied default identifications and passwords, for computer, network, 
or online site access that are reasonably designed to maintain the 
security of the beneficiary's information and the fiduciary's financial 
transactions;
    (B) Control access to data security passwords to ensure that such 
passwords are kept in a location and format that do not compromise the 
security of the beneficiary's private information; and
    (C) For records containing private information on a computer system 
that is connected to the internet, keep reasonably up-to-date firewall 
and virus protection and operating system security patches to maintain 
the integrity of the beneficiary's private information and prevent 
unauthorized disclosure. For purposes of this section, a system is 
reasonably updated if the fiduciary installs software updates 
immediately upon release by the original equipment or software 
manufacturer, uses internet browser security settings suitable for 
transmission of private information, and maintains password-protected 
wireless connections or other networks.
    (iv) The fiduciary must keep all paper and electronic records 
relating to the fiduciary's management of VA benefit funds for the 
beneficiary for the duration of service as fiduciary for the beneficiary 
and for a minimum of 2 years from the date that VA removes the fiduciary 
under Sec.  13.500 or from the date that the fiduciary withdraws as 
fiduciary for the beneficiary under Sec.  13.510.
    (b) Financial responsibilities. The fiduciary's primary financial 
responsibilities include, but are not limited to:
    (1) The use of the beneficiary's VA benefit funds under management 
only for the care, support, education, health, and welfare of the 
beneficiary and his or her dependents. Except as authorized under Sec.  
13.220 regarding fiduciary fees, a fiduciary may not derive a personal 
financial benefit from management or use of the beneficiary's funds;
    (2) Protection of the beneficiary's VA benefits from loss or 
diversion;
    (3) Except as prescribed in Sec.  13.200 regarding fiduciary 
accounts, maintenance of separate financial accounts to prevent 
commingling of the beneficiary's funds with the fiduciary's own funds or 
the funds of any other beneficiary for whom the fiduciary has funds 
under management;
    (4) Determination of the beneficiary's just debts. For purposes of 
this section, just debts mean the beneficiary's legitimate, legally 
enforceable debts;
    (5) Timely payment of the beneficiary's just debts, provided that 
the fiduciary has VA benefit funds under management for the beneficiary 
to cover such debts;
    (6) Providing the beneficiary with information regarding VA benefit 
funds under management for the beneficiary, including fund usage, upon 
request;
    (7) Providing the beneficiary with a copy of the annual accounting 
approved by VA under Sec.  13.280;
    (8) Ensuring that any best-interest determination regarding the use 
of funds is consistent with VA policy, which recognizes that 
beneficiaries in the fiduciary program are entitled to the same standard 
of living as any other beneficiary with the same or similar financial 
resources, and that the fiduciary program is not primarily for the 
purpose of preserving funds for the beneficiary's heirs or disbursing 
funds according to the fiduciary's own beliefs, values, preferences, and 
interests; and
    (9) Protecting the beneficiary's funds from the claims of creditors 
as described in Sec.  13.270.
    (c) Non-financial responsibilities. The fiduciary's primary non-
financial responsibilities include, but are not limited to:
    (1) Contacting social workers, mental health professionals, or the 
beneficiary's legal guardian regarding the beneficiary, when necessary;
    (2) To the extent possible, ensuring the beneficiary receives 
appropriate medical care;
    (3) Correcting any discord or uncomfortable living or other 
situations when possible;

[[Page 622]]

    (4) Acknowledging and addressing any complaints or concerns of the 
beneficiary to the best of the fiduciary's ability;
    (5) Reporting to the appropriate authorities, including any legal 
guardian, any type of known or suspected abuse of the beneficiary;
    (6) Maintaining contact with the beneficiary for purposes of 
assessing the beneficiary's capabilities, limitations, needs, and 
opportunities;
    (7) Being responsive to the beneficiary and ensuring the beneficiary 
and his or her legal guardian have the fiduciary's current contact 
information.
    (d) The fiduciary's responsibilities to VA. Any fiduciary who has VA 
benefit funds under management on behalf of a beneficiary in the 
fiduciary program must:
    (1) If the fiduciary is also appointed by a court, annually provide 
to the fiduciary hub with jurisdiction a certified copy of the 
accounting(s) provided to the court or facilitate the hub's receipt of 
such accountings;
    (2) Notify the fiduciary hub regarding any change in the 
beneficiary's circumstances, to include the beneficiary's relocation, 
the beneficiary's serious illness, or any other significant change in 
the beneficiary's circumstances which might adversely impact the 
beneficiary's well-being;
    (3) Provide documentation or verification of any records concerning 
the beneficiary or matters relating to the fiduciary's responsibilities 
within 30 days of a VA request, unless otherwise directed by the Hub 
Manager;
    (4) When necessary, appear before VA for face-to-face meetings; and
    (5) Comply with the policies and procedures prescribed in this part.

(Authority: 38 U.S.C. 501, 512, 5502, 5507, 5509, 5711)

(Approved by the Office of Management and Budget under control numbers 
2900-0017 and 2900-0085)



Sec.  13.200  Fiduciary accounts.

    Except as prescribed in paragraph (b) of this section, any fiduciary 
appointed by VA to receive payments on behalf of a beneficiary must 
deposit the beneficiary's VA benefits in a fiduciary account that meets 
the requirements prescribed in paragraph (a) of this section.
    (a) Separate accounts. Except as prescribed in paragraph (b) of this 
section, a fiduciary must establish and maintain a separate financial 
institution account for each VA beneficiary that the fiduciary serves. 
The fiduciary must not commingle a beneficiary's funds with the 
fiduciary's funds or any other beneficiary's funds, either upon or after 
receipt. The account must be:
    (1) Established for direct deposit of VA benefits,
    (2) Established in a Federally-insured financial institution, and in 
Federally-insured accounts when funds qualify for such deposit 
insurance, and
    (3) Titled in the beneficiary's and fiduciary's names and note the 
existence of the fiduciary relationship.
    (b) Exceptions. The general rule prescribed in paragraph (a) of this 
section regarding establishment and maintenance of separate accounts 
does not apply to the following fiduciaries:
    (1) The beneficiary's spouse;
    (2) State or local Government entities;
    (3) Institutions, such as public or private medical care facilities, 
nursing homes, or other residential care facilities, when an annual 
accounting is not required. See Sec.  13.280 regarding accounting 
requirements; or
    (4) A trust company or a bank with trust powers organized under the 
laws of the United States or a state.

(Authority: U.S.C. 501, 5502, 5509, 5711)



Sec.  13.210  Fiduciary investments.

    (a) General. A fiduciary must conserve or invest any VA benefits 
that the fiduciary receives on behalf of a beneficiary, whether such 
benefits are in the form of recurring monthly payments or a one-time 
payment, if the beneficiary or the beneficiary's dependents do not need 
the benefits for current maintenance, reasonably foreseeable expenses, 
or reasonable improvements in the beneficiary's and the beneficiary's 
dependents' standard of living. Conservation of beneficiary funds is for 
the purpose of addressing unforeseen circumstances or planning for 
future care needs given the beneficiary's disabilities, circumstances, 
and eligibility for care furnished by the

[[Page 623]]

Government at Government expense. Fiduciaries should not conserve VA 
benefit funds under management for a beneficiary based primarily upon 
the interests of the beneficiary's heirs or according to the fiduciary's 
own values, preferences, and interests.
    (b) Types of investments. An investment must be prudent and in the 
best interest of the beneficiary. Authorized investments include United 
States savings bonds or interest or dividend-paying accounts insured 
under Federal law. Any such investment must be clearly titled in the 
beneficiary's and fiduciary's names and identify the fiduciary 
relationship.
    (c) Exceptions. The general rules regarding investment of VA 
benefits do not apply to the following fiduciaries:
    (1) The beneficiary's spouse, and
    (2) The chief officer of an institution in which the beneficiary is 
being furnished hospital treatment or institutional, nursing, or 
domiciliary care. VA benefits paid to the chief officer may not be 
invested.

(Authority: 38 U.S.C. 501, 5502)



Sec.  13.220  Fiduciary fees.

    (a) Authority. The Hub Manager with jurisdiction over a fiduciary 
appointment may determine whether a fee is necessary to obtain the 
services of a fiduciary. A fee is necessary only if no other person or 
entity is qualified and willing to serve without a fee and the 
beneficiary's interests would be served by the appointment of a 
qualified paid fiduciary. The Hub Manager will not authorize a fee if 
the fiduciary:
    (1) Is a spouse, dependent, or other relative of the beneficiary; or
    (2) Will receive any other form of payment in connection with 
providing fiduciary services for the beneficiary.
    (b) Limitation on fees. The Hub Manager will authorize a fiduciary 
to whom a fee is payable under paragraph (a) of this section to deduct 
from the beneficiary's account a reasonable monthly fee for fiduciary 
services rendered.
    (1) For purposes of this section, reasonable monthly fee means a 
monetary amount that is authorized by the Hub Manager and does not 
exceed 4 percent of the monthly VA benefit paid to the fiduciary on 
behalf of the beneficiary for a month in which the fiduciary is eligible 
under paragraph (b)(2) of this section to collect a fee.
    (2) A monthly fee may be collected for any month during which the 
fiduciary:
    (i) Provides fiduciary services on behalf of the beneficiary,
    (ii) Receives a recurring VA benefit payment for the beneficiary, 
and
    (iii) Is authorized by the Hub Manager to receive a fee for 
fiduciary services.
    (3) Fees may not be computed based upon:
    (i) Any one-time, retroactive, or lump-sum payment made to the 
fiduciary on behalf of the beneficiary;
    (ii) Any funds conserved by the fiduciary for the beneficiary in the 
beneficiary's account under Sec.  13.200 or invested by the fiduciary 
for the beneficiary under Sec.  13.210, to include any interest income 
and return on investment derived from any account; or
    (iii) Any funds transferred to the fiduciary by a prior fiduciary 
for the beneficiary, or from the personal funds of patients or any other 
source.
    (4) The Hub Manager will not authorize a fee for any month for 
which:
    (i) VA or a court with jurisdiction determines that the fiduciary 
misused or misappropriated benefits, or
    (ii) The beneficiary does not receive a VA benefit payment. However, 
the Hub Manager may authorize a fee for a month in which the beneficiary 
did not receive a benefit payment if VA later issues benefits for that 
month and the fiduciary:
    (A) Receives VA approval to collect a fee for the month for which 
payment was made,
    (B) Provided fiduciary services during the month for which payment 
was made, and
    (C) Was the beneficiary's fiduciary when VA made the retroactive 
payment.

(Authority: 38 U.S.C. 501, 5502, 6101, 6106)



Sec.  13.230  Protection of beneficiary funds.

    (a) General. Except as prescribed in paragraph (c) of this section, 
within 60 days of appointment, the fiduciary must furnish to the 
fiduciary hub with jurisdiction a corporate surety bond

[[Page 624]]

that is conditioned upon faithful discharge of all of the 
responsibilities of a fiduciary prescribed in Sec.  13.140 and meets the 
requirements of paragraph (d) of this section, if the VA benefit funds 
that are due and to be paid for the beneficiary will exceed $25,000 at 
the time of appointment. The Hub Manager will not authorize the release 
of a retroactive, one-time, or other pending lump-sum benefit payment to 
the fiduciary until the fiduciary has furnished the bond prescribed by 
this section.
    (b) Accumulated funds. The provisions of paragraph (a) of this 
section, which require a fiduciary to furnish a surety bond, apply in 
any case in which the accumulation over time of VA benefit funds under 
management by a fiduciary for a beneficiary exceeds $25,000. Except as 
prescribed in paragraph (c) of this section, within 60 days of 
accumulated funds exceeding the prescribed threshold, the fiduciary will 
furnish to the fiduciary hub a bond that meets the requirements of 
paragraph (d) of this section.
    (c) Exceptions. (1) The provisions of paragraphs (a) and (b) of this 
section do not apply to:
    (i) A fiduciary that is a trust company or a bank with trust powers 
organized under the laws of the United States or a state;
    (ii) A fiduciary who is the beneficiary's spouse; or
    (iii) A fiduciary in the Commonwealth of Puerto Rico, Guam, or 
another territory of the United States, or in the Republic of the 
Philippines, who has entered into a restricted withdrawal agreement in 
lieu of a surety bond.
    (2) The Hub Manager may, at any time, require the fiduciary to 
obtain a bond described in paragraph (a) of this section and meeting the 
requirements of paragraph (d) of this section, without regard to the 
amount of VA benefit funds under management by the fiduciary for the 
beneficiary, if special circumstances indicate that obtaining a bond 
would be in the beneficiary's interest. Such special circumstances may 
include but are not limited to:
    (i) A marginal credit report for the fiduciary; or
    (ii) A fiduciary's misdemeanor criminal conviction either before or 
after appointment for any offense listed in Sec.  13.130(a)(2)(ii);
    (d) Bond requirements. A bond furnished by a fiduciary under 
paragraph (a) or (b) of this section must meet the following 
requirements:
    (1) The bond must be a corporate surety bond in an amount sufficient 
to cover the value of the VA benefit funds under management by the 
fiduciary for the beneficiary.
    (2) After furnishing the prescribed bond to the fiduciary hub, the 
fiduciary must:
    (i) Adjust the bond amount to account for any increase or decrease 
of more than 20 percent in the VA benefit funds under management by the 
fiduciary for the beneficiary; and
    (ii) Furnish proof of the adjustment to the fiduciary hub not later 
than 60 days after a change in circumstance described in paragraph 
(d)(2)(i) of this section.
    (3) The bond furnished by the fiduciary must also:
    (i) Identify the fiduciary, the beneficiary, and the bonding 
company; and
    (ii) Contain a statement that the bond is payable to the Secretary 
of Veterans Affairs.
    (e) Periodic proof of bond. A fiduciary must furnish proof of 
adequate bonding:
    (1) With each annual accounting prescribed by Sec.  13.280; and
    (2) At any other time the Hub Manager with jurisdiction requests 
proof.
    (f) Liability. (1) Except as otherwise provided by the terms of the 
bond, the surety and the fiduciary guaranteed by the surety are jointly 
and severally liable for any misappropriation or misuse of VA benefits 
by the fiduciary.
    (2) VA may collect on the bond regardless of any prior reissuance of 
benefits by VA under Sec.  13.410 and until liability under the terms of 
the bond is exhausted.
    (g) Bond expenses--(1) Authority. The fiduciary may deduct from the 
beneficiary's account any expense related to obtaining, maintaining, or 
adjusting a bond prescribed by this section.
    (2) Notice. The Hub Manager will provide the beneficiary written 
notice regarding any bond furnished at the

[[Page 625]]

beneficiary's expense under paragraph (a), (b), or (c)(2) of this 
section or adjusted under paragraph (d)(2) of this section.

(Authority: 38 U.S.C. 501, 5502, 5507)

(Approved by the Office of Management and Budget under control numbers 
2900-0017 and 2900-0804)



Sec.  13.240  Funds of beneficiaries less than the age of majority.

    (a) General. Except as prescribed in paragraph (b) of this section, 
a fiduciary who receives VA benefits on behalf of a beneficiary who is 
less than the age of majority may use the benefits only for the use and 
benefit of that beneficiary and only if the fiduciary first determines 
that the person or persons who have custody of the beneficiary and are 
responsible for the beneficiary's needs are unable to provide for those 
needs.
    (b) Education benefits. A fiduciary who receives VA education 
benefits on behalf of a beneficiary who is less than the age of majority 
may use the benefits for the beneficiary's education regardless of the 
ability of the person or persons who have custody of the beneficiary to 
pay for the beneficiary's education.

(Authority: 38 U.S.C. 501, 5502)



Sec.  13.250  Funds of deceased beneficiaries.

    (a) General. When a beneficiary who has a fiduciary dies without 
leaving a valid will and without heirs, all VA benefit funds under 
management by the fiduciary for the deceased beneficiary on the date of 
death, less any deductions authorized by paragraph (c) of this section, 
must be returned to VA if such funds would escheat to a state.
    (b) Accountings. Upon the death of a beneficiary described in 
paragraph (a) for whom the fiduciary must return to VA all benefit funds 
under management, less any deductions authorized under paragraph (c) of 
this section, or upon the death of any beneficiary for whom a fiduciary 
was required to submit an annual accounting to VA under Sec.  13.280, 
the fiduciary must submit a final accounting to the fiduciary hub with 
jurisdiction within 90 days of the beneficiary's death.
    (c) Expenses. The fiduciary may deduct a reasonable fee from the 
deceased beneficiary's account for purposes of determining whether the 
beneficiary's funds under management would escheat to a state under 
state law or whether the deceased beneficiary left a valid will or is 
survived by heirs. For the purpose of this section, reasonable fee means 
an amount customarily charged by attorneys or other professionals 
authorized to do such work in the state where the deceased beneficiary 
had his or her permanent place of residence.
    (d) Estate matters. Upon the death of a beneficiary who has a valid 
will or heirs, the fiduciary must hold the remaining funds under 
management in trust for the deceased beneficiary's estate until the will 
is probated or heirs are ascertained, and disburse the funds according 
to applicable state law.

(Authority: U.S.C. 501, 5502)



Sec.  13.260  Personal funds of patients.

    (a) Distribution of funds. Benefits deposited by VA in the personal 
funds of patients account for a veteran who was rated by VA as being 
unable to manage his or her VA benefits and who died leaving an account 
balance are payable to an eligible person. For purposes of this section, 
eligible person means an individual living at the time the account 
balance is distributed in the following order of preference:
    (1) The deceased veteran's spouse, as defined by Sec.  3.1000(d)(1) 
of this chapter;
    (2) The veteran's children (in equal shares), as defined by Sec.  
3.57 of this chapter, but without regard to age or marital status; or
    (3) The veteran's dependent parents (in equal shares) or surviving 
parent, as defined by Sec.  3.59 of this chapter, provided that the 
parents were or parent was dependent within the meaning of Sec.  3.250 
of this chapter on the date of the veteran's death.
    (4) Any balance remaining in the personal funds of patients account 
that cannot be distributed in accordance with paragraphs (a)(1) through 
(3) of this section will be used by VA to reimburse anyone who bore the 
expense of the veteran's last sickness or burial or will be deposited to 
the credit of the applicable current VA appropriation.

[[Page 626]]

    (b) Application. A person who seeks distribution of a deceased 
veteran's funds from the personal funds of patients account under 
paragraph (a) of this section must file an application with VA not later 
than 5 years after the veteran's death. If any person who seeks such 
distribution is under a legal disability that prevents him or her from 
filing an application at the time of the veteran's death, the 5-year 
period will run from the date of termination or removal of the legal 
disability.

(Authority: 38 U.S.C. 501, 5502)



Sec.  13.270  Creditors' claims.

    Under 38 U.S.C. 5301(a)(1), VA benefit payments are exempt, both 
before and after receipt by the beneficiary, from the claims of 
creditors and taxation. The fiduciary should invoke this defense in 
applicable circumstances. If the fiduciary does not do so, the Hub 
Manager may refer the matter to the District Counsel for evaluation and 
appropriate legal action.

(Authority: 38 U.S.C. 501, 512, 5301)



Sec.  13.280  Accountings.

    (a) General. Except as prescribed in paragraph (d) of this section, 
a fiduciary for a beneficiary must submit to the fiduciary hub with 
jurisdiction an annual accounting regarding the VA benefit funds under 
management by the fiduciary for the beneficiary if:
    (1) The amount of VA benefit funds under management for the 
beneficiary exceeds $10,000;
    (2) The fiduciary deducts a fee authorized under Sec.  13.220 from 
the beneficiary's account;
    (3) The beneficiary is being paid VA compensation benefits at a 
total disability rating (100 percent), whether schedular, extra-
schedular, or based on individual unemployability; or
    (4) The Hub Manager determines an accounting is necessary to ensure 
the fiduciary has properly managed the beneficiary's funds.
    (b) Scope of accounting. For purposes of this section, accounting 
means the fiduciary's written report regarding the income and funds 
under management by the fiduciary for the beneficiary during the 
accounting period prescribed by the Hub Manager. The accounting 
prescribed by this section pertains to all activity in the beneficiary's 
accounts, regardless of the source of funds maintained in those 
accounts. An accounting consists of:
    (1) A beginning inventory or account balance,
    (2) An itemization of income,
    (3) An itemization of expenses,
    (4) An ending inventory or account balance,
    (5) Copies of financial institution documents reflecting receipts, 
expenditures, and beginning and ending balances, and
    (6) Receipts, when required by the Hub Manager.
    (c) Submission requirements. Fiduciaries must submit annual 
accountings to the fiduciary hub as follows:
    (1) The fiduciary must submit accountings on the appropriate VA form 
not later than 30 days after the end of the accounting period prescribed 
by the Hub Manager.
    (2) The fiduciary must submit a corrected or supplemental accounting 
not later than 14 days after the date of VA notice of an accounting 
discrepancy.
    (d) Exceptions. The provisions of this section that generally 
require the submission of an annual accounting do not apply to a 
fiduciary who is:
    (1) The beneficiary's spouse;
    (2) A chief officer of a Federal institution;
    (3) A chief officer of a non-VA facility receiving benefits for a 
beneficiary institutionalized in the facility and:
    (i) The beneficiary's monthly care, maintenance, and personal use 
expenses equal or exceed the amount of the beneficiary's monthly VA 
benefit; and
    (ii) The amount of VA benefit funds under management by the 
fiduciary does not exceed $10,000; or
    (4) A fiduciary who receives benefits on behalf of a beneficiary and 
both permanently resides outside of the United States or in the 
Commonwealth of Puerto Rico or the Republic of the Philippines, and the 
fiduciary was appointed outside of the United States or in the 
Commonwealth of Puerto Rico or the Republic of the Philippines.
    (e) Failure to comply with accounting requirements. The Hub Manager 
will

[[Page 627]]

treat any willful neglect or refusal to file proper accountings as prima 
facie evidence of embezzlement or misappropriation of VA benefits. Such 
evidence is grounds for starting a misuse investigation under Sec.  
13.400.

(Authority: 38 U.S.C. 501, 5502, 5509, 6101)

(Approved by the Office of Management and Budget under control number 
2900-0017)



Sec.  13.300  Onsite reviews.

    (a) Periodic onsite reviews. (1) The Hub Manager will conduct a 
periodic, scheduled, onsite review of any fiduciary in the United 
States, whether the fiduciary is an individual or an entity, if:
    (i) The fiduciary serves 20 or more beneficiaries, and
    (ii) The total annual amount of recurring VA benefits paid to the 
fiduciary for such beneficiaries exceeds the threshold established in 38 
U.S.C. 5508 as adjusted by VA under 38 U.S.C. 5312.
    (2) The Hub Manager must complete at least one periodic onsite 
review triennially if the fiduciary meets the requirements of paragraph 
(a)(1) of this section.
    (3) VA will provide the fiduciary with written notice of the 
periodic onsite review at least 30 days before the scheduled review 
date. The notice will:
    (i) Inform the fiduciary of the pending review and the fiduciary's 
obligation under this part to cooperate in the onsite review process, 
and
    (ii) Request that the fiduciary make available for review all 
relevant records, including but not limited to case files, bank 
statements, accountings, ledgers, check registers, receipts, bills, and 
any other items necessary to determine that the fiduciary has been 
acting in the best interest of VA beneficiaries and meeting the 
responsibilities of fiduciaries prescribed in Sec.  13.140.
    (b) Unscheduled onsite reviews. The Hub Manager may conduct 
unscheduled onsite reviews of any fiduciary, regardless of the number of 
beneficiaries served by the fiduciary or the total amount of VA benefit 
funds under management by the fiduciary, if:
    (1) VA receives from any source credible information that the 
fiduciary has misused or is misusing VA benefits;
    (2) The fiduciary's annual accounting is seriously delinquent. For 
purposes of this section, seriously delinquent means the fiduciary 
failed to submit the required accounting within 120 days after the 
ending date of the annual accounting period;
    (3) VA receives from any source credible information that the 
fiduciary is not adequately performing the responsibilities of a 
fiduciary prescribed in Sec.  13.140; or
    (4) The Hub Manager determines that an unscheduled onsite review is 
necessary to ensure that the fiduciary is acting in the interest of the 
beneficiary or beneficiaries served by the fiduciary.
    (c) Procedures. (1) Onsite reviews will consist of the following:
    (i) A face-to-face meeting with the fiduciary. In the case of a 
fiduciary that is an entity, the face-to-face meeting will be with a 
representative of the entity;
    (ii) A review of all relevant records maintained by the fiduciary, 
including but not limited to case files, bank statements, accountings, 
ledgers, check registers, receipts, bills, and any other items necessary 
to determine whether the fiduciary has been acting in the interest of VA 
beneficiaries; and
    (iii) Interviews of beneficiaries, the fiduciary's employees, and 
other individuals as determined necessary by the Hub Manager.
    (2) Not later than 30 days after completing a periodic or 
unscheduled onsite review, the Hub Manager will provide the fiduciary a 
written report of VA's findings, recommendations for correction of 
deficiencies, requests for additional information, and notice of VA's 
intent regarding further action.
    (3) Unless good cause for an extension is shown, not later than 30 
days after the date that VA mails the report prescribed by paragraph 
(d)(2) of this section, the fiduciary must submit to the fiduciary hub a 
response to any VA request for additional information or recommendation 
for corrective action.
    (4) The Hub Manager will remove the fiduciary for all VA 
beneficiaries whom the fiduciary serves if the fiduciary:
    (i) Refuses to cooperate with VA during a periodic or unscheduled 
onsite review,
    (ii) Is unable to produce necessary records,

[[Page 628]]

    (iii) Fails to respond to a VA request for additional information or 
recommendation for corrective action, or
    (iv) Is found during an onsite review to have misused VA benefits.

(Authority: 38 U.S.C. 501, 5508)



Sec.  13.400  Misuse of benefits.

    (a) Definition of misuse. Misuse of benefits by a fiduciary occurs 
in any case in which the fiduciary receives payment of benefits for the 
use and benefit of a beneficiary and the beneficiary's dependents, if 
any, and uses any part of such payment for a use other than the use and 
benefit of the beneficiary or the beneficiary's dependents. For the 
purpose of this section, use and benefit means any expenditure 
reasonably intended for the care, support, or maintenance of the 
beneficiary or the beneficiary's dependents. Such expenditures may 
include the fiduciary's efforts to improve the beneficiary's standard of 
living under rules prescribed in this part.
    (b) Misuse determinations. Upon receipt of information from any 
source regarding possible misuse of VA benefits by a fiduciary, the Hub 
Manager may, upon his or her discretion, investigate the matter and 
issue a misuse determination in writing. This decision will:
    (1) Identify the beneficiary,
    (2) Identify the fiduciary,
    (3) State whether the fiduciary is an individual fiduciary serving 
10 or more beneficiaries or a corporation or other entity serving one or 
more beneficiaries,
    (4) Identify the source of the information,
    (5) Describe in detail the facts found as a result of the 
investigation,
    (6) State the reasons for the Hub Manager's determination regarding 
whether the fiduciary misused any part of the beneficiary's benefit paid 
to the fiduciary, and
    (7) If the Hub Manager determines that the fiduciary did misuse any 
part of the beneficiary's benefit, identify the months in which such 
misuse occurred.
    (c) Notice. The Hub Manager will provide written notice of the 
misuse determination prescribed in paragraph (b) of this section, 
including a copy of the Hub Manager's written decision, an explanation 
regarding the reconsideration procedure prescribed in paragraph (d) of 
this section, and the beneficiary's right to appeal under Sec.  13.600, 
to:
    (1) The fiduciary;
    (2) The beneficiary or the beneficiary's legal guardian, and the 
beneficiary's accredited representative, attorney, or claims agents;
    (3) The court of jurisdiction if the fiduciary is also the 
beneficiary's court-appointed guardian and/or conservator; and
    (4) The Director of the Pension and Fiduciary Service.
    (d) Finality and reconsideration of misuse determinations. (1) The 
Hub Manager's misuse determination is a final decision, unless:
    (i) The Hub Manager receives a written request for reconsideration 
from the fiduciary or the beneficiary not later than 30 days after the 
date that the Hub Manager mailed notice of his or her misuse 
determination; or
    (ii) The Hub Manager receives a notice of disagreement from the 
beneficiary not later than 1 year after the date that the Hub Manager 
mailed notice of his or her misuse determination.
    (2) The fiduciary or the beneficiary may submit additional 
information pertinent to reconsideration of the misuse determination and 
not previously considered by the Hub Manager, provided that the 
additional information is submitted with the written reconsideration 
request.
    (3) The Hub Manager will close the record regarding reconsideration 
at the end of the 30-day period described in paragraph (d)(1)(i) of this 
section and furnish a timely request submitted by the fiduciary or the 
beneficiary, including any new information, to the Director of the VA 
Regional Office with jurisdiction over the fiduciary hub for a final 
decision.
    (4) In making the misuse determination on reconsideration, the 
Regional Office Director's decision will be based upon a review of the 
information of record as of the date of the Hub Manager's misuse 
determination and any new information submitted with the request. The 
decision will:
    (i) Identify the beneficiary,

[[Page 629]]

    (ii) Identify the fiduciary,
    (iii) Identify if the fiduciary is also the beneficiary's court-
appointed guardian or conservator,
    (iv) Identify the date of the Hub Manager's prior decision,
    (v) Describe in detail the facts found as a result of the Director's 
review of the Hub Manager's decision and any new information submitted 
with the reconsideration request, and
    (vi) State the reasons for the Director's final decision, which may 
affirm, modify, or overturn the Hub Manager's decision.
    (5) The Hub Manager will provide written notice of the Regional 
Office Director's final decision on reconsideration to:
    (i) The fiduciary,
    (ii) The beneficiary or the beneficiary's legal guardian, and the 
beneficiary's accredited representative, attorney, or claims agent;
    (iii) The court, if the fiduciary is also the beneficiary's court-
appointed guardian or conservator; and
    (iv) The Director of the Pension and Fiduciary Service.
    (e) Reporting of misuse. Except as prescribed in Sec.  1.204 of this 
chapter, which requires VA management officials to promptly report 
possible criminal matters involving felonies to the VA Office of 
Inspector General, reporting of misuse cases will occur as follows:
    (1) Not later than 30 days after a final determination is made under 
paragraph (d) of this section that a fiduciary has misused VA benefits, 
the Director of the VA Regional Office who has jurisdiction over the 
fiduciary hub will notify the VA Office of Inspector General for 
purposes of any further action that the Inspector General deems 
appropriate under separate authority, and the court of jurisdiction if 
the fiduciary is also the beneficiary's court-appointed legal guardian 
and/or conservator.
    (2) For purposes of application of Sec.  13.410 regarding reissuance 
and recoupment of benefits, the Office of Inspector General will advise 
the Director of the Pension and Fiduciary Service of any final decision 
regarding prosecution of a fiduciary who misused VA benefits and any 
final judgment of a court in such a prosecution not later than 30 days 
after the decision is made or judgment is entered.

(Authority: 38 U.S.C. 501, 5502, 6106)



Sec.  13.410  Reissuance and recoupment of misused benefits.

    (a) General. (1) If the Hub Manager or the Regional Office Director 
upon reconsideration determines that a fiduciary described in paragraph 
(a)(2) of this section misused any part of a beneficiary's benefit paid 
to the fiduciary, the Regional Office Director will reissue benefits to 
the beneficiary's successor fiduciary in an amount equal to the amount 
of funds misused.
    (2) This paragraph (a) applies to a fiduciary that is:
    (i) An individual who served 10 or more beneficiaries during any 
month in which misuse occurred; or
    (ii) A corporation or other entity serving one or more 
beneficiaries.
    (b) Negligence. In any case in which the Hub Manager or the Regional 
Office Director upon reconsideration determines that an individual 
fiduciary who served fewer than 10 beneficiaries during any month in 
which misuse occurred misused a beneficiary's funds under management by 
the fiduciary, the Hub Manager will refer the matter to the Director, 
Pension and Fiduciary Service, for a determination of whether VA 
negligence caused the misuse. The Regional Office Director will reissue 
benefits to the beneficiary's successor fiduciary in an amount equal to 
the amount of funds misused if the Director of the Pension and Fiduciary 
Service determines that VA negligence caused the misuse. The Pension and 
Fiduciary Service Director's negligence determination will be based upon 
a review of the VA information of record as of the date of the Hub 
Manager's or Regional Office Director's misuse determination. For 
purposes of this section, VA negligence causes misuse when:
    (1) The Hub Manager failed to properly investigate or monitor the 
fiduciary; for example, when:
    (i) The Hub Manager failed to review the fiduciary's accounting 
within 60 days after the date on which the accounting was scheduled for 
review. The date that an accounting is scheduled for review is the date 
the fiduciary hub receives the accounting;

[[Page 630]]

    (ii) The Hub Manager did not decide whether to investigate an 
allegation of misuse within 60 days of receipt of the allegation;
    (iii) After deciding to investigate an allegation of misuse and 
finding misuse, the Hub Manager failed to initiate action within 60 days 
of receipt of the misuse allegation to terminate the fiduciary.
    (2) Actual negligence by VA is shown. For purposes of this section, 
actual negligence means the Hub Manager's failure to exercise toward a 
beneficiary in the fiduciary program the care which a reasonable or 
prudent person would exercise in the circumstances, or the Hub Manager's 
taking action that a reasonable or prudent person would not take. The 
Regional Office Director shall reissue benefits based on actual 
negligence if the Director of the Pension and Fiduciary Service 
determines that:
    (i) The Hub Manager owed a duty to the beneficiary under this part,
    (ii) The Hub Manager's action or failure to act was negligent, and
    (iii) The Hub Manager's negligence proximately caused the misuse of 
benefits by the fiduciary. For purposes of this section, proximate cause 
means that the misuse would not have occurred but for the Hub Manager's 
negligence.
    (c) Recoupment of misused benefits. In all cases in which the Hub 
Manager or Regional Office Director upon reconsideration determines that 
a fiduciary misused benefits, VA will make a good faith effort to recoup 
the total amount of misused benefits from the fiduciary.
    (1) For purposes of this section, good faith effort means that the 
Hub Manager will:
    (i) Recover any misused benefits from the surety company, if a 
surety bond was in place regarding protection of beneficiary funds; or
    (ii) In cases in which no surety bond was in place and the fiduciary 
does not repay all misused benefits within the time prescribed by the 
Hub Manager in consultation with the fiduciary:
    (A) Request the creation of a debt to the United States in the 
amount of any misused benefits that remain unpaid; and
    (B) Coordinate further recoupment action, including collection of 
any debt owed by the fiduciary to the United States as a result of the 
misuse, with the appropriate Federal and state agencies.
    (2) VA will pay benefits recouped under paragraph (c) of this 
section to the beneficiary's successor fiduciary after deducting any 
amount reissued under paragraph (a) or (b) of this section.
    (d) Notice. The Hub Manager, or in the case of a negligence 
determination, the Director of the Pension and Fiduciary Service, will 
provide the beneficiary or the beneficiary's legal guardian, and the 
beneficiary's accredited representative, attorney or claims agent 
written notice of any decision regarding reissuance or recoupment of 
benefits under this section.

(Authority: 38 U.S.C. 501, 6106, 6107)



Sec.  13.500  Removal of fiduciaries.

    (a) The Hub Manager may remove a fiduciary if the Hub Manager 
determines that fiduciary services are no longer required for a 
beneficiary or removal is in the beneficiary's interest. Reasons for 
removal include, but are not limited to:
    (1) Beneficiary reasons. (i) A VA rating authority determines that 
the beneficiary can manage his or her own VA benefits without VA 
supervision or appointment of a fiduciary;
    (ii) The beneficiary requests appointment of a successor fiduciary 
under Sec.  13.100;
    (iii) The beneficiary requests supervised direct payment of benefits 
under Sec.  13.110; or
    (iv) The beneficiary dies.
    (2) Fiduciary reasons. (i) The fiduciary's further service is barred 
under Sec.  13.130;
    (ii) The fiduciary fails to maintain his or her qualifications or 
does not adequately perform the responsibilities of a fiduciary 
prescribed in Sec.  13.140;
    (iii) The fiduciary fails to timely submit a complete accounting as 
prescribed in Sec.  13.280;
    (iv) VA or a court with jurisdiction determines that the fiduciary 
misused or misappropriated VA benefits;
    (v) The fiduciary fails to respond to a VA request for information 
within 30 days after such request is made, unless the Hub Manager grants 
an extension

[[Page 631]]

based upon good cause shown by the fiduciary;
    (vi) The fiduciary is unable or unwilling to provide the surety bond 
prescribed by Sec.  13.230 or, if applicable, enter into a restricted 
withdrawal agreement;
    (vii) The fiduciary no longer meets the requirements for appointment 
under Sec.  13.100; or
    (viii) The fiduciary is unable or unwilling to manage the 
beneficiary's benefit payments, accounts, or investments.
    (b) Procedures. (1) If the Hub Manager determines that it is 
necessary to remove a fiduciary and appoint a successor fiduciary, the 
Hub Manager will:
    (i) Provide the fiduciary and the beneficiary written notice of the 
removal; and
    (ii) Instruct the fiduciary regarding the fiduciary's 
responsibilities prior to transfer of funds to a successor fiduciary or 
provide other instructions to the fiduciary.
    (2) The fiduciary must:
    (i) Continue as fiduciary for the beneficiary until the Hub Manager 
provides the fiduciary with the name and address of the successor 
fiduciary and instructions regarding the transfer of funds to the 
successor fiduciary; and
    (ii) Not later than 30 days after transferring funds to the 
successor fiduciary or as otherwise instructed by the Hub Manager, 
provide the fiduciary hub a final accounting.

(Authority: 38 U.S.C. 501, 5502, 5507, 6106)



Sec.  13.510  Fiduciary withdrawals.

    (a) General. A fiduciary may not withdraw as fiduciary for a 
beneficiary until the fiduciary receives notice from the Hub Manager 
regarding transfer of the beneficiary's funds to a successor fiduciary.
    (b) Voluntary withdrawal. (1) Subject to the limitation prescribed 
in paragraph (a) of this section, a fiduciary who has VA benefit funds 
under management for a beneficiary may withdraw from the fiduciary 
relationship with the beneficiary at any time if the fiduciary:
    (i) Provides the fiduciary hub with jurisdiction written notice of 
the fiduciary's intent to withdraw as fiduciary for the beneficiary;
    (ii) Describes the reasons for withdrawal;
    (iii) Continues as fiduciary for the beneficiary until the Hub 
Manager provides the fiduciary with the name and address of the 
successor fiduciary and instructions regarding the transfer of funds to 
the successor fiduciary; and
    (iv) Not later than 30 days after transferring funds to the 
successor fiduciary or as otherwise instructed by the Hub Manager, 
provides the fiduciary hub with jurisdiction a final accounting.
    (2) Upon receipt of the notice of intent to withdraw prescribed in 
paragraph (b)(1)(i) of this section, the Hub Manager will make a 
reasonable effort under the circumstances to expedite the appointment of 
a successor fiduciary. In determining the extent to which the fiduciary 
hub must expedite the appointment of a successor fiduciary, the Hub 
Manager will consider:
    (i) The reasons for the withdrawal request provided under paragraph 
(b)(1)(ii) of this section;
    (ii) The number of beneficiaries affected;
    (iii) The relationship between the affected beneficiary or 
beneficiaries and the fiduciary; and
    (iv) Whether expedited appointment of a successor fiduciary is 
necessary to protect the interests of the beneficiary or beneficiaries.
    (c) Notice. If a fiduciary requests to withdraw from service for a 
beneficiary, the Hub Manager will provide the beneficiary or the 
beneficiary's legal guardian, and the beneficiary's accredited 
representative, attorney, or claims agent written notice of the 
withdrawal request and the procedures for appointment of a successor 
fiduciary.

(Authority: 38 U.S.C. 501, 5502)



Sec.  13.600  Appeals.

    Except as prescribed in paragraph (a) of this section, VA decisions 
regarding fiduciary matters are committed to the Secretary of Veterans 
Affairs' discretion by law, as delegated to subordinate officials under 
this part, and cannot be appealed to the Board of Veterans' Appeals or 
any court.

[[Page 632]]

    (a) Appealable decisions. A beneficiary may appeal to the Board of 
Veterans' Appeals the following decisions:
    (1) The Hub Manager's appointment of a fiduciary under Sec.  13.100;
    (2) The Hub Manager's removal of a fiduciary under Sec.  13.500;
    (3) The Hub Manager's misuse determination under Sec.  13.400;
    (4) The VA Regional Office Director's final decision upon 
reconsideration of a misuse determination under Sec.  13.400(d); and
    (5) The Director of the Pension and Fiduciary Service's negligence 
determination for purposes of reissuance of benefits under Sec.  13.410.
    (b) Procedures. (1) VA decisions regarding fiduciary matters are 
final, subject only to the right of appeal prescribed in this section.
    (2) The initiation and processing of appeals under this section are 
governed by parts 19 and 20 of this chapter.

(Authority: 38 U.S.C. 501)

(Approved by the Office of Management and Budget under control number 
2900-0085)



PART 14_LEGAL SERVICES, GENERAL COUNSEL, AND MISCELLANEOUS CLAIMS-
-Table of Contents



Sec.
14.500 Functions and responsibilities of General Counsel.
14.501 Functions and responsibilities of Regional Counsels.
14.502 Requests for legal opinions from Central Office.
14.503 Requests for legal advice and assistance in other than domestic 
          relations matters.
14.504 Domestic relations questions, authority and exceptions.
14.505 Submissions.
14.507 Opinions.

       Litigation (Other Than Under the Federal Tort Claims Act); 
                             Indemnification

14.514 Suits by or against United States or Department of Veterans 
          Affairs officials; indemnification of Department of Veterans 
          Affairs employees.
14.515 Suits involving loan guaranty matters.
14.516 Escheat and post fund cases.
14.517 Cases affecting the Department of Veterans Affairs generally.
14.518 Litigation involving beneficiaries in custody of Department of 
          Veterans Affairs employees acting in official capacity.

                               Prosecution

14.560 Procedure where violation of penal statutes is involved including 
          those offenses coming within the purview of the Assimilative 
          Crime Act (18 U.S.C. 13).
14.561 Administrative action prior to submission.
14.562 Collections or adjustments.

                           Federal Tort Claims

14.600 Federal Tort Claims Act--general.
14.601 Investigation and development.
14.602 Requests for medical information.
14.603 Disposition of claims.
14.604 Filing a claim.
14.605 Suits against Department of Veterans Affairs employees arising 
          out of a wrongful act or omission or based upon medical care 
          and treatment furnished in or for the Veterans Health 
          Administration.

  Administrative Settlement of Tort Claims Arising in Foreign Countries

14.615 General.
14.616 Form and place of filing claim.
14.617 Disposition of claims.

           Claims for Damage to or Loss of Government Property

14.618 Collection action.

              Claims for Cost of Medical Care and Services

14.619 Collection action.

Representation of Department of Veterans Affairs Claimants; Recognition 
 of Organizations, Accredited Representatives, Attorneys, Agents; Rules 
    of Practice and Information Concerning Fees, 38 U.S.C. 5901-5905

14.626 Purpose.
14.627 Definitions.
14.628 Recognition of organizations.
14.629 Requirements for accreditation of service organization 
          representatives; agents; and attorneys.
14.630 Authorization for a particular claim.
14.631 Powers of attorney; disclosure of claimant information.
14.632 Standards of conduct for persons providing representation before 
          the Department.
14.633 Termination of accreditation or authority to provide 
          representation under Sec.  14.630.
14.634 Banks or trust companies acting as guardians.
14.635 Office space and facilities.
14.636 Payment of fees for representation by agents and attorneys in 
          proceedings before Agencies of Original Jurisdiction

[[Page 633]]

          and before the Board of Veterans' Appeals.
14.637 Payment of the expenses of agents and attorneys in proceedings 
          before Agencies of Original Jurisdiction and before the Board 
          of Veterans' Appeals.

                            Personnel Claims

14.664 Scope of authority and effective date.
14.665 Claims.
14.666 Regional Counsel responsibility.
14.667 Claims payable.
14.668 Disposition of claims.
14.669 Fees of agents or attorneys; penalty.

                        Commitments--Fiduciaries

14.700 Court cost and expenses; commitment, restoration, fiduciary 
          appointments.
14.701 Commitment and restoration proceedings.
14.702 Medical testimony in commitment or restoration proceedings.
14.703 Costs in commitment or restoration proceedings.
14.704 Authorization of transportation necessary for commitment of a 
          veteran beneficiary.
14.705 Authority to file petitions for appointment of fiduciaries in 
          State courts.
14.706 Legal services in behalf of beneficiaries.
14.707 Authorization of transportation of a veteran beneficiary for 
          appointment of a fiduciary.
14.708 Costs and other expenses incident to appointment of fiduciary.
14.709 Surety bonds; court-appointed fiduciary.

 Testimony of Department Personnel and Production of Department Records 
                          in Legal Proceedings

14.800 Purpose.
14.801 Applicability.
14.802 Definitions.
14.803 Policy.
14.804 Factors to consider.
14.805 Contents of a demand or request.
14.806 Scope of testimony or production.
14.807 Procedure when demand or request is made.
14.808 Expert or opinion testimony.
14.809 Demands or requests in legal proceedings for records protected by 
          confidentiality statutes.
14.810 Fees.

    Authority: 5 U.S.C. 301; 28 U.S.C. 2671-2680; 38 U.S.C. 501(a), 512, 
515, 5502, 5901-5905; 28 CFR part 14, appendix to part 14, unless 
otherwise noted.

    Source: 19 FR 5552, Aug. 31, 1954, unless otherwise noted.



Sec.  14.500  Functions and responsibilities of General Counsel.

    The General Counsel is responsible to the Secretary for the 
following:
    (a) All litigation arising in, or out of, the activities of the 
Department of Veterans Affairs or involving any employee thereof in his 
or her official capacity.
    (b) All interpretative legal advice involving construction or 
application of laws, including statutes, regulations, and decisional as 
well as common law.
    (c) All legal services, advice and assistance required to implement 
any law administered by the Department of Veterans Affairs.
    (d) All delegations of authority and professional guidance required 
to meet these responsibilities.
    (e) Maintenance of a system of field offices capable of providing 
legal advice and assistance to all Department of Veterans Affairs field 
installations and acting for the General Counsel as provided by 
Department of Veterans Affairs Regulations and instructions, or as 
directed by the General Counsel in special cases. This includes 
cooperation with U.S. Attorneys in all civil and criminal cases 
pertaining to the Department of Veterans Affairs and reporting to the 
U.S. Attorneys, as authorized, or to the General Counsel, or both, 
criminal matters coming to the attention of the Regional Counsel.
    (f) Other matters assigned.

[42 FR 41410, Aug. 17, 1977]



Sec.  14.501  Functions and responsibilities of Regional Counsels.

    (a) Functions and responsibilities of the Regional Counsels are 
those set forth in this part and all other matters assigned by the 
General Counsel.
    (b) In any matter within the jurisdiction of the General Counsel, 
delegated or otherwise assigned, the Regional Counsel and designated 
staff attorneys are authorized to conduct investigations, examine 
witnesses, take affadavits, administer oaths and affirmations and 
certify copies of public or private documents.
    (c) The Regional Counsel is authorized to, and shall, under the 
guidance of the General Counsel, provide legal

[[Page 634]]

services, advice and assistance to Department of Veterans Affairs 
installations within the district assigned. In any area of regulatory, 
assigned or delegated responsibility, the Regional Counsel may delegate 
to staff members or other Department of Veterans Affairs attorneys 
authority to perform, to the extent specified, any legal function under 
the professional direction of the Regional Counsel. Conversely, the 
Regional Counsel may modify, suspend, or rescind any authority delegated 
hereunder.
    (d) The Regional Counsel is authorized to cooperate with affiliated 
organizations, legislative committees, and with local and State bar 
associations to the end that any State law deficiencies relating to 
Department of Veterans Affairs operations may be removed. No commitment 
as to proposed legislation will be made without the approval of the 
General Counsel.
    (e) In any case wherein the Regional Counsel is authorized to take 
legal action and payment of costs and necessary expenses incident 
thereto are involved, the administration requesting such action will pay 
such cost and expenses. Where it is impractical for the Regional Counsel 
to perform the legal service because of cost, distance, etc., the 
customary fee for the service rendered by a local attorney employed by 
the Regional Counsel will be borne by the administration requesting such 
action.
    (f) The jurisdictions and addresses of Regional Counsels are as 
follows:
    (1) Region 1: (JURISDICTION) Connecticut, Maine, Massachusetts, New 
Hampshire, Rhode Island; (ADDRESS) VAMC, 200 Springs Road, Bldg. 61, 
Bedford, MA 01730.
    (2) Region 2: (JURISDICTION) New Jersey, Metropolitan New York City; 
(ADDRESS) 800 Poly Place, Building 14, Brooklyn, NY 11209.
    (3) Region 3: (JURISDICTION) District of Columbia; Fairfax, 
Virginia; Arlington, Virginia; Alexandria, Virginia; Martinsburg, West 
Virginia; and Maryland; (ADDRESS) 3900 Loch Raven Blvd., Bldg. 4, 
Baltimore, MD 21218.
    (4) Region 4: (JURISDICTION) Pennsylvania, Delaware; (ADDRESS) 
University & Woodland Avenues, Philadelphia, PA 19104.
    (5) Region 5: (JURISDICTION) Georgia, South Carolina; (ADDRESS) 1700 
Clairmont Rd., Decatur, GA 30033-4032.
    (6) Region 6: (JURISDICTION) Florida, Puerto Rico; (ADDRESS) P.O. 
Box 5005, Building 22, Room 333, Bay Pines, FL 33744.
    (7) Region 7: (JURISDICTION) Ohio, West Virginia (excluding 
Martinsburg, West Virginia); (ADDRESS) 10000 Brecksville Rd., Bldg. 1, 
5th Floor, Brecksville, OH 44141.
    (8) Region 8: (JURISDICTION) Arkansas, Tennessee; (ADDRESS) 110 9th 
Ave., South Room A-201A, Nashville, TN 37203.
    (9) Region 9: (JURISDICTION) Alabama, Mississippi; (ADDRESS) 1500 E. 
Woodrow Wilson Dr., Jackson, MS 39216.
    (10) Region 10: (JURISDICTION) Illinois, Iowa; (ADDRESS) VA Medical 
Center, Bldg. 1, G Section 1st Floor, P. O. Box 1427, Hines, IL 60141.
    (11) Region 11: (JURISDICTION) Michigan, Wisconsin; (ADDRESS) 
Patrick V. McNamara Federal Bldg., Suite 1460, 477 Michigan Ave., 
Detroit, MI 48226.
    (12) Region 12: (JURISDICTION) Kansas, Missouri, Nebraska; (ADDRESS) 
1 Jefferson Barracks Drive, St. Louis, MO 63125-4185.
    (13) Region 13: (JURISDICTION) Oklahoma, Northern Texas; (ADDRESS) 
4800 Memorial Drive, Bldg. 12, Waco, TX 76711.
    (14) Region 14: (JURISDICTION) Louisiana, Southern Texas; (ADDRESS) 
6900 Almeda Road, Houston, TX 77030.
    (15) Region 15: (JURISDICTION) Minnesota, North Dakota, South 
Dakota; (ADDRESS) VA Medical Center, One Veterans Drive, Bldg. 73, 
Minneapolis, MN 55417.
    (16) Region 16: (JURISDICTION) Colorado, Wyoming, Utah, Montana; 
(ADDRESS) Box 25126, 155 Van Gordon Street, Denver, CO 80225.
    (17) Region 18: (JURISDICTION) California, Hawaii, and Philippine 
Islands; (ADDRESS) VA Medical Center, 4150 Clement Street, Bldg. 210, 
San Francisco, CA 94121.

[[Page 635]]

    (18) Region 19: (JURISDICTION) Arizona, Nevada, and New Mexico; 
(ADDRESS) 650 E. Indian School Rd., Bldg. 24, Phoenix AZ 85012.
    (19) Region 20: (JURISDICTION) Idaho, Oregon, Washington, Alaska; 
(ADDRESS) 1220 S.W. Third Ave., Suite 1224, Portland, OR 97204.
    (20) Region 21: (JURISDICTION) New York (except Metropolitan New 
York City), Vermont; (ADDRESS) 120 LeBrun, Buffalo, NY 14215.
    (21) Region 22: (JURISDICTION) Indiana, Kentucky; (ADDRESS) 575 N. 
Pennsylvania Street, Room 309, Indianapolis, IN 46204.
    (22) Region 23: (JURISDICTION) North Carolina, Virginia (excluding 
Fairfax, Arlington, and Alexandria); (ADDRESS) Hiram H. Ward Federal 
Bldg., 251 N. Main Street, Winston-Salem, NC 27155.

[42 FR 41411, Aug. 17, 1977, as amended at 61 FR 7216, Feb. 27, 1996; 70 
FR 52015, Sept. 1, 2005]



Sec.  14.502  Requests for legal opinions from Central Office.

    Requests for formal legal advice, including interpretation of law or 
regulations, shall be made only by the Secretary, the Deputy Secretary, 
the Assistant Secretaries, the Deputy Assistant Secretaries, and the 
administration head or top staff office official having jurisdiction 
over the particular subject matter, or by a subordinate acting for any 
such official.

[54 FR 34982, Aug. 23, 1989]



Sec.  14.503  Requests for legal advice and assistance in other than
domestic relations matters.

    (a) Requests from administrative officials in the field for legal 
advice or assistance will be addressed to the appropriate Regional 
Counsel and will be in writing if requested by the Regional Counsel. 
Questions regarding insurance activities at St. Paul and Philadelphia 
should be referred to the Regional Counsel at the respective station. 
Except as to matters referred to in Sec.  14.504(b), the Regional 
Counsel's authority to render legal advice and assistance shall extend 
to the release (unless otherwise instructed by the General Counsel), 
without prior approval of the General Counsel, of opinions on all legal 
questions which are either:
    (1) Wholly controlled by the interpretation or application of the 
laws of the State or States in the district office area, or
    (2) Covered by Department of Veterans Affairs precedents and 
opinions of the General Counsel which the Regional Counsel knows to be 
currently authoritative on the issues involved.

In cases covered by Sec.  14.504(b) and all others not included in 
paragraph (a)(1) or (2) or paragraph (b) of this section, the Regional 
Counsel will prepare a tentative opinion (including identification of 
the benefit sought) and forward it to the General Counsel for review. 
When it is returned, the Regional Counsel will conform the opinion (if 
necessary) to the views of the General Counsel, and release it to the 
requesting official. The Regional Counsel may release any modified 
opinion as the opinion of the General Counsel.
    (b) The Regional Counsel may submit to the General Counsel any legal 
question, opinion, or question pertinent to legal functions, upon which 
the views or advice of the General Counsel are desired. This request 
should set forth the special circumstances, contain a statement of the 
legal implications involved (including any Department of Veterans 
Affairs benefits claimed), set forth the facts out of which they arise, 
and cite any statutes or court decisions readily available, regulations, 
related opinions of the General Counsel and other matters deemed 
pertinent, with appropriate discussion. If any administration will be 
affected, a copy of the reply will be forwarded to that administration 
head.

[42 FR 41411, Aug. 17, 1977, as amended at 54 FR 34982, Aug. 23, 1989]



Sec.  14.504  Domestic relations questions, authority and exceptions.

    (a) Regional Counsels have the same authority with respect to 
domestic relations questions as they do with respect to matters covered 
by Sec.  14.503 except as specifically excluded by the provisions of 
paragraph (a) of that section.
    (b) In the following instances the Regional Counsel, regardless of 
whether

[[Page 636]]

State law is wholly controlling or a Department of Veterans Affairs 
precedent is available, will prepare a tentative opinion, researched as 
completely as possible with reasonably available facilities, and forward 
two copies thereof directly to the General Counsel for review and 
disposition (as provided in Sec.  14.503 respecting other than domestic 
relations matters):
    (1) Where it is not clear under applicable State law: (i) Whether 
the marriage of a veteran's child or the remarriage of a veteran's widow 
was void without decree of annulment, or (ii) whether an annulment 
decree was rendered by a court with basic authority to render annulment 
decrees;
    (2) When fraud or collusion by either party appears to have 
influenced the granting of an annulment decree;
    (3) Cases in which there are contesting claims;
    (4) Unusual situations, such as those involving proxy marriages, the 
law of two or more jurisdictions or of a foreign country;
    (5) Cases involving difference of opinion between Regional Counsels 
or between a Regional Counsel and the official who submitted the 
question involved.

[42 FR 41411, Aug. 17, 1977]



Sec.  14.505  Submissions.

    All submissions will set forth the question of law on which the 
opinion is desired, together with a complete and accurate summary of 
relevant facts. Files, correspondence, and other original papers will 
not be submitted unless pertinent portions thereof cannot practicably be 
summarized or copies made and attached as exhibits.

[42 FR 41411, Aug. 17, 1977]



Sec.  14.507  Opinions.

    (a) A written legal opinion of the General Counsel involving 
veterans' benefits under laws administered by the Department of Veterans 
Affairs shall be conclusive as to all Department officials and employees 
with respect to the matter at issue, unless there has been a material 
change in controlling statute or regulation, a superseding written legal 
opinion by the General Counsel, or the designation on its face as 
``advisory only'' by the General Counsel or the Deputy General Counsel 
acting as or for the General Counsel. Written legal opinions having 
conclusive effect under this section and not designated as precedent 
opinions pursuant to paragraph (b) of this section shall be considered 
by the Department of Veterans Affairs to be subject to the provisions of 
5 U.S.C. 552(a)(2). Advice, recommendations, or conclusions on matters 
of Government or Department policy, contained within a written legal 
opinion, shall not be binding on Department officials and employees 
merely because of their being contained within a written legal opinion. 
Written legal opinions will be maintained in the Office of the General 
Counsel. Written legal opinions involving veterans' benefits under laws 
administered by the Department of Veterans Affairs, which pertain to a 
particular benefit matter, in addition to being maintained in the Office 
of the General Counsel, will be filed in the individual claim folder.
    (b) A written legal opinion of the General Counsel involving 
veterans' benefits under laws administered by the Department of Veterans 
Affairs which, in the judgment of the General Counsel or the Deputy 
General Counsel acting as or for the General Counsel, necessitates 
regulatory change, interprets a statute or regulation as a matter of 
first impression, clarifies or modifies a prior opinion, or is otherwise 
of significance beyond the matter at issue, may be designated a 
``precedent opinion'' for purposes of such benefits. Written legal 
opinions designated as precedent opinions under this section shall be 
considered by Department of Veterans Affairs to be subject to the 
provisions of 5 U.S.C. 552(a)(1). An opinion designated as a precedent 
opinion is binding on Department officials and employees in subsequent 
matters involving a legal issue decided in the precedent opinion, unless 
there has been a material change in a controlling statute or regulation 
or the opinion has been overruled or modified by a subsequent precedent 
opinion or judicial decision.
    (c) For purposes of this section, the term written legal opinion of 
the General Counsel means a typed or printed

[[Page 637]]

memorandum or letter signed by the General Counsel or by the Deputy 
General Counsel acting as or for the General Counsel, addressed to an 
official or officials of the Department of Veterans Affairs stating a 
conclusion on a legal issue pertaining to Department of Veterans Affairs 
activities.

(Authority: 38 U.S.C. 501)

[54 FR 5613, Feb. 6, 1989, as amended at 61 FR 68666, Dec. 30, 1996]

       Litigation (Other Than Under the Federal Tort Claims Act); 
                             Indemnification



Sec.  14.514  Suits by or against United States or Department of Veterans
Affairs officials; indemnification of Department of Veterans Affairs 
employees.

    (a) Suits against United States or Department of Veterans Affairs 
officials. When a suit involving any activities of the Department of 
Veterans Affairs is filed against the United States or the Secretary or 
a suit is filed against any employee of the Department of Veterans 
Affairs in which is involved any official action of the employee, not 
covered by the provisions of Sec. Sec.  14.600 through 14.617, a copy of 
the petition will be forwarded to the General Counsel who will take 
necessary action to obtain the pertinent facts, cooperate with or 
receive the cooperation of the Department of Justice and, where 
indicated, advise the Regional Counsel of any further action required.
    (b) Counsel and representation of employees. The Department of 
Justice may afford counsel and representation to Government employees 
who are sued individually as a result of the performance of their 
official duties. A civil action commenced in a State court against an 
employee, as the result of an action under color of his or her office, 
may be removed to the applicable Federal District Court. If a suit is 
filed against an employee as the result of the performance of his or her 
official duties, where the provisions of either 28 U.S.C. 2679 or 38 
U.S.C. 7316 are not applicable (see Sec.  14.610), and the employee 
desires to be represented by the U.S. Attorney, the Regional Counsel 
will obtain a written request to this effect from the employee and will 
also obtain an affidavit of the facility Director describing the 
incident in sufficient detail to enable a determination to be made as to 
whether the employee was in the scope of his or her employment at the 
time. These statements, together with a copy of the petition and two 
copies of a summary of pertinent facts, will be sent to the General 
Counsel, who will transmit copies thereof to the Department of Justice 
for appropriate action.
    (c) Indemnification. (1) The Department of Veterans Affairs may 
indemnify a Department of Veterans Affairs employee, who is personally 
named as a defendant in any civil suit in state or Federal court or an 
arbitration proceeding or other proceeding seeking damages against the 
employee personally, where either 28 U.S.C. 2679 or 38 U.S.C. 7316 is 
not applicable, for any verdict, judgment, or other monetary award which 
is rendered against such employee; provided that: the alleged conduct 
giving rise to the verdict, judgment, or award was taken within the 
scope of his or her employment and that such indemnification is in the 
interest of the Department of Veterans Affairs, as determined by the 
Secretary or his designee.
    (2) The Department of Veterans Affairs may settle or compromise a 
personal damage claim against a Department of Veterans Affairs employee, 
in cases where the provisions of either 28 U.S.C. 2679 or 38 U.S.C. 7316 
are not applicable, by the payment of available funds, at any time; 
provided that: the alleged conduct giving rise to the personal damage 
claim was taken within the employee's scope of employment and that such 
settlement or compromise is in the interest of the Department of 
Veterans Affairs, as determined by the Secretary or his designee.
    (3) Absent exceptional circumstances as determined by the Secretary 
or his designee, the Agency will not entertain a request either to agree 
to indemnify or to settle a personal damage claim before entry of an 
adverse verdict, judgment, or award.
    (4) A Department of Veterans Affairs employee may request 
indemnification to satisfy a verdict, judgment, or award entered against 
that employee. The employee shall submit a written

[[Page 638]]

request, with appropriate documentation including copies of the verdict, 
judgment, award, or settlement proposal, in a timely manner to the 
Department of Veterans Affairs General Counsel, who shall make a 
recommended disposition of the request. Where the Department of Veterans 
Affairs determines it appropriate, the Agency shall seek the view of the 
Department of Justice. The General Counsel shall forward the employee 
request for indemnification, and the accompanying documentation, with 
the General Counsel's recommendation to the Secretary for decision.
    (5) Any payment under this section either to indemnify a Department 
of Veterans Affairs employee or to settle or compromise a personal 
damage claim shall be contingent upon the availability of appropriated 
funds of the Department of Veterans Affairs.
    (d) Attorney-client privilege. Attorneys employed by the Department 
of Veterans Affairs who participate in any process utilized for the 
purpose of determining whether the Agency should request the Department 
of Justice to provide representation to a Department employee sued, 
subpoenaed or charged in his individual capacity, or whether attorneys 
employed by the Department of Veterans Affairs should provide assistance 
in the representation of such a Department employee, undertake a full 
and traditional attorney-client relationship with the employee with 
respect to application of the attorney-client privilege. If 
representation is authorized, Department of Veterans Affairs attorneys 
who assist in the representation of an employee also undertake a full 
and traditional attorney-client relationship with the employee with 
respect to the attorney-client privilege. Any adverse information 
communicated by the client-employee to an attorney during the course of 
such attorney-client relationship shall not be disclosed to anyone, 
either inside or outside the Department of Veterans Affairs, other than 
attorneys responsible for representation of the employee, unless such 
disclosure is authorized by the employee.
    (e) Suits by the United States. In any instance wherein direct 
submission to a U.S. Attorney for institution of civil action has been 
authorized by the Department of Justice, the Regional Counsel will 
furnish the U.S. Attorney a complete report of the facts and applicable 
law, documentary evidence, names and addresses of witnesses and, in 
cases wherein Department of Veterans Affairs action has been taken, a 
copy of any pertinent decision rendered. The Regional Counsel will 
forward two copies of such report and of any proposed pleading to the 
General Counsel, and will render any practicable assistance requested by 
the U.S. Attorney.

[42 FR 41411, Aug. 17, 1977, as amended at 54 FR 5614, Feb. 6, 1989]



Sec.  14.515  Suits involving loan guaranty matters.

    (a) In actions for debt, possession or actions similar in substance 
(including title actions) in which Sec.  36.4282 or Sec.  36.4319 of 
this chapter has been complied with, the Regional Counsel is authorized 
to enter the appearance of and represent the Secretary of Veterans 
Affairs as the attorney of record and to file claims for debt in probate 
proceedings without prior reference to the General Counsel. Any such 
action will normally be taken within the time prescribed by law as 
though there had been valid service of process. In all other types of 
cases, the Regional Counsel will not enter an appearance or file any 
pleading on behalf of the Secretary except in imperative emergency until 
authorization is received from the General Counsel after submission of 
all relevant facts. In doubtful cases, the Regional Counsel will request 
instructions from the General Counsel, submitting copy of so much of the 
pleadings or other papers, together with a sufficient recital of the 
facts as will make clear the background, the issues, and the relief 
sought. The submission also will include names and addresses of adverse 
parties and attorneys so that immediate action may be taken if 
injunctive relief seems proper. Where necessary in any case to preserve 
rights which might be lost by default if there had been proper service 
of process, appropriate action will be taken by a special appearance, 
or, in jurisdictions where a special appearance does not serve the 
purpose or

[[Page 639]]

under State statute or decisions will constitute a general appearance 
for a later date, by an appearance through amicus curiae, to obtain an 
extension of time, preferably 30 days or more, in which to appear and 
plead without prejudice. If not feasible to obtain an extension, the 
Regional Counsel will explain to adverse counsel by letter, and 
personally, if desirable, the necessity of deferring all action and will 
see that the proper judge receives a signed copy of the letter before 
default day. The letter will point out that there is no valid service of 
process on the Secretary of Veterans Affairs but will not base the delay 
on that alone.
    (b) The General Counsel or each Regional Counsel representing the 
General Counsel is the attorney of the Secretary of Veterans Affairs for 
all purposes of 38 U.S.C. 3720 and, as such, is authorized to represent 
the Secretary in any court action or other legal matter arising under 
said statutory provisions. Said authorization is subject to any 
applicable statutes and Executive orders concerning claims of the United 
States. A Regional Counsel may enter appearance in such cases, subject 
to the provisions of Sec. Sec.  36.4282 and 36.4319 of this chapter and 
paragraph (a) of this section. Each Regional Counsel is authorized to 
contract for the employment of attorneys on a fee basis for conducting 
any action arising under guaranty or insurance of loans or direct loans 
by the Department of Veterans Affairs; or for examination and other 
proper services with respect to title to and liens on real and personal 
property, material incident to such activities of the Department of 
Veterans Affairs, when, such employment is deemed by the Regional 
Counsel to be appropriate. the authority delegated to the Regional 
Counsel may be redelegated with the approval of the General Counsel.
    (c) The General Counsel and each Regional Counsel, in carrying out 
their duties as authorized in paragraph (a) or (b) of this section, are 
authorized: (1) To contract for and execute, for and on behalf of the 
Secretary, any bond (and appropriate contract or application therefor) 
which is required in or preliminary to or in connection with any 
judicial proceeding in which the Regional Counsel is attorney for the 
Secretary, and to incur obligations for premiums for such bonds and (2) 
to do all other acts and incur all costs and expenses which are 
necessary or appropriate to further or protect the interests of the 
Secretary in or in connection with prosecuting or defending any cause in 
any court or tribunal within the United States, which cause arises out 
of or incident to the guaranty or insurance of loans, or the making or 
direct loans by the Department of Veterans Affairs, pursuant to 38 
U.S.C. ch. 37.
    (d) Except in an emergency, no Regional Counsel will initiate action 
for appellate review without prior approval by the General Counsel. 
These limitations do not preclude the filing of a motion for a new 
trial, appeal to intermediate court with hearing do novo, the giving of 
notice of appeal, reserving of bills of exception, or any other 
preliminary action in the trial court which may be necessary or 
appropriate to protect or facilitate, the exercise of the right of 
appellate review, nor do they preclude the taking of appropriate steps 
on behalf of the Secretary as appellee (respondent) without prior 
reference to the General Counsel. Upon the conclusion of the trial of a 
case, the Regional Counsel will report the result thereof to the General 
Counsel with recommendation as to seeking appellate review if the result 
reported is adverse to the position of the Department of Veterans 
Affairs in the litigation. The reporting Regional Counsel who recommends 
appellate review will include as a part of the communication, or in 
exhibits attached: (1) A summary of the evidence; (2) a summary of the 
law points to be reviewed; (3) citations of statutes and cases; (4) 
statements of special reasons for recommending appellate review; (5) 
time limitations for the action recommended; (6) requirements, if any, 
respecting printing of the record and briefs; (7) the estimated total 
expenses to be incurred by reason of the appeal, reporting separately 
the estimated costs for printing the brief and record so that authority 
for printing may be

[[Page 640]]

granted in accordance with the prescribed procedure, MP-1, part II, 
chapter 9;\1\ and (8) the recommendation or a statement as to 
nonrecommendation by the Loan Guaranty Officer.
---------------------------------------------------------------------------

    \1\ Available in any Department of Veterans Affairs facility.

[42 FR 41411, Aug. 17, 1977]



Sec.  14.516  Escheat and post fund cases.

    In any case in which the Department of Veterans Affairs is entitled 
to possession of assets or property under the escheat provisions of 38 
U.S.C. 5502(e), the gifts provisions of 38 U.S.C. ch. 83 or the General 
Post Fund provisions of 38 U.S.C. ch. 85, the Regional Counsel will 
endeavor to obtain possession of such assets or property in any manner 
appropriate under local procedure and practice, other than litigation. 
This procedure would include exploratory inquiry of the person having 
custody or possession of the assets or property for the purpose of 
determining whether the person would be willing to turn over the 
property to the Department of Veterans Affairs without litigation. If 
unsuccessful in this effort, a complete report will be submitted by the 
Regional Counsel to the General Counsel so that appropriate action may 
be taken to obtain the assistance of the Department of Justice in the 
matter.

[42 FR 41411, Aug. 17, 1977]



Sec.  14.517  Cases affecting the Department of Veterans Affairs 
generally.

    Regional Counsels will establish and maintain such close liaison 
with the State and Federal courts as to insure that notice will be 
afforded the Department of Veterans Affairs on all cases affecting the 
Department of Veterans Affairs. Such information will be forwarded to 
the General Counsel promptly in every case.

[42 FR 41411, Aug. 17, 1977]



Sec.  14.518  Litigation involving beneficiaries in custody of 
Department of Veterans Affairs employees acting in official capacity.

    (a) Service of process generally. An employee, at a field facility, 
served with a writ of habeas corpus involving a beneficiary of the 
Department of Veterans Affairs in the employee's custody will 
immediately notify the Regional Counsel of the region in addition to 
taking such steps as in his or her judgment are necessary for self 
protection.
    (b) Habeas corpus writs. (1) If a Director of a Department of 
Veterans Affairs hospital concerned advises that, according, to current 
medical opinion, hospitalization is necessary for the veteran's safety 
or the safety of others, the Regional Counsel will vigorously oppose the 
writ at the trial court level. If the writ is granted, no further action 
will be taken unless so instructed by the General Counsel.
    (2) If the medical opinion is that hospitalization is not required 
for the veteran's safety or the safety of others but continued treatment 
is clearly indicated in the veteran's interest, the Regional Counsel 
will assure that the court issuing the writ is so informed and will 
abide by the court's decision.
    (3) If the medical opinion is that there is no danger of self injury 
to the veteran or others and the need for continued treatment is not 
clearly demonstrated, the Regional Counsel will advise the Director of 
the hospital concerned that the veteran should be released and will 
notify the veteran's attorney of the planned discharge. These cases will 
be handled informally to the extent practicable.
    (4) Involuntary confinement of mentally ill patients in Department 
of Veterans Affairs installations is predicated upon the law of the 
State in which the installation is located. In the event the writ is 
filed in Federal Court, the Regional Counsel will cooperate with the 
U.S. Attorney to the end that the case is removed to the appropriate 
State court.

[42 FR 41411, Aug. 17, 1977, as amended at 61 FR 7216, Feb. 27, 1996]

                               Prosecution



Sec.  14.560  Procedure where violation of penal statutes is involved
including those offenses coming within the purview of the Assimilative
Crime Act (18 U.S.C. 13).

    The Department of Justice, or the U.S. Attorneys, are charged with 
the duty and responsibility of interpreting and enforcing criminal 
statutes, and

[[Page 641]]

the final determination as to whether the evidence in any case is 
sufficient to warrent prosecution is a matter solely for their 
determination. If the Department of Justice or U.S. Attorney decides to 
initiate action, the Regional Counsel will cooperate as may be 
requested. The Regional Counsel will promptly bring to the attention of 
the General Counsel any case wherein he or she is of the opinion that 
criminal or civil action should be initiated notwithstanding a decision 
by the U.S. Attorney not to bring such action; any case where action has 
been inordinately delayed; and any case which would cause significant 
publicity or notoriety.

(Authority: 38 U.S.C. 501)

[50 FR 24767, June 13, 1985, as amended at 68 FR 17551, Apr. 10, 2003]



Sec.  14.561  Administrative action prior to submission.

    Before a submission is made to the U.S. Attorney in cases involving 
personnel or claims, the General Counsel, if the file is in Central 
Office, or the Regional Counsel at the regional office, hospital or 
center, if the file is in the regional office or other field facility, 
will first ascertain that necessary administrative or adjudicatory 
(forfeiture (see Pub. L. 86-222; 73 Stat. 452), etc.), action has been 
taken; except that in urgent cases such as breaches of the peace, 
disorderly conduct, trespass, robbery, or where the evidence may be lost 
by delay, or prosecution barred by the statute of limitations, 
submission to the U.S. Attorney will be made immediately.

[42 FR 41413, Aug. 17, 1977]



Sec.  14.562  Collections or adjustments.

    When it is determined that a submission is to be made to the U.S. 
Attorney, no demand for payment or adjustment will be made without the 
advice of the U.S. Attorney. However, if, before or after submission, 
the potential defendant or other person tenders payment of the liability 
to the United States, payment will be accepted if the U.S. Attorney has 
no objection. If the U.S. Attorney determines that prosecution is not 
indicated, or when prosecution has ended, the file will be returned to 
the appropriate office with a report as to the action taken.

[42 FR 41413, Aug. 17, 1977]

                           Federal Tort Claims



Sec.  14.600  Federal Tort Claims Act--general.

    (a) Federal Tort Claims Act--overview. The Federal Tort Claims Act 
(28 U.S.C. 1291, 1346, 1402, 2401, 2402, 2411, 2412, and 2671 through 
2680) prescribes a uniform procedure for handling of claims against the 
United States, for money only, on account of damage to or loss of 
property, or on account of personal injury or death, caused by the 
negligent or wrongful act or omission of a Government employee while 
acting within the scope of his or her office or employment, under 
circumstances where the United States, if a private person, would be 
liable in accordance with the law of the place where the act or omission 
occurred.
    (b) Applicable regulations. The regulations issued by the Department 
of Justice at 28 CFR part 14 are applicable to claims asserted under the 
Federal Tort Claims Act, including such claims that are filed with VA. 
The regulations in Sec. Sec.  14.600 through 14.605 of this part 
supplement the regulations at 28 CFR part 14.
    (c) Delegations of authority concerning claims. Subject to the 
limitations in 28 CFR 14.6(c), (d), and (e), authority to consider, 
ascertain, adjust, determine, compromise, and settle claims asserted 
under the Federal Tort Claims Act (including the authority to execute an 
appropriate voucher and other necessary instruments in connection 
therewith) is delegated as follows:
    (1) To the Under Secretary for Health, the Deputy Under Secretary 
for Health, Veterans Integrated Service Network (VISN) Directors, and VA 
Medical Facility Directors; with respect to any claim for $2,500 or less 
that arises out of the operations of the Veterans Health Administration.
    (2) To the General Counsel, Deputy General Counsel, and Assistant 
General Counsel (Professional Staff Group I) or those authorized to act 
for them with respect to any claim; provided that any award, compromise, 
or settlement in excess of $300,000 shall be effected only

[[Page 642]]

with the prior written approval of the Attorney General or his or her 
designee; provided further that whenever a settlement is effected in an 
amount in excess of $100,000, a memorandum fully explaining the basis 
for the action taken shall be sent to the Department of Justice.
    (3) To the Regional Counsels and the Deputy Assistant General 
Counsel (Professional Staff Group I) or those authorized to act for them 
with respect to any claim, provided that:
    (i) Any award, compromise, or settlement in excess of $150,000 but 
not more than $300,000 shall be effected only with the prior written 
approval of the General Counsel, Deputy General Counsel, or Assistant 
General Counsel (Professional Staff Group I); provided further that 
whenever a settlement is effected in an amount in excess of $100,000, a 
memorandum fully explaining the basis for the action taken shall be sent 
to the Department of Justice; and
    (ii) Any award where, for any reason, the compromise of a particular 
claim, as a practical matter, will, or may control the disposition of a 
related claim in which the amount to be paid may exceed $150,000 shall 
be effected only with the prior written approval of the General Counsel, 
Deputy General Counsel, or Assistant General Counsel (Professional Staff 
Group I); and
    (iii) Any award, compromise, or settlement in excess of $300,000 
shall be effected only with the prior written approval of the General 
Counsel, Deputy General Counsel, or Assistant General Counsel 
(Professional Staff Group I) and with the prior written approval of the 
Attorney General or his or her designee.
    (d) Delegations of authority to reconsider final denial of a claim. 
Subject to the limitations in 28 CFR 14.6(c), (d), and (e), authority 
under 28 CFR 14.9 to reconsider final denials of claims under the 
Federal Tort Claims Act is delegated as follows:
    (1) To the Regional Counsel with jurisdiction over the geographic 
area where the occurrence complained of arose, with respect to any claim 
for $2,500 or less that arises out of the operations of the Veterans 
Health Administration.
    (2) To the General Counsel, Deputy General Counsel, and Assistant 
General Counsel (Professional Staff Group I) with respect to any claim; 
provided that any award, compromise, or settlement in excess of $300,000 
shall be effected only with the prior written approval of the Attorney 
General or his or her designee; provided further that whenever a 
settlement is effected in an amount in excess of $100,000, a memorandum 
fully explaining the basis for the action taken shall be sent to the 
Department of Justice.

(Authority: 28 U.S.C. 1291, 1346, 1402, 2401, 2402, 2411, 2412, 2671-80; 
38 U.S.C. 512, 515; 28 CFR part 14, appendix to part 14)

[64 FR 47112, Aug. 30, 1999, as amended at 74 FR 67076, Dec. 18, 2009]



Sec.  14.601  Investigation and development.

    (a) Development of untoward incidents. (1) A report of any collision 
involving a Government-owned vehicle which results in property damage or 
personal injury or death will be made by the operator of the Government 
vehicle immediately following the accident, on SF 91, Operator's Report 
of Motor Vehicle Accident, and shall be submitted to the Director of the 
facility involved. A copy of said report, accompanied by an executed 
copy of VA Form 2162, Report of Accident, will be promptly submitted by 
the Director to the appropriate Regional Counsel, who will authorize 
such additional investigation as the circumstances of the case may 
warrant. Forms required by other agencies will continue to be used in 
addition to VA Form 2162.
    (2)(i) Any incident resulting in damage to, or loss of, property, 
other than personal effects of a patient in a Department of Veterans 
Affairs facility, or in personal injury or death, due apparently or 
allegedly to the negligent or wrongful act or omission of an employee of 
the Department of Veterans Affairs acting within the scope of his or her 
office or employment, or damage to or loss of Government-owned property 
caused by other than a Department of Veterans Affairs employee acting 
within the scope of his or her office or employment, will be immediately 
reported. The Director of the facility where such occurrence took place 
will

[[Page 643]]

promptly transmit a copy of the report to the appropriate Regional 
Counsel who will authorize such additional investigation as the 
circumstances of the case may warrant.
    (ii) Where the incident involves the loss of personal effects of a 
patient in a Department of Veterans Affairs facility, the Director will 
assist the patient in completing an SF 95, Claim for Damage, Injury, or 
Death, and will advise the patient that it will be forwarded immediately 
to the appropriate Regional Counsel for consideration. The Director will 
forward along with the claim a brief summary of the facts, as well as 
his or her recommendation, to the Regional Counsel. The Regional Counsel 
will expedite the processing of claims of this nature.
    (3) An employee will be designated at each facility to investigate 
motor vehicle collisions and other incidents involving damage to, or 
loss of privately owned property or personal injury or death, apparently 
or allegedly resulting from the negligent or wrongful act or omission of 
an employee of the Department of Veterans Affairs acting within the 
scope of his or her employment, other than investigation of alleged 
malpractice, or damage to or loss of Government-owned property caused by 
other than Department of Veterans Affairs employees. In Central Office, 
the designation will be made by the Director of Support Service, Office 
of the Assistant Secretary for Human Resources and Administration, and 
at all other facilities, by the Director.
    (4) The Regional Counsel for the area in which a field facility is 
located will be responsible for processing claims involving motor 
vehicle collisions and other occurrences resulting in property damage, 
personal injury, or death, within such area. The Baltimore Regional 
Counsel will also have jurisdiction, except as otherwise provided in 
paragraph (a)(3) of this section over incidents occurring in Department 
of Veterans Affairs Central Office.
    (b) Development of medical malpractice claims. In medical 
malpractice cases, the Regional Counsel may refer a claim to the Under 
Secretary for Health via the Director, Medical-Legal Affairs for review 
and for professional opinion or guidance. In the consideration of claims 
involving a medical question, the responsible Regional Counsel involved 
and the General Counsel will be guided by the views of the Under 
Secretary for Health as to the standard of medical care and treatment, 
the nature and extent of the injuries, the degree of temporary or 
permanent disability, the prognosis, the necessity for future treatment 
or physical rehabilitation, and any other pertinent medical aspects of a 
claim.

(Authority: 28 U.S.C. 2671-2680; 38 U.S.C. 512, 515; 28 CFR part 14, 
appendix to part 14)

[42 FR 41414, Aug. 17, 1977. Redesignated and amended at 61 FR 27784, 
June 3, 1996; 64 FR 47112, Aug. 30, 1999]



Sec.  14.602  Requests for medical information.

    (a) Where there is indication that a tort claim will be filed, 
medical records or other information shall not be released without 
approval of the Regional Counsel.
    (b) Request for medical records, documents, reports, or other 
information shall be handled in accordance with the provisions of Sec.  
1.511(a)(2) of this chapter.

[38 FR 5470, Mar. 1, 1973, as amended 42 FR 41415, Aug. 17, 1977. 
Redesignated at 61 FR 27784, June 3, 1996, as amended at 64 FR 47112, 
Aug. 30, 1999]



Sec.  14.603  Disposition of claims.

    Setoff for cost of unauthorized medical treatment. In any tort claim 
administratively settled or compromised where the claimant owes the 
Department of Veterans Affairs for unauthorized medical treatment, there 
will be included in the tort claim award the amount of the claimant's 
indebtedness to the Government. The amount of the indebtedness is for 
credit to the appropriation account from which the services were 
provided. The voucher prepared for settlement of the claim will specify 
the amount to be deposited to the credit of the designated account and 
that the balance of the award be paid to the claimant.

[42 FR 41416, Aug. 17, 1977, as amended at 43 FR 2722, Jan. 19, 1978. 
Redesignated and amended at 61 FR 27784, June 3, 1996]

[[Page 644]]



Sec.  14.604  Filing a claim.

    (a) Each person who inquires as to the procedure for filing a claim 
against the United States, predicated on a negligent or wrongful act or 
omission of an employee of the Department of Veterans Affairs acting 
within the scope of his or her employment, will be furnished a copy of 
SF 95, Claim for Damage, Injury, or Death. The claimant will be advised 
to submit the executed claim directly to the Regional Counsel having 
jurisdiction of the area wherein the occurrence complained of took 
place. He or she will also be advised to submit the information 
prescribed by 28 CFR 14.4 to the extent applicable. If a claim is 
presented to the Department of Veterans Affairs which involves the 
actions of employees or officers of other agencies, it will be forwarded 
to the Department of Veterans Affairs General Counsel, for appropriate 
action in accord with 28 CFR 14.2.
    (b) A claim shall be deemed to have been presented when the 
Department of Veterans Affairs receives from a claimant, his or her duly 
authorized agent or legal representative, an executed SF 95, or other 
written notification of an incident, together with a claim for money 
damages, in a sum certain, for damage to or loss of property or personal 
injury or death: Provided, however, That before compromising or settling 
any claim, an executed SF 95 shall be obtained from the claimant.
    (c) A claim presented in compliance with paragraphs (a) and (b) of 
this section may be amended by the claimant at any time prior to final 
Department of Veterans Affairs action or prior to the exercise of the 
claimant's option under 28 U.S.C. 2675(a). Amendments shall be submitted 
in writing and signed by the claimant or his or her duly authorized 
agent or legal representative. Upon the timely filing of an amendment to 
a pending claim, the Department of Veterans Affairs shall have 6 months 
in which to make a final disposition of the claim as amended and the 
claimant's option under 28 U.S.C. 2675(a) shall not accrue until 6 
months after the filing of the amendment.

(Authority: 28 U.S.C. 1346(b)(1), 2401(b), 2671-2680; 38 U.S.C. 512, 
515; 28 CFR part 14, appendix to part 14)

[42 FR 41414, Aug. 17, 1977, as amended at 61 FR 27784, June 3, 1996; 64 
FR 47112, Aug. 30, 1999]



Sec.  14.605  Suits against Department of Veterans Affairs employees
arising out of a wrongful act or omission or based upon medical care and
treatment furnished in or for the Veterans Health Administration.

    (a)(1) Section 2679 of title 28 U.S.C., provides that no suit will 
lie against a Federal employee, or the employee's estate, for damage to 
property, personal injury, or death resulting from his or her wrongful 
act or omission while acting within the scope of his or her office or 
employment with the Federal Government. An action against the United 
States under 28 U.S.C. 2671-2680 is the exclusive remedy under these 
circumstances.
    (2) Section 7316 of title 38 U.S.C., provides that (i) where there 
is remedy against the United States under 28 U.S.C. 2671-2680, or (ii) 
where proceedings for compensation or other benefits from the United 
States are provided by law, and the availability of such benefits 
precludes a remedy under 28 U.S.C. 2671-2680 (as is the case, for 
example, in the Federal Employees' Compensation Act, 5 U.S.C. 8101, et 
seq.), such recourse is the exclusive remedy for property damage, 
personal injury, or death allegedly occurring as a result of malpractice 
or negligence committed by a physician, dentist, nurse, physician's 
assistant, dentist's assistant, pharmacist or paramedical (for example, 
medical and dental technicians, nursing assistants, and therapists), or 
other supporting personnel, while furnishing medical care and treatment 
in the exercise of duties in or for the Veterans Health Administration. 
Accordingly, a malpractice or negligence suit for property damage, 
personal injury, or death will not lie against such personnel under the 
circumstances set forth in this subparagraph.
    (b) The Department of Justice will defend any civil action or 
proceeding

[[Page 645]]

brought in any court against persons referred to in paragraph (a) (1) or 
(2) of this section under the circumstances set forth therein. 
Accordingly, when a suit is filed against any employee of the Department 
of Veterans Affairs as a result of a wrongful act or omission arising 
out of employment with the Government, or as a result of furnishing 
medical or dental care and treatment in or for the Veterans Health 
Administration, the employee shall immediately forward a copy of all 
papers served on him or her to the Regional Counsel having jurisdiction 
over the area in which the employee works. The employee will also 
promptly forward to the appropriate Regional Counsel a signed statement 
indicating whether he or she desires the Department of Justice to 
provide representation, and to otherwise protect his or her interests as 
provided for by law. Even though there may not have been service, if an 
employee learns that a suit arising from either of the above-described 
circumstances has been filed against him or her, the employee shall 
immediately so advise the appropriate Regional Counsel, provide the 
Regional Counsel with a brief description of the facts involved, and 
state whether he or she desires Federal intervention.
    (c) Upon receipt of notice that suit has been filed against an 
employee of the Department of Veterans Affairs who is entitled to 
protection under 28 U.S.C. 2679 or 38 U.S.C. 7316, the Regional Counsel 
having jurisdiction over the place where the employee works will conduct 
a preliminary investigation, which will include an affidavit by the 
employee's supervisor as to whether the defendant-employee was acting in 
the scope of his or her employment at the time of the incident, and a 
request from the defendant-employee for representation. The affidavit 
will contain a factual description of the employee's duties and 
responsibilities at the time of the incident and should describe the 
incident in question. Upon receipt of such information, the Regional 
Counsel will make a preliminary determination as to whether such suit 
comes within the provisions of either 28 U.S.C. 2679 or 38 U.S.C. 7316. 
The Regional Counsel will refer the matter to the appropriate U.S. 
Attorney with a recommendation as to whether the employee is eligible 
for protection under 28 U.S.C. 2679 or 38 U.S.C. 7316. The U.S. Attorney 
will decide whether the Department of Veterans Affairs employee is 
eligible for the protection. The Regional Counsel will submit to the 
General Counsel a preliminary report in duplicate containing the 
information furnished the U.S. Attorney. In all such cases, the Regional 
Counsel will conduct a complete investigation of the facts and law. Two 
copies of the investigation report will be sent to the General Counsel 
and one copy will be sent to the appropriate U.S. Attorney. The General 
Counsel, through the Regional Counsel, will keep the employee advised of 
the action being taken concerning the suit. In the event that the U.S. 
Attorney or the Department of Justice determines that the employee is 
not eligible for immunization pursuant to one of the aformentioned 
provisions, the General Counsel's office, through the Regional Counsel, 
will advise the employee and will call to his or her attention the 
discretionary conditional indemnification provisions of section 7316(e) 
of title 38 U.S.C.
    (d) Where a civil action is commenced in a State court against a 
Department of Veterans Affairs employee, and the matter is within the 
purview of either 28 U.S.C. 2679, or 38 U.S.C. 7316, the Department of 
Justice will be asked to remove such suit to the appropriate Federal 
District Court before trial, where it will be deemed an action against 
the United States. The defendant employee will be dismissed from the 
suit. After such removal, the United States has available all defenses 
to which it would have been entitled if the action had originally been 
commenced against the United States in the proper Federal District 
Court. Should a Federal District Court determine that the Department of 
Veterans Affairs employee whose acts or omissions gave rise to the suit 
was not acting within the scope of his or her office or employment, and 
therefore not eligible for immunization as provided for in the 
aforementioned section, the case will be remanded to the State court

[[Page 646]]

from which it was removed, the employee will be reinstated as the 
defendant, and the United States will be dismissed from the suit. Where 
the employee has been reinstated as the defendant under such 
circumstances, in order to protect any rights which he or she may have 
under 38 U.S.C. 7316(e), he or she shall immediately notify the General 
Counsel, through the local Regional Counsel. Through the Regional 
Counsel, the General Counsel will call the employee's attention to the 
discretionary conditional indemnification provisions of section 7316(e).
    (e) Under the authority of 38 U.S.C. 7316(e), the Secretary of 
Veterans Affairs may pay for monetary damages sustained by or assessed 
against an individual (or his or her estate) described in paragraph 
(a)(2) of this section, as the result of any suit instituted against 
such individual which is not congnizable under the provisions of 28 
U.S.C. 2671-2680 because the individual was assigned to a foreign 
country, the said individual was detailed to a State or political 
division thereof, or the cause of action was specifically excluded under 
the provisions of 28 U.S.C. 2680(h); Provided, That the amount of 
damages sustained is reasonable when compared with similar cases, 
litigated or settled, and the United States was given a reasonable 
opportunity to defend such individual and to participate in settlement 
negotiations.

(Authority: 28 U.S.C 2671-2680; 38 U.S.C. 512, 515, 7316; 28 CFR part 
14, appendix to part 14)

[42 FR 41417, Aug. 17, 1977. Redesignated and amended at 61 FR 27784, 
June 3, 1996; 64 FR 47112, Aug. 30, 1999]

  Administrative Settlement of Tort Claims Arising in Foreign Countries



Sec.  14.615  General.

    (a) Authority. Section 515(b), title 38 U.S.C., provides that the 
Secretary of Veterans Affairs may pay tort claims, in the manner 
authorized in the first paragraph of section 2672 of title 28 U.S.C., 
when such claims arise in foreign countries in connection with 
Department of Veterans Affairs operations abroad.
    (b) Action by claimant. Claims for property loss or damage may be 
filed by the owner of the property or his or her duly authorized agent 
or legal representative. If the property was insured and the insurer is 
subrogated, in whole or in part, and if both the owner and the insurer 
desire to file a claim for their respective losses they should join in 
one claim. Claims for personal injury may be filed by the injured person 
or his or her agent or legal representative. Claims for death may be 
filed by the personal representative of the decedent or any other 
legally qualified person. When filed by an agent or legal 
representative, the claim must show the title or capacity of the person 
representing the claimant and be accompanied by evidence of the 
appointment of such person as agent, legal representative, executor/
executrix, administrator/administratrix, guardian, or other fiduciary.
    (c) Time for filing. A claim may not be allowed under 38 U.S.C. 
515(b) unless it is presented to the Secretary or his or her designee 
within 2 years after the claim accrues.

(Authority: 28 U.S.C 2671-2680; 38 U.S.C. 512, 515, 7316; 28 CFR part 
14, appendix to part 14)

[38 FR 5473, Mar. 1, 1973, as amended at 42 FR 41417, Aug. 17, 1977; 64 
FR 47112, Aug. 30, 1999]



Sec.  14.616  Form and place of filing claim.

    (a) Form of claim. Claims arising under 38 U.S.C. 515(b) will be 
prepared in the form of a sworn statement and submitted in duplicate. 
The original copy of the claim will be sworn to or affirmed before an 
official with authority to administer oaths or affirmations and will 
contain the following information, at least:
    (1) The name and address of claimant;
    (2) The amount claimed for injury or death, and for property loss or 
damage;
    (3) If property was lost or damaged, the amount paid or payable by 
the insurer together with the name of the insurer;
    (4) A detailed statement of the facts and circumstances giving rise 
to the claim, including the time, place, and date of the accident or 
incident;
    (5) If property was involved, a description of the property and the 
nature and extent of the damage and the cost of repair or replacement 
based upon at least two impartial estimates;

[[Page 647]]

    (6) If personal injury was involved, the nature of the injury, the 
cost of medical and/or hospital services, and time and income lost due 
to the injury;
    (7) If death is involved, the names and ages of claimants and their 
relationship to decedent;
    (8) The name and official position of the employee of the United 
States allegedly responsible for the accident or injury, or loss or 
damage of property;
    (9) The names and addresses of any witnesses to accident or 
incident; and
    (10) If desired, the law applicable to the claim.
    (b) Place of filing claim. Claims arising in the Philippines under 
38 U.S.C. 515(b) will be filed with the Director, Department of Veterans 
Affairs Regional Office, Manila, Republic of the Philippines. Claims 
arising in other foreign countries will be filed with the American 
Embassy or Consulate nearest the place where the incident giving rise to 
the claim took place.
    (c) Evidence to be submitted by claimant--(1) General. The amount 
claimed on account of damage to or loss of property or on account of 
personal injury or death shall, so far as possible, be substantiated by 
competent evidence. Supporting statements, estimates and the like will, 
if possible, be obtained from disinterested parties. All evidence will 
be submitted in duplicate. Original evidence or certified copies shall 
be attached to the original copy of the claim, and simple copies shall 
be attached to the other copy of the claim. All documents in other than 
the English language will be accompanied by English translations.
    (2) Personal injury or death. In support of claims for personal 
injury or death, the claimant will submit, as may be appropriate, 
itemized bills for medical, hospital, or burial expenses actually 
incurred; a statement from the claimant's or decedent's employer as to 
time and income lost from work; and a written report by the attending 
physician with respect to the nature and extent of the injury, the 
nature and extent of treatment, the degree of disability, the period of 
hospitalization or incapacitation, and the prognosis as to future 
treatment, hospitalization and the like.
    (3) Damage to personal property. In support of claims for damage to 
personal property which has been repaired, the claimant will submit an 
itemized receipt, or, if not repaired, itemized estimates of the cost of 
repairs by two reliable parties who specialize in such work. If the 
property is not economically repairable, the claimant will submit 
corroborative statements of two reliable, qualified persons with respect 
to cost, age of the property and salvage value.
    (4) Damage to real property. In support of claims for damage to 
land, trees, buildings, fences, or other improvements to real property, 
the claimant will submit an itemized receipt if repairs have been made, 
or, if repairs have not been made, itemized estimates of the cost of 
repairs by two reliable persons who specialize in such work. If the 
property is not economically repairable, the claimant will submit 
corroborative statements of two reliable, qualified persons with respect 
to the value of the improvements both before and after the accident or 
incident and the cost of replacements.
    (5) Damage to crops. In support of claims for damage to crops, the 
claimant will submit an itemized signed statement showing the number of 
acres, or other unit measure of crop damaged, the probable yield per 
unit, the gross amount which would have been realized from such probable 
yield and an estimate of the costs of cultivating, harvesting and 
marketing the crop. If the crop is one which need not be planted each 
year, the diminution in value of the land beyond the damage to the 
current year's crop will also be stated.

(Approved by the Office of Management and Budget under control number 
2900-0437)

[38 FR 5474, Mar. 1, 1973, as amended at 42 FR 41418, Aug. 17, 1977; 49 
FR 32848, Aug. 17, 1984]



Sec.  14.617  Disposition of claims.

    (a) Disposition of claims arising in Philippines. All claims arising 
under 38 U.S.C. 515(b) in the Philippines, including a complete 
investigation report and a brief r[eacute]sum[eacute] of applicable law, 
will be forwarded directly by the Director to the General Counsel, 
together with a recommendation as to disposition.

[[Page 648]]

    (b) Disposition of claims arising in foreign countries other than 
the Philippines. When a claim is received in an American Embassy or 
Consulate, the Embassy or Consulate receiving such claim shall make such 
investigation as may be necessary or appropriate for a determination of 
the validity of the claim and thereafter shall forward the claim, 
together with all pertinent material, including a r[eacute]sum[eacute] 
of applicable law and a recommendation regarding allowance or 
disallowance of the claim, through regular channels of the Department of 
State to the General Counsel, Department of Veterans Affairs Central 
Office, Washington, DC.
    (c) Payment of claims. Upon determining that there is liability on 
the part of the United States under 38 U.S.C. 515(b), the General 
Counsel, or such other personnel as may be designated by the Secretary, 
will take the necessary action to effect payment.

[38 FR 5474, Mar. 1, 1973, as amended at 42 FR 41418, Aug. 17, 1977]

           Claims for Damage to or Loss of Government Property



Sec.  14.618  Collection action.

    (a) In a case where the Regional Counsel determines that damage to 
or loss of Government property under the jurisdiction of the Department 
of Veterans Affairs resulted from the negligence or other legal wrong of 
a person other than an employee of the United States, while acting 
within the scope of his or her employment, the Regional Counsel will 
request payment in full of the amount of damage from the person liable 
therefor or such person's insurer.
    (b) The Regional Counsel may collect, compromise, suspend, or 
terminate collection action on any such claim as is authorized under 
Sec.  2.6(e)(4)(ii) of this chapter, in conformity with the standards in 
Sec.  1.900 series of this chapter. Any such claim that has not been 
collected in full and which has not been compromised, suspended or 
terminated and does not exceed $100,000, will be referred by the 
Regional Counsel to the appropriate U.S. attorney along with the 
information required by Sec. Sec.  1.951 through 1.953 of this chapter. 
Any claim in excess of $100,000 for which payment in full has not been 
made, will be transmitted along with the report required by Sec.  
14.601(a)(2)(i), a report on credit data (Sec.  1.952 of this chapter), 
and any other pertinent information, to the General Counsel for 
appropriate action.
    (c) The General Counsel or those designated in Sec.  2.6(e)(4) of 
this chapter will take action to collect in full on such claims and to 
compromise, suspend, or terminate any such claims not exceeding $100,000 
in conformity with Sec.  1.900 series of this chapter. Any such claims 
not compromised, or on which collection actions is not suspended or 
terminated and does not exceed $100,000, will be referred to the 
appropriate U.S. Attorney. Any such claims in excess of $100,000, which 
have not been collected in full, will be referred by the General Counsel 
to the Department of Justice for appropriate action.
    (d) The provisions of paragraphs (a) through (c) of this section are 
not applicable to the collection of claims involving damage to General 
Services Administration Motor Pool System vehicles issued for Department 
of Veterans Affairs use. Whenever there is any indication that a party 
other than the operator of a motor pool system vehicle is at fault in an 
accident, all documents and data pertaining to the accident and its 
investigation will be submitted to the General Services Administration 
Regional Counsel of the region that issued the vehicle who has 
jurisdiction over such matters. Whenever a motor pool system vehicle is 
involved in an accident, resulting in damage to the property of, or 
injury to the person of a third party, and the third party asserts a 
claim against the Department of Veterans Affairs based upon the alleged 
negligence of the vehicle operator, the claim will be considered under 
Sec.  14.600 et seq.

[38 FR 5474, Mar. 1, 1973, as amended at 42 FR 41418, Aug. 17, 1977; 61 
FR 27784, June 3, 1996]

              Claims for Cost of Medical Care and Services



Sec.  14.619  Collection action.

    (a) In a case where the Regional Counsel determines that medical 
care and services were furnished as a result of the negligence of a 
third party, other than an employee of the United

[[Page 649]]

States while acting in the scope of his or her employment, the Regional 
Counsel will request payment in full of the amount of damage from the 
person liable therefor or such person's insurer.
    (b) The Regional Counsel may collect, compromise, suspend, or 
terminate collection activity on any such claim as is authorized under 
Sec.  2.6(e)(3) of this chapter. However, claims in excess of $100,000 
may be compromised, settled, or waived only with the prior approval of 
the Department of Justice, which will be obtained through the General 
Counsel. Any such claim that has not been collected in full and which 
has not been compromised, suspended or terminated will be referred by 
the Regional Counsel to the appropriate U.S. Attorney along with 
appropriate information necessary to protect the interest of the 
Government. A copy of the referral to the U.S. Attorney will be sent to 
the General Counsel's office.
    (c) In a case where the Regional Counsel determines that a claim is 
appropriate under the provisions of Sec.  17.48(g) of this chapter or 38 
U.S.C. 1729, for the cost of medical, hospital, or surgical care, the 
Regional Counsel may assert the claim and collect payment in full. The 
Regional Counsel may compromise, settle, waive, suspend or terminate 
collection activity on any claim not exceeding $100,000. Claims in 
excess of $100,000 may only be compromised, settled, or waived with the 
approval of the General Counsel. Any such claim not compromised, 
settled, or waived or where collection action is not suspended or 
terminated will be referred to the appropriate United States Attorney 
with sufficient data to enable that office to protect the interest of 
the Government. A copy of all materials referred to the United States 
Attorney will be furnished the General Counsel.

(Authority: 38 U.S.C. 1729(c)(1))

[42 FR 41418, Aug. 17, 1977, as amended at 43 FR 10560, Mar. 14, 1978; 
51 FR 23227, June 26, 1986; 58 FR 39153, July 22, 1993; 61 FR 27785, 
June 3, 1996]

Representation of Department of Veterans Affairs Claimants; Recognition 
 of Organizations, Accredited Representatives, Attorneys, Agents; Rules 
    of Practice and Information Concerning Fees, 38 U.S.C. 5901-5905



Sec.  14.626  Purpose.

    The purpose of the regulation of representatives, agents, attorneys, 
and other individuals is to ensure that claimants for Department of 
Veterans Affairs (VA) benefits have responsible, qualified 
representation in the preparation, presentation, and prosecution of 
claims for veterans' benefits.

[73 FR 29870, May 22, 2008]



Sec.  14.627  Definitions.

    As used in regulations on representation of VA claimants:
    (a) Accreditation means the authority granted by VA to 
representatives, agents, and attorneys to assist claimants in the 
preparation, presentation, and prosecution of claims for VA benefits.
    (b) Agency of original jurisdiction means the VA activity or 
administration that made the initial determination on a claim or matter 
or that handles any subsequent adjudication of a claim or matter in the 
first instance, and includes the Office of the General Counsel with 
respect to proceedings under part 14 of this chapter to suspend or 
cancel accreditation or to review fee agreements.
    (c) Agent means a person who has met the standards and 
qualifications outlined in Sec.  14.629(b).
    (d) Attorney means a member in good standing of a State bar who has 
met the standards and qualifications in Sec.  14.629(b).
    (e) Benefit means any payment, service, commodity, function, or 
status, entitlement to which is determined under laws administered by VA 
pertaining to veterans, dependents, and survivors.
    (f) Cancellation means termination of authority to represent 
claimants.
    (g) Chief Counsel includes a designee of the Chief Counsel.
    (h) Claim means application made under title 38 U.S.C., and 
implementing directives, for entitlement to VA benefits, reinstatement, 
continuation, or

[[Page 650]]

increase of benefits, or the defense of a proposed agency adverse action 
concerning benefits.
    (i) Claimant means a person who has filed or has expressed to a 
representative, agent, or attorney an intention to file a written 
application for determination of entitlement to benefits provided under 
title 38, United States Code, and implementing directives.
    (j) Complete claims service means representation of each claimant 
requesting assistance, from the initiation of a claim until the 
completion of any potential administrative appeal.
    (k) Cross-accreditation means an accreditation based on the status 
of a representative as an accredited and functioning representative of 
another organization.
    (l) Deputy Chief Counsel includes a designee of the Deputy Chief 
Counsel.
    (m) Facilities means equipment and furnishings that promote the 
efficient operation of an office, and adjacent accommodations, which are 
needed to facilitate access to office space.
    (n) General Counsel includes the Deputy General Counsel for Legal 
Policy if designated by the General Counsel. When so designated, 
references to ``the General Counsel or his or her designee'' may further 
include a designee of the Deputy General Counsel for Legal Policy.
    (o) Recognition means certification by VA of organizations to assist 
claimants in the preparation, presentation, and prosecution of claims 
for VA benefits.
    (p) Representation means the acts associated with representing a 
claimant in a proceeding before VA pursuant to a properly executed and 
filed VA Form 21-22, ``Appointment of Veterans Service Organization as 
Claimant's Representative,'' or VA Form 21-22a, ``Appointment of 
Individual as Claimant's Representative.''
    (q) Representative means a person who has been recommended by a 
recognized organization and accredited by VA.
    (r) Service means the delivery of a motion, response, or reply to a 
person or entity to which it is directed. Proof of service consists of a 
statement by the person who made service certifying the date and manner 
of service, the names of the persons served, and the addresses of the 
place of delivery. For service by mail, proof of service shall include 
the date and manner by which the document was mailed.
    (s) State includes any State, possession, territory, or Commonwealth 
of the United States, and the District of Columbia.
    (t) Suspension means temporary withholding of authority to represent 
claimants.
    (u) Tribal government means the Federally recognized governing body 
of any Indian tribe, band, nation, or other organized group or 
community, including any Alaska Native village or Regional or Village 
Corporation as defined in or established pursuant to the Alaska Native 
Claims Settlement Act, which is recognized as eligible for the special 
programs and services provided by the United States to Indians because 
of their status as Indians.

(Authority: 38 U.S.C. 501(a), 5902, 5903, 5904)

[53 FR 52419, Dec. 28, 1988, as amended at 68 FR 8544, Feb. 24, 2003; 73 
FR 29870, May 22, 2008; 82 FR 6272, Jan. 19, 2017; 82 FR 26753, June 9, 
2017]



Sec.  14.628  Recognition of organizations.

    Authorized officers of an organization may request recognition by 
letter to the Secretary of Veterans Affairs.
    (a) National organization. An organization may be recognized as a 
national organization if:
    (1) It was recognized by the Department of Veterans Affairs prior to 
October 10, 1978, and continues to satisfy the requirements of Sec.  
14.628(d) of this section, or
    (2) It satisfies the following requirements:
    (i) Requirements set forth in paragraph (d) of this section, 
including information required to be submitted under that paragraph;
    (ii) In the case of a membership organization, membership of 2,000 
or more persons, as certified by the head of the organization;
    (iii) Capability and resources to provide representation to a 
sizable number of claimants;
    (iv) Capability to represent claimants before the Board of Veterans' 
Appeals in Washington, D.C.; and
    (v) Geographic diversification, i.e., either one or more posts, 
chapters, or offices in at least ten states, or one or

[[Page 651]]

more members in at least twenty states.
    (b)(1) State organization. An organization created and primarily 
funded by a State government for the purpose of serving the needs of 
veterans of that State may be recognized. Only one such organization may 
be recognized in each State.
    (2) Tribal organization. For the purposes of 38 CFR 14.626 through 
14.637, an organization that is a legally established organization that 
is primarily funded and controlled, sanctioned, or chartered by one or 
more tribal governments and that has a primary purpose of serving the 
needs of Native American veterans. Only one tribal organization may be 
recognized for each tribal government. If a tribal organization is 
created and funded by more than one tribal government, the approval of 
each tribal government must be obtained prior to applying for VA 
recognition. If one of the supporting tribal governments withdraws from 
the tribal organization, the tribal organization must notify VA of the 
withdrawal and certify that the tribal organization continues to meet 
the recognition requirements in paragraph (d) of this section.
    (c) Regional or local organization. An organization other than a 
State or national organization as set forth in paragraphs (a) and (b) of 
this section may be recognized when the Department of Veterans Affairs 
has determined that it is a veterans' service organization primarily 
involved in delivering services connected with either title 38 U.S.C., 
benefits and programs or other Federal and State programs designed to 
assist veterans. The term veteran as used in this paragraph shall 
include veterans, former armed forces personnel, and the dependents or 
survivors of either. Further, the organization shall provide 
responsible, qualified representation in the preparation, presentation, 
and prosecution of claims for title 38 U.S.C., benefits.
    (d) Requirements for recognition. (1) In order to be recognized 
under this section, an organization shall meet the following 
requirements:
    (i) Have as a primary purpose serving veterans. In establishing that 
it meets this requirement, an organization requesting recognition shall 
submit a statement establishing the purpose of the organization and that 
veterans would benefit by recognition of the organization.
    (ii) Demonstrate a substantial service commitment to veterans either 
by showing a sizable organizational membership or by showing performance 
of veterans' services to a sizable number of veterans. In establishing 
that it meets this requirement, an organization requesting recognition 
shall submit:
    (A) The number of members and number of posts, chapters, or offices 
and their addresses;
    (B) A copy of the articles of incorporation, constitution, charter, 
and bylaws of the organization, as appropriate;
    (C) A description of the services performed or to be performed in 
connection with programs administered by the Department of Veterans 
Affairs, with an approximation of the number of veterans, survivors, and 
dependents served or to be served by the organization in each type of 
service designated; and
    (D) A description of the type of services, if any, performed in 
connection with other Federal and State programs which are designed to 
assist former Armed Forces personnel and their dependents, with an 
approximation of the number of veterans, survivors, and dependents 
served by the organization under each program designated.
    (iii) Commit a significant portion of its assets to veterans' 
services and have adequate funding to properly perform those services. 
In establishing that it meets this requirement, an organization 
requesting recognition shall submit:
    (A) A copy of the last financial statement of the organization 
indicating the amount of funds allocated for conducting particular 
veterans' services (VA may, in cases where it deems necessary, require 
an audited financial statement); and
    (B) A statement indicating that use of the organization's funding is 
not subject to limitations imposed under any Federal grant or law which 
would prevent it from representing claimants

[[Page 652]]

before the Department of Veterans Affairs.
    (iv) Maintain a policy and capability of providing complete claims 
service to each claimant requesting representation or give written 
notice of any limitation in its claims service with advice concerning 
the availability of alternative sources of claims service. Except as 
provided in paragraphs (d)(1)(iv)(A) and (B) of this section, in 
establishing that it meets this requirement, an organization requesting 
recognition shall submit evidence of its capability to represent 
claimants before Department of Veterans Affairs regional offices and 
before the Board of Veterans' Appeals.
    (A) If an organization does not intend to represent claimants before 
the Board of Veterans' Appeals, the organization shall submit evidence 
of an association or agreement with a recognized service organization 
for the purpose of representation before the Board of Veterans' Appeals, 
or the proposed method of informing claimants of the limitations in 
service that can be provided, with advice concerning the availability of 
alternative sources of claims service.
    (B) If an organization does not intend to represent each claimant 
requesting assistance, the organization shall submit a statement of its 
policy concerning the selection of claimants and the proposed method of 
informing claimants of this policy, with advice concerning the 
availability of alternative sources of claims service.

    Note to paragraph (d)(1)(iv): An organization may be considered to 
provide complete claims service notwithstanding the exercise of 
discretion to determine that provision of representation in a particular 
case is impracticable or inappropriate because, under the circumstances, 
the facts or law do not support the filing of a claim or appeal, an 
appropriate representative-claimant relationship cannot be maintained, 
or representation would give rise to a conflict of interest on the part 
of the organization.

    (v) Take affirmative action, including training and monitoring of 
accredited representatives, to ensure proper handling of claims. In 
establishing that it meets this requirement, an organization requesting 
recognition shall submit:
    (A) A statement of the skills, training, and other qualifications of 
current paid or volunteer staff personnel for handling veterans' claims; 
and
    (B) A plan for recruiting and training qualified claim 
representatives, including the number of hours of formal classroom 
instruction, the subjects to be taught, the period of on-the-job 
training, a schedule or timetable for training, the projected number of 
trainees for the first year, and the name(s) and qualifications of the 
individual(s) primarily responsible for the training.
    (2) In addition, the organization requesting recognition shall 
supply:
    (i) A statement that neither the organization nor its accredited 
representatives will charge or accept a fee or gratuity for service to a 
claimant and that the organization will not represent to the public that 
Department of Veterans Affairs recognition of the organization is for 
any purpose other than claimant representation; and
    (ii) The names, titles, and addresses of officers and the 
official(s) authorized to certify representatives.
    (e) Recognition or denial. Only the Secretary is authorized to 
recognize organizations. Notice of the Secretary's determination on a 
request for recognition will be sent to an organization within 90 days 
of receipt of all information to be supplied.
    (f) Requests for further information. The Secretary or the 
Secretary's designee may request further information from any recognized 
organization, including progress reports, updates, or verifications.

(Authority: 38 U.S.C. 501(a), 5902)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0850)

[53 FR 52419, Dec. 28, 1988, as amended at 57 FR 33878, July 31, 1992; 
68 FR 8544, Feb. 24, 2003; 82 FR 6272, Jan. 19, 2017]



Sec.  14.629  Requirements for accreditation of service organization
representatives; agents; and attorneys.

    (a) Service Organization Representatives. A recognized organization 
shall file with the Office of the General Counsel VA Form 21 
(Application for Accreditation as Service Organization

[[Page 653]]

Representative) for each person it desires accredited as a 
representative of that organization. The form must be signed by the 
prospective representative and the organization's certifying official. 
For each of its accredited representatives, a recognized organization's 
certifying official shall complete, sign and file with the Office of the 
General Counsel, not later than five years after initial accreditation 
through that organization or the most recent recertification by that 
organization, VA Form 21 to certify that the representative continues to 
meet the criteria for accreditation specified in paragraph (a)(1), (2) 
and (3) of this section. In recommending a person, the organization 
shall certify that the designee:
    (1) Is of good character and reputation and has demonstrated an 
ability to represent claimants before the VA;
    (2) Is either a member in good standing or a paid employee of such 
organization working for it not less than 1,000 hours annually; is 
accredited and functioning as a representative of another recognized 
organization; or, in the case of a county veterans' service officer or 
tribal veterans' service officer recommended by a recognized State 
organization, meets the following criteria:
    (i) Is a paid employee of the county or tribal government working 
for it not less than 1,000 hours annually;
    (ii) Has successfully completed a course of training and an 
examination which have been approved by the appropriate District Chief 
Counsel; and
    (iii) Will receive either regular supervision and monitoring or 
annual training to assure continued qualification as a representative in 
the claim process; and
    (3) Is not employed in any civil or military department or agency of 
the United States.


(Authority: 38 U.S.C. 501(a), 5902)

    (b) Accreditation of Agents and Attorneys. (1) No individual may 
assist claimants in the preparation, presentation, and prosecution of 
claims for VA benefits as an agent or attorney unless he or she has 
first been accredited by VA for such purpose.
    (i) For agents, the initial accreditation process consists of 
application to the Office of the General Counsel, self-certification of 
admission information concerning practice before any other court, bar, 
or State or Federal agency, an affirmative determination of character 
and fitness by VA, and a written examination.
    (ii) For attorneys, the initial accreditation process consists of 
application to the Office of the General Counsel, self-certification of 
admission information concerning practice before any other court, bar, 
or State or Federal agency, and a determination of character and 
fitness. The Office of the General Counsel will presume an attorney's 
character and fitness to practice before VA based on State bar 
membership in good standing unless the Office of the General Counsel 
receives credible information to the contrary.
    (iii) As a further condition of initial accreditation, both agents 
and attorneys are required to complete 3 hours of qualifying continuing 
legal education (CLE) during the first 12-month period following the 
date of initial accreditation by VA. To qualify under this subsection, a 
CLE course must be approved for a minimum of 3 hours of CLE credit by 
any State bar association and, at a minimum, must cover the following 
topics: representation before VA, claims procedures, basic eligibility 
for VA benefits, right to appeal, disability compensation (38 U.S.C. 
Chapter 11), dependency and indemnity compensation (38 U.S.C. Chapter 
13), and pension (38 U.S.C. Chapter 15). Upon completion of the initial 
CLE requirement, agents and attorneys shall certify to the Office of the 
General Counsel in writing that they have completed qualifying CLE. Such 
certification shall include the title of the CLE, date and time of the 
CLE, and identification of the CLE provider, and shall be submitted to 
VA as part of the annual certification prescribed by Sec.  14.629(b)(4).
    (iv) To maintain accreditation, agents and attorneys are required to 
complete an additional 3 hours of qualifying CLE on veterans benefits 
law and procedure not later than 3 years from the date of initial 
accreditation and every 2 years thereafter. To qualify under this 
subsection, a CLE

[[Page 654]]

course must be approved for a minimum of 3 hours of CLE credit by any 
State bar association. Agents and attorneys shall certify completion of 
the post-accreditation CLE requirement in the same manner as described 
in Sec.  14.629(b)(1)(iii).
    (2) An individual desiring accreditation as an agent or attorney 
must establish that he or she is of good character and reputation, is 
qualified to render valuable assistance to claimants, and is otherwise 
competent to advise and assist claimants in the preparation, 
presentation, and prosecution of their claim(s) before the Department. 
An individual desiring accreditation as an agent or attorney must file a 
completed application (VA Form 21a) with the Office of the General 
Counsel (022D), 810 Vermont Avenue, NW., Washington, DC 20420, on which 
the applicant submits the following:
    (i) His or her full name and home and business addresses;
    (ii) Information concerning the applicant's military and civilian 
employment history (including character of military discharge, if 
applicable);
    (iii) Information concerning representation provided by the 
applicant before any department, agency, or bureau of the Federal 
government;
    (iv) Information concerning any criminal background of the 
applicant;
    (v) Information concerning whether the applicant has ever been 
determined mentally incompetent or hospitalized as a result of a mental 
disease or disability, or is currently under treatment for a mental 
disease or disability;
    (vi) Information concerning whether the applicant was previously 
accredited as a representative of a veterans service organization and, 
if so, whether that accreditation was terminated or suspended by or at 
the request of that organization;
    (vii) Information concerning the applicant's level of education and 
academic history;
    (viii) The names, addresses, and phone numbers of three character 
references; and
    (ix) Information relevant to whether the applicant for accreditation 
as an agent has any physical limitations that would interfere with the 
completion of a comprehensive written examination administered under the 
supervision of the appropriate District Chief Counsel (agents only); and
    (x) Certification that the applicant has satisfied the 
qualifications and standards required for accreditation as prescribed by 
VA in this section, and that the applicant will abide by the standards 
of conduct prescribed by VA in Sec.  14.632 of this part.
    (3) Evidence showing lack of good character and reputation includes, 
but is not limited to, one or more of the following: Conviction of a 
felony, conviction of a misdemeanor involving fraud, bribery, deceit, 
theft, or misappropriation; suspension or disbarment from a court, bar, 
or Federal or State agency on ethical grounds; or resignation from 
admission to a court, bar, or Federal or State agency while under 
investigation to avoid sanction.
    (4) As a further condition of initial accreditation and annually 
thereafter, each person seeking accreditation as an agent or attorney 
shall submit to VA information about any court, bar, or Federal or State 
agency to which the agent or attorney is admitted to practice or 
otherwise authorized to appear. Applicants shall provide identification 
numbers and membership information for each jurisdiction in which the 
applicant is admitted and a certification that the agent or attorney is 
in good standing in every jurisdiction in which admitted. After 
accreditation, agents and attorneys must notify VA within 30 days of any 
change in their status in any jurisdiction in which they are admitted to 
appear.
    (5) VA will not accredit an individual as an agent or attorney if 
the individual has been suspended by any court, bar, or Federal or State 
agency in which the individual was previously admitted and not 
subsequently reinstated. However, if an individual remains suspended in 
a jurisdiction on grounds solely derivative of suspension or disbarment 
in another jurisdiction to which he or she has been subsequently 
reinstated, the Chief Counsel with subject-matter jurisdiction may 
evaluate the facts and grant or reinstate accreditation as appropriate.
    (6) After an affirmative determination of character and fitness for 
practice before the Department, applicants

[[Page 655]]

for accreditation as a claims agent must achieve a score of 75 percent 
or more on a written examination administered by VA as a prerequisite to 
accreditation. No applicant shall be allowed to sit for the examination 
more than twice in any 6-month period.
    (c) Representation by Attorneys, Law Firms, Law Students and 
Paralegals. (1) After accreditation by the Office of the General 
Counsel, an attorney may represent a claimant upon submission of a VA 
Form 21-22a, ``Appointment of Attorney or Agent as Claimant's 
Representative.''
    (2) If the claimant consents in writing, an attorney associated or 
affiliated with the claimant's attorney of record or employed by the 
same legal services office as the attorney of record may assist in the 
representation of the claimant.
    (3) A legal intern, law student, or paralegal may not be 
independently accredited to represent claimants under this paragraph. A 
legal intern, law student, or certified paralegal may assist in the 
preparation, presentation, or prosecution of a claim, under the direct 
supervision of an attorney of record designated under Sec.  14.631(a), 
if the claimant's written consent is furnished to VA. Such consent must 
specifically state that participation in all aspects of the claim by a 
legal intern, law student, or paralegal furnishing written authorization 
from the attorney of record is authorized. In addition, suitable 
authorization for access to the claimant's records must be provided in 
order for such an individual to participate. The supervising attorney 
must be present at any hearing in which a legal intern, law student, or 
paralegal participates. The written consent must include the name of the 
veteran, or the name of the appellant if other than the veteran (e.g., a 
veteran's survivor, a guardian, or a fiduciary appointed to receive VA 
benefits on an individual's behalf); the applicable VA file number; the 
name of the attorney-at-law; the consent of the appellant for the use of 
the services of legal interns, law students, or paralegals and for such 
individuals to have access to applicable VA records; and the names of 
the legal interns, law students, or paralegals who will be assisting in 
the case. The signed consent must be submitted to the agency of original 
jurisdiction and maintained in the claimant's file.In the case of 
appeals before the Board in Washington, DC, the signed consent must be 
submitted to: Director, Office of Management, Planning and Analysis 
(014), Board of Veterans' Appeals, P.O. Box 27063, Washington, DC 20038. 
In the case of hearings before a Member or Members of the Board at VA 
field facilities, the consent must be presented to the presiding Member 
of the hearing.
    (4) Unless revoked by the claimant, consent provided under paragraph 
(c)(2) or paragraph (c)(3) of this section shall remain effective in the 
event the claimant's original attorney is replaced as attorney of record 
by another member of the same law firm or an attorney employed by the 
same legal services office.

    (d) Decisions on applications for accreditation. The Chief Counsel 
with subject-matter jurisdiction will conduct an inquiry and make an 
initial determination regarding any question relating to the 
qualifications of a prospective service organization representative, 
agent, or attorney.
    (1) If the Chief Counsel determines that the prospective service 
organization representative, agent, or attorney meets the requirements 
for accreditation in paragraph (a) or (b) of this section, notification 
of accreditation will be issued by the Chief Counsel and will constitute 
authority to prepare, present, and prosecute claims before an agency of 
original jurisdiction or the Board of Veterans' Appeals.
    (2)(i) If the Chief Counsel determines that the prospective 
representative, agent, or attorney does not meet the requirements for 
accreditation, notification will be issued by the Chief Counsel 
concerning the reasons for disapproval, an opportunity to submit 
additional information, and any restrictions on further application for 
accreditation. If an applicant submits additional evidence, the Chief 
Counsel will consider such evidence and provide further notice 
concerning his or her final decision.
    (ii) The determination of the Chief Counsel regarding the 
qualifications of a prospective service organization representative, 
agent, or attorney is a

[[Page 656]]

final adjudicative determination of an agency of original jurisdiction 
that may only be appealed to the Board of Veterans' Appeals.
    Note to Sec.  14.629: A legal intern, law student, paralegal, or 
veterans service organization support-staff person, working under the 
supervision of an individual designated under Sec.  14.631(a) as the 
claimant's representative, attorney, or agent, may qualify for read-only 
access to pertinent Veterans Benefits Administration automated claims 
records as described in Sec. Sec.  1.600 through 1.603 in part 1 of this 
chapter.

(Authority: 38 U.S.C. 501(a), 5904)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control numbers 2900-0018 
and 2900-0605)

[53 FR 52421, Dec. 28, 1988, as amended at 55 FR 38057, Sept. 17, 1990; 
68 FR 8545, Feb. 24, 2003; 71 FR 28586, May 17, 2006; 72 FR 58012, Oct. 
12, 2007; 73 FR 29871, May 22, 2008; 73 FR 29871, May 22, 2008; 81 FR 
32649, May 24, 2016; 82 FR 6272, Jan. 19, 2017; 82 FR 26753, June 9, 
2017; 84 FR 174, Jan. 18, 2019]



Sec.  14.630  Authorization for a particular claim.

    (a) Any person may be authorized to prepare, present, and prosecute 
one claim. A power of attorney executed on VA Form 21-22a, ``Appointment 
of Attorney or Agent as Claimant's Representative,'' and a statement 
signed by the person and the claimant that no compensation will be 
charged or paid for the services, shall be filed with the agency of 
original jurisdiction where the claim is presented. The power of 
attorney identifies to VA the claimant's appointment of representation 
and authorizes VA's disclosure of information to the person representing 
the claimant.
    (b) Representation may be provided by an individual pursuant to this 
section one time only. An exception to this limitation may be granted by 
the General Counsel in unusual circumstances. Among the factors which 
may be considered in determining whether an exception will be granted 
are:
    (1) The number of accredited representatives, agents, and attorneys 
operating in the claimant's geographic region;
    (2) Whether the claimant has unsuccessfully sought representation 
from other sources;
    (3) The nature and status of the claim; and
    (4) Whether there exists unique circumstances which would render 
alternative representation inadequate.
    (c) Persons providing representation under this section must comply 
with the laws administered by VA and with the regulations governing 
practice before VA including the rules of conduct in Sec.  14.632 of 
this part.
    (d) Persons providing representation under this section are subject 
to suspension and or exclusion from representation of claimants before 
VA on the same grounds as apply to representatives, agents, and 
attorneys in Sec.  14.633 of this part.
    (e) With respect to the limitation in paragraph (b) of this section, 
a person who had been authorized under paragraph (a) of this section to 
represent a claimant who later dies and is replaced by a substitute 
pursuant to 38 CFR 3.1010 for purposes of processing the claim to 
completion will be permitted to represent the substitute if the 
procedures of Sec.  14.631(g) are followed.

(Authority: 38 U.S.C. 501(a), 5121A, 5903)

[68 FR 8546, Feb. 24, 2003, as amended at 73 FR 29872, May 22, 2008; 79 
FR 52983, Sept. 5, 2014]



Sec.  14.631  Powers of attorney; disclosure of claimant information.

    (a) A power of attorney, executed on either VA Form 21-22, 
``Appointment of Veterans Service Organization as Claimant's 
Representative,'' or VA Form 21-22a, ``Appointment of Attorney or Agent 
as Claimant's Representative,'' is required to represent a claimant 
before VA and to authorize VA's disclosure of information to any person 
or organization representing a claimant before the Department. Without 
the signature of a person providing representation for a particular 
claim under Sec.  14.630 of this part or an accredited veterans service 
organization representative, agent, or attorney, the appointment is 
invalid, and the person appointed to provide representation is under no 
obligation to do so. The power of attorney shall meet the following 
requirements:

[[Page 657]]

    (1) Contain signature by:
    (i) The claimant, or
    (ii) The claimant's guardian, or
    (iii) In the case of an incompetent, minor, or otherwise 
incapacitated person without a guardian, the following in the order 
named--spouse, parent, other relative or friend (if interests are not 
adverse), or the director of the hospital in which the claimant is 
maintained; and
    (iv) An individual providing representation on a particular claim 
under Sec.  14.630 of this part or an accredited veterans service 
organization representative, agent, or attorney; and
    (2) Shall be presented to the appropriate VA office for filing in 
the veteran's claims folder.
    (b) VA may, for any purpose, treat a power of attorney naming as a 
claimant's representative an organization recognized under Sec.  14.628, 
a particular office of such an organization, or an individual 
representative of such an organization as an appointment of the entire 
organization as the claimant's representative, unless the claimant 
specifically indicates in the power of attorney a desire to appoint only 
the individual representative. Such specific indication must be made in 
the space on the power-of-attorney form for designation of the 
representative and must use the word ``only'' with reference to the 
individual representative.
    (c) An organization, individual providing representation on a 
particular claim under Sec.  14.630, representative, agent, or attorney 
named in a power of attorney executed pursuant to paragraph (a) of this 
section may withdraw from representation provided before a VA agency of 
original jurisdiction if such withdrawal would not adversely impact the 
claimant's interests. This section is applicable unless 38 CFR 20.6 
governs withdrawal from the representation. Withdrawal is also 
permissible if a claimant persists in a course of action that the 
organization or individual providing representation reasonably believes 
is fraudulent or criminal and is furthered through the representation of 
the organization or individual; the claimant fails to uphold an 
obligation to the organization or individual providing representation 
regarding the services of the organization or individual; or other good 
cause for withdrawal exists. An organization or individual providing 
representation withdraws from representation by notifying the claimant, 
the VA organization in possession of the claims file, and the agency of 
original jurisdiction in writing prior to taking any action to withdraw 
and takes steps necessary to protect the claimant's interests including, 
but not limited to, giving advance notice to the claimant, allowing time 
for appointment of alternative representation, and returning any 
documents provided by VA in the course of the representation to the 
agency of original jurisdiction or pursuant to the claimant's 
instructions, to the organization or individual substituted as the 
representative, agent, or attorney of record. Upon withdrawing from 
representation, all property of the claimant must be returned to the 
claimant. If the claimant is unavailable, all documents provided by VA 
for purposes of representation must be returned to the VA organization 
in possession of the claims file. Any other property of the claimant 
must be maintained by the organization or individual according to 
applicable law.
    (d) Questions concerning the validity or effect of powers of 
attorney shall be referred to the appropriate District Chief Counsel for 
initial determination. This determination may be appealed to the General 
Counsel.
    (e)(1) Only one organization, representative, agent, or attorney 
will be recognized at one time in the prosecution of a particular claim. 
Except as provided in Sec.  14.629(c) and paragraph (f)(2) of this 
section, all transactions concerning the claim will be conducted 
exclusively with the recognized organization, representative, agent, or 
attorney of record until notice of a change, if any, is received by the 
appropriate office of VA.
    (2) An organization named in a power of attorney executed in 
accordance with paragraph (a) of this section may employ an attorney to 
represent a claimant in a particular claim. Unless the attorney is an 
accredited representative of the organization, the written consent of 
the claimant shall be required.

[[Page 658]]

    (f)(1) A power of attorney may be revoked at any time, and an agent 
or attorney may be discharged at any time. Unless a claimant 
specifically indicates otherwise, the receipt of a new power of attorney 
executed by the claimant and the organization or individual providing 
representation shall constitute a revocation of an existing power of 
attorney.
    (2) If an agent or attorney limits the scope of his or her 
representation regarding a particular claim by so indicating on VA Form 
21-22a, or a claimant authorizes a person to provide representation in a 
particular claim under Sec.  14.630, such specific authority shall 
constitute a revocation of an existing general power of attorney filed 
under paragraph (a) of this section only as it pertains to, and during 
the pendency of, that particular claim. Following the final 
determination of such claim, the general power of attorney shall remain 
in effect as to any new or reopened claim.
    (g) If a request to substitute is granted pursuant to 38 CFR 3.1010, 
then a new VA Form 21-22, ``Appointment of Veterans Service Organization 
as Claimant's Representative,'' or VA Form 21-22a, ``Appointment of 
Individual as Claimant's Representative,'' under paragraph (a) of this 
section is required in order to represent the substitute before VA. If 
the substitute desires representation on a one-time basis pursuant to 
Sec.  14.630(a), a statement signed by the person providing 
representation and the substitute that no compensation will be charged 
or paid for the services is also required.

(Authority: 38 U.S.C. 501(a), 5121A, 5902, 5903, 5904)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0321)

[43 FR 46535, Oct. 10, 1978, as amended at 53 FR 52421, Dec. 28, 1988; 
68 FR 8546, Feb. 24, 2003; 73 FR 29873, May 22, 2008; 79 FR 52983, Sept. 
5, 2014; 82 FR 26754, June 9, 2017; 84 FR 174, Jan. 18, 2019]



Sec.  14.632  Standards of conduct for persons providing representation
before the Department

    (a)(1) All persons acting on behalf of a claimant shall faithfully 
execute their duties as individuals providing representation on a 
particular claim under Sec.  14.630, representatives, agents, or 
attorneys.
    (2) All individuals providing representation are required to be 
truthful in their dealings with claimants and VA.
    (b) An individual providing representation on a particular claim 
under Sec.  14.630, representative, agent, or attorney shall:
    (1) Provide claimants with competent representation before VA. 
Competent representation requires the knowledge, skill, thoroughness, 
and preparation necessary for the representation. This includes 
understanding the issues of fact and law relevant to the claim as well 
as the applicable provisions of title 38, United States Code, and title 
38, Code of Federal Regulations;
    (2) Act with reasonable diligence and promptness in representing 
claimants. This includes responding promptly to VA requests for 
information or assisting a claimant in responding promptly to VA 
requests for information.
    (c) An individual providing representation on a particular claim 
under Sec.  14.630, representative, agent, or attorney shall not:
    (1) Violate the standards of conduct as described in this section;
    (2) Circumvent a rule of conduct through the actions of another;
    (3) Engage in conduct involving fraud, deceit, misrepresentation, or 
dishonesty;
    (4) Violate any of the provisions of title 38, United States Code, 
or title 38, Code of Federal Regulations;
    (5) Enter into an agreement for, charge, solicit, or receive a fee 
that is clearly unreasonable or otherwise prohibited by law or 
regulation;
    (6) Solicit, receive, or enter into agreements for gifts related to 
services for which a fee could not lawfully be charged;
    (7) Delay, without good cause, the processing of a claim at any 
stage of the administrative process;
    (8) Mislead, threaten, coerce, or deceive a claimant regarding 
benefits or other rights under programs administered by VA;
    (9) Engage in, or counsel or advise a claimant to engage in acts or 
behavior

[[Page 659]]

prejudicial to the fair and orderly conduct of administrative 
proceedings before VA;
    (10) Disclose, without the claimant's authorization, any information 
provided by VA for purposes of representation; or
    (11) Engage in any other unlawful or unethical conduct.
    (d) In addition to complying with standards of conduct for practice 
before VA in paragraphs (a) through (c) of this section, an attorney 
shall not, in providing representation to a claimant before VA, engage 
in behavior or activities prohibited by the rules of professional 
conduct of any jurisdiction in which the attorney is licensed to 
practice law.

(Authority: 38 U.S.C. 501(a), 5902, 5904)

[73 FR 29873, May 22, 2008, as amended at 84 FR 174, Jan. 18, 2019]



Sec.  14.633  Termination of accreditation or authority to provide
representation under Sec.  14.630.

    (a) Accreditation or authority to provide representation on a 
particular claim under Sec.  14.630 may be suspended or canceled at the 
request of an organization, individual providing representation under 
Sec.  14.630, representative, agent, or attorney. When an organization 
requests suspension or cancellation of the accreditation of a 
representative due to misconduct or lack of competence on the part of 
the representative or because the representative resigned to avoid 
suspension or cancellation of accreditation for misconduct or lack of 
competence, the organization shall inform VA of the reason for the 
request for suspension or cancellation and the facts and circumstances 
surrounding any incident that led to the request.
    (b) Accreditation shall be canceled at such time as a determination 
is made by the General Counsel that any requirement of Sec.  14.629 is 
no longer met by a representative, agent, or attorney.
    (c) Accreditation or authority to provide representation on a 
particular claim shall be canceled when the General Counsel finds, by 
clear and convincing evidence, one or more of the following:
    (1) Violation of or refusal to comply with the laws administered by 
VA or with the regulations governing practice before VA including the 
standards of conduct in Sec.  14.632;
    (2) Knowingly presenting or prosecuting a fraudulent claim against 
the United States, or knowingly providing false information to the 
United States;
    (3) Demanding or accepting unlawful compensation for preparing, 
presenting, prosecuting, or advising or consulting, concerning a claim;
    (4) Knowingly presenting to VA a frivolous claim, issue, or 
argument. A claim, issue, or argument is frivolous if the individual 
providing representation under Sec.  14.630, representative, agent, or 
attorney is unable to make a good faith argument on the merits of the 
position taken or to support the position taken by a good faith argument 
for an extension, modification, or reversal of existing law;
    (5) Suspension or disbarment by any court, bar, or Federal or State 
agency to which such individual providing representation under Sec.  
14.630, representative, agent, or attorney was previously admitted to 
practice, or disqualification from participating in or appearing before 
any court, bar, or Federal or State agency and lack of subsequent 
reinstatement;
    (6) Charging excessive or unreasonable fees for representation as 
determined by VA, the Court of Appeals for Veterans Claims, or the 
United States Court of Appeals for the Federal Circuit; or
    (7) Any other unlawful or unethical practice adversely affecting an 
individual's fitness for practice before VA.
    (d) Accreditation or authority to provide representation on a 
particular claim shall be canceled when the General Counsel finds that 
the performance of an individual providing representation under Sec.  
14.630, representative, agent, or attorney before VA demonstrates a lack 
of the degree of competence necessary to adequately prepare, present, 
and prosecute claims for veteran's benefits. A determination that the 
performance of an individual providing representation under Sec.  
14.630, representative, agent, or attorney before VA demonstrates a lack 
of the degree of competence required to represent claimants before VA 
will be

[[Page 660]]

based upon consideration of the following factors:
    (1) The relative complexity and specialized nature of the matter;
    (2) The individual's general experience;
    (3) The individual's training and experience; and
    (4) The preparation and study the individual is able to give 
veterans benefits matters and whether it is feasible to refer such 
matters to, or associate or consult with, an individual of established 
competence in the field of practice.
    (e) As to cancellation of accreditation under paragraphs (c) or (d) 
of this section, upon receipt of credible written information from any 
source indicating improper conduct, or incompetence, the Chief Counsel 
with subject-matter jurisdiction shall inform the subject of the 
allegations about the specific law, regulation, or policy alleged to 
have been violated or the nature of the alleged incompetence and the 
source of the complaint, and shall provide the subject with the 
opportunity to respond. If the matter involves an accredited 
representative of a recognized organization, the notice shall include 
contact with the representative's organization. When appropriate, 
including situations where no harm results to the claimant or VA, the 
Chief Counsel will provide the subject with an opportunity to correct 
the offending behavior before deciding whether to proceed with a formal 
inquiry. If the subject refuses to comply and the matter remains 
unresolved, or the behavior subsequently results in harm to a claimant 
or VA, the Chief Counsel shall immediately initiate a formal inquiry 
into the matter.
    (1) If the result of the inquiry does not justify further action, 
the Chief Counsel will close the inquiry and maintain the record for 3 
years.
    (2) If the result of the inquiry justifies further action, the Chief 
Counsel shall:
    (i) Inform the General Counsel of the result of the inquiry and 
notify the individual providing representation under Sec.  14.630, 
representative, agent or attorney of an intent to cancel accreditation 
or authority to provide representation on a particular claim. The notice 
will be sent to individuals providing representation on a particular 
claim by certified or registered mail to the individual's last known 
address of record as indicated on the VA Form 21-22a on file with the 
agency of original jurisdiction. The notice will be sent to accredited 
individuals by certified or registered mail to the individual's last 
known address of record as indicated in VA's accreditation records. The 
notice will state the reason(s) for the cancellation proceeding and 
advise the individual to file an answer, in oath or affidavit form or 
the form specified for unsworn declarations under penalty of perjury in 
28 U.S.C. 1746, within 30 days from the date the notice was mailed, 
responding to the stated reasons for cancellation and explaining why he 
or she should not be suspended or excluded from practice before VA. The 
notice will also advise the individual of the right to submit additional 
evidence and the right to request a hearing on the matter. Requests for 
hearings must be made in the answer. If the individual does not file an 
answer with the Office of the General Counsel within 30 days of the date 
that the Chief Counsel mailed the notice, the Chief Counsel shall close 
the record before the Office of the General Counsel and forward it with 
a recommendation to the General Counsel for a final decision.
    (ii) In the event that a hearing is not requested, the Chief Counsel 
shall close the record before the Office of the General Counsel and 
forward it with a recommendation to the General Counsel for a final 
decision.
    (iii) The Chief Counsel may extend the time to file an answer or 
request a hearing for a reasonable period upon a showing of sufficient 
cause.
    (iv) For purposes of computing time for responses to notices of 
intent to cancel accreditation, days means calendar days. In computing 
the time for filing this response, the date on which the notice was 
mailed by the Chief Counsel shall be excluded. A response postmarked 
prior to the expiration of the 30th day shall be accepted as timely 
filed. If the 30th day falls on a weekend or legal holiday, the first 
business day thereafter shall be included in the computation. As used in 
this section, legal holiday means New Year's Day,

[[Page 661]]

Birthday of Martin Luther King, Jr., Washington's Birthday, Memorial 
Day, Independence Day, Labor Day, Columbus Day, Veterans Day, 
Thanksgiving Day, Christmas Day, and any other day appointed as a 
holiday by the President or the Congress of the United States, or by the 
State in which the individual resides.
    (f) If a hearing is requested, it will be held at the VA Regional 
Office nearest the individual's principal place of business. If the 
individual's principal place of business is Washington, DC, the hearing 
will be held at the VA Central Office or other VA facility in 
Washington, DC. For hearings conducted at either location, the Chief 
Counsel with subject-matter jurisdiction shall present the evidence. The 
hearing officer shall not report, directly or indirectly to, or be 
employed by the General Counsel or the head of the VA agency of original 
jurisdiction before which the individual provided representation. The 
hearing officer shall provide notice of the hearing to the individual 
providing representation under Sec.  14.630, representative, agent, or 
attorney by certified or registered mail at least 21 days before the 
date of the hearing. Hearings shall not be scheduled before the 
completion of the 30-day period for filing an answer to the notice of 
intent to cancel accreditation. The hearing officer will have authority 
to administer oaths. The party requesting the hearing will have a right 
to counsel, to present evidence, and to cross-examine witnesses. Upon 
request of the individual requesting the hearing, an appropriate VA 
official designated in Sec.  2.1 of this chapter may issue subpoenas to 
compel the attendance of witnesses and the production of documents 
necessary for a fair hearing. The hearing shall be conducted in an 
informal manner and court rules of evidence shall not apply. Testimony 
shall be recorded verbatim. The evidentiary record shall be closed 10 
days after the completion of the hearing. The hearing officer shall 
submit the entire hearing transcript, any pertinent records or 
information, and a recommended finding to the Chief Counsel within 30 
days of closing the record. The Chief Counsel shall immediately forward 
the record and the hearing officer's recommendation to the General 
Counsel for a final decision.
    (g) The General Counsel may suspend the accreditation of a 
representative, agent, or attorney, under paragraphs (b), (c), or (d) of 
this section, for a definite period or until the conditions for 
reinstatement specified by the General Counsel are satisfied. The 
General Counsel shall reinstate an individual's accreditation at the end 
of the suspension period or upon verification that the individual has 
satisfied the conditions for reinstatement.
    (h) The decision of the General Counsel is a final adjudicative 
determination of an agency of original jurisdiction that may only be 
appealed to the Board of Veterans' Appeals.
    (1) Decisions issued before the effective date of the modernized 
review system. Notwithstanding provisions in this section for closing 
the record before the Office of the General Counsel at the end of the 
30-day period for filing an answer or 10 days after a hearing, appeals 
of decisions issued before the effective date of the modernized review 
system as provided in Sec.  19.2(a) of this chapter shall be initiated 
and processed using the procedures in 38 CFR parts 19 and 20 applicable 
to legacy appeals. Nothing in this section shall be construed to limit 
the Board's authority to remand a matter to which this paragraph (h)(1) 
applies to the General Counsel under 38 CFR 20.904 for any action that 
is essential for a proper appellate decision or the General Counsel's 
ability to issue a Supplemental Statement of the Case under 38 CFR 
19.31.
    (2) Decisions issued on or after the effective date of the 
modernized review system. Notwithstanding provisions in this section for 
closing the record before the Office of the General Counsel at the end 
of the 30-day period for filing an answer or 10 days after a hearing, 
appeals of decisions issued on or after the effective date of the 
modernized review system as provided in Sec.  19.2(a) of this chapter 
shall be initiated and processed using the procedures in 38 CFR part 20 
applicable to appeals under the modernized system.
    (i) In cases where the accreditation of an agent or attorney is 
suspended or cancelled, the Office of the General

[[Page 662]]

Counsel may notify all agencies, courts, and bars to which the agent or 
attorney is admitted to practice.
    (j) The effective date for suspension or cancellation of 
accreditation or authority to provide representation on a particular 
claim shall be the date upon which the General Counsel's final decision 
is rendered.

(Authority: 38 U.S.C. 501, 5902, 5904)

(The Office of Management and Budget has approved the information 
collections requirements in this section control number 2900-0018)

[53 FR 52422, Dec. 28, 1988, as amended at 72 FR 58012, Oct. 12, 2007; 
73 FR 29874, May 22, 2008; 82 FR 26754, June 9, 2017; 84 FR 174, Jan. 
18, 2019]



Sec.  14.634  Banks or trust companies acting as guardians.

    Banks or trust companies, corporate entities, acting as guardians 
for claimants, may be represented before adjudicating agencies as 
authorized representatives of claimants by an officer or employee, 
including a regularly employed attorney, if the employee or attorney 
represents the corporation in its fiduciary capacity.

(Authority: 38 U.S.C. 5903, 5904)

[43 FR 46535, Oct. 10, 1978. Redesignated and amended at 57 FR 4104, 
Feb. 3, 1992; 68 FR 8547, Feb. 24, 2003]



Sec.  14.635  Office space and facilities.

    The Secretary may furnish office space and facilities, if available, 
in buildings owned or occupied by the Department of Veterans Affairs, 
for the use of paid full-time representatives of recognized national 
organizations, and for employees of recognized State or tribal 
organizations who are accredited to national organizations, for purposes 
of assisting claimants in the preparation, presentation, and prosecution 
of claims for Department of Veterans Affairs benefits.
    (a) Request for office space should be made by an appropriate 
official of the organization to the Director of the Department of 
Veterans Affairs facility in which space is desired and should set 
forth:
    (1) The number of full-time paid representatives who will be 
permanently assigned to the office;
    (2) The number of secretarial or other support staff who will be 
assigned to the office;
    (3) The number of claimants for whom the organization holds powers 
of attorney whose claims are within the jurisdiction of the facility or 
who reside in the area served by the facility, the number of such 
claimants whose claims are pending, and the number of claims prosecuted 
during the previous three years; and
    (4) Any other information the organization deems relevant to the 
allocation of office space.
    (b) When in the judgment of the Director office space and facilities 
previously granted could be better used by the Department of Veterans 
Affairs, or would receive more effective use or serve more claimants if 
allocated to another recognized national organization, the Director may 
withdraw such space or reassign such space to another organization. In 
the case of a facility under the control of the Veterans Benefits 
Administration or the Veterans Health Administration, the final decision 
on such matters will be made by the Under Secretary for Benefits or the 
Under Secretary for Health, respectively.

(Authority: 38 U.S.C. 501(a), 5902)

[53 FR 52423, Dec. 28, 1988. Redesignated and amended at 57 FR 4104, 
Feb. 3, 1992; 68 FR 8547, Feb. 24, 2003; 82 FR 6272, Jan. 19, 2017]



Sec.  14.636  Payment of fees for representation by agents and attorneys
in proceedings before Agencies of Original Jurisdiction and before the
Board of Veterans' Appeals.

    (a) Applicability of rule. The provisions of this section apply to 
the services of accredited agents and attorneys with respect to benefits 
under laws administered by VA in all proceedings before the agency of 
original jurisdiction or before the Board of Veterans' Appeals 
regardless of whether an appeal has been initiated.
    (b) Who may charge fees for representation. Only accredited agents 
and attorneys may receive fees from claimants or appellants for their 
services provided in connection with representation. Recognized 
organizations (including their accredited representatives when acting as 
such) and individuals

[[Page 663]]

recognized under Sec.  14.630 of this part are not permitted to receive 
fees. An agent or attorney who may also be an accredited representative 
of a recognized organization may not receive such fees unless he or she 
has been properly designated as an agent or attorney in accordance with 
Sec.  14.631 of this part in his or her individual capacity as an 
accredited agent or attorney.
    (c) Circumstances under which fees may be charged. Except as noted 
in paragraph (d) of this section, agents and attorneys may only charge 
fees as follows:
    (1)(i) Agents and attorneys may charge claimants or appellants for 
representation provided after an agency of original jurisdiction has 
issued notice of an initial decision on the claim or claims if the 
notice of the initial decision was issued on or after the effective date 
of the modernized review system as provided in Sec.  19.2(a) of this 
chapter, and the agent or attorney has complied with the power of 
attorney requirements in Sec.  14.631 and the fee agreement requirements 
in paragraph (g) of this section. For purposes of this paragraph 
(c)(1)(i), an initial decision on a claim would include an initial 
decision on an initial claim for an increase in rate of benefit, an 
initial decision on a request to revise a prior decision based on clear 
and unmistakable error (unless fees are permitted at an earlier point 
pursuant to paragraph (c)(1)(ii) or paragraph (c)(2)(ii) of this 
section), and an initial decision on a supplemental claim that was 
presented after the final adjudication of an earlier claim. However, a 
supplemental claim will be considered part of the earlier claim if the 
claimant has continuously pursued the earlier claim by filing any of the 
following, either alone or in succession: A request for higher-level 
review, on or before one year after the date on which the agency of 
original jurisdiction issued a decision; a supplemental claim, on or 
before one year after the date on which the agency of original 
jurisdiction issued a decision; a Notice of Disagreement, on or before 
one year after the date on which the agency of original jurisdiction 
issued a decision; a supplemental claim, on or before one year after the 
date on which the Board of Veterans' Appeals issued a decision; or a 
supplemental claim, on or before one year after the date on which the 
Court of Appeals for Veterans Claims issued a decision.
    (ii) Agents and attorneys may charge fees for representation 
provided with respect to a request for revision of a decision of an 
agency of original jurisdiction under 38 U.S.C. 5109A or the Board of 
Veterans' Appeals under 38 U.S.C. 7111 based on clear and unmistakable 
error if notice of the challenged decision on a claim or claims was 
issued on or after the effective date of the modernized review system as 
provided in Sec.  19.2(a), and the agent or attorney has complied with 
the power of attorney requirements in Sec.  14.631 and the fee agreement 
requirements in paragraph (g) of this section.
    (2)(i) Agents and attorneys may charge claimants or appellants for 
representation provided: After an agency of original jurisdiction has 
issued a decision on a claim or claims, including any claim to reopen 
under 38 CFR 3.156(a) or for an increase in rate of a benefit; the 
agency of original jurisdiction issued notice of that decision before 
the effective date of the modernized review system as provided in Sec.  
19.2(a) of this chapter; a Notice of Disagreement has been filed with 
respect to that decision on or after June 20, 2007; and the agent or 
attorney has complied with the power of attorney requirements in Sec.  
14.631 and the fee agreement requirements in paragraph (g) of this 
section.
    (ii) Agents and attorneys may charge fees for representation 
provided with respect to a request for revision of a decision of an 
agency of original jurisdiction under 38 U.S.C. 5109A or the Board of 
Veterans' Appeals under 38 U.S.C. 7111 based on clear and unmistakable 
error if notice of the challenged decision was issued before the 
effective date of the modernized review system as provided in Sec.  
19.2(a); a Notice of Disagreement was filed with respect to the 
challenged decision on or after June 20, 2007; and the agent or attorney 
has complied with the power of attorney requirements in Sec.  14.631 and 
the fee agreement requirements in paragraph (g) of this section.
    (3) In cases in which a Notice of Disagreement was filed on or 
before June

[[Page 664]]

19, 2007, agents and attorneys may charge fees only for services 
provided after both of the following conditions have been met:
    (i) A final decision was promulgated by the Board with respect to 
the issue, or issues, involved in the appeal; and
    (ii) The agent or attorney was retained not later than 1 year 
following the date that the decision by the Board was promulgated. (This 
condition will be considered to have been met with respect to all 
successor agents or attorneys acting in the continuous prosecution of 
the same matter if a predecessor was retained within the required time 
period.)
    (4) Except as noted in paragraph (i) of this section and Sec.  
14.637(d), the agency of original jurisdiction that issued the decision 
referenced in paragraph (c)(1) or (2) of this section shall determine 
whether an agent or attorney is eligible for fees under this section. 
The agency of original jurisdiction's eligibility determination is a 
final adjudicative action that may only be appealed to the Board.
    (d) Exceptions--(1) Chapter 37 loans. With respect to services of 
agents and attorneys provided after October 9, 1992, a reasonable fee 
may be charged or paid in connection with any proceeding in a case 
arising out of a loan made, guaranteed, or insured under chapter 37, 
United States Code, even though the conditions set forth in paragraph 
(c) of this section are not met.
    (2) Payment of fee by disinterested third party. (i) An agent or 
attorney may receive a fee or salary from an organization, governmental 
entity, or other disinterested third party for representation of a 
claimant or appellant even though the conditions set forth in paragraph 
(c) of this section have not been met. An organization, governmental 
entity, or other third party is considered disinterested only if the 
entity or individual does not stand to benefit financially from the 
successful outcome of the claim. In no such case may the attorney or 
agent charge a fee which is contingent, in whole or in part, on whether 
the matter is resolved in a manner favorable to the claimant or 
appellant.
    (ii) For purposes of this part, a person shall be presumed not to be 
disinterested if that person is the spouse, child, or parent of the 
claimant or appellant, or if that person resides with the claimant or 
appellant. This presumption may be rebutted by clear and convincing 
evidence that the person in question has no financial interest in the 
success of the claim.
    (iii) The provisions of paragraph (g) of this section (relating to 
fee agreements) shall apply to all payments or agreements to pay 
involving disinterested third parties. In addition, the agreement shall 
include or be accompanied by the following statement, signed by the 
attorney or agent: ``I certify that no agreement, oral or otherwise, 
exists under which the claimant or appellant will provide anything of 
value to the third-party payer in this case in return for payment of my 
fee or salary, including, but not limited to, reimbursement of any fees 
paid.''
    (e) Fees permitted. Fees permitted for services of an agent or 
attorney admitted to practice before VA must be reasonable. They may be 
based on a fixed fee, hourly rate, a percentage of benefits recovered, 
or a combination of such bases. Factors considered in determining 
whether fees are reasonable include:
    (1) The extent and type of services the representative performed;
    (2) The complexity of the case;
    (3) The level of skill and competence required of the representative 
in giving the services;
    (4) The amount of time the representative spent on the case;
    (5) The results the representative achieved, including the amount of 
any benefits recovered;
    (6) The level of review to which the claim was taken and the level 
of the review at which the representative was retained;
    (7) Rates charged by other representatives for similar services;
    (8) Whether, and to what extent, the payment of fees is contingent 
upon the results achieved; and
    (9) If applicable, the reasons why an agent or attorney was 
discharged or withdrew from representation before the date of the 
decision awarding benefits.

[[Page 665]]

    (f) Presumptions and discharge. (1) Fees which do not exceed 20 
percent of any past-due benefits awarded as defined in paragraph (h)(3) 
of this section shall be presumed to be reasonable if the agent or 
attorney provided representation that continued through the date of the 
decision awarding benefits. Fees which exceed 33\1/3\ percent of any 
past-due benefits awarded shall be presumed to be unreasonable. These 
presumptions may be rebutted through an examination of the factors in 
paragraph (e) of this section establishing that there is clear and 
convincing evidence that a fee which does not exceed 20 percent of any 
past-due benefits awarded is not reasonable or that a fee which exceeds 
33\1/3\ percent is reasonable in a specific circumstance.
    (2) With regard to a fee agreement in which the amount of the fee is 
contingent on the claimant receiving an award of benefits, a reasonable 
fee for an agent or attorney who is discharged by the claimant or 
withdraws from representation before the date of the decision awarding 
benefits is one that fairly and accurately reflects his or her 
contribution to and responsibility for the benefits awarded. The amount 
of the fee is informed by an examination of the factors in paragraph (e) 
of this section.
    (g) Fee agreements. All agreements for the payment of fees for 
services of agents and attorneys (including agreements involving fees or 
salary paid by an organization, governmental entity or other 
disinterested third party) must be in writing and signed by both the 
claimant or appellant and the agent or attorney.
    (1) To be valid, a fee agreement must include the following:
    (i) The name of the veteran,
    (ii) The name of the claimant or appellant if other than the 
veteran,
    (iii) The name of any disinterested third-party payer (see paragraph 
(d)(2) of this section) and the relationship between the third-party 
payer and the veteran, claimant, or appellant,
    (iv) The applicable VA file number, and
    (v) The specific terms under which the amount to be paid for the 
services of the attorney or agent will be determined.
    (2) Fee agreements must also clearly specify if VA is to pay the 
agent or attorney directly out of past due benefits. A direct-pay fee 
agreement is a fee agreement between the claimant or appellant and an 
agent or attorney providing for payment of fees out of past-due benefits 
awarded directly to an agent or attorney. A fee agreement that does not 
clearly specify that VA is to pay the agent or attorney out of past-due 
benefits or that specifies a fee greater than 20 percent of past-due 
benefits awarded by VA shall be considered to be an agreement in which 
the agent or attorney is responsible for collecting any fees for 
representation from the claimant without assistance from VA.
    (3) A copy of a direct-pay fee agreement, as defined in paragraph 
(g)(2) of this section, must be filed with the agency of original 
jurisdiction within 30 days of its execution. A copy of any fee 
agreement that is not a direct-pay fee agreement must be filed with the 
Office of the General Counsel within 30 days of its execution by mailing 
the copy to the following address: Office of the General Counsel (022D), 
Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 
20420. Only fee agreements that do not provide for the direct payment of 
fees, documents related to review of fees under paragraph (i) of this 
section, and documents related to review of expenses under Sec.  14.637, 
may be filed with the Office of the General Counsel. All documents 
relating to the adjudication of a claim for VA benefits, including any 
correspondence, evidence, or argument, must be filed with the agency of 
original jurisdiction, Board of Veterans' Appeals, or other VA office as 
appropriate.
    (h) Payment of fees by Department of Veterans Affairs directly to an 
agent or attorney from past-due benefits. (1) Subject to the 
requirements of the other paragraphs of this section, including 
paragraphs (c) and (e), the claimant or appellant and an agent or 
attorney may enter into a fee agreement providing that payment for the 
services of the agent or attorney will be made directly to the agent or 
attorney by VA out of any past-due benefits awarded in any proceeding 
before VA or the United States Court of Appeals for Veterans

[[Page 666]]

Claims. VA will charge and collect an assessment out of the fees paid 
directly to agents or attorneys from past-due benefits awarded. The 
amount of such assessment shall be equal to five percent of the amount 
of the fee required to be paid to the agent or attorney, but in no event 
shall the assessment exceed $100. Such an agreement will be honored by 
VA only if the following conditions are met:
    (i) The total fee payable (excluding expenses) does not exceed 20 
percent of the total amount of the past-due benefits awarded,
    (ii) The amount of the fee is contingent on whether or not the claim 
is resolved in a manner favorable to the claimant or appellant, and
    (iii) The award of past-due benefits results in a cash payment to a 
claimant or an appellant from which the fee may be deducted. (An award 
of past-due benefits will not always result in a cash payment to a 
claimant or an appellant. For example, no cash payment will be made to 
military retirees unless there is a corresponding waiver of retirement 
pay. (See 38 U.S.C. 5304(a) and 38 CFR 3.750)
    (2) For purposes of this paragraph (h), a claim will be considered 
to have been resolved in a manner favorable to the claimant or appellant 
if all or any part of the relief sought is granted.
    (3) For purposes of this paragraph (h), ``past-due benefits'' means 
a nonrecurring payment resulting from a benefit, or benefits, granted on 
appeal or awarded on the basis of a claim readjudicated after a denial 
by a VA agency of original jurisdiction or the Board of Veterans' 
Appeals or the lump sum payment that represents the total amount of 
recurring cash payments that accrued between the effective date of the 
award, as determined by applicable laws and regulations, and the date of 
the grant of the benefit by the agency of original jurisdiction, the 
Board of Veterans' Appeals, or an appellate court.
    (i) When the benefit granted on appeal, or as the result of the 
readjudicated claim, is service connection for a disability, the ``past-
due benefits'' will be based on the initial disability rating assigned 
by the agency of original jurisdiction following the award of service 
connection. The sum will equal the payments accruing from the effective 
date of the award to the date of the initial disability rating decision. 
If an increased evaluation is subsequently granted as the result of an 
appeal of the disability evaluation initially assigned by the agency of 
original jurisdiction, and if the agent or attorney represents the 
claimant or appellant in that phase of the claim, the agent or attorney 
will be paid a supplemental payment based upon the increase granted on 
appeal, to the extent that the increased amount of disability is found 
to have existed between the initial effective date of the award 
following the grant of service connection and the date of the rating 
action implementing the appellate decision granting the increase.
    (ii) Unless otherwise provided in the fee agreement between the 
claimant or appellant and the agent or attorney, the agent's or 
attorney's fees will be determined on the basis of the total amount of 
the past-due benefits even though a portion of those benefits may have 
been apportioned to the claimant's or appellant's dependents.
    (iii) If an award is made as the result of favorable action with 
respect to several issues, the past-due benefits will be calculated only 
on the basis of that portion of the award which results from action 
taken on issues concerning which the criteria in paragraph (c) of this 
section have been met.
    (4) As required by paragraph (g)(3) of this section, the agent or 
attorney must file with the agency of original jurisdiction within 30 
days of the date of execution a copy of the agreement providing for the 
direct payment of fees out of any benefits subsequently determined to be 
past due.
    (i) Motion for review of fee agreement. Before the expiration of 120 
days from the date of the final VA action, the Office of the General 
Counsel may review a fee agreement between a claimant or appellant and 
an agent or attorney upon its own motion or upon the motion of the 
claimant or appellant. The Office of the General Counsel may order a 
reduction in the fee called for in the agreement if it finds by a 
preponderance of the evidence, or by clear and convincing evidence in 
the case of

[[Page 667]]

a fee presumed reasonable under paragraph (f) of this section, that the 
fee is unreasonable. The Office of the General Counsel may approve a fee 
presumed unreasonable under paragraph (f) of this section if it finds by 
clear and convincing evidence that the fee is reasonable. The Office of 
the General Counsel's review of the agreement under this paragraph will 
address the issues of eligibility under paragraph (c) of this section 
and reasonableness under paragraph (e) of this section. The Office of 
the General Counsel will limit its review and decision under this 
paragraph to the issue of reasonableness if another agency of original 
jurisdiction has reviewed the agreement and made an eligibility 
determination under paragraph (c) of this section. Motions for review of 
fee agreements must be in writing and must include the name of the 
veteran, the name of the claimant or appellant if other than the 
veteran, and the applicable VA file number. Such motions must set forth 
the reason, or reasons, why the fee called for in the agreement is 
unreasonable and must be accompanied by all evidence the moving party 
desires to submit.
    (1) A claimant's or appellant's motion for review of a fee agreement 
must be served on the agent or attorney and must be filed at the 
following address: Office of the General Counsel (022D), 810 Vermont 
Avenue, NW., Washington, DC 20420. The agent or attorney may file a 
response to the motion, with any relevant evidence, with the Office of 
the General Counsel not later than 30 days from the date on which the 
claimant or appellant served the motion on the agent or attorney. Such 
responses must be served on the claimant or appellant. The claimant or 
appellant then has 15 days from the date on which the agent or attorney 
served a response to file a reply with the Office of the General 
Counsel. Such replies must be served on the agent or attorney.
    (2) The Deputy Chief Counsel with subject-matter jurisdiction shall 
initiate the Office of the General Counsel's review of a fee agreement 
on its own motion by serving the motion on the agent or attorney and the 
claimant or appellant. The agent or attorney may file a response to the 
motion, with any relevant evidence, with the Office of the General 
Counsel (022D), 810 Vermont Avenue, NW., Washington, DC 20420, not later 
than 30 days from the date on which the Office of the General Counsel 
served the motion on the agent or attorney. Such responses must be 
served on the claimant or appellant.
    (3) The Office of the General Counsel shall close the record before 
the Office of the General Counsel in proceedings to review fee 
agreements 15 days after the date on which the agent or attorney served 
a response on the claimant or appellant, or 30 days after the claimant, 
appellant, or the Office of the General Counsel served the motion on the 
agent or attorney if there is no response. The Deputy Chief Counsel with 
subject-matter jurisdiction may, for a reasonable period upon a showing 
of sufficient cause, extend the time for an agent or attorney to serve 
an answer or for a claimant or appellant to serve a reply. The Deputy 
Chief Counsel shall forward the record and a recommendation to the 
General Counsel or his or her designee for a final decision. Unless 
either party files a Notice of Disagreement, the agent or attorney must 
refund any excess payment to the claimant or appellant not later than 
the expiration of the time within which the Office of the General 
Counsel's decision may be appealed to the Board of Veterans' Appeals.
    (j) In addition to whatever other penalties may be prescribed by law 
or regulation, failure to comply with the requirements of this section 
may result in proceedings under Sec.  14.633 of this chapter to 
terminate the agent's or attorney's accreditation to practice before VA.
    (k)(1) Decisions issued before the effective date of the modernized 
review system. Notwithstanding provisions in this section for closing 
the record before the Office of the General Counsel at the end of the 
30-day period for serving a response or 15 days after the date on which 
the agent or attorney served a response, appeals of decisions issued 
before the effective date of the modernized review system as provided in 
Sec.  19.2(a) of this chapter, shall be initiated and processed using 
the procedures in 38 CFR parts 19 and 20 applicable to legacy appeals. 
Nothing in this section shall be construed to limit the

[[Page 668]]

Board's authority to remand a matter to the General Counsel under 38 CFR 
20.904 for any action that is essential for a proper appellate decision 
or the General Counsel's ability to issue a Supplemental Statement of 
the Case under 38 CFR 19.31.
    (2) Decisions issued on or after the effective date of the 
modernized review system. Notwithstanding provisions in this section for 
closing the record before the Office of the General Counsel at the end 
of the 30-day period for serving a response or 15 days after the date on 
which the agent or attorney served a response, appeals of decisions 
issued on or after the effective date of the modernized review system as 
provided in Sec.  19.2(a) of this chapter, shall be initiated and 
processed using the procedures in 38 CFR part 20 applicable to appeals 
under the modernized system.

(Authority: 38 U.S.C. 5902, 5904, 5905)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0605.)

[73 FR 29875, May 22, 2008, as amended at 80 FR 81193, Dec. 29, 2015; 82 
FR 26754, June 9, 2017; 84 FR 175, Jan. 18, 2019]



Sec.  14.637  Payment of the expenses of agents and attorneys in 
proceedings before Agencies of Original Jurisdiction and before the
Board of Veterans' Appeals.

    (a) Applicability of rule. The provisions of this section apply to 
the services of accredited agents and attorneys with respect to benefits 
under laws administered by VA in all proceedings before the agency of 
original jurisdiction or before the Board of Veterans' Appeals 
regardless of whether an appeal has been initiated.
    (b) General. Any agent or attorney may be reimbursed for expenses 
incurred on behalf of a veteran or a veteran's dependents or survivors 
in the prosecution of a claim for benefits pending before VA. Whether 
such an agent or attorney will be reimbursed for expenses and the method 
of such reimbursement is a matter to be determined by the agent or 
attorney and the claimant or appellant in the fee agreement filed with 
the Office of the General Counsel or the agency of original jurisdiction 
under Sec.  14.636 of this part. Expenses are not payable directly to 
the agent or attorney by VA out of benefits determined to be due to a 
claimant or appellant.
    (c) Nature of expenses subject to reimbursement. ``Expenses'' 
include nonrecurring expenses incurred directly in the prosecution of a 
claim for benefits on behalf of a claimant or appellant. Examples of 
such expenses include expenses for travel specifically to attend a 
hearing with respect to a particular claim, the cost of copies of 
medical records or other documents obtained from an outside source, and 
the cost of obtaining the services of an expert witness or an expert 
opinion. ``Expenses'' do not include normal overhead costs of the agent 
or attorney such as office rent, utilities, the cost of obtaining or 
operating office equipment or a legal library, salaries of the 
representative and his or her support staff, and the cost of office 
supplies.
    (d) Expense charges permitted; motion for review of expenses. 
Reimbursement for the expenses of an agent or attorney may be obtained 
only if the expenses are reasonable. The Office of the General Counsel 
may review the expenses charged by an agent or attorney upon its own 
motion or the motion of the claimant or appellant and may order a 
reduction in the expenses charged if it finds that they are excessive or 
unreasonable. The Office of the General Counsel's review of expenses 
under this paragraph will address the issues of eligibility under Sec.  
14.636(c) and reasonableness. The Office of the General Counsel will 
limit its review and decision under this paragraph to the issue of 
reasonableness if another agency of original jurisdiction has reviewed 
the fee agreement between the claimant and the agent or attorney and 
determined that the agent or attorney is eligible for reimbursement of 
expenses. Motions for review of expenses must be in writing and must 
include the name of the veteran, the name of the claimant or appellant 
if other than the veteran, and the applicable VA file number. Such 
motions must specifically identify which expenses charged are 
unreasonable; must set forth the reason, or reasons, why such expenses 
are excessive or unreasonable and must be

[[Page 669]]

accompanied by all evidence the claimant or appellant desires to submit. 
Factors considered in determining whether expenses are excessive or 
unreasonable include the complexity of the case, the potential extent of 
benefits recoverable, and whether travel expenses are in keeping with 
expenses normally incurred by other representatives.
    (1) A claimant's or appellant's motion for review of expenses must 
be served on the agent or attorney and must be filed at the following 
address: Office of the General Counsel (022D), 810 Vermont Avenue, NW., 
Washington, DC 20420. The agent or attorney may file a response to the 
motion, with any accompanying evidence, with the Office of the General 
Counsel not later than 30 days from the date on which the claimant or 
appellant served the motion on the agent or attorney. Such responses 
must be served on the claimant or appellant. The claimant or appellant 
then has 15 days from the date on which the agent or attorney served a 
response to file a reply with the Office of the General Counsel. Such 
replies must be served on the agent or attorney.
    (2) The Deputy Chief Counsel with subject-matter jurisdiction shall 
initiate the Office of the General Counsel's review of expenses on its 
own motion by serving the motion on the agent or attorney and the 
claimant or appellant. The agent or attorney may file a response to the 
motion, with any accompanying evidence, with the Office of the General 
Counsel (022D), 810 Vermont Avenue, NW., Washington, DC 20420, not later 
than 30 days from the date on which the Office of the General Counsel 
served the motion on the agent or attorney. Such responses must be 
served on the claimant or appellant.
    (3) The Office of the General Counsel shall close the record before 
the Office of the General Counsel in proceedings to review expenses 15 
days after the date on which the agent or attorney served a response on 
the claimant or appellant, or 30 days after the claimant, appellant, or 
the Office of the General Counsel served the motion on the agent or 
attorney if there is no response. The Deputy Chief Counsel with subject-
matter jurisdiction may, for a reasonable period upon a showing of 
sufficient cause, extend the time for an agent or attorney to serve an 
answer or for a claimant or appellant to serve a reply. The Deputy Chief 
Counsel shall forward the record and a recommendation to the General 
Counsel or his or her designee for a final decision. Unless either party 
files a Notice of Disagreement, the agent or attorney must refund any 
excess payment to the claimant or appellant not later than the 
expiration of the time within which the Office of the General Counsel's 
decision may be appealed to the Board of Veterans' Appeals.
    (e) In addition to whatever other penalties may be prescribed by law 
or regulation, failure to comply with the requirements of this section 
may result in proceedings under Sec.  14.633 of this part to terminate 
the agent's or attorney's accreditation to practice before VA.
    (f)(1) Decisions issued before the effective date of the modernized 
review system. Notwithstanding provisions in this section for closing 
the record before the Office of the General Counsel at the end of the 
30-day period for serving a response or 15 days after the date on which 
the agent or attorney served a response, appeals of decisions issued 
before the effective date of the modernized review system as provided in 
Sec.  19.2(a) of this chapter, shall be initiated and processed using 
the procedures in 38 CFR parts 19 and 20 applicable to legacy appeals. 
Nothing in this section shall be construed to limit the Board's 
authority to remand a matter to the General Counsel under 38 CFR 20.904 
for any action that is essential for a proper appellate decision or the 
General Counsel's ability to issue a Supplemental Statement of the Case 
under 38 CFR 19.31.
    (2) Decisions issued on or after the effective date of the 
modernized review system. Notwithstanding provisions in this section for 
closing the record before the Office of the General Counsel at the end 
of the 30-day period for serving a response or 15 days after the date on 
which the agent or attorney served a response, appeals of decisions 
issued on or after the effective date of the modernized review system as 
provided in

[[Page 670]]

Sec.  19.2(a) of this chapter, shall be initiated and processed using 
the procedures in 38 CFR part 20 applicable to appeals under the 
modernized system.

(Authority: 38 U.S.C. 5904)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0085)

[73 FR 29878, May 22, 2008, as amended at 80 FR 81194, Dec. 29, 2015; 82 
FR 26754, June 9, 2017; 84 FR 176, Jan. 18, 2019]

                            Personnel Claims



Sec.  14.664  Scope of authority and effective date.

    Pub. L. 88-558 (78 Stat. 767), approved August 31, 1964, as amended, 
authorizes the Secretary or the Secretary's designee to settle and pay a 
claim for not more than $40,000 made by a civilian officer or employee 
of the Department of Veterans Affairs for damage to, or loss of personal 
property incident to such person's service. Authority is delegated by 
Sec.  2.6(e)(5) of this chapter to the General Counsel, Deputy General 
Counsel, Assistant General Counsel (Professional Staff Group III), and 
the Deputy Assistant General Counsel, of said staff group and the 
Regional Counsel and those acting for them to settle and pay such claims 
on behalf of the Secretary, and such settlement shall be final and 
conclusive.

(Authority: 31 U.S.C. 3721(b))

[42 FR 41421, Aug. 17, 1977, as amended at 49 FR 47005, Nov. 30, 1984; 
55 FR 48841, Nov. 23, 1990]



Sec.  14.665  Claims.

    (a) The claim must be presented in writing on VA Form 2-4760, 
Employee's Claim for Reimbursement for Personal Property Damaged or Lost 
Incident to Employment. It will be submitted to the personnel office 
where the claim originates within 2 years after it accrues except that 
if the claim accrues in time of war or in time of armed conflict in 
which any Armed Force of the United States is engaged or if such war or 
armed conflict intervenes within 2 years after it accrues, and if good 
cause is shown, the claim may be presented not later than 2 years after 
that cause ceases to exist. The claim must be executed and certified by 
the officer or the employee suffering the loss or damage, or in the 
event of his or her death, by the surviving spouse, children, father or 
mother or both, or brothers or sisters or both. Claims of survivors 
shall be settled and paid in the order named. All claims must contain 
the following:
    (1) The date, time, and place the loss or damage occurred and the 
circumstances surrounding such loss or damage, together with the 
supporting statements of any witnesses who can verify such facts.
    (2) In the event of damage, the date of acquisition, original cost, 
condition before damage, and at least two estimates of the cost of 
repair or replacement. In the event of loss, the date of acquisition, 
the original cost, the condition, and an estimate of the reasonable 
market value of the article or articles.
    (3) A statement as to any claims or potential claim he or she may 
have for indemnification of the loss or damage against other than the 
United States and whether he or she will assign such to the United 
States and cooperate in its prosecution. Where such claim or potential 
claim is against a carrier or insurer, evidence that a timely claim has 
been properly made. Where a recovery from the carrier or his or her 
insurer has been obtained or offered, such information shall be 
included.
    (4) In cases involving damage or destruction of personal property by 
patients or domiciliary members, a statement as to whether a claim was 
filed pursuant to 38 U.S.C. 703(a)(5) and whether such claim has been 
finally denied.
    (b) The Personnel Officer receiving the claim will forward same to 
the person designated to investigate accidents at the station pursuant 
to Sec.  14.605 within 5 days after receipt.
    (c) The employee designated pursuant to Sec.  14.605 will ascertain 
if such claim is complete in all respects and conduct such investigation 
as is necessary to establish all facts required to properly evaluate the 
claim both as to merit and the reasonable amount payable for the loss or 
damage. Where it is indicated that the claimant may have a potential 
claim against other than

[[Page 671]]

the United States, the employee designated will secure a suitable 
assignment of all right and title to such claim, to the extent the 
United States makes reimbursement, and the agreement of the claimant to 
furnish such evidence as may be necessary to pursue such claim. If the 
potential claim is against a carrier or insurer, the employee designated 
will ascertain that the claimant has filed a timely proper claim and 
procure evidence thereof. The employee designated will also include 
information concerning any offer of settlement the carrier may have 
made. The completed investigation, original claim and supporting 
evidence will be forwarded to the appropriate Regional Counsel.

[38 FR 5475, Mar. 1, 1973, as amended at 42 FR 41421, Aug. 17, 1977]



Sec.  14.666  Regional Counsel responsibility.

    (a) The Regional Counsel having jurisdiction will conduct such 
additional investigation as is deemed necessary to establish all facts 
required. If the claimant has a potential claim for indemnification 
against other than the United States, the Regional Counsel will 
ascertain that a suitable assignment, legally enforceable, of all right 
and title to such claim, to the extent the United States makes 
reimbursement, and the agreement of the claimant to furnish such 
evidence as may be necessary to pursue such claim is of record. If such 
potential claim is against a carrier or insurer, the Regional Counsel 
will ascertain that claimant has filed a timely proper claim against the 
carrier or insurer and review same for legal sufficiency.
    (b) The Regional Counsel having jurisdiction over a claim will not 
authorize payment thereon unless the requirement of Sec. Sec.  14.664 
through 14.667 are met. In determining the equitable value of a claim, 
the depreciation schedule issued by the General Counsel will be used as 
a guide.

[42 FR 41422, Aug. 17, 1977]



Sec.  14.667  Claims payable.

    (a) No claim shall be paid unless timely filed in proper form as 
provided in Sec.  14.665 and the preponderance of the evidence 
establishes that the loss or damage:
    (1) Actually occurred and the amount claimed is reasonable,
    (2) Was incident to the employee's service and his or her possession 
of the property was reasonable, useful, or proper under the 
circumstances,
    (3) Did not occur at quarters occupied within the 50 States or the 
District of Columbia that were not assigned to the claimant or otherwise 
provided in kind by the United States.
    (4) Was not caused wholly or partly by the negligent act of 
claimant, the claimant's agent, or employee, and that the claimant has 
no right to indemnification for the loss or damage from other than the 
United States, except to the extent that the claimant assigns such right 
to the United States and agrees to furnish evidence required to enable 
the United States to enforce such right. In the event there is a right 
to recovery for the loss or damage from a carrier or insurer the 
claimant will be required to file a timely claim for such recovery 
before consideration of the claim against the United States.
    (b) No claim for the cost of repair or replacement of personal 
property of employees damaged or destroyed by patients or domiciliary 
members while such employees are engaged in the performance of official 
duties shall be entertained under Sec. Sec.  14.664 through 14.667, 
unless claim filed pursuant to 38 U.S.C. 703(a)(5) (Sec.  17.78 of this 
chapter) has been finally denied for the reason that such claim did not 
meet the criteria established by that law.

[38 FR 5475, Mar. 1, 1973, as amended at 42 FR 41422, Aug. 17, 1977]



Sec.  14.668  Disposition of claims.

    (a) Disallowed claims. Claimants will be promptly notified of the 
disallowance of a claim and the reasons therefor.
    (b) Allowed claims--(1) Reimbursement in kind. Where a claim is 
allowed and it is determined to be to the advantage of the Government, 
reimbursement will be made in kind. The official authorizing settlement 
will request the Director, Supply Service, Veterans Health Services and 
Research Administration,

[[Page 672]]

to procure the necessary article or articles and deliver same to the 
claimant.
    (2) Reimbursement by check. The official authorizing settlement will 
forward allowed claims, other than those requiring reimbursement in 
kind, to the Finance activity at the Department of Veterans Affairs 
installation where the claim arose. That activity will audit the claim, 
which if found proper for payment, will be scheduled on SF 1166, Voucher 
and Schedule of Payments, and forwarded to the appropriate Regional 
Disbursing Office for payment.

[38 FR 5475, Mar. 1, 1973, as amended at 42 FR 41422, Aug. 17, 1977]



Sec.  14.669  Fees of agents or attorneys; penalty.

    The Military Personnel and Civilian Employees' Claims Act of 1964 
(Pub. L. 88-558; 78 Stat. 767) was amended by Pub. L. 89-185 (79 Stat. 
789), on September 15, 1965, by adding a new section which provided that 
no more than 10 percent of the amount paid in settlement of each 
individual claim submitted and settled under the authority of the Act 
shall be paid or delivered to or received by any agent or attorney on 
account of services rendered in connection with that claim. Any person 
violating the provisions of this Act is deemed to be guilty of a 
misdemeanor and upon conviction thereof shall be fined in any sum not 
exceeding $1,000.

[38 FR 5475, Mar. 1, 1973]

                        Commitments--Fiduciaries

    Source: 42 FR 41422, Aug. 17, 1977, unless otherwise noted.



Sec.  14.700  Court cost and expenses; commitment, restoration,
fiduciary appointments.

    It is the responsibility of the Regional Counsel to assure the 
protection of the veteran, his or her beneficiaries, and their estates 
in State court proceedings involving commitment and restoration, and the 
appointment of fiduciaries. To this end certain expenses such as court 
costs, publication fees, recording fees, transportation expenses and 
fees for medical testimony may be authorized by the Regional Counsel. 
Payment of these costs will be borne by the administration concerned. 
However, every effort will be made by the Regional Counsel to avoid 
having these costs imposed on the Department of Veterans Affairs. The 
travel and per diem cost of the Regional Counsel personnel will be borne 
by the Regional Counsel.



Sec.  14.701  Commitment and restoration proceedings.

    (a) State institutions. Regional Counsels are authorized to 
cooperate with State courts, including the production of required 
records in the commitment of veterans to State hospitals or in their 
restoration to full civil rights.
    (b) Department of Veterans Affairs institutions--(1) Assistance to 
courts in commitment proceedings. The Regional Counsel will render 
assistance to the courts in cases involving the commitment of mentally 
ill veterans to the Department of Veterans Affairs. To this end, the 
Regional Counsel may:
    (i) Produce Department of Veterans Affairs records.
    (ii) Appear in court and present material facts.
    (iii) When authorized to institute commitment proceedings under 
paragraph (b)(2) of this section, prepare and present all necessary 
legal papers, and arrange and authorize transportation costs of veterans 
and attendants at Department of Veterans Affairs expense (Sec. Sec.  
14.703 and 14.704).
    (2) Commitment proceedings. If a mentally ill veteran will accept 
hospitalization voluntarily, no action will be initiated by any 
Department of Veterans Affairs employee to commit such veteran. If the 
veteran will not accept hospitalization, or after being voluntarily 
hospitalized by the Department of Veterans Affairs demands his or her 
release, and hospitalization is necessary for the veteran's safety or 
the safety of others, the Regional Counsel (if a relative of the veteran 
or other interested person has not done so) may institute proceedings to 
commit the veteran to the Department of Veterans Affairs subject to the 
following conditions:
    (i) That the written consent of the veteran's nearest relative has 
been obtained. If the nearest relative cannot

[[Page 673]]

be readily contacted or refuses to consent, coupled with inability or 
refusal to offer adequate alternative care, the Regional Counsel may 
initiate the action if the petition is signed by another relative, a 
civil official or representative of a cooperating agency or other person 
authorized by State law.
    (ii) If timely action cannot be taken under paragraph (b)(2)(i) of 
this section, the Hospital or Clinic Director, or designee, may sign the 
petition if permissible under State law, and the Regional Counsel will 
then take any action necessary to bring the matter before the 
appropriate court.
    (3) Illegal commitment. When a hospitalized veteran, previously 
committed to the Department of Veterans Affairs, demands release and 
continued hospitalization is necessary for the veteran's safety or the 
safety of others, and the Regional Counsel determines the commitment to 
be illegal, immediate action will be taken to obtain a legal commitment.
    (4) Restoration proceedings. When a veteran has been a committed 
patient in a Department of Veterans Affairs hospital and is subsequently 
rated competent by the Department of Veterans Affairs, the Regional 
Counsel upon request, may institute proceedings necessary to restore the 
veteran to full civil rights.



Sec.  14.702  Medical testimony in commitment or restoration proceedings.

    (a) Commitment. When permissable under State law, Department of 
Veterans Affairs physicans, upon request of the Regional Counsel, will 
sign interrogatories or certificates of mental illness or insanity and, 
unless unavailable, as provided in paragraph (c) of this section, will 
testify in proceedings which the Regional Counsel is authorized to 
institute under Sec.  14.701 to commit eligible veterans to the 
Department of Veterans Affairs.
    (b) Restoration. (1) When permissible under State law, Department of 
Veterans Affairs physicans, upon the request of the Regional Counsel, 
will testify in proceedings brought for the purpose of restoring a 
committed veteran to full civil rights when the veteran is a committed 
patient in a Department of Veterans Affairs hospital.
    (2) The Director of a Department of Veterans Affairs hospital or the 
Regional Counsel upon discharge of the veteran, may furnish a 
certificate of sanity or such similar certificate to the proper civil 
authorities.
    (c) Employment of private physicians. When testimony of Department 
of Veterans Affairs physicians is prohibited or is unavailable because 
of a duty assignment, comparative expense or other valid reason, the 
Director of the Department of Veterans Affairs hospital, upon 
recommendation of the Regional Counsel, may employ any qualified 
physician for preliminary examination of the veteran and for testimony 
in any commitment or restoration proceeding which the Regional Counsel 
is authorized to institute under Sec.  14.701, and authorize the payment 
of a fee not to exceed the prescribed fee, or in the absence thereof, 
the customary fee charged for the service rendered.



Sec.  14.703  Costs in commitment or restoration proceedings.

    (a) When authorized to institute a proceeding under Sec.  14.701, 
the Regional Counsel may authorize in advance or thereafter the payment 
or reimbursement of costs and other expenses for which the veteran is 
legally liable, including publication of notice necessary to accomplish 
the commitment.
    (b) The Regional Counsel also may authorize the payment of necessary 
costs and expenses for which the veteran is legally liable incident to 
his or her restoration to full civil rights in any case in which the 
Regional Counsel ia authorized to institute restoration proceedings 
under Sec.  14.701(b)(4).



Sec.  14.704  Authorization of transportation necessary for commitment
of a veteran beneficiary.

    When a mentally ill veteran who should be committed is hospitalized 
by the Department of Veterans Affairs and under the law of the State 
wherein the hospital is located, a commitment may not be had locally, 
the veteran may be returned temporarily to the jurisdiction of the 
appropriate court in order that the commitment can be accomplished. If 
the veteran is in a Department of Veterans Affairs hospital,

[[Page 674]]

the Hospital Director may authorize travel of the veteran and an 
attendant or attendants, if necessary, upon request of the Regional 
Counsel. If the veteran is being maintained in a non-Department of 
Veterans Affairs hospital, the Director of the facility authorizing and 
paying for the care may authorize such travel upon request of the 
Regional Counsel.



Sec.  14.705  Authority to file petitions for appointment of fiduciaries 
in State courts.

    (a) Adult beneficiary. The Regional Counsel is authorized to file or 
cause to be filed on behalf of a petitioner in a case coming within 
Sec.  14.706(a) a petition for the appointment of a fiduciary and all 
necessary legal papers for an adult beneficiary only if it has been 
determined that alternative methods of payment would not be to the best 
interests of the beneficiary and when the Regional Counsel has obtained 
the written consent of:
    (1) The beneficiary's spouse.
    (2) The beneficiary's adult child, parent, adult brother or sister 
if the beneficiary is unmarried, or consent of the spouse is immaterial 
because of estrangement or mental incapacity, or refusal to consent 
coupled with failure to offer adequate alternative means for providing 
for the beneficiary's needs.
    (3) A civil official or representative of a cooperating agency when 
none of the relative listed in paragraph (a) (1) and (2) of this section 
can be located after reasonable inquiry or those located are not 
mentally competent to consent or refuse without offering adequate 
alternative means for providing for the needs of the beneficiary.
    (b) Minor beneficiaries. The Regional Counsel is authorized to file 
or cause to be filed on behalf of a petitioner in a case coming within 
Sec.  14.706(a) a petition for the appointment of a fiduciary for a 
minor. If permissible under the law of the jurisdiction concerned and if 
it has been determined that protection of the minor's rights under laws 
administered by the Department of Veterans Affairs requires the 
appointment, provided: the written consent of the minor's natural or 
adoptive parent or parents or the person or persons occupying the 
relationship of ``in loco parentis'' as defined, by the law of the 
jurisdiction, in which they reside has been obtained. The Regional 
Counsel will not institute a court proceeding for the appointment of a 
fiduciary over the objections of such parent or parents if they are sui 
juris unless the parent or parents have abandoned the minor or have 
otherwise refused to meet their parental obligations toward the minor or 
they have previously been appointed or recognized as the minor's 
fiduciary and failed to properly execute the duties of their trust. If 
the minor has no parent or the parent or parents are not sui juris, the 
Regional Counsel may file the petition without the consent of any 
relative.
    (c) Court-appointed fiduciaries. In court-appointed fiduciary cases, 
the Regional Counsel may appear in the court of appointment or in any 
court having original, concurrent, or appellate jurisdiction, and make 
proper presentation relating to the foregoing matters. The Regional 
Counsel's authority includes by is not limited to:
    (1) Petitioning the court to cite a fiduciary to account;
    (2) Filing exceptions to accountings;
    (3) Requiring fiduciaries to file bonds or make any necessary 
adjustments;
    (4) Requiring investments;
    (5) Filing petitions to vacate or modify court orders;
    (6) Appearing or intervening in any State court as attorney for the 
Secretary of Veterans Affairs in litigation instituted by the Secretary 
or otherwise affecting money paid to such fiduciary by the Department of 
Veterans Affairs;
    (7) Incurring necessary court costs and other expenses, including 
witness fees, appeal bonds, advertising in any newspaper or other 
publication, preparing briefs or transcripts, purchase of records of 
trial or other records;
    (8) Instituting any other action necessary to secure proper 
administration of the estate of a Department of Veterans Affairs 
beneficiary, such as filing petitions for the removal of a fiduciary and 
appointment of a successor;
    (9) Taking appropriate action to recover funds improperly disbursed.

[[Page 675]]

    (d) Appeal. Unless a trial is de novo, no appeal shall be taken to 
an appellate court and no costs incurred in connection therewith without 
the prior approval of the General Counsel and the Under Secretary for 
Benefits or their designees.



Sec.  14.706  Legal services in behalf of beneficiaries.

    (a) The Regional Counsel may furnish legal services in behalf of 
minor and incompetent beneficiaries of the Department of Veterans 
Affairs in fiduciary appointment and estate administration matters 
involving Department of Veterans Affairs benefits or property derived 
therefrom when the beneficiary's estate or income is not sufficient to 
justify the employment of an attorney.
    (b) The Regional Counsel may also furnish legal services in hardship 
situations when restoration from legal disability is a condition of 
precedent to direct payment of Department of Veterans Affairs benefits.
    (c) Where the fiduciary does not in due course institute the 
necessary action to terminate the trust relationship and the beneficiary 
requests representation by the Regional Counsel or in any such case 
where there is in question the proper administration of the estate, the 
Regional Counsel may file the necessary action and supply legal 
services. Costs, unless assessed against the fiduciary, should be 
charged to the estate of the beneficiary.



Sec.  14.707  Authorization of transportation of a veteran beneficiary
for appointment of a fiduciary.

    When the appointment of a fiduciary is required for an incompetent 
veteran hospitalized by the Department of Veterans Affairs and, under 
the law of the State wherein the hospital is located, the appointment 
cannot be had locally, the veteran may be returned temporarily to the 
jurisdiction of the appropriate court in order that the appointment can 
be accomplished. If the veteran is in a Department of Veterans Affairs 
hospital, the Hospital Director, upon request of the Regional Counsel, 
may authorize travel of the veteran and an attendant or attendants, if 
necessary. If the veteran is being maintained in a non-Department of 
Veterans Affairs hospital, the Director of the facility authorizing and 
paying for the care may authorize such travel upon request of the 
Regional Counsel.



Sec.  14.708  Costs and other expenses incident to appointment of 
fiduciary.

    (a) The Regional Counsel may authorize the payment of costs and 
other necessary expenses incident to the appointment of an initial or 
successor fiduciary for a Department of Veterans Affairs beneficiary 
when:
    (1) Authorized to render legal services under Sec.  14.706.
    (2) Appointment was caused by the Department of Veterans Affairs and 
it develops that no benefits are payable and there is no estate from 
which costs may be paid.
    (3) Costs must be advanced when there is no immediate estate from 
which same may be paid. These costs are to be recovered from benefits 
payable unless the case falls within paragraph (a)(1) of this section.
    (b) Costs and necessary expenses include:
    (1) All those chargeable by statute or rule of court and certified 
by the clerk of court.
    (2) Certified copies of court records required by the Department of 
Veterans Affairs.
    (3) Fees for guardian ad litem when chargeable as court costs and 
required by State law.



Sec.  14.709  Surety bonds; court-appointed fiduciary.

    (a) It is the policy of the Department of Veterans Affairs to 
require, where possible under State laws and rules of the court, 
corporate surety bonds in all court-appointed fiduciary cases where the 
fiduciary is an individual and the estate is sufficient to justify the 
expense of procuring a corporate surety bond. Corporate bonds may be 
required of corporate fiduciaries in accordance with State laws. In 
cases wherein fiduciaries neglect or refuse to furnish corporate bonds, 
as requested by the Regional Counsel, the Regional Counsel should take 
appropriate court action and notify the Veterans Service Center Manager.
    (b) When it is not practical or feasible to require a fiduciary to 
furnish a

[[Page 676]]

corporate surety bond, the Regional Counsel is authorized to accept 
bonds with such number of personal sureties as is permissible under 
State law, but in no event less than one. To be acceptable for 
Department of Veterans Affairs purposes, each personal surety must be 
worth at least the penal sum named in the bond over and above all debts, 
liabilities and exemptions and qualify in accordance with the 
requirements of State law. The Regional Counsel will request suitable 
evidence of financial responsibility whenever there is any question as 
to the ability of a personal surety to meet any probable liability. When 
suitable evidence is not furnished as requested, or financial 
responsibility is found to be insufficient to meet the penal sum of the 
bond, the Regional Counsel should take appropriate court action and 
notify the Veterans Service Center Manager.
    (c) It is the policy of the Department of Veterans Affairs to 
require surety bonds in an amount commensurate with value of the 
personal estate derived from Department of Veterans Affairs benefits 
plus the anticipated net income from Department of Veterans Affairs 
benefits received during the ensuing accounting period. In cases where 
the fiduciaries neglect or refuse to furnish surety bonds in the amount 
requested by the Regional Counsel, the Regional Counsel should take 
appropriate court action and notify the Veterans Service Center Manager. 
When permissible under State law, the Regional Counsel may accept, 
without objection, a lesser degree of protection approved by the court 
when it is determined that such action will adequately protect the 
beneficiary's estate.

[42 FR 41422, Aug. 17, 1977, as amended at 71 FR 28586, May 17, 2006]

 Testimony of Department Personnel and Production of Department Records 
                          in Legal Proceedings

    Source: 59 FR 6566, Feb. 11, 1994, unless otherwise noted.



Sec.  14.800  Purpose.

    Sections 14.800 through 14.810 establish policy, assign 
responsibilities and prescribe procedures with respect to:
    (a) The production or disclosure of official information or records 
of the Department of Veterans Affairs (VA); and
    (b) The testimony of present or former VA personnel relating to any 
official information acquired by any individual as part of that 
individual's performance of official duties, or by virtue of that 
individual's official status, in federal, state or other legal 
proceedings covered by these regulations.

(Authority: 38 U.S.C. 501(a) and (b); 5 U.S.C. 301)



Sec.  14.801  Applicability.

    (a) Sections 14.800 through 14.810 apply to:
    (1) Contractors and subcontractors which undertake a VA activity or 
maintain VA records when the contract covering their actions provides 
that these regulations apply, as well as the personnel of contractors 
and subcontractors.
    (2) All components of the Department, including Canteen Service, the 
Office of Inspector General, and all staff offices, services and 
administrations, and their personnel.
    (b) Sections 14.800 through 14.810 do not apply to:
    (1) Testimony or records provided in accordance with Office of 
Personnel Management regulations implementing 5 U.S.C. 6322.
    (2)(i) Legal proceedings in which the Department of Veterans 
Affairs, the Secretary of Veterans Affairs or the United States is a 
party, is represented or has a direct and substantial interest; or
    (ii) Legal proceedings in which an individual or entity is a party 
for whom the United States is providing representation.
    (3) Legal proceedings in which VA personnel are to testify while in 
leave or off-duty status as to matters which are purely personal and 
that do not arise out of, or relate in any way to, the personnel's 
official duties or to the functions and activities of the VA or the 
United States.
    (4) Official comments on matters in legal proceedings, where 
appropriate.
    (5) Disclosures, in the absence of a request or demand, of 
information or records by VA components, particularly the Office of 
Inspector General, to

[[Page 677]]

federal, state, local and foreign law enforcement or regulatory 
agencies.
    (6) Congressional demands or requests for testimony or documents.
    (7) Requests for, and release of, records under the Freedom of 
Information Act, 5 U.S.C. 552, and the Privacy Act, 5 U.S.C. 552a.
    (8) Disclosures in child support and alimony proceedings under the 
authority of 42 U.S.C. 659 and regulations promulgated by the Office of 
Personnel Management implementing that section.
    (9) Legal proceedings before or involving the VA concerning a claim 
or dispute as to the rights of a beneficiary or obligations or 
liabilities of the United States under any law or program administered 
by the Department of Veterans Affairs.
    (10) Requests by a veteran or that veteran's representative for 
access to the veteran's records for use in an administrative or judicial 
claim for benefits administered by the Department of Veterans Affairs.
    (11) Foreign legal proceedings covered by Department of State 
procedures governing the production of records or witnesses in response 
to requests or demands in connection with foreign legal proceedings.
    (c) Sections 14.800 through 14.810 are not intended to, and do not:
    (1) Waive the sovereign immunity of the United States;
    (2) Infringe upon or displace the responsibilities committed to the 
Department of Justice in conducting litigation on behalf of the United 
States in appropriate cases;
    (3) Remove the need for the Department to comply with any applicable 
legal confidentiality provisions, such as the Privacy Act, before having 
the legal authority to make any disclosure or providing any testimony 
under these regulations. (Sections 14.800 through 14.810 do not give VA 
disclosure authority under applicable confidentiality statutes; absent 
disclosure authority granted by those statutes, information and records 
subject to those laws may not be disclosed, or testimony given as to 
them under the procedures established in these regulations); or
    (4) Preclude treating any written request for agency records that is 
not in the nature of a request or demand related to legal proceedings as 
a request under the Freedom of Information or Privacy Acts.

(Authority: 38 U.S.C. 501(a) and (b); 5 U.S.C. 301)



Sec.  14.802  Definitions.

    (a) Demand. Order, subpoena, or other demand of a court of competent 
jurisdiction, or other specific authority or under color of law, for the 
production, disclosure, or release of VA information or records or for 
the appearance and testimony of VA personnel as witnesses.
    (b) Request. Any informal request, by whatever method, from a party, 
a party's attorney, or any person acting on behalf of a party, for the 
production of VA records or information or for the testimony of VA 
personnel as witnesses, which has not been ordered by a court of 
competent jurisdiction or other specific authority or under color of 
law.
    (c) VA personnel. All present and former officers and employees of 
the VA and any other individuals who are or have been appointed by, or 
subject to the supervision, jurisdiction, or control of the Secretary of 
Veterans Affairs or another official of the VA, including 
nonappropriated fund activity employees, and other individuals hired 
through contractual agreements by or on behalf of the VA, or performing 
services under such agreements for VA, such as consultants, contractors, 
subcontractors, their employees and personnel. This phrase also includes 
individuals who served or are serving on any advisory committee or in 
any advisory capacity, whether formal or informal.
    (d) Legal proceedings. All pretrial, trial, and post-trial stages of 
all existing or reasonably anticipated judicial or administrative 
actions, hearings, investigations, or similar proceedings before courts, 
commissions, boards, or other tribunals, foreign or domestic that are 
not specified in Sec.  14.801(b). This phrase includes depositions and 
other pretrial proceedings, as well as responses to formal or informal 
requests by attorneys or others in situations involving legal 
proceedings not specified in Sec.  14.801(b).

[[Page 678]]

    (e) Official VA information. All information of any kind, however 
stored, that is in the custody and control of VA or was acquired by VA 
personnel as part of their official duties or because of their official 
status.
    (f) Testimony. Testimony in any form, including personal appearances 
in court, depositions, recorded interviews, telephonic, televised or 
videotaped testimony or any response during discovery or similar 
proceedings, which response would involve more than the production of 
records.
    (g) VA records. All documents which are records of the Department of 
Veterans Affairs for purposes of the Freedom of Information Act, 5 
U.S.C. 552, regardless of storage media, including the term ``record'' 
as defined in 44 U.S.C. 3301, and implementing regulations.

(Authority: 38 U.S.C. 501(a) and (b); 5 U.S.C. 301)



Sec.  14.803  Policy.

    (a) VA personnel may provide testimony or produce VA records in 
legal proceedings covered by Sec. Sec.  14.800 through 14.810 only as 
authorized in accordance with these regulations. In determining whether 
to authorize testimony or the production of records, the determining 
official will consider the effect in this case, as well as in future 
cases generally, based on the factors set forth in Sec.  14.804, which 
testifying or producing records not available for public disclosure will 
have on the ability of the agency or VA personnel to perform their 
official duties.
    (b) The Department of Veterans Affairs does not seek to deny its 
employees access to the courts as citizens, or in the employees' private 
capacities on off-duty time.
    (c) The Department of Veterans Affairs does not seek to deny the 
Nation's veterans access to the courts.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.804  Factors to consider.

    In deciding whether to authorize the disclosure of VA records or 
information or the testimony of VA personnel, VA personnel responsible 
for making the decision should consider the following types of factors:
    (a) The need to avoid spending the time and money of the United 
States for private purposes and to conserve the time of VA personnel for 
conducting their official duties concerning servicing the Nation's 
veteran population;
    (b) How the testimony or production of records would assist VA in 
performing its statutory duties;
    (c) Whether the disclosure of the records or presentation of 
testimony is necessary to prevent the perpetration of fraud or other 
injustice in the matter in question;
    (d) Whether the demand or request is unduly burdensome or otherwise 
inappropriate under the applicable court or administrative rules;
    (e) Whether the testimony or production of records, including 
release in camera, is appropriate or necessary under the rules of 
procedure governing the case or matter in which the demand or request 
arose, or under the relevant substantive law concerning privilege;
    (f) Whether the testimony or production of records would violate a 
statute, executive order, regulation or directive. (Where the production 
of a record or testimony as to the content of a record or about 
information contained in a record would violate a confidentiality 
statute's prohibition against disclosure, disclosure will not be made. 
Examples of such statutes are the Privacy Act, 5 U.S.C. 552a, and 
sections 5701, 5705 and 7332 of title 38, United States Code.);
    (g) Whether the testimony or production of records, except when in 
camera and necessary to assert a claim of privilege, would reveal 
information properly classified pursuant to applicable statutes or 
Executive Orders;
    (h) Whether the testimony would interfere with ongoing law 
enforcement proceedings, compromise constitutional rights, compromise 
national security interests, hamper VA or private health care research 
activities, reveal sensitive patient or beneficiary information, 
interfere with patient care,

[[Page 679]]

disclose trade secrets or similarly confidential commercial or financial 
information or otherwise be inappropriate under the circumstances.
    (i) Whether such release or testimony reasonably could be expected 
to result in the appearance of VA or the Federal government favoring one 
litigant over another;
    (j) Whether such release or testimony reasonably could be expected 
to result in the appearance of VA or the Federal government endorsing or 
supporting a position advocated by a party to the proceeding;
    (k) The need to prevent the public's possible misconstruction of 
variances between personal opinions of VA personnel and VA or Federal 
policy.
    (l) The need to minimize VA's possible involvement in issues 
unrelated to its mission;
    (m) Whether the demand or request is within the authority of the 
party making it;
    (n) Whether the demand or request is sufficiently specific to be 
answered;
    (o) Other matters or concerns presented for consideration in making 
the decision.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.805  Contents of a demand or request.

    The request or demand for testimony or production of documents shall 
set forth in, or be accompanied by, an affidavit, or if that is not 
feasible, in, or accompanied by, a written statement by the party 
seeking the testimony or records or by the party's attorney, a summary 
of the nature and relevance of the testimony or records sought in the 
legal proceedings containing sufficient information for the responsible 
VA official to determine whether VA personnel should be allowed to 
testify or records should be produced. Where the materials are 
considered insufficient to make the determination as described in Sec.  
14.807, the responsible VA official may ask the requester to provide 
additional information.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.806  Scope of testimony or production.

    VA personnel shall not, in response to a request or demand for 
testimony or production of records in legal proceedings, comment or 
testify or produce records without the prior written approval of the 
responsible VA official designated in Sec.  14.807(b). VA personnel may 
only testify concerning or comment upon official VA information, 
subjects or activities, or produce records, that were specified in 
writing, submitted to and properly approved by the responsible VA 
official.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.807  Procedure when demand or request is made.

    (a) VA personnel upon whom a demand or request for testimony or the 
production of records in connection with legal proceedings as defined in 
Sec.  14.802(d) is made shall notify the head of his or her field 
station, or if in Central Office, the head of the component for which he 
or she works. The field station or Central Office component shall notify 
the responsible VA official designated in Sec.  14.807(b).
    (b) In response to a demand or request for the production of records 
or the testimony of VA personnel, other than personnel in the Office of 
the Inspector General (OIG), as witnesses in legal proceedings covered 
by these regulations, the General Counsel, the Regional Counsel, an 
attorney in the Office of General Counsel designated by the General 
Counsel, or an attorney in the Regional Counsel office designated by the 
Regional Counsel is the responsible VA official authorized to determine 
whether VA personnel may be interviewed, contacted or used as witnesses, 
including used as expert witnesses, and whether VA records may be 
produced; and what, if any, conditions will be imposed upon such 
interview, contact, testimony or production of records. For personnel in 
the OIG, the Counselor to the Inspector General or an attorney 
designated by the Counselor to the Inspector General, is the responsible 
VA official authorized to make the determinations provided in Sec.  
14.807, and that official will keep the

[[Page 680]]

General Counsel informed of such determinations for purposes of 
litigation or claims of privilege.
    (c) In appropriate cases, the responsible VA official shall promptly 
notify the Department of Justice of the demand or request. After 
consultation and coordination with the Department of Justice, as 
required, and after any necessary consultation with the VA component 
which employs or employed the VA personnel whose testimony is sought or 
which is responsible for the maintenance of the records sought, the VA 
official shall determine in writing whether the individual is required 
to comply with the demand or request and shall notify the requester or 
the court or other authority of the determination reached where the 
determination is that VA will not comply fully with the request or 
demand. The responsible VA official shall give notice of the decision to 
other persons as circumstances may warrant. Oral approval may be 
granted, and a record of such approval made and retained in accordance 
with the procedures in Sec.  14.807(f) concerning oral requests or 
demands.
    (d) If, after VA personnel have received a request or demand in a 
legal proceeding and have notified the responsible VA official in 
accordance with this section, a response to the request or demand is 
required before instructions from the responsible official are received, 
the responsible official designated in paragraph (b) of this section 
shall furnish the requester or the court or other authority with a copy 
of Sec. Sec.  14.800 through 14.810 and any other relevant 
documentation, inform the requester or the court or other authority that 
the request or demand is being reviewed, and seek a stay of the request 
or demand pending a final determination by the VA official concerned.
    (e) If a court of competent jurisdiction or other appropriate 
authority declines to stay the effect of the demand or request in 
response to action taken pursuant to Sec.  14.807(d), or if such court 
or other authority orders that the demand or request be complied with 
notwithstanding the final decision of the appropriate VA official, the 
VA personnel upon whom the demand or request was made shall notify the 
responsible VA official of such ruling or order. If the responsible VA 
official determines that no further legal review of or challenge to the 
ruling or order will be sought, the affected VA personnel shall comply 
with the demand, order or request. If directed by the appropriate VA 
official after consultation with the appropriate United States 
Attorney's office, however, the affected VA personnel shall respectfully 
decline to comply with the demand, request or order. See United States 
ex rel. Touhy v. Ragen, 340 U.S. 462 (1951).
    (f) Normally, written demands or requests allowing reasonable lead 
time for evaluation and processing are required. However, in emergency 
situations where response time is limited and a written demand or 
request is impractical, the following procedures should be followed:
    (1) The responsible VA official has the authority to waive the 
requirement of a written demand or request and may expedite a response 
in the event of an emergency under conditions which could not be 
anticipated in the course of proper planning or which demonstrate a good 
faith attempt to comply with these regulations. Determinations on oral 
demands or requests should be reserved for instances where insistence on 
compliance with the requirements of a proper written request would 
result in the effective denial of the request and cause an injustice in 
the outcome of the legal proceeding for which the testimony or records 
are sought. No requester has a right to make an oral demand or request 
and receive a determination, however. Whether to permit such an 
exceptional procedure is a decision within the sole discretion of the 
responsible VA official.
    (2) If the responsible VA official concludes that the demand or 
request, or any portion of it, should be granted (after considering the 
factors listed in Sec.  14.804), the responsible VA official will then 
orally advise the requester of the determination in accordance with the 
procedures provided in Sec.  14.807(c), including any limitations on 
such testimony or production of records, and seek a written confirmation 
of the oral demand or request. The responsible VA official will make a 
written record of

[[Page 681]]

the determination made concerning the oral demand or request, including 
the grant or denial, the circumstances requiring the procedure, and the 
conditions to which the requester agreed.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.808  Expert or opinion testimony.

    (a) VA personnel shall not provide, with or without compensation, 
opinion or expert testimony in any legal proceedings concerning official 
VA information, subjects or activities, except on behalf of the United 
States or a party represented by the United States Department of 
Justice. Upon a showing by the requester or court or other appropriate 
authority that, in light of the factors listed in Sec.  14.804, there 
are exceptional circumstances and that the anticipated testimony will 
not be adverse to the interests of the Department of Veterans Affairs or 
to the United States, the responsible VA official designated in Sec.  
14.807(b) may, in writing, grant special authorization for VA personnel 
to appear and testify. If, despite the final determination of the 
responsible VA official, a court of competent jurisdiction or other 
appropriate authority, orders the expert or opinion testimony of VA 
personnel, the personnel shall notify the responsible VA official of 
such order. If the responsible VA official determines that no further 
legal review of or challenge to the order will be sought, the affected 
VA personnel shall comply with the order. If directed by the appropriate 
VA official after consultation with the appropriate United States 
Attorney's office, however, the affected VA personnel shall respectfully 
decline to comply with the demand, request or order. See United States 
ex rel. Touhy v. Ragen, 340 U.S. 462 (1951).
    (b)(1) If, while testifying in any legal proceeding, VA personnel 
are asked for expert or opinion testimony concerning official VA 
information, subjects or activities, which testimony has not been 
approved in advance in accordance with these regulations, the witness 
shall:
    (i) Respectfully decline to answer on the grounds that such expert 
or opinion testimony is forbidden by these regulations;
    (ii) Request an opportunity to consult with the responsible VA 
official mentioned in Sec.  14.807(b) before giving such testimony;
    (iii) Explain that, upon such consultation, approval for such 
testimony may be provided; and
    (iv) Explain that providing such testimony absent such approval may 
expose the individual to criminal liability under 18 U.S.C. 201-209 and 
to disciplinary or other adverse personnel action.
    (2) If the witness is then ordered by the body conducting the 
proceeding to provide expert or opinion testimony concerning official VA 
information, subjects or activities without the opportunity to consult 
with the appropriate VA official, the witness respectfully shall refuse 
to do so. See United States ex rel. Touhy v. Ragen, 340 U.S. 462 (1951).
    (c) Upon notification by the witness of a request for opinion or 
expert testimony concerning official VA information, subjects or 
activities during Sec.  14.802(d) legal proceedings, the responsible VA 
official shall follow the procedures contained in this section to 
determine whether such testimony shall be approved.
    (d) If VA personnel who are unaware of these regulations provide 
expert or opinion testimony concerning official VA information, subjects 
or activities in any legal proceeding, including one mentioned in Sec.  
14.802(d) in which the United States is not already represented, without 
consulting with the responsible VA official, the witness, as soon after 
testifying as possible, shall inform the responsible VA official of the 
fact that such testimony was given and provide a summary of the expert 
or opinion testimony given.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.809  Demands or requests in legal proceedings for records
protected by confidentiality statutes.

    In addition to complying with the requirements of Sec. Sec.  14.800 
through 14.810, requests or demands in legal proceedings for the 
production of records, or for testimony of VA employees concerning 
information, protected by the Privacy Act, 5 U.S.C. 552a, or other

[[Page 682]]

confidentiality statutes, such as 38 U.S.C. 5701, 5705 and 7332, must 
satisfy the requirements for disclosure imposed by those statutes, and 
implementing regulations, such as 38 CFR 1.511, before the records may 
be provided or testimony given. Accordingly, the responsible VA official 
may first determine whether there is legal authority to provide the 
testimony or records sought under applicable confidentiality statutes 
before applying Sec. Sec.  14.800 through 14.810. Where an applicable 
confidentiality statute mandates disclosure, Sec. Sec.  14.800 through 
14.810 will not apply.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



Sec.  14.810  Fees.

    (a) The testimony of VA personnel as witnesses, particularly as 
expert witnesses, and the production of VA records in legal proceedings 
subject to Sec. Sec.  14.800 through 14.810 are services which convey 
special benefits to the individuals or entities seeking such testimony 
or production of records above and beyond those accruing to the general 
public. These services are not regularly received by or available 
without charge to the public at large. Consequently, these are the sort 
of services for which the VA may establish a charge for providing under 
31 U.S.C. 9701. The responsible VA official will determine all fees 
associated with Sec. Sec.  14.800 through 14.810, and shall timely 
notify the requester of the fees, particularly those which are to be 
paid in advance.
    (b)(1) When a request is granted under Sec.  14.808 to permit VA 
personnel to testify in whole or in part as to expert, opinion or policy 
matters, the requester shall pay to the government a fee calculated to 
reimburse the cost of providing the witness. The fee shall include:
    (i) Costs of the time expended by VA personnel to process and 
respond to the demand or request;
    (ii) Costs of attorney time expended in reviewing the demand or 
request and any information located in connection with the demand or 
request;
    (iii) Expenses generated by materials and equipment used to search 
for, produce, and copy the responsive information;
    (iv) The cost of the time expended by the witness to prepare to 
testify; and
    (v) Costs of travel by the witness and attendance at trial.
    (2) All costs for documents necessary for such expert testimony 
shall be calculated as provided in VA regulations implementing the fee 
provisions of the Freedom of Information Act, 5 U.S.C. 552.
    (c) When an individual testifies in legal proceedings covered by 
these regulations in any capacity other than as an expert witness, the 
requester shall pay to the witness the fee and expenses prescribed for 
attendance by the applicable rule of court. If no such fee is 
prescribed, the applicable Federal rule, such as a local Federal 
district court rule, will apply. No additional fee will be prescribed 
for the time spent while testifying or in attendance to do so.
    (d) When a requester wishes to interview VA personnel as part of 
legal proceedings covered by these regulations, and such interview has 
been approved in accordance with these regulations, the requester shall 
pay a fee calculated upon the total hourly pay of the individual 
interviewed.
    (e) When VA produces records in legal proceedings pursuant to 
Sec. Sec.  14.800 through 14.810, the fees to be charged and paid prior 
to production of the records shall be the fees charged by VA under its 
regulations implementing the fee provisions of the Freedom of 
Information Act, 5 U.S.C. 552.
    (f) Fees shall be paid as follows:
    (1) Fees for copies of documents, blueprints, electronic tapes, or 
other VA records will be paid to the VA office or station providing the 
records, and covered to the General Fund of the Department of the 
Treasury.
    (2) Witness fees for testimony shall be paid to the witness, who 
shall endorse the check ``pay to the United States,'' and surrender it 
to his or her supervisor. It shall thereafter be deposited in the 
General Fund.
    (3) The private party requesting a VA witness shall forward in 
advance necessary round trip tickets and all requisite travel and per 
diem funds.

[[Page 683]]

    (g) A waiver of any fees in connection with the testimony of an 
expert witness may be granted by the appropriate VA official at the 
official's discretion provided that the waiver is in the interest of the 
United States. Fee waivers shall not be routinely granted, nor shall 
they be granted under circumstances which might create the appearance 
that the VA or the United States favors one party or a position 
advocated by a party to the legal proceeding.

(Authority: 38 U.S.C. 501 (a) and (b); 5 U.S.C. 301)



PART 15_ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN
PROGRAMS OR ACTIVITIES CONDUCTED BY THE DEPARTMENT OF VETERANS AFFAIRS-
-Table of Contents



Sec.
15.101 Purpose.
15.102 Application.
15.103 Definitions.
15.104-15.109 [Reserved]
15.110 Self-evaluation.
15.111 Notice.
15.112-15.129 [Reserved]
15.130 General prohibitions against discrimination.
15.131-15.139 [Reserved]
15.140 Employment.
15.141-15.148 [Reserved]
15.149 Program accessibility: Discrimination prohibited.
15.150 Program accessibility: Existing facilities.
15.151 Program accessibility: New construction and alterations.
15.152-15.159 [Reserved]
15.160 Communications.
15.161-15.169 [Reserved]
15.170 Compliance procedures.
15.171-15.999 [Reserved]

    Authority: 29 U.S.C. 794.

    Source: 53 FR 25885, July 8, 1988, unless otherwise noted.



Sec.  15.101  Purpose.

    The purpose of this regulation is to effectuate section 119 of the 
Rehabilitation, Comprehensive Services, and Developmental Disabilities 
Amendments of 1978, which amended section 504 of the Rehabilitation Act 
of 1973 to prohibit discrimination on the basis of handicap in programs 
or activities conducted by Executive agencies or the United States 
Postal Service.



Sec.  15.102  Application.

    This regulation (Sec. Sec.  15.101-15.170) applies to all programs 
or activities conducted by the agency, except for programs or activities 
conducted outside the United States that do not involve individuals with 
handicaps in the United States.



Sec.  15.103  Definitions.

    For purposes of this regulation, the term--
    Assistant Attorney General means the Assistant Attorney General, 
Civil Rights Division, United States Department of Justice.
    Auxiliary aids means services or devices that enable persons with 
impaired sensory, manual, or speaking skills to have an equal 
opportunity to participate in, and enjoy the benefits of, programs or 
activities conducted by the agency. For example, auxiliary aids useful 
for persons with impaired vision include readers, Brailled materials, 
audio recordings, and other similar services and devices. Auxiliary aids 
useful for persons with impaired hearing include telephone handset 
amplifiers, telephones compatible with hearing aids, telecommunication 
devices for deaf persons (TDD's), interpreters, notetakers, written 
materials, and other similar services and devices.
    Complete complaint means a written statement that contains the 
complainant's name and address and describes the agency's alleged 
discriminatory action in sufficient detail to inform the agency of the 
nature and date of the alleged violation of section 504. It shall be 
signed by the complainant or by someone authorized to do so on his or 
her behalf. Complaints filed on behalf of classes or third parties shall 
describe or identify (by name, if possible) the alleged victims of 
discrimination.
    Facility means all or any portion of buildings, structures, 
equipment, roads, walks, parking lots, rolling stock or other 
conveyances, or other real or personal property.
    Historic preservation programs means programs conducted by the 
agency that have preservation of historic properties as a primary 
purpose.

[[Page 684]]

    Historic properties means those properties that are listed or 
eligible for listing in the National Register of Historic Places or 
properties designated as historic under a statute of the appropriate 
State or local government body.
    Individual with handicaps means any person who has a physical or 
mental impairment that substantially limits one or more major life 
activities, has a record of such an impairment, or is regarded as having 
such an impairment.

As used in this definition, the phrase:
    (1) Physical or mental impairment includes--
    (i) Any physiological disorder or condition, cosmetic disfigurement, 
or anatomical loss affecting one or more of the following body systems: 
Neurological; musculoskeletal; special sense organs; respiratory, 
including speech organs; cardiovascular; reproductive; digestive; 
genitourinary; hemic and lymphatic; skin; and endocrine; or
    (ii) Any mental or psychological disorder, such as mental 
retardation, organic brain syndrome, emotional or mental illness, and 
specific learning disabilities. The term physical or mental impairment 
includes, but is not limited to, such diseases and conditions as 
orthopedic, visual, speech, and hearing impairments, cerebral palsy, 
epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, 
diabetes, mental retardation, emotional illness, and drug addiction and 
alcoholism.
    (2) Major life activities includes functions such as caring for 
one's self, performing manual tasks, walking, seeing, hearing, speaking, 
breathing, learning, and working.
    (3) Has a record of such an impairment means has a history of, or 
has been misclassified as having, a mental or physical impairment that 
substantially limits one or more major life activities.
    (4) Is regarded as having an impairment means--
    (i) Has a physical or mental impairment that does not substantially 
limit major life activities but is treated by the agency as constituting 
such a limitation;
    (ii) Has a physical or mental impairment that substantially limits 
major life activities only as a result of the attitudes of others toward 
such impairment; or
    (iii) Has none of the impairments defined in paragraph (1) of this 
definition but is treated by the agency as having such an impairment.
    Qualified individual with handicaps means--
    (1) With respect to preschool, elementary, or secondary education 
services provided by the agency, an individual with handicaps who is a 
member of a class of persons otherwise entitled by statute, regulation, 
or agency policy to receive education services from the agency;
    (2) With respect to any other agency program or activity under which 
a person is required to perform services or to achieve a level of 
accomplishment, an individual with handicaps who meets the essential 
eligibility requirements and who can achieve the purpose of the program 
or activity without modifications in the program or activity that the 
agency can demonstrate would result in a fundamental alteration in its 
nature;
    (3) With respect to any other program or activity, an individual 
with handicaps who meets the essential eligibility requirements for 
participation in, or receipt of benefits from, that program or activity; 
and
    (4) Qualified handicapped person as that term is defined for 
purposes of employment in 29 CFR 1613.702(f), which is made applicable 
to this regulation by Sec.  15.140.
    Section 504 means section 504 of the Rehabilitation Act of 1973 
(Pub. L. 93-112, 87 Stat. 394 (29 U.S.C. 794)), as amended by the 
Rehabilitation Act Amendments of 1974 (Pub. L. 93-516, 88 Stat. 1617); 
the Rehabilitation, Comprehensive Services, and Developmental 
Disabilities Amendments of 1978 (Pub. L. 95-602, 92 Stat. 2955); and the 
Rehabilitation Act Amendments of 1986 (Pub. L. 99-506, 100 Stat. 1810). 
As used in this regulation, section 504 applies only to programs or 
activities conducted by Executive agencies and not to federally assisted 
programs.
    Substantial impairment means a significant loss of the integrity of 
finished materials, design quality, or special character resulting from 
a permanent alteration.

[[Page 685]]



Sec. Sec.  15.104-15.109  [Reserved]



Sec.  15.110  Self-evaluation.

    (a) The agency shall, by September 6, 1989, evaluate its current 
policies and practices, and the effects thereof, that do not or may not 
meet the requirements of this regulation and, to the extent modification 
of any such policies and practices is required, the agency shall proceed 
to make the necessary modifications.
    (b) The agency shall provide an opportunity to interested persons, 
including individuals with handicaps or organizations representing 
individuals with handicaps, to participate in the self-evaluation 
process by submitting comments (both oral and written).
    (c) The agency shall, for at least three years following completion 
of the self-evaluation, maintain on file and make available for public 
inspection:
    (1) A description of areas examined and any problems identified; and
    (2) A description of any modifications made.



Sec.  15.111  Notice.

    The agency shall make available to employees, applicants, 
participants, beneficiaries, and other interested persons such 
information regarding the provisions of this regulation and its 
applicability to the programs or activities conducted by the agency, and 
make such information available to them in such manner as the head of 
the agency finds necessary to apprise such persons of the protections 
against discrimination assured them by section 504 and this regulation.



Sec. Sec.  15.112-15.129  [Reserved]



Sec.  15.130  General prohibitions against discrimination.

    (a) No qualified individual with handicaps shall, on the basis of 
handicap, be excluded from participation in, be denied the benefits of, 
or otherwise be subjected to discrimination under any program or 
activity conducted by the agency.
    (b)(1) The agency, in providing any aid, benefit, or service, may 
not, directly or through contractual, licensing, or other arrangements, 
on the basis of handicap--
    (i) Deny a qualified individual with handicaps the opportunity to 
participate in or benefit from the aid, benefit, or service;
    (ii) Afford a qualified individual with handicaps an opportunity to 
participate in or benefit from the aid, benefit, or service that is not 
equal to that afforded others;
    (iii) Provide a qualified individual with handicaps with an aid, 
benefit, or service that is not as effective in affording equal 
opportunity to obtain the same result, to gain the same benefit, or to 
reach the same level of achievement as that provided to others;
    (iv) Provide different or separate aid, benefits, or services to 
individuals with handicaps or to any class of individuals with handicaps 
than is provided to others unless such action is necessary to provide 
qualified individuals with handicaps with aid, benefits, or services 
that are as effective as those provided to others;
    (v) Deny a qualified individual with handicaps the opportunity to 
participate as a member of planning or advisory boards;
    (vi) Otherwise limit a qualified individual with handicaps in the 
enjoyment of any right, privilege, advantage, or opportunity enjoyed by 
others receiving the aid, benefit, or service.
    (2) The agency may not deny a qualified individual with handicaps 
the opportunity to participate in programs or activities that are not 
separate or different, despite the existence of permissibly separate or 
different programs or activities.
    (3) The agency may not, directly or through contractual or other 
arrangements, utilize criteria or methods of administration the purpose 
or effect of which would--
    (i) Subject qualified individuals with handicaps to discrimination 
on the basis of handicap; or
    (ii) Defeat or substantially impair accomplishment of the objectives 
of a program or activity with respect to individuals with handicaps.
    (4) The agency may not, in determining the site or location of a 
facility, make selections the purpose or effect of which would--
    (i) Exclude individuals with handicaps from, deny them the benefits 
of,

[[Page 686]]

or otherwise subject them to discrimination under any program or 
activity conducted by the agency; or
    (ii) Defeat or substantially impair the accomplishment of the 
objectives of a program or activity with respect to individuals with 
handicaps.
    (5) The agency, in the selection of procurement contractors, may not 
use criteria that subject qualified individuals with handicaps to 
discrimination on the basis of handicap.
    (6) The agency may not administer a licensing or certification 
program in a manner that subjects qualified individuals with handicaps 
to discrimination on the basis of handicap, nor may the agency establish 
requirements for the programs or activities of licensees or certified 
entities that subject qualified individuals with handicaps to 
discrimination on the basis of handicap. However, the programs or 
activities of entities that are licensed or certified by the agency are 
not, themselves, covered by this regulation.
    (c) The exclusion of nonhandicapped persons from the benefits of a 
program limited by Federal statute or Executive order to individuals 
with handicaps or the exclusion of a specific class of individuals with 
handicaps from a program limited by Federal statute or Executive order 
to a different class of individuals with handicaps is not prohibited by 
this regulation.
    (d) The agency shall administer programs and activities in the most 
integrated setting appropriate to the needs of qualified individuals 
with handicaps.



Sec. Sec.  15.131-15.139  [Reserved]



Sec.  15.140  Employment.

    No qualified individual with handicaps shall, on the basis of 
handicap, be subject to discrimination in employment under any program 
or activity conducted by the agency. The definitions, requirements, and 
procedures of section 501 of the Rehabilitation Act of 1973 (29 U.S.C. 
791), as established by the Equal Employment Opportunity Commission in 
29 CFR part 1613, shall apply to employment in federally conducted 
programs or activities.



Sec. Sec.  15.141-15.148  [Reserved]



Sec.  15.149  Program accessibility: Discrimination prohibited.

    Except as otherwise provided in Sec.  15.150, no qualified 
individual with handicaps shall, because the agency's facilities are 
inaccessible to or unusable by individuals with handicaps, be denied the 
benefits of, be excluded from participation in, or otherwise be 
subjected to discrimination under any program or activity conducted by 
the agency.



Sec.  15.150  Program accessibility: Existing facilities.

    (a) General. The agency shall operate each program or activity so 
that the program or activity, when viewed in its entirety, is readily 
accessible to and usable by individuals with handicaps. This paragraph 
does not--
    (1) Necessarily require the agency to make each of its existing 
facilities accessible to and usable by individuals with handicaps;
    (2) In the case of historic preservation programs, require the 
agency to take any action that would result in a substantial impairment 
of significant historic features of an historic property; or
    (3) Require the agency to take any action that it can demonstrate 
would result in a fundamental alteration in the nature of a program or 
activity or in undue financial and administrative burdens. In those 
circumstances where agency personnel believe that the proposed action 
would fundamentally alter the program or activity or would result in 
undue financial and administrative burdens, the agency has the burden of 
proving that compliance with Sec.  15.150(a) would result in such 
alteration or burdens. The decision that compliance would result in such 
alteration or burdens must be made by the agency head or his or her 
designee after considering all agency resources available for use in the 
funding and operation of the conducted program or activity, and must be 
accompanied by a written statement of the reasons for reaching that 
conclusion. If an action would result in such an alteration or such 
burdens, the agency shall take any other action that would not result

[[Page 687]]

in such an alteration or such burdens but would nevertheless ensure that 
individuals with handicaps receive the benefits and services of the 
program or activity.
    (b) Methods--(1) General. The agency may comply with the 
requirements of this section through such means as redesign of 
equipment, reassignment of services to accessible buildings, assignment 
of aides to beneficiaries, home visits, delivery of services at 
alternate accessible sites, alteration of existing facilities and 
construction of new facilities, use of accessible rolling stock, or any 
other methods that result in making its programs or activities readily 
accessible to and usable by individuals with handicaps. The agency is 
not required to make structural changes in existing facilities where 
other methods are effective in achieving compliance with this section. 
The agency, in making alterations to existing buildings, shall meet 
accessibility requirements to the extent compelled by the Architectural 
Barriers Act of 1968, as amended (42 U.S.C. 4151-4157), and any 
regulations implementing it. In choosing among available methods for 
meeting the requirements of this section, the agency shall give priority 
to those methods that offer programs and activities to qualified 
individuals with handicaps in the most integrated setting appropriate.
    (2) Historic preservation programs. In meeting the requirements of 
Sec.  15.150(a) in historic preservation programs, the agency shall give 
priority to methods that provide physical access to individuals with 
handicaps. In cases where a physical alteration to an historic property 
is not required because of Sec.  15.150(a)(2) or (3), alternative 
methods of achieving program accessibility include--
    (i) Using audio-visual materials and devices to depict those 
portions of an historic property that cannot otherwise be made 
accessible;
    (ii) Assigning persons to guide individuals with handicaps into or 
through portions of historic properties that cannot otherwise be made 
accessible; or
    (iii) Adopting other innovative methods.
    (c) Time period for compliance. The agency shall comply with the 
obligations established under this section by November 7, 1988, except 
that where structural changes in facilities are undertaken, such changes 
shall be made by September 6, 1991, but in any event as expeditiously as 
possible.
    (d) Transition plan. In the event that structural changes to 
facilities will be undertaken to achieve program accessibility, the 
agency shall develop, by March 6, 1989, a transition plan setting forth 
the steps necessary to complete such changes. The agency shall provide 
an opportunity to interested persons, including individuals with 
handicaps or organizations representing individuals with handicaps, to 
participate in the development of the transition plan by submitting 
comments (both oral and written). A copy of the transition plan shall be 
made available for public inspection. The plan shall, at a minimum--
    (1) Identify physical obstacles in the agency's facilities that 
limit the accessibility of its programs or activities to individuals 
with handicaps;
    (2) Describe in detail the methods that will be used to make the 
facilities accessible;
    (3) Specify the schedule for taking the steps necessary to achieve 
compliance with this section and, if the time period of the transition 
plan is longer than one year, identify steps that will be taken during 
each year of the transition period; and
    (4) Indicate the official responsible for implementation of the 
plan.



Sec.  15.151  Program accessibility: New construction and alterations.

    Each building or part of a building that is constructed or altered 
by, on behalf of, or for the use of the agency shall be designed, 
constructed, or altered so as to be readily accessible to and usable by 
individuals with handicaps. The definitions, requirements, and standards 
of the Architectural Barriers Act (42 U.S.C. 4151-4157), as established 
in 41 CFR 101-19.600 to 101-19.607, apply to buildings covered by this 
section.

[[Page 688]]



Sec. Sec.  15.152-15.159  [Reserved]



Sec.  15.160  Communications.

    (a) The agency shall take appropriate steps to ensure effective 
communication with applicants, participants, personnel of other Federal 
entities, and members of the public.
    (1) The agency shall furnish appropriate auxiliary aids where 
necessary to afford an individual with handicaps an equal opportunity to 
participate in, and enjoy the benefits of, a program or activity 
conducted by the agency.
    (i) In determining what type of auxiliary aid is necessary, the 
agency shall give primary consideration to the requests of the 
individual with handicaps.
    (ii) The agency need not provide individually prescribed devices, 
readers for personal use or study, or other devices of a personal 
nature.
    (2) Where the agency communicates with applicants and beneficiaries 
by telephone, telecommunication devices for deaf persons (TDD's) or 
equally effective telecommunication systems shall be used to communicate 
with persons with impaired hearing.
    (b) The agency shall ensure that interested persons, including 
persons with impaired vision or hearing, can obtain information as to 
the existence and location of accessible services, activities, and 
facilities.
    (c) The agency shall provide signage at a primary entrance to each 
of its inaccessible facilities, directing users to a location at which 
they can obtain information about accessible facilities. The 
international symbol for accessibility shall be used at each primary 
entrance of an accessible facility.
    (d) This section does not require the agency to take any action that 
it can demonstrate would result in a fundamental alteration in the 
nature of a program or activity or in undue financial and administrative 
burdens. In those circumstances where agency personnel believe that the 
proposed action would fundamentally alter the program or activity or 
would result in undue financial and administrative burdens, the agency 
has the burden of proving that compliance with Sec.  15.160 would result 
in such alteration or burdens. The decision that compliance would result 
in such alteration or burdens must be made by the agency head or his or 
her designee after considering all agency resources available for use in 
the funding and operation of the conducted program or activity and must 
be accompanied by a written statement of the reasons for reaching that 
conclusion. If an action required to comply with this section would 
result in such an alteration or such burdens, the agency shall take any 
other action that would not result in such an alteration or such burdens 
but would nevertheless ensure that, to the maximum extent possible, 
individuals with handicaps receive the benefits and services of the 
program or activity.



Sec. Sec.  15.161-15.169  [Reserved]



Sec.  15.170  Compliance procedures.

    (a) Except as provided in paragraph (b) of this section, this 
section applies to all allegations of discrimination on the basis of 
handicap in programs and activities conducted by the agency.
    (b) The agency shall process complaints alleging violations of 
section 504 with respect to employment according to the procedures 
established by the Equal Employment Opportunity Commission in 29 CFR 
part 1613 pursuant to section 501 of the Rehabilitation Act of 1973 (29 
U.S.C. 791).
    (c) The Deputy Assistant Secretary for Resolution Management shall 
be responsible for coordinating implementation of this section. 
Complaints may be sent to the Secretary of Veterans Affairs or the 
Deputy Assistant Secretary for Resolution Management at the following 
address: Department of Veterans Affairs, 810 Vermont Avenue NW., 
Washington, DC 20420.
    (d) The agency shall accept and investigate all complete complaints 
for which it has jurisdiction. All complete complaints must be filed 
within 180 days of the alleged act of discrimination. The agency may 
extend this time period for good cause.
    (e) If the agency receives a complaint over which it does not have 
jurisdiction, it shall promptly notify the complainant and shall make 
reasonable efforts to refer the complaint to the appropriate Government 
entity.

[[Page 689]]

    (f) The agency shall notify the Architectural and Transportation 
Barriers Compliance Board upon receipt of any complaint alleging that a 
building or facility that is subject to the Architectural Barriers Act 
of 1968, as amended (42 U.S.C. 4151-4157), is not readily accessible to 
and usable by individuals with handicaps.
    (g) Within 180 days of the receipt of a complete complaint for which 
it has jurisdiction, the agency shall notify the complainant of the 
results of the investigation in a letter containing--
    (1) Findings of fact and conclusions of law;
    (2) A description of a remedy for each violation found; and
    (3) A notice of the right to appeal.
    (h) Appeals of the findings of fact and conclusions of law or 
remedies must be filed by the complainant within 90 days of receipt from 
the agency of the letter required by Sec.  15.170(g). The agency may 
extend this time for good cause.
    (i) Timely appeals shall be accepted and processed by the head of 
the agency.
    (j) The head of the agency shall notify the complainant of the 
results of the appeal within 60 days of the receipt of the request. If 
the head of the agency determines that additional information is needed 
from the complainant, he or she shall have 60 days from the date of 
receipt of the additional information to make his or her determination 
on the appeal.
    (k) The time limits cited in paragraphs (g) and (j) of this section 
may be extended with the permission of the Assistant Attorney General.
    (l) The agency may delegate its authority for conducting complaint 
investigations to other Federal agencies, except that the authority for 
making the final determination may not be delegated to another agency.

[53 FR 25885, July 8, 1988, as amended at 53 FR 25885, July 8, 1988; 54 
FR 34982, Aug. 23, 1989; 67 FR 3435, Jan. 24, 2002]



Sec. Sec.  15.171-15.999  [Reserved]



PART 16_PROTECTION OF HUMAN SUBJECTS--Table of Contents



Sec.
16.101 To what does this policy apply?
16.102 Definitions for purposes of this policy.
16.103 Assuring compliance with this policy--research conducted or 
          supported by any Federal department or agency.
16.104 Exempt research.
16.105 [Reserved]
16.106 [Reserved]
16.107 IRB membership.
16.108 IRB functions and operations.
16.109 IRB review of research.
16.110 Expedited review procedures for certain kinds of research 
          involving no more than minimal risk, and for minor changes in 
          approved research.
16.111 Criteria for IRB approval of research.
16.112 Review by institution.
16.113 Suspension or termination of IRB approval of research.
16.114 Cooperative research.
16.115 IRB records.
16.116 General requirements for informed consent.
16.117 Documentation of informed consent.
16.118 Applications and proposals lacking definite plans for involvement 
          of human subjects.
16.119 Research undertaken without the intention of involving human 
          subjects.
16.120 Evaluation and disposition of applications and proposals for 
          research to be conducted or supported by a Federal department 
          or agency.
16.121 [Reserved]
16.122 Use of Federal funds.
16.123 Early termination of research support: Evaluation of applications 
          and proposals.
16.124 Conditions.

    Authority: 5 U.S.C. 301; 38 U.S.C. 501, 7331, 7334; 42 U.S.C. 300v-
1(b).

    Source: 82 FR 7272, Jan. 19, 2017, unless otherwise noted.



Sec.  16.101  To what does this policy apply?

    (a) Except as detailed in Sec.  16.104, this policy applies to all 
research involving human subjects conducted, supported, or otherwise 
subject to regulation by any Federal department or agency that takes 
appropriate administrative action to make the policy applicable to such 
research. This includes research conducted by Federal civilian employees 
or military personnel, except that each department or agency head may 
adopt such procedural modifications as may be appropriate from an 
administrative standpoint. It also includes research conducted, 
supported, or otherwise subject to regulation by the Federal Government 
outside the United

[[Page 690]]

States. Institutions that are engaged in research described in this 
paragraph and institutional review boards (IRBs) reviewing research that 
is subject to this policy must comply with this policy.
    (b) [Reserved]
    (c) Department or agency heads retain final judgment as to whether a 
particular activity is covered by this policy and this judgment shall be 
exercised consistent with the ethical principles of the Belmont 
Report.\62\
---------------------------------------------------------------------------

    \62\ The National Commission for the Protection of Human Subjects of 
Biomedical and Behavioral Research.- Belmont Report. Washington, DC: 
U.S. Department of Health and Human Services. 1979.
---------------------------------------------------------------------------

    (d) Department or agency heads may require that specific research 
activities or classes of research activities conducted, supported, or 
otherwise subject to regulation by the Federal department or agency but 
not otherwise covered by this policy comply with some or all of the 
requirements of this policy.
    (e) Compliance with this policy requires compliance with pertinent 
federal laws or regulations that provide additional protections for 
human subjects.
    (f) This policy does not affect any state or local laws or 
regulations (including tribal law passed by the official governing body 
of an American Indian or Alaska Native tribe) that may otherwise be 
applicable and that provide additional protections for human subjects.
    (g) This policy does not affect any foreign laws or regulations that 
may otherwise be applicable and that provide additional protections to 
human subjects of research.
    (h) When research covered by this policy takes place in foreign 
countries, procedures normally followed in the foreign countries to 
protect human subjects may differ from those set forth in this policy. 
In these circumstances, if a department or agency head determines that 
the procedures prescribed by the institution afford protections that are 
at least equivalent to those provided in this policy, the department or 
agency head may approve the substitution of the foreign procedures in 
lieu of the procedural requirements provided in this policy. Except when 
otherwise required by statute, Executive Order, or the department or 
agency head, notices of these actions as they occur will be published in 
the Federal Register or will be otherwise published as provided in 
department or agency procedures.
    (i) Unless otherwise required by law, department or agency heads may 
waive the applicability of some or all of the provisions of this policy 
to specific research activities or classes of research activities 
otherwise covered by this policy, provided the alternative procedures to 
be followed are consistent with the principles of the Belmont 
Report.\63\ Except when otherwise required by statute or Executive 
Order, the department or agency head shall forward advance notices of 
these actions to the Office for Human Research Protections, Department 
of Health and Human Services (HHS), or any successor office, or to the 
equivalent office within the appropriate Federal department or agency, 
and shall also publish them in the Federal Register or in such other 
manner as provided in department or agency procedures. The waiver notice 
must include a statement that identifies the conditions under which the 
waiver will be applied and a justification as to why the waiver is 
appropriate for the research, including how the decision is consistent 
with the principles of the Belmont Report.
---------------------------------------------------------------------------

    \63\ Id.
---------------------------------------------------------------------------

    (j) Federal guidance on the requirements of this policy shall be 
issued only after consultation, for the purpose of harmonization (to the 
extent appropriate), with other Federal departments and agencies that 
have adopted this policy, unless such consultation is not feasible.
    (k) [Reserved]
    (l) Compliance dates and transition provisions:
    (1) Pre-2018 Requirements. For purposes of this section, the pre-
2018 Requirements means this subpart as published in the 2016 edition of 
the Code of Federal Regulations.
    (2) 2018 Requirements. For purposes of this section, the 2018 
Requirements

[[Page 691]]

means the Federal Policy for the Protection of Human Subjects 
requirements contained in this part. The general compliance date for the 
2018 Requirements is January 21, 2019. The compliance date for Sec.  
16.114(b) (cooperative research) of the 2018 Requirements is January 20, 
2020.
    (3) Research subject to pre-2018 requirements. The pre-2018 
Requirements shall apply to the following research, unless the research 
is transitioning to comply with the 2018 Requirements in accordance with 
paragraph (l)(4) of this section:
    (i) Research initially approved by an IRB under the pre-2018 
Requirements before January 21, 2019;
    (ii) Research for which IRB review was waived pursuant to Sec.  
16.101(i) of the pre-2018 Requirements before January 21, 2019; and
    (iii) Research for which a determination was made that the research 
was exempt under Sec.  16.101(b) of the pre-2018 Requirements before 
January 21, 2019.
    (4) Transitioning research. If, on or after July 19, 2018, an 
institution planning or engaged in research otherwise covered by 
paragraph (l)(3) of this section determines that such research instead 
will transition to comply with the 2018 Requirements, the institution or 
an IRB must document and date such determination.
    (i) If the determination to transition is documented between July 
19, 2018, and January 20, 2019, the research shall:
    (A) Beginning on the date of such documentation through January 20, 
2019, comply with the pre-2018 Requirements, except that the research 
shall comply with the following:
    (1) Section 16.102(l) of the 2018 Requirements (definition of 
research) (instead of Sec.  16.102(d) of the pre-2018 Requirements);
    (2) Section 16.103(d) of the 2018 Requirements (revised 
certification requirement that eliminates IRB review of application or 
proposal) (instead of Sec.  16.103(f) of the pre-2018 Requirements); and
    (3) Section 16.109(f)(1)(i) and (iii) of the 2018 Requirements 
(exceptions to mandated continuing review) (instead of Sec.  16.103(b), 
as related to the requirement for continuing review, and in addition to 
Sec.  16.109, of the pre-2018 Requirements); and
    (B) Beginning on January 21, 2019, comply with the 2018 
Requirements.
    (ii) If the determination to transition is documented on or after 
January 21, 2019, the research shall, beginning on the date of such 
documentation, comply with the 2018 Requirements.
    (5) Research subject to 2018 Requirements. The 2018 Requirements 
shall apply to the following research:
    (i) Research initially approved by an IRB on or after January 21, 
2019;
    (ii) Research for which IRB review is waived pursuant to paragraph 
(i) of this section on or after January 21, 2019; and
    (iii) Research for which a determination is made that the research 
is exempt on or after January 21, 2019.
    (m) Severability: Any provision of this part held to be invalid or 
unenforceable by its terms, or as applied to any person or circumstance, 
shall be construed so as to continue to give maximum effect to the 
provision permitted by law, unless such holding shall be one of utter 
invalidity or unenforceability, in which event the provision shall be 
severable from this part and shall not affect the remainder thereof or 
the application of the provision to other persons not similarly situated 
or to other dissimilar circumstances.

[82 FR 7272, Jan. 19, 2017, as amended at 83 FR 28517, June 19, 2018]



Sec.  16.102  Definitions for purposes of this policy.

    (a) Certification means the official notification by the institution 
to the supporting Federal department or agency component, in accordance 
with the requirements of this policy, that a research project or 
activity involving human subjects has been reviewed and approved by an 
IRB in accordance with an approved assurance.
    (b) Clinical trial means a research study in which one or more human 
subjects are prospectively assigned to one or more interventions (which 
may include placebo or other control) to evaluate the effects of the 
interventions on biomedical or behavioral health-related outcomes.

[[Page 692]]

    (c) Department or agency head means the head of any Federal 
department or agency, for example, the Secretary of HHS, and any other 
officer or employee of any Federal department or agency to whom the 
authority provided by these regulations to the department or agency head 
has been delegated.
    (d) Federal department or agency refers to a federal department or 
agency (the department or agency itself rather than its bureaus, offices 
or divisions) that takes appropriate administrative action to make this 
policy applicable to the research involving human subjects it conducts, 
supports, or otherwise regulates (e.g., the U.S. Department of Health 
and Human Services, the U.S. Department of Defense, or the Central 
Intelligence Agency).
    (e)(1) Human subject means a living individual about whom an 
investigator (whether professional or student) conducting research:
    (i) Obtains information or biospecimens through intervention or 
interaction with the individual, and uses, studies, or analyzes the 
information or biospecimens; or (ii) Obtains, uses, studies, analyzes, 
or generates identifiable private information or identifiable 
biospecimens.
    (2) Intervention includes both physical procedures by which 
information or biospecimens are gathered (e.g., venipuncture) and 
manipulations of the subject or the subject's environment that are 
performed for research purposes.
    (3) Interaction includes communication or interpersonal contact 
between investigator and subject.
    (4) Private information includes information about behavior that 
occurs in a context in which an individual can reasonably expect that no 
observation or recording is taking place, and information that has been 
provided for specific purposes by an individual and that the individual 
can reasonably expect will not be made public (e.g., a medical record).
    (5) Identifiable private information is private information for 
which the identity of the subject is or may readily be ascertained by 
the investigator or associated with the information.
    (6) An identifiable biospecimen is a biospecimen for which the 
identity of the subject is or may readily be ascertained by the 
investigator or associated with the biospecimen.
    (7) Federal departments or agencies implementing this policy shall:
    (i) Upon consultation with appropriate experts (including experts in 
data matching and re-identification), reexamine the meaning of 
``identifiable private information,'' as defined in paragraph (e)(5) of 
this section, and ``identifiable biospecimen,'' as defined in paragraph 
(e)(6) of this section. This reexamination shall take place within 1 
year and regularly thereafter (at least every 4 years). This process 
will be conducted by collaboration among the Federal departments and 
agencies implementing this policy. If appropriate and permitted by law, 
such Federal departments and agencies may alter the interpretation of 
these terms, including through the use of guidance.
    (ii) Upon consultation with appropriate experts, assess whether 
there are analytic technologies or techniques that should be considered 
by investigators to generate ``identifiable private information,'' as 
defined in paragraph (e)(5) of this section, or an ``identifiable 
biospecimen,'' as defined in paragraph (e)(6) of this section. This 
assessment shall take place within 1 year and regularly thereafter (at 
least every 4 years). This process will be conducted by collaboration 
among the Federal departments and agencies implementing this policy. Any 
such technologies or techniques will be included on a list of 
technologies or techniques that produce identifiable private information 
or identifiable biospecimens. This list will be published in the Federal 
Register after notice and an opportunity for public comment. The 
Secretary, HHS, shall maintain the list on a publicly accessible Web 
site.
    (f) Institution means any public or private entity, or department or 
agency (including federal, state, and other agencies).
    (g) IRB means an institutional review board established in accord 
with and for the purposes expressed in this policy.
    (h) IRB approval means the determination of the IRB that the 
research has been reviewed and may be conducted at an institution within 
the

[[Page 693]]

constraints set forth by the IRB and by other institutional and federal 
requirements.
    (i) Legally authorized representative means an individual or 
judicial or other body authorized under applicable law to consent on 
behalf of a prospective subject to the subject's participation in the 
procedure(s) involved in the research. If there is no applicable law 
addressing this issue, legally authorized representative means an 
individual recognized by institutional policy as acceptable for 
providing consent in the nonresearch context on behalf of the 
prospective subject to the subject's participation in the procedure(s) 
involved in the research.
    (j) Minimal risk means that the probability and magnitude of harm or 
discomfort anticipated in the research are not greater in and of 
themselves than those ordinarily encountered in daily life or during the 
performance of routine physical or psychological examinations or tests.
    (k) Public health authority means an agency or authority of the 
United States, a state, a territory, a political subdivision of a state 
or territory, an Indian tribe, or a foreign government, or a person or 
entity acting under a grant of authority from or contract with such 
public agency, including the employees or agents of such public agency 
or its contractors or persons or entities to whom it has granted 
authority, that is responsible for public health matters as part of its 
official mandate.
    (l) Research means a systematic investigation, including research 
development, testing, and evaluation, designed to develop or contribute 
to generalizable knowledge. Activities that meet this definition 
constitute research for purposes of this policy, whether or not they are 
conducted or supported under a program that is considered research for 
other purposes. For example, some demonstration and service programs may 
include research activities. For purposes of this part, the following 
activities are deemed not to be research:
    (1) Scholarly and journalistic activities (e.g., oral history, 
journalism, biography, literary criticism, legal research, and 
historical scholarship), including the collection and use of 
information, that focus directly on the specific individuals about whom 
the information is collected.
    (2) Public health surveillance activities, including the collection 
and testing of information or biospecimens, conducted, supported, 
requested, ordered, required, or authorized by a public health 
authority. Such activities are limited to those necessary to allow a 
public health authority to identify, monitor, assess, or investigate 
potential public health signals, onsets of disease outbreaks, or 
conditions of public health importance (including trends, signals, risk 
factors, patterns in diseases, or increases in injuries from using 
consumer products). Such activities include those associated with 
providing timely situational awareness and priority setting during the 
course of an event or crisis that threatens public health (including 
natural or man-made disasters).
    (3) Collection and analysis of information, biospecimens, or records 
by or for a criminal justice agency for activities authorized by law or 
court order solely for criminal justice or criminal investigative 
purposes.
    (4) Authorized operational activities (as determined by each agency) 
in support of intelligence, homeland security, defense, or other 
national security missions.
    (m) Written, or in writing, for purposes of this part, refers to 
writing on a tangible medium (e.g., paper) or in an electronic format.



Sec.  16.103  Assuring compliance with this policy--research conducted
or supported by any Federal department or agency.

    (a) Each institution engaged in research that is covered by this 
policy, with the exception of research eligible for exemption under 
Sec.  16.104, and that is conducted or supported by a Federal department 
or agency, shall provide written assurance satisfactory to the 
department or agency head that it will comply with the requirements of 
this policy. In lieu of requiring submission of an assurance, individual 
department or agency heads shall accept the existence of a current 
assurance, appropriate for the research in question, on

[[Page 694]]

file with the Office for Human Research Protections, HHS, or any 
successor office, and approved for Federal-wide use by that office. When 
the existence of an HHS-approved assurance is accepted in lieu of 
requiring submission of an assurance, reports (except certification) 
required by this policy to be made to department and agency heads shall 
also be made to the Office for Human Research Protections, HHS, or any 
successor office. Federal departments and agencies will conduct or 
support research covered by this policy only if the institution has 
provided an assurance that it will comply with the requirements of this 
policy, as provided in this section, and only if the institution has 
certified to the department or agency head that the research has been 
reviewed and approved by an IRB (if such certification is required by 
Sec.  16.103(d)).
    (b) The assurance shall be executed by an individual authorized to 
act for the institution and to assume on behalf of the institution the 
obligations imposed by this policy and shall be filed in such form and 
manner as the department or agency head prescribes.
    (c) The department or agency head may limit the period during which 
any assurance shall remain effective or otherwise condition or restrict 
the assurance.
    (d) Certification is required when the research is supported by a 
Federal department or agency and not otherwise waived under Sec.  
16.101(i) or exempted under Sec.  16.104. For such research, 
institutions shall certify that each proposed research study covered by 
the assurance and this section has been reviewed and approved by the 
IRB. Such certification must be submitted as prescribed by the Federal 
department or agency component supporting the research. Under no 
condition shall research covered by this section be initiated prior to 
receipt of the certification that the research has been reviewed and 
approved by the IRB.
    (e) For nonexempt research involving human subjects covered by this 
policy (or exempt research for which limited IRB review takes place 
pursuant to Sec.  16.104(d)(2)(iii), (d)(3)(i)(C), or (d)(7) or (8)) 
that takes place at an institution in which IRB oversight is conducted 
by an IRB that is not operated by the institution, the institution and 
the organization operating the IRB shall document the institution's 
reliance on the IRB for oversight of the research and the 
responsibilities that each entity will undertake to ensure compliance 
with the requirements of this policy (e.g., in a written agreement 
between the institution and the IRB, by implementation of an 
institution-wide policy directive providing the allocation of 
responsibilities between the institution and an IRB that is not 
affiliated with the institution, or as set forth in a research 
protocol).

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec.  16.104  Exempt research.

    (a) Unless otherwise required by law or by department or agency 
heads, research activities in which the only involvement of human 
subjects will be in one or more of the categories in paragraph (d) of 
this section are exempt from the requirements of this policy, except 
that such activities must comply with the requirements of this section 
and as specified in each category.
    (b) Use of the exemption categories for research subject to the 
requirements of subparts B, C, and D: Application of the exemption 
categories to research subject to the requirements of 45 CFR part 46, 
subparts B, C, and D, is as follows:
    (1) Subpart B. Each of the exemptions at this section may be applied 
to research subject to subpart B if the conditions of the exemption are 
met.
    (2) Subpart C. The exemptions at this section do not apply to 
research subject to subpart C, except for research aimed at involving a 
broader subject population that only incidentally includes prisoners.
    (3) Subpart D. The exemptions at paragraphs (d)(1), (4), (5), (6), 
(7), and (8) of this section may be applied to research subject to 
subpart D if the conditions of the exemption are met. Paragraphs 
(d)(2)(i) and (ii) of this section only may apply to research subject to 
subpart D involving educational tests or the observation of public 
behavior when the investigator(s) do not participate in the activities 
being observed. Paragraph (d)(2)(iii) of this section

[[Page 695]]

may not be applied to research subject to subpart D.
    (c) [Reserved]
    (d) Except as described in paragraph (a) of this section, the 
following categories of human subjects research are exempt from this 
policy:
    (1) Research, conducted in established or commonly accepted 
educational settings, that specifically involves normal educational 
practices that are not likely to adversely impact students' opportunity 
to learn required educational content or the assessment of educators who 
provide instruction. This includes most research on regular and special 
education instructional strategies, and research on the effectiveness of 
or the comparison among instructional techniques, curricula, or 
classroom management methods.
    (2) Research that only includes interactions involving educational 
tests (cognitive, diagnostic, aptitude, achievement), survey procedures, 
interview procedures, or observation of public behavior (including 
visual or auditory recording) if at least one of the following criteria 
is met:
    (i) The information obtained is recorded by the investigator in such 
a manner that the identity of the human subjects cannot readily be 
ascertained, directly or through identifiers linked to the subjects;
    (ii) Any disclosure of the human subjects' responses outside the 
research would not reasonably place the subjects at risk of criminal or 
civil liability or be damaging to the subjects' financial standing, 
employability, educational advancement, or reputation; or
    (iii) The information obtained is recorded by the investigator in 
such a manner that the identity of the human subjects can readily be 
ascertained, directly or through identifiers linked to the subjects, and 
an IRB conducts a limited IRB review to make the determination required 
by Sec.  16.111(a)(7).
    (3)(i) Research involving benign behavioral interventions in 
conjunction with the collection of information from an adult subject 
through verbal or written responses (including data entry) or 
audiovisual recording if the subject prospectively agrees to the 
intervention and information collection and at least one of the 
following criteria is met:
    (A) The information obtained is recorded by the investigator in such 
a manner that the identity of the human subjects cannot readily be 
ascertained, directly or through identifiers linked to the subjects;
    (B) Any disclosure of the human subjects' responses outside the 
research would not reasonably place the subjects at risk of criminal or 
civil liability or be damaging to the subjects' financial standing, 
employability, educational advancement, or reputation; or
    (C) The information obtained is recorded by the investigator in such 
a manner that the identity of the human subjects can readily be 
ascertained, directly or through identifiers linked to the subjects, and 
an IRB conducts a limited IRB review to make the determination required 
by Sec.  16.111(a)(7).
    (ii) For the purpose of this provision, benign behavioral 
interventions are brief in duration, harmless, painless, not physically 
invasive, not likely to have a significant adverse lasting impact on the 
subjects, and the investigator has no reason to think the subjects will 
find the interventions offensive or embarrassing. Provided all such 
criteria are met, examples of such benign behavioral interventions would 
include having the subjects play an online game, having them solve 
puzzles under various noise conditions, or having them decide how to 
allocate a nominal amount of received cash between themselves and 
someone else.
    (iii) If the research involves deceiving the subjects regarding the 
nature or purposes of the research, this exemption is not applicable 
unless the subject authorizes the deception through a prospective 
agreement to participate in research in circumstances in which the 
subject is informed that he or she will be unaware of or misled 
regarding the nature or purposes of the research.
    (4) Secondary research for which consent is not required: Secondary 
research uses of identifiable private information or identifiable 
biospecimens, if at least one of the following criteria is met:

[[Page 696]]

    (i) The identifiable private information or identifiable 
biospecimens are publicly available;
    (ii) Information, which may include information about biospecimens, 
is recorded by the investigator in such a manner that the identity of 
the human subjects cannot readily be ascertained directly or through 
identifiers linked to the subjects, the investigator does not contact 
the subjects, and the investigator will not re-identify subjects;
    (iii) The research involves only information collection and analysis 
involving the investigator's use of identifiable health information when 
that use is regulated under 45 CFR parts 160 and 164, subparts A and E, 
for the purposes of ``health care operations'' or ``research'' as those 
terms are defined at 45 CFR 164.501 or for ``public health activities 
and purposes'' as described under 45 CFR 164.512(b); or
    (iv) The research is conducted by, or on behalf of, a Federal 
department or agency using government-generated or government-collected 
information obtained for nonresearch activities, if the research 
generates identifiable private information that is or will be maintained 
on information technology that is subject to and in compliance with 
section 208(b) of the E-Government Act of 2002, 44 U.S.C. 3501 note, if 
all of the identifiable private information collected, used, or 
generated as part of the activity will be maintained in systems of 
records subject to the Privacy Act of 1974, 5 U.S.C. 552a, and, if 
applicable, the information used in the research was collected subject 
to the Paperwork Reduction Act of 1995, 44 U.S.C. 3501 et seq.
    (5) Research and demonstration projects that are conducted or 
supported by a Federal department or agency, or otherwise subject to the 
approval of department or agency heads (or the approval of the heads of 
bureaus or other subordinate agencies that have been delegated authority 
to conduct the research and demonstration projects), and that are 
designed to study, evaluate, improve, or otherwise examine public 
benefit or service programs, including procedures for obtaining benefits 
or services under those programs, possible changes in or alternatives to 
those programs or procedures, or possible changes in methods or levels 
of payment for benefits or services under those programs. Such projects 
include, but are not limited to, internal studies by Federal employees, 
and studies under contracts or consulting arrangements, cooperative 
agreements, or grants. Exempt projects also include waivers of otherwise 
mandatory requirements using authorities such as sections 1115 and 1115A 
of the Social Security Act, as amended.
    (i) Each Federal department or agency conducting or supporting the 
research and demonstration projects must establish, on a publicly 
accessible Federal Web site or in such other manner as the department or 
agency head may determine, a list of the research and demonstration 
projects that the Federal department or agency conducts or supports 
under this provision. The research or demonstration project must be 
published on this list prior to commencing the research involving human 
subjects.
    (ii) [Reserved]
    (6) Taste and food quality evaluation and consumer acceptance 
studies:
    (i) If wholesome foods without additives are consumed, or
    (ii) If a food is consumed that contains a food ingredient at or 
below the level and for a use found to be safe, or agricultural chemical 
or environmental contaminant at or below the level found to be safe, by 
the Food and Drug Administration or approved by the Environmental 
Protection Agency or the Food Safety and Inspection Service of the U.S. 
Department of Agriculture.
    (7) Storage or maintenance for secondary research for which broad 
consent is required: Storage or maintenance of identifiable private 
information or identifiable biospecimens for potential secondary 
research use if an IRB conducts a limited IRB review and makes the 
determinations required by Sec.  16.111(a)(8).
    (8) Secondary research for which broad consent is required: Research 
involving the use of identifiable private information or identifiable 
biospecimens for secondary research use, if the following criteria are 
met:
    (i) Broad consent for the storage, maintenance, and secondary 
research

[[Page 697]]

use of the identifiable private information or identifiable biospecimens 
was obtained in accordance with Sec.  16.116(a)(1) through (4), (a)(6), 
and (d);
    (ii) Documentation of informed consent or waiver of documentation of 
consent was obtained in accordance with Sec.  16.117;
    (iii) An IRB conducts a limited IRB review and makes the 
determination required by Sec.  16.111(a)(7) and makes the determination 
that the research to be conducted is within the scope of the broad 
consent referenced in paragraph (d)(8)(i) of this section; and (iv) The 
investigator does not include returning individual research results to 
subjects as part of the study plan. This provision does not prevent an 
investigator from abiding by any legal requirements to return individual 
research results.

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec. Sec.  16.105-16.106  [Reserved]



Sec.  16.107  IRB membership.

    (a) Each IRB shall have at least five members, with varying 
backgrounds to promote complete and adequate review of research 
activities commonly conducted by the institution. The IRB shall be 
sufficiently qualified through the experience and expertise of its 
members (professional competence), and the diversity of its members, 
including race, gender, and cultural backgrounds and sensitivity to such 
issues as community attitudes, to promote respect for its advice and 
counsel in safeguarding the rights and welfare of human subjects. The 
IRB shall be able to ascertain the acceptability of proposed research in 
terms of institutional commitments (including policies and resources) 
and regulations, applicable law, and standards of professional conduct 
and practice. The IRB shall therefore include persons knowledgeable in 
these areas. If an IRB regularly reviews research that involves a 
category of subjects that is vulnerable to coercion or undue influence, 
such as children, prisoners, individuals with impaired decision-making 
capacity, or economically or educationally disadvantaged persons, 
consideration shall be given to the inclusion of one or more individuals 
who are knowledgeable about and experienced in working with these 
categories of subjects.
    (b) Each IRB shall include at least one member whose primary 
concerns are in scientific areas and at least one member whose primary 
concerns are in nonscientific areas.
    (c) Each IRB shall include at least one member who is not otherwise 
affiliated with the institution and who is not part of the immediate 
family of a person who is affiliated with the institution.
    (d) No IRB may have a member participate in the IRB's initial or 
continuing review of any project in which the member has a conflicting 
interest, except to provide information requested by the IRB.
    (e) An IRB may, in its discretion, invite individuals with 
competence in special areas to assist in the review of issues that 
require expertise beyond or in addition to that available on the IRB. 
These individuals may not vote with the IRB.



Sec.  16.108  IRB functions and operations.

    (a) In order to fulfill the requirements of this policy each IRB 
shall:
    (1) Have access to meeting space and sufficient staff to support the 
IRB's review and recordkeeping duties;
    (2) Prepare and maintain a current list of the IRB members 
identified by name; earned degrees; representative capacity; indications 
of experience such as board certifications or licenses sufficient to 
describe each member's chief anticipated contributions to IRB 
deliberations; and any employment or other relationship between each 
member and the institution, for example, full-time employee, part-time 
employee, member of governing panel or board, stockholder, paid or 
unpaid consultant;
    (3) Establish and follow written procedures for:
    (i) Conducting its initial and continuing review of research and for 
reporting its findings and actions to the investigator and the 
institution;
    (ii) Determining which projects require review more often than 
annually and which projects need verification from sources other than 
the investigators that no material changes have occurred since previous 
IRB review; and

[[Page 698]]

    (iii) Ensuring prompt reporting to the IRB of proposed changes in a 
research activity, and for ensuring that investigators will conduct the 
research activity in accordance with the terms of the IRB approval until 
any proposed changes have been reviewed and approved by the IRB, except 
when necessary to eliminate apparent immediate hazards to the subject.
    (4) Establish and follow written procedures for ensuring prompt 
reporting to the IRB; appropriate institutional officials; the 
department or agency head; and the Office for Human Research 
Protections, HHS, or any successor office, or the equivalent office 
within the appropriate Federal department or agency of
    (i) Any unanticipated problems involving risks to subjects or others 
or any serious or continuing noncompliance with this policy or the 
requirements or determinations of the IRB; and
    (ii) Any suspension or termination of IRB approval.
    (b) Except when an expedited review procedure is used (as described 
in Sec.  16.110), an IRB must review proposed research at convened 
meetings at which a majority of the members of the IRB are present, 
including at least one member whose primary concerns are in 
nonscientific areas. In order for the research to be approved, it shall 
receive the approval of a majority of those members present at the 
meeting.

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec.  16.109  IRB review of research.

    (a) An IRB shall review and have authority to approve, require 
modifications in (to secure approval), or disapprove all research 
activities covered by this policy, including exempt research activities 
under Sec.  16.104 for which limited IRB review is a condition of 
exemption (under Sec.  16.104(d)(2)(iii), (d)(3)(i)(C), and (d)(7), and 
(8)).
    (b) An IRB shall require that information given to subjects (or 
legally authorized representatives, when appropriate) as part of 
informed consent is in accordance with Sec.  16.116. The IRB may require 
that information, in addition to that specifically mentioned in Sec.  
16.116, be given to the subjects when in the IRB's judgment the 
information would meaningfully add to the protection of the rights and 
welfare of subjects.
    (c) An IRB shall require documentation of informed consent or may 
waive documentation in accordance with Sec.  16.117.
    (d) An IRB shall notify investigators and the institution in writing 
of its decision to approve or disapprove the proposed research activity, 
or of modifications required to secure IRB approval of the research 
activity. If the IRB decides to disapprove a research activity, it shall 
include in its written notification a statement of the reasons for its 
decision and give the investigator an opportunity to respond in person 
or in writing.
    (e) An IRB shall conduct continuing review of research requiring 
review by the convened IRB at intervals appropriate to the degree of 
risk, not less than once per year, except as described in Sec.  
16.109(f).
    (f)(1) Unless an IRB determines otherwise, continuing review of 
research is not required in the following circumstances:
    (i) Research eligible for expedited review in accordance with Sec.  
16.110;
    (ii) Research reviewed by the IRB in accordance with the limited IRB 
review described in Sec.  16.104(d)(2)(iii), (d)(3)(i)(C), or (d)(7) or 
(8);
    (iii) Research that has progressed to the point that it involves 
only one or both of the following, which are part of the IRB-approved 
study:
    (A) Data analysis, including analysis of identifiable private 
information or identifiable biospecimens, or
    (B) Accessing follow-up clinical data from procedures that subjects 
would undergo as part of clinical care.
    (2) [Reserved]
    (g) An IRB shall have authority to observe or have a third party 
observe the consent process and the research.

(Approved by the Office of Management and Budget under Control Number 
0990-0260)

[[Page 699]]



Sec.  16.110  Expedited review procedures for certain kinds of research
involving no more than minimal risk, and for minor changes in approved 
research.

    (a) The Secretary of HHS has established, and published as a Notice 
in the Federal Register, a list of categories of research that may be 
reviewed by the IRB through an expedited review procedure. The Secretary 
will evaluate the list at least every 8 years and amend it, as 
appropriate, after consultation with other federal departments and 
agencies and after publication in the Federal Register for public 
comment. A copy of the list is available from the Office for Human 
Research Protections, HHS, or any successor office.
    (b)(1) An IRB may use the expedited review procedure to review the 
following:
    (i) Some or all of the research appearing on the list described in 
paragraph (a) of this section, unless the reviewer determines that the 
study involves more than minimal risk;
    (ii) Minor changes in previously approved research during the period 
for which approval is authorized; or
    (iii) Research for which limited IRB review is a condition of 
exemption under Sec.  16.104(d)(2)(iii), (d)(3)(i)(C), and (d)(7) and 
(8).
    (2) Under an expedited review procedure, the review may be carried 
out by the IRB chairperson or by one or more experienced reviewers 
designated by the chairperson from among members of the IRB. In 
reviewing the research, the reviewers may exercise all of the 
authorities of the IRB except that the reviewers may not disapprove the 
research. A research activity may be disapproved only after review in 
accordance with the nonexpedited procedure set forth in Sec.  16.108(b).
    (c) Each IRB that uses an expedited review procedure shall adopt a 
method for keeping all members advised of research proposals that have 
been approved under the procedure.
    (d) The department or agency head may restrict, suspend, terminate, 
or choose not to authorize an institution's or IRB's use of the 
expedited review procedure.



Sec.  16.111  Criteria for IRB approval of research.

    (a) In order to approve research covered by this policy the IRB 
shall determine that all of the following requirements are satisfied:
    (1) Risks to subjects are minimized:
    (i) By using procedures that are consistent with sound research 
design and that do not unnecessarily expose subjects to risk, and
    (ii) Whenever appropriate, by using procedures already being 
performed on the subjects for diagnostic or treatment purposes.
    (2) Risks to subjects are reasonable in relation to anticipated 
benefits, if any, to subjects, and the importance of the knowledge that 
may reasonably be expected to result. In evaluating risks and benefits, 
the IRB should consider only those risks and benefits that may result 
from the research (as distinguished from risks and benefits of therapies 
subjects would receive even if not participating in the research). The 
IRB should not consider possible long-range effects of applying 
knowledge gained in the research (e.g., the possible effects of the 
research on public policy) as among those research risks that fall 
within the purview of its responsibility.
    (3) Selection of subjects is equitable. In making this assessment 
the IRB should take into account the purposes of the research and the 
setting in which the research will be conducted. The IRB should be 
particularly cognizant of the special problems of research that involves 
a category of subjects who are vulnerable to coercion or undue 
influence, such as children, prisoners, individuals with impaired 
decision-making capacity, or economically or educationally disadvantaged 
persons.
    (4) Informed consent will be sought from each prospective subject or 
the subject's legally authorized representative, in accordance with, and 
to the extent required by, Sec.  16.116.
    (5) Informed consent will be appropriately documented or 
appropriately waived in accordance with Sec.  16.117.
    (6) When appropriate, the research plan makes adequate provision for 
monitoring the data collected to ensure the safety of subjects.

[[Page 700]]

    (7) When appropriate, there are adequate provisions to protect the 
privacy of subjects and to maintain the confidentiality of data.
    (i) The Secretary of HHS will, after consultation with the Office of 
Management and Budget's privacy office and other Federal departments and 
agencies that have adopted this policy, issue guidance to assist IRBs in 
assessing what provisions are adequate to protect the privacy of 
subjects and to maintain the confidentiality of data.
    (ii) [Reserved]
    (8) For purposes of conducting the limited IRB review required by 
Sec.  16.104(d)(7)), the IRB need not make the determinations at 
paragraphs (a)(1) through (7) of this section, and shall make the 
following determinations:
    (i) Broad consent for storage, maintenance, and secondary research 
use of identifiable private information or identifiable biospecimens is 
obtained in accordance with the requirements of Sec.  16.116(a)(1)-(4), 
(a)(6), and (d);
    (ii) Broad consent is appropriately documented or waiver of 
documentation is appropriate, in accordance with Sec.  16.117; and
    (iii) If there is a change made for research purposes in the way the 
identifiable private information or identifiable biospecimens are stored 
or maintained, there are adequate provisions to protect the privacy of 
subjects and to maintain the confidentiality of data.
    (b) When some or all of the subjects are likely to be vulnerable to 
coercion or undue influence, such as children, prisoners, individuals 
with impaired decision-making capacity, or economically or educationally 
disadvantaged persons, additional safeguards have been included in the 
study to protect the rights and welfare of these subjects.



Sec.  16.112  Review by Institution

    Research covered by this policy that has been approved by an IRB may 
be subject to further appropriate review and approval or disapproval by 
officials of the institution. However, those officials may not approve 
the research if it has not been approved by an IRB.



Sec.  16.113  Suspension or Termination of IRB Approval of Research.

    An IRB shall have authority to suspend or terminate approval of 
research that is not being conducted in accordance with the IRB's 
requirements or that has been associated with unexpected serious harm to 
subjects. Any suspension or termination of approval shall include a 
statement of the reasons for the IRB's action and shall be reported 
promptly to the investigator, appropriate institutional officials, and 
the department or agency head.

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec.  16.114  Cooperative Research.

    (a) Cooperative research projects are those projects covered by this 
policy that involve more than one institution. In the conduct of 
cooperative research projects, each institution is responsible for 
safeguarding the rights and welfare of human subjects and for complying 
with this policy.
    (b)(1) Any institution located in the United States that is engaged 
in cooperative research must rely upon approval by a single IRB for that 
portion of the research that is conducted in the United States. The 
reviewing IRB will be identified by the Federal department or agency 
supporting or conducting the research or proposed by the lead 
institution subject to the acceptance of the Federal department or 
agency supporting the research.
    (2) The following research is not subject to this provision:
    (i) Cooperative research for which more than single IRB review is 
required by law (including tribal law passed by the official governing 
body of an American Indian or Alaska Native tribe); or
    (ii) Research for which any Federal department or agency supporting 
or conducting the research determines and documents that the use of a 
single IRB is not appropriate for the particular context.
    (c) For research not subject to paragraph (b) of this section, an 
institution participating in a cooperative project may enter into a 
joint review arrangement, rely on the review of another

[[Page 701]]

IRB, or make similar arrangements for avoiding duplication of effort.



Sec.  16.115  IRB Records.

    (a) An institution, or when appropriate an IRB, shall prepare and 
maintain adequate documentation of IRB activities, including the 
following:
    (1) Copies of all research proposals reviewed, scientific 
evaluations, if any, that accompany the proposals, approved sample 
consent forms, progress reports submitted by investigators, and reports 
of injuries to subjects.
    (2) Minutes of IRB meetings, which shall be in sufficient detail to 
show attendance at the meetings; actions taken by the IRB; the vote on 
these actions including the number of members voting for, against, and 
abstaining; the basis for requiring changes in or disapproving research; 
and a written summary of the discussion of controverted issues and their 
resolution.
    (3) Records of continuing review activities, including the rationale 
for conducting continuing review of research that otherwise would not 
require continuing review as described in Sec.  16.109(f)(1).
    (4) Copies of all correspondence between the IRB and the 
investigators.
    (5) A list of IRB members in the same detail as described in Sec.  
16.108(a)(2).
    (6) Written procedures for the IRB in the same detail as described 
in Sec.  16.108(a)(3) and (4).
    (7) Statements of significant new findings provided to subjects, as 
required by Sec.  16.116(c)(5).
    (8) The rationale for an expedited reviewer's determination under 
Sec.  16.110(b)(1)(i) that research appearing on the expedited review 
list described in Sec.  16.110(a) is more than minimal risk.
    (9) Documentation specifying the responsibilities that an 
institution and an organization operating an IRB each will undertake to 
ensure compliance with the requirements of this policy, as described in 
Sec.  16.103(e).
    (b) The records required by this policy shall be retained for at 
least 3 years, and records relating to research that is conducted shall 
be retained for at least 3 years after completion of the research. The 
institution or IRB may maintain the records in printed form, or 
electronically. All records shall be accessible for inspection and 
copying by authorized representatives of the Federal department or 
agency at reasonable times and in a reasonable manner.

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec.  16.116  General Requirements for Informed Consent.

    (a) General. General requirements for informed consent, whether 
written or oral, are set forth in this paragraph and apply to consent 
obtained in accordance with the requirements set forth in paragraphs (b) 
through (d) of this section. Broad consent may be obtained in lieu of 
informed consent obtained in accordance with paragraphs (b) and (c) of 
this section only with respect to the storage, maintenance, and 
secondary research uses of identifiable private information and 
identifiable biospecimens. Waiver or alteration of consent in research 
involving public benefit and service programs conducted by or subject to 
the approval of state or local officials is described in paragraph (e) 
of this section. General waiver or alteration of informed consent is 
described in paragraph (f) of this section. Except as provided elsewhere 
in this policy:
    (1) Before involving a human subject in research covered by this 
policy, an investigator shall obtain the legally effective informed 
consent of the subject or the subject's legally authorized 
representative.
    (2) An investigator shall seek informed consent only under 
circumstances that provide the prospective subject or the legally 
authorized representative sufficient opportunity to discuss and consider 
whether or not to participate and that minimize the possibility of 
coercion or undue influence.
    (3) The information that is given to the subject or the legally 
authorized representative shall be in language understandable to the 
subject or the legally authorized representative.
    (4) The prospective subject or the legally authorized representative 
must be provided with the information that a reasonable person would 
want to have in order to make an informed decision about whether to 
participate,

[[Page 702]]

and an opportunity to discuss that information.
    (5) Except for broad consent obtained in accordance with paragraph 
(d) of this section:
    (i) Informed consent must begin with a concise and focused 
presentation of the key information that is most likely to assist a 
prospective subject or legally authorized representative in 
understanding the reasons why one might or might not want to participate 
in the research. This part of the informed consent must be organized and 
presented in a way that facilitates comprehension.
    (ii) Informed consent as a whole must present information in 
sufficient detail relating to the research, and must be organized and 
presented in a way that does not merely provide lists of isolated facts, 
but rather facilitates the prospective subject's or legally authorized 
representative's understanding of the reasons why one might or might not 
want to participate.
    (6) No informed consent may include any exculpatory language through 
which the subject or the legally authorized representative is made to 
waive or appear to waive any of the subject's legal rights, or releases 
or appears to release the investigator, the sponsor, the institution, or 
its agents from liability for negligence.
    (b) Basic elements of informed consent. Except as provided in 
paragraph (d), (e), or (f) of this section, in seeking informed consent 
the following information shall be provided to each subject or the 
legally authorized representative:
    (1) A statement that the study involves research, an explanation of 
the purposes of the research and the expected duration of the subject's 
participation, a description of the procedures to be followed, and 
identification of any procedures that are experimental;
    (2) A description of any reasonably foreseeable risks or discomforts 
to the subject;
    (3) A description of any benefits to the subject or to others that 
may reasonably be expected from the research;
    (4) A disclosure of appropriate alternative procedures or courses of 
treatment, if any, that might be advantageous to the subject;
    (5) A statement describing the extent, if any, to which 
confidentiality of records identifying the subject will be maintained;
    (6) For research involving more than minimal risk, an explanation as 
to whether any compensation and an explanation as to whether any medical 
treatments are available if injury occurs and, if so, what they consist 
of, or where further information may be obtained;
    (7) An explanation of whom to contact for answers to pertinent 
questions about the research and research subjects' rights, and whom to 
contact in the event of a research-related injury to the subject;
    (8) A statement that participation is voluntary, refusal to 
participate will involve no penalty or loss of benefits to which the 
subject is otherwise entitled, and the subject may discontinue 
participation at any time without penalty or loss of benefits to which 
the subject is otherwise entitled; and
    (9) One of the following statements about any research that involves 
the collection of identifiable private information or identifiable 
biospecimens:
    (i) A statement that identifiers might be removed from the 
identifiable private information or identifiable biospecimens and that, 
after such removal, the information or biospecimens could be used for 
future research studies or distributed to another investigator for 
future research studies without additional informed consent from the 
subject or the legally authorized representative, if this might be a 
possibility; or
    (ii) A statement that the subject's information or biospecimens 
collected as part of the research, even if identifiers are removed, will 
not be used or distributed for future research studies.
    (c) Additional elements of informed consent. Except as provided in 
paragraph (d), (e), or (f) of this section, one or more of the following 
elements of information, when appropriate, shall also be provided to 
each subject or the legally authorized representative:
    (1) A statement that the particular treatment or procedure may 
involve risks to the subject (or to the embryo

[[Page 703]]

or fetus, if the subject is or may become pregnant) that are currently 
unforeseeable;
    (2) Anticipated circumstances under which the subject's 
participation may be terminated by the investigator without regard to 
the subject's or the legally authorized representative's consent;
    (3) Any additional costs to the subject that may result from 
participation in the research;
    (4) The consequences of a subject's decision to withdraw from the 
research and procedures for orderly termination of participation by the 
subject;
    (5) A statement that significant new findings developed during the 
course of the research that may relate to the subject's willingness to 
continue participation will be provided to the subject;
    (6) The approximate number of subjects involved in the study;
    (7) A statement that the subject's biospecimens (even if identifiers 
are removed) may be used for commercial profit and whether the subject 
will or will not share in this commercial profit;
    (8) A statement regarding whether clinically relevant research 
results, including individual research results, will be disclosed to 
subjects, and if so, under what conditions; and
    (9) For research involving biospecimens, whether the research will 
(if known) or might include whole genome sequencing (i.e., sequencing of 
a human germline or somatic specimen with the intent to generate the 
genome or exome sequence of that specimen).
    (d) Elements of broad consent for the storage, maintenance, and 
secondary research use of identifiable private information or 
identifiable biospecimens. Broad consent for the storage, maintenance, 
and secondary research use of identifiable private information or 
identifiable biospecimens (collected for either research studies other 
than the proposed research or nonresearch purposes) is permitted as an 
alternative to the informed consent requirements in paragraphs (b) and 
(c) of this section. If the subject or the legally authorized 
representative is asked to provide broad consent, the following shall be 
provided to each subject or the subject's legally authorized 
representative:
    (1) The information required in paragraphs (b)(2), (b)(3), (b)(5), 
and (b)(8) and, when appropriate, (c)(7) and (9) of this section;
    (2) A general description of the types of research that may be 
conducted with the identifiable private information or identifiable 
biospecimens. This description must include sufficient information such 
that a reasonable person would expect that the broad consent would 
permit the types of research conducted;
    (3) A description of the identifiable private information or 
identifiable biospecimens that might be used in research, whether 
sharing of identifiable private information or identifiable biospecimens 
might occur, and the types of institutions or researchers that might 
conduct research with the identifiable private information or 
identifiable biospecimens;
    (4) A description of the period of time that the identifiable 
private information or identifiable biospecimens may be stored and 
maintained (which period of time could be indefinite), and a description 
of the period of time that the identifiable private information or 
identifiable biospecimens may be used for research purposes (which 
period of time could be indefinite);
    (5) Unless the subject or legally authorized representative will be 
provided details about specific research studies, a statement that they 
will not be informed of the details of any specific research studies 
that might be conducted using the subject's identifiable private 
information or identifiable biospecimens, including the purposes of the 
research, and that they might have chosen not to consent to some of 
those specific research studies;
    (6) Unless it is known that clinically relevant research results, 
including individual research results, will be disclosed to the subject 
in all circumstances, a statement that such results may not be disclosed 
to the subject; and
    (7) An explanation of whom to contact for answers to questions about 
the subject's rights and about storage and use of the subject's 
identifiable private

[[Page 704]]

information or identifiable biospecimens, and whom to contact in the 
event of a research-related harm.
    (e) Waiver or alteration of consent in research involving public 
benefit and service programs conducted by or subject to the approval of 
state or local officials--(1) Waiver. An IRB may waive the requirement 
to obtain informed consent for research under paragraphs (a) through (c) 
of this section, provided the IRB satisfies the requirements of 
paragraph (e)(3) of this section. If an individual was asked to provide 
broad consent for the storage, maintenance, and secondary research use 
of identifiable private information or identifiable biospecimens in 
accordance with the requirements at paragraph (d) of this section, and 
refused to consent, an IRB cannot waive consent for the storage, 
maintenance, or secondary research use of the identifiable private 
information or identifiable biospecimens.
    (2) Alteration. An IRB may approve a consent procedure that omits 
some, or alters some or all, of the elements of informed consent set 
forth in paragraphs (b) and (c) of this section provided the IRB 
satisfies the requirements of paragraph (e)(3) of this section. An IRB 
may not omit or alter any of the requirements described in paragraph (a) 
of this section. If a broad consent procedure is used, an IRB may not 
omit or alter any of the elements required under paragraph (d) of this 
section.
    (3) Requirements for waiver and alteration. In order for an IRB to 
waive or alter consent as described in this subsection, the IRB must 
find and document that:
    (i) The research or demonstration project is to be conducted by or 
subject to the approval of state or local government officials and is 
designed to study, evaluate, or otherwise examine:
    (A) Public benefit or service programs;
    (B) Procedures for obtaining benefits or services under those 
programs;
    (C) Possible changes in or alternatives to those programs or 
procedures; or
    (D) Possible changes in methods or levels of payment for benefits or 
services under those programs; and
    (ii) The research could not practicably be carried out without the 
waiver or alteration.
    (f) General waiver or alteration of consent--(1) Waiver. An IRB may 
waive the requirement to obtain informed consent for research under 
paragraphs (a) through (c) of this section, provided the IRB satisfies 
the requirements of paragraph (f)(3) of this section. If an individual 
was asked to provide broad consent for the storage, maintenance, and 
secondary research use of identifiable private information or 
identifiable biospecimens in accordance with the requirements at 
paragraph (d) of this section, and refused to consent, an IRB cannot 
waive consent for the storage, maintenance, or secondary research use of 
the identifiable private information or identifiable biospecimens.
    (2) Alteration. An IRB may approve a consent procedure that omits 
some, or alters some or all, of the elements of informed consent set 
forth in paragraphs (b) and (c) of this section provided the IRB 
satisfies the requirements of paragraph (f)(3) of this section. An IRB 
may not omit or alter any of the requirements described in paragraph (a) 
of this section. If a broad consent procedure is used, an IRB may not 
omit or alter any of the elements required under paragraph (d) of this 
section.
    (3) Requirements for waiver and alteration. In order for an IRB to 
waive or alter consent as described in this subsection, the IRB must 
find and document that:
    (i) The research involves no more than minimal risk to the subjects;
    (ii) The research could not practicably be carried out without the 
requested waiver or alteration;
    (iii) If the research involves using identifiable private 
information or identifiable biospecimens, the research could not 
practicably be carried out without using such information or 
biospecimens in an identifiable format;
    (iv) The waiver or alteration will not adversely affect the rights 
and welfare of the subjects; and
    (v) Whenever appropriate, the subjects or legally authorized 
representatives will be provided with additional pertinent information 
after participation.

[[Page 705]]

    (g) Screening, recruiting, or determining eligibility. An IRB may 
approve a research proposal in which an investigator will obtain 
information or biospecimens for the purpose of screening, recruiting, or 
determining the eligibility of prospective subjects without the informed 
consent of the prospective subject or the subject's legally authorized 
representative, if either of the following conditions are met:
    (1) The investigator will obtain information through oral or written 
communication with the prospective subject or legally authorized 
representative, or
    (2) The investigator will obtain identifiable private information or 
identifiable biospecimens by accessing records or stored identifiable 
biospecimens.
    (h) Posting of clinical trial consent form. (1) For each clinical 
trial conducted or supported by a Federal department or agency, one IRB-
approved informed consent form used to enroll subjects must be posted by 
the awardee or the Federal department or agency component conducting the 
trial on a publicly available Federal Web site that will be established 
as a repository for such informed consent forms.
    (2) If the Federal department or agency supporting or conducting the 
clinical trial determines that certain information should not be made 
publicly available on a Federal Web site (e.g. confidential commercial 
information), such Federal department or agency may permit or require 
redactions to the information posted.
    (3) The informed consent form must be posted on the Federal Web site 
after the clinical trial is closed to recruitment, and no later than 60 
days after the last study visit by any subject, as required by the 
protocol.
    (i) Preemption. The informed consent requirements in this policy are 
not intended to preempt any applicable Federal, state, or local laws 
(including tribal laws passed by the official governing body of an 
American Indian or Alaska Native tribe) that require additional 
information to be disclosed in order for informed consent to be legally 
effective.
    (j) Emergency medical care. Nothing in this policy is intended to 
limit the authority of a physician to provide emergency medical care, to 
the extent the physician is permitted to do so under applicable Federal, 
state, or local law (including tribal law passed by the official 
governing body of an American Indian or Alaska Native tribe).

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec.  16.117  Documentation of informed consent.

    (a) Except as provided in paragraph (c) of this section, informed 
consent shall be documented by the use of a written informed consent 
form approved by the IRB and signed (including in an electronic format) 
by the subject or the subject's legally authorized representative. A 
written copy shall be given to the person signing the informed consent 
form.
    (b) Except as provided in paragraph (c) of this section, the 
informed consent form may be either of the following:
    (1) A written informed consent form that meets the requirements of 
Sec.  16.116. The investigator shall give either the subject or the 
subject's legally authorized representative adequate opportunity to read 
the informed consent form before it is signed; alternatively, this form 
may be read to the subject or the subject's legally authorized 
representative.
    (2) A short form written informed consent form stating that the 
elements of informed consent required by Sec.  16.116 have been 
presented orally to the subject or the subject's legally authorized 
representative, and that the key information required by Sec.  
16.116(a)(5)(i) was presented first to the subject, before other 
information, if any, was provided. The IRB shall approve a written 
summary of what is to be said to the subject or the legally authorized 
representative. When this method is used, there shall be a witness to 
the oral presentation. Only the short form itself is to be signed by the 
subject or the subject's legally authorized representative. However, the 
witness shall sign both the short form and a copy of the summary, and 
the person actually obtaining consent shall sign a copy of the summary. 
A copy of the summary shall be given to the subject or the subject's

[[Page 706]]

legally authorized representative, in addition to a copy of the short 
form.
    (c)(1) An IRB may waive the requirement for the investigator to 
obtain a signed informed consent form for some or all subjects if it 
finds any of the following:
    (i) That the only record linking the subject and the research would 
be the informed consent form and the principal risk would be potential 
harm resulting from a breach of confidentiality. Each subject (or 
legally authorized representative) will be asked whether the subject 
wants documentation linking the subject with the research, and the 
subject's wishes will govern;
    (ii) That the research presents no more than minimal risk of harm to 
subjects and involves no procedures for which written consent is 
normally required outside of the research context; or
    (iii) If the subjects or legally authorized representatives are 
members of a distinct cultural group or community in which signing forms 
is not the norm, that the research presents no more than minimal risk of 
harm to subjects and provided there is an appropriate alternative 
mechanism for documenting that informed consent was obtained.
    (2) In cases in which the documentation requirement is waived, the 
IRB may require the investigator to provide subjects or legally 
authorized representatives with a written statement regarding the 
research.

(Approved by the Office of Management and Budget under Control Number 
0990-0260)



Sec.  16.118  Applications and proposals lacking definite plans for
involvement of human subjects.

    Certain types of applications for grants, cooperative agreements, or 
contracts are submitted to Federal departments or agencies with the 
knowledge that subjects may be involved within the period of support, 
but definite plans would not normally be set forth in the application or 
proposal. These include activities such as institutional type grants 
when selection of specific projects is the institution's responsibility; 
research training grants in which the activities involving subjects 
remain to be selected; and projects in which human subjects' involvement 
will depend upon completion of instruments, prior animal studies, or 
purification of compounds. Except for research waived under Sec.  
16.101(i) or exempted under Sec.  16.104, no human subjects may be 
involved in any project supported by these awards until the project has 
been reviewed and approved by the IRB, as provided in this policy, and 
certification submitted, by the institution, to the Federal department 
or agency component supporting the research.



Sec.  16.119  Research undertaken without the intention of involving 
human subjects.

    Except for research waived under Sec.  16.101(i) or exempted under 
Sec.  16.104, in the event research is undertaken without the intention 
of involving human subjects, but it is later proposed to involve human 
subjects in the research, the research shall first be reviewed and 
approved by an IRB, as provided in this policy, a certification 
submitted by the institution to the Federal department or agency 
component supporting the research, and final approval given to the 
proposed change by the Federal department or agency component.



Sec.  16.120  Evaluation and disposition of applications and proposals
for research to be conducted or supported by a Federal department or agency.

    (a) The department or agency head will evaluate all applications and 
proposals involving human subjects submitted to the Federal department 
or agency through such officers and employees of the Federal department 
or agency and such experts and consultants as the department or agency 
head determines to be appropriate. This evaluation will take into 
consideration the risks to the subjects, the adequacy of protection 
against these risks, the potential benefits of the research to the 
subjects and others, and the importance of the knowledge gained or to be 
gained.
    (b) On the basis of this evaluation, the department or agency head 
may approve or disapprove the application or proposal, or enter into 
negotiations to develop an approvable one.

[[Page 707]]



Sec.  16.121  [Reserved]



Sec.  16.122  Use of Federal funds.

    Federal funds administered by a Federal department or agency may not 
be expended for research involving human subjects unless the 
requirements of this policy have been satisfied.



Sec.  16.123  Early termination of research support: Evaluation of 
applications and proposals.

    (a) The department or agency head may require that Federal 
department or agency support for any project be terminated or suspended 
in the manner prescribed in applicable program requirements, when the 
department or agency head finds an institution has materially failed to 
comply with the terms of this policy.
    (b) In making decisions about supporting or approving applications 
or proposals covered by this policy the department or agency head may 
take into account, in addition to all other eligibility requirements and 
program criteria, factors such as whether the applicant has been subject 
to a termination or suspension under paragraph (a) of this section and 
whether the applicant or the person or persons who would direct or has/
have directed the scientific and technical aspects of an activity has/
have, in the judgment of the department or agency head, materially 
failed to discharge responsibility for the protection of the rights and 
welfare of human subjects (whether or not the research was subject to 
federal regulation).



Sec.  16.124  Conditions.

    With respect to any research project or any class of research 
projects the department or agency head of either the conducting or the 
supporting Federal department or agency may impose additional conditions 
prior to or at the time of approval when in the judgment of the 
department or agency head additional conditions are necessary for the 
protection of human subjects.



PART 17_MEDICAL--Table of Contents



                       Definitions and Active Duty

Sec.
17.1 Incorporation by reference.
17.30 Definitions.
17.31 Duty periods defined.

                      Protection of Patient Rights

17.32 Informed consent and advance directives.
17.33 Patients' rights.

                  Tentative Eligibility Determinations

17.34 Tentative eligibility determinations.

 Hospital or Nursing Home Care and Medical Services in Foreign Countries

17.35 Hospital care and outpatient services in foreign countries.

           Enrollment Provisions and Medical Benefits Package

17.36 Enrollment--provision of hospital and outpatient care to veterans.
17.37 Enrollment not required--provision of hospital and outpatient care 
          to veterans.
17.38 Medical benefits package.
17.39 Certain Filipino veterans.
17.40 Additional services for indigents.

              Examinations and Observation and Examination

17.41 Persons eligible for hospital observation and physical 
          examination.
17.42 Examinations on an outpatient basis.

               Hospital, Domiciliary and Nursing Home Care

17.43 Persons entitled to hospital or domiciliary care.
17.44 Hospital care for certain retirees with chronic disability 
          (Executive Orders 10122, 10400 and 11733).
17.45 Hospital care for research purposes.
17.46 Eligibility for hospital, domiciliary or nursing home care of 
          persons discharged or released from active military, naval, or 
          air service.
17.47 Considerations applicable in determining eligibility for hospital 
          care, medical services, nursing home care, or domiciliary 
          care.
17.48 Compensated Work Therapy/Transitional Residences program.
17.49 Priorities for outpatient medical services and inpatient hospital 
          care.

  Use of Department of Defense, Public Health Service or Other Federal 
                                Hospitals

17.50 Use of Department of Defense, Public Health Service or other 
          Federal hospitals with beds allocated to the Department of 
          Veterans Affairs.
17.51 Emergency use of Department of Defense, Public Health Service or 
          other Federal hospitals.

[[Page 708]]

                   Use of Public or Private Hospitals

17.52 Hospital care and medical services in non-VA facilities.
17.53 Limitations on use of public or private hospitals.
17.54 [Reserved]
17.55 Payment for authorized public or private hospital care.
17.56 VA payment for inpatient and outpatient health care professional 
          services at non-departmental facilities and other medical 
          charges associated with non-VA outpatient care.

              Use of Community Nursing Home Care Facilities

17.57 Use of community nursing homes.
17.58 Evacuation of community nursing homes.
17.60 Extensions of community nursing home care beyond six months.

                       Community Residential Care

17.61 Eligibility.
17.62 Definitions.
17.63 Approval of community residential care facilities.
17.64 [Reserved]
17.65 Approvals and provisional approvals of community residential care 
          facilities.
17.66 Notice of noncompliance with VA standards.
17.67 Request for a hearing.
17.68 Notice and conduct of hearing.
17.69 Waiver of opportunity for hearing.
17.70 Written decision following a hearing.
17.71 Revocation of VA approval.
17.72 Availability of information.
17.73 Medical foster homes--general.
17.74 Standards applicable to medical foster homes.

                Use of Services of Other Federal Agencies

17.80 Alcohol and drug dependence or abuse treatment and rehabilitation 
          in residential and nonresidential facilities by contract.
17.81 Contracts for residential treatment services for veterans with 
          alcohol or drug dependence or abuse disabilities.
17.82 Contracts for outpatient services for veterans with alcohol or 
          drug dependence or abuse disabilities.
17.83 Limitations on payment for alcohol and drug dependence or abuse 
          treatment and rehabilitation.

                        Research-Related Injuries

17.85 Treatment of research-related injuries to human subjects.

              Care During Certain Disasters and Emergencies

17.86 Provision of hospital care and medical services during certain 
          disasters and emergencies under 38 U.S.C. 1785.

 Vocational Training and Health-Care Eligibility Protection for Pension 
                               Recipients

17.90 Medical care for veterans receiving vocational training under 38 
          U.S.C. chapter 15.
17.91 Protection of health-care eligibility.

                          Outpatient Treatment

17.92 Outpatient care for research purposes.
17.93 Eligibility for outpatient services.
17.94 Outpatient medical services for military retirees and other 
          beneficiaries.
17.95 Outpatient medical services for Department of Veterans Affairs 
          employees and others in emergencies.
17.96 Medication prescribed by non-VA physicians.
17.97 [Reserved]
17.98 Mental health services.

                    Charges, Waivers, and Collections

17.100 Requirements for provider-based status.
17.101 Collection or recovery by VA for medical care or services 
          provided or furnished to a veteran for a non-service connected 
          disability.
17.102 Charges for care or services.
17.103 Referrals of compromise settlement offers.
17.104 Terminations and suspensions.
17.105 Waivers.
17.106 VA collection rules; third-party payers.

Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary or 
                            Nursing Home Care

17.107 VA response to disruptive behavior of patients.

                               Copayments

17.108 Copayments for inpatient hospital care and outpatient medical 
          care.
17.109 Presumptive eligibility for psychosis and mental illness other 
          than psychosis.
17.110 Copayments for medication.
17.111 Copayments for extended care services.

                               Ceremonies

17.112 Services or ceremonies on Department of Veterans Affairs hospital 
          or center reservations.

[[Page 709]]

   Reimbursement for Loss By Natural Disaster of Personal Effects of 
                  Hospitalized or Nursing Home Patients

17.113 Conditions of custody.
17.114 Submittal of claim for reimbursement.
17.115 Claims in cases of incompetent patients.

   Reimbursement to Employees for the Cost of Repairing or Replacing 
  Certain Personal Property Damaged or Destroyed by Patients or Members

17.116 Adjudication of claims.

   Payment and Reimbursement of the Expenses of Medical Services Not 
                          Previously Authorized

17.120 Payment or reimbursement for emergency treatment furnished by 
          non-VA providers to certain veterans with service-connected 
          disabilities.
17.121 Limitations on payment or reimbursement of the costs of emergency 
          treatment not previously authorized.
17.122 [Reserved]
17.123 Claimants.
17.124 Preparation of claims.
17.125 Where to file claims.
17.126 Timely filing.
17.127 Date of filing claims.
17.128 Allowable rates and fees.
17.129 Retroactive payments prohibited.
17.130 Payment for treatment dependent upon preference prohibited.
17.131 Payment of abandoned claims prohibited.
17.132 Appeals.

                    Reconsideration of Denied Claims

17.133 Procedures.

                         Delegation of Authority

17.142 Authority to approve sharing agreements, contracts for scarce 
          medical specialist services and contracts for other medical 
          services.

                  Sensory and Other Rehabilitative Aids

17.148 Service dogs.
17.149 Sensori-neural aids.
17.150 [Reserved].
17.151 Invalid lifts for recipients of aid and attendance allowance or 
          special monthly compensation.
17.152 Devices to assist in overcoming the handicap of deafness.
17.153 [Reserved]
17.154 Equipment for blind veterans.

                Automotive Equipment and Driver Training

17.155 Minimum standards of safety and quality for automotive adaptive 
          equipment.
17.156 Eligibility for automobile adaptive equipment.
17.157 Definition-adaptive equipment.
17.158 Limitations on assistance.
17.159 Obtaining vehicles for special driver training courses.

                             Dental Services

17.160 Authorization of dental examinations.
17.161 Authorization of outpatient dental treatment.
17.162 Eligibility for Class II dental treatment without rating action.
17.163 Posthospital outpatient dental treatment.
17.164 Patient responsibility in making and keeping dental appointments.
17.165 Emergency outpatient dental treatment.
17.166 Dental services for hospital or nursing home patients and 
          domiciled members.
17.169 VA Dental Insurance Program for veterans and survivors and 
          dependents of veterans (VADIP).

                                Autopsies

17.170 Autopsies.

                        Veterans Canteen Service

17.180 Delegation of authority.

        Sharing of Medical Facilities, Equipment, and Information

17.230 Contingency backup to the Department of Defense.
17.240 Sharing health-care resources.
17.241 Sharing medical information services.
17.242 Coordination of programs with Department of Health and Human 
          Services.

                   Grants for Exchange of Information

17.250 Scope of the grant program.
17.251 The Subcommittee on Academic Affairs.
17.252 Ex officio member of subcommittee.
17.253 Applicants for grants.
17.254 Applications.
17.255 Applications for grants for programs which include construction 
          projects.
17.256 Amended or supplemental applications.
17.257 Awards procedures.
17.258 Terms and conditions to which awards are subject.
17.259 Direct costs.
17.260 Patient care costs to be excluded from direct costs.
17.261 Indirect costs.
17.262 Authority to approve applications discretionary.
17.263 Suspension and termination procedures.
17.264 Recoupments and releases.

[[Page 710]]

17.265 Payments.
17.266 Copyrights and patents.

   Civilian Health and Medical Program of the Department of Veterans 
Affairs (CHAMPVA)--Medical Care for Survivors and Dependents of Certain 
                                Veterans

17.270 General provisions.
17.271 Eligibility.
17.272 Benefit limitations/exclusions.
17.273 Preauthorization.
17.274 Cost sharing.
17.275 Claim filing deadline.
17.276 Appeal/review process.
17.277 Third party liability/medical care cost recovery.
17.278 Confidentiality of records.

      In Vitro Fertilization and Reimbursement of Adoption Expenses

17.380 In vitro fertilization treatment.
17.390 Reimbursement for qualifying adoption expenses incurred by 
          certain veterans.

    Hospital Care and Medical Services for Camp Lejeune Veterans and 
                                Families

17.400 Hospital care and medical services for Camp Lejeune veterans.

       Hospital Care and Medical Services for Spouses and Families

17.410 Hospital care and medical services for Camp Lejeune family 
          members.
17.412 Fertility counseling and treatment for certain spouses.

          Authority of Health Care Providers to Practice in VA

17.415 Full practice authority for advanced practice registered nurses.
17.417 Health care providers practicing via telehealth.
17.419 Health care professionals' practice in VA.

               Center for Innovation for Care and Payment

17.450 Center for Innovation for Care and Payment.

     Confidentiality of Healthcare Quality Assurance Review Records

17.500 General.
17.501 Confidential and privileged documents.
17.502 Applicability of other statutes.
17.503 Improper disclosure.
17.504 Disclosure methods.
17.505 Disclosure authorities.
17.506 Appeal of decision by Veterans Health Administration to deny 
          disclosure.
17.507 Employee responsibilities.
17.508 Access to quality assurance records and documents within the 
          agency.
17.509 Authorized disclosure: Non-Department of Veterans Affairs 
          requests.
17.510 Redisclosure.
17.511 Penalties for violations.

               Specialty Education Loan Repayment Program

17.525 Purpose.
17.526 Definitions.
17.527 Eligibility.
17.528 Application.
17.529 Award procedures.
17.530 Agreement and obligated service.
17.531 Failure to comply with terms and conditions of agreement.

               VA Health Professional Scholarship Program

17.600 Purpose.
17.601 Definitions.
17.602 Eligibility.
17.603 Availability of HPSP scholarships.
17.604 Application for the HPSP.
17.605 Selection of participants.
17.606 Award procedures.
17.607 Obligated service.
17.608 Deferment of obligated service.
17.609 Pay during period of obligated service.
17.610 Failure to comply with terms and conditions of participation.
17.611 Bankruptcy.
17.612 Cancellation, waiver, or suspension of obligation.

    Veterans Healing Veterans Medical Access and Scholarship Program

17.613 Purpose.
17.614 Definitions.
17.615 Eligibility.
17.616 Award procedures.
17.617 Agreement and obligated service.
17.618 Failure to comply with terms and conditions of agreement.

Visual Impairment and Orientation and Mobility Professional Scholarship 
                                 Program

17.625 Purpose.
17.626 Definitions.
17.627 Eligibility for the VIOMPSP.
17.628 Availability of VIOMPSP scholarships.
17.629 Application for the VIOMPSP.
17.630 Selection of VIOMPSP participants.
17.631 Award procedures.
17.632 Obligated service.
17.633 Deferment of obligated service.
17.634 Failure to comply with terms and conditions of participation.
17.635 Bankruptcy.
17.636 Cancellation, waiver, or suspension of obligation.

[[Page 711]]

 Program for Repayment of Educational Loans for Certain VA Psychiatrists

17.640 Purpose.
17.641 Definitions.
17.642 Eligibility.
17.643 Application for the program for the repayment of educational 
          loans.
17.643 Application for the program for the repayment of educational 
          loans.
17.644 Selection of participants.
17.645 Award procedures.
17.646 Obligated service.
17.647 Failure to comply with terms and conditions of participation.

                            Chaplain Services

17.655 Ecclesiastical endorsing organizations.

       Grants for Transportation of Veterans in Highly Rural Areas

17.700 Purpose and scope.
17.701 Definitions.
17.702 Grants--general.
17.703 Eligibility and application.
17.705 Scoring criteria and selection.
17.710 Notice of Fund Availability.
17.715 Grant agreements.
17.720 Payments under the grant.
17.725 Grantee reporting requirements.
17.730 Recovery of funds by VA.

                    Transitional Housing Loan Program

17.800 Purpose.
17.801 Definitions.
17.802 Application provisions.
17.803 Order of consideration.
17.804 Loan approval criteria.
17.805 Additional terms of loans.

   Health Care Benefits for Certain Children of Vietnam Veterans and 
 Veterans with Covered Service in Korea--Spina Bifida and Covered Birth 
                                 Defects

17.900 Definitions.
17.901 Provision of health care.
17.902 Preauthorization.
17.903 Payment.
17.904 Review and appeal process.
17.905 Medical records.

Payment or Reimbursement for Emergency Services for Nonservice-Connected 
                     Conditions in Non-VA Facilities

17.1000 Payment or reimbursement for emergency services for nonservice-
          connected conditions in non-VA facilities.
17.1001 Definitions.
17.1002 Substantive conditions for payment or reimbursement.
17.1003 Emergency transportation.
17.1004 Filing claims.
17.1005 Payment limitations.
17.1006 Decisionmakers.
17.1007 Independent right of recovery.
17.1008 Balance billing prohibited.

   Expanded Access to Non-VA Care Through the Veterans Choice Program

17.1500 Purpose and scope.
17.1505 Definitions.
17.1510 Eligible veterans.
17.1515 Authorizing non-VA care.
17.1520 Effect on other provisions.
17.1525 [Reserved]
17.1530 Eligible entities and providers.
17.1535 Payment rates and methodologies.
17.1540 Claims processing system.

                               Vet Centers

17.2000 Vet Center services.

       Home Improvements and Structural Alterations (HISA) Program

17.3100 Purpose and scope.
17.3101 Definitions.
17.3102 Eligibility.
17.3103-17.3104 [Reserved]
17.3105 HISA benefit lifetime limits.
17.3106-17.3119 [Reserved]
17.3120 Application for HISA benefits.
17.3121-17.3124 [Reserved]
17.3125 Approving HISA benefits applications.
17.3126 Disapproving HISA benefits applications.
17.3127-17.3129 [Reserved]
17.3130 HISA benefits payment procedures.

            Prosthetic and Rehabilitative Items and Services

17.3200 Purpose and scope.
17.3210 Definitions.
17.3220 Eligibility.
17.3230 Authorized items and services.
17.3240 Furnishing authorized items and services.
17.3250 Veteran responsibilities.

                      Clinical Laboratory Standards

17.3500 VA application of 42 CFR part 493 standards for clinical 
          laboratory operations.

                     Veterans Community Care Program

17.4000 Purpose and scope.
17.4005 Definitions.
17.4010 Veteran eligibility.
17.4015 Designated VA medical service lines.
17.4020 Authorized non-VA care.
17.4025 Effect on other provisions.
17.4030 Eligible entities and providers.
17.4035 Payment rates.
17.4040 Designated access standards.

                        Veterans Care Agreements

17.4100 Definitions.
17.4105 Purpose and scope.
17.4110 Entity or provider certification.

[[Page 712]]

17.4115 VA use of Veterans Care Agreements.
17.4120 Payment rates.
17.4125 Review of Veterans Care Agreements.
17.4130 Discontinuation of Veterans Care Agreements.
17.4135 Disputes.
17.4600 Urgent care.

    Authority: 38 U.S.C. 501, and as noted in specific sections.
    Section 17.32 also issued under 38 U.S.C. 7331-7334.
    Section 17.35 is also issued under 38 U.S.C. 1724.
    Section 17.38 is also issued under 38 U.S.C. 1703.
    Section 17.46 is also issued under 38 U.S.C. 1710.
    Section 17.52 is also issued under 38 U.S.C. 1701, 1703, 1710, 1712, 
and 3104.
    Section 17.55 is also issued under 38 U.S.C. 513, 1703, and 1728.
    Section 17.56 is also issued under 38 U.S.C. 1703 and 1728.
    Sections 17.61 through 17.74 are also issued under 38 U.S.C. 1730.
    Section 17.101 is also issued under 38 U.S.C. 101, 1701, 1705, 1710, 
1721, 1722, 1729.
    Section 17.105 is also issued under 38 U.S.C. 501, 1721, 1722A, 
1724, and 1725A.
    Section 17.108 is also issued under 38 U.S.C. 501, 1703, 1710, 
1725A, and 1730A.
    Section 17.110 is also issued under 38 U.S.C. 501, 1703, 1710, 
1720D, 1722A, and 1730A.
    Section 17.111 is also issued under 38 U.S.C. 101(28), 501, 1701(7), 
1703, 1710, 1710B, 1720B, 1720D, and 1722A.
    Section 17.125 is also issued under 38 U.S.C. 7304.
    Section 17.169 is also issued under 38 U.S.C. 1712C.
    Sections 17.380, 17.390 and 17.412 are also issued under sec. 260, 
Pub. L. 114-223, 130 Stat. 857, and sec. 236, Public Law 115-141, 132 
Stat. 348, and sec. 236, div. J, Pub. L 115-141, 132 Stat. 348.
    Section 17.410 is also issued under 38 U.S.C. 1787.
    Section 17.415 is also issued under 38 U.S.C. 7301, 7304, 7402, and 
7403.
    Section 17.417 also issued under 38 U.S.C. 1701 (note), 1709A, 1712A 
(note), 1722B, 7301, 7330A, 7401-7403, 7406 (note).
    Section 17.419 also issued under 38 U.S.C. 1701 (note), 7301, 7306, 
7330A, 7401-7403, 7405, 7406, 7408).
    Section 17.450 is also issued under 38 U.S.C. 1703E.
    Sections 17.525 through 17.531 are also issued under 38 U.S.C. 7691 
through 7697.
    Sections 17.613 through 17.618 are also issued under Pub. L. 115-
182, sec. 304.
    Sections 17.640 and 17.647 are also issued under sec. 4, Pub. L. 
114-2, 129 Stat. 30.
    Sections 17.641 through 17.646 are also issued under 38 U.S.C. 
501(a) and sec. 4, Pub. L. 114-2, 129 Stat. 30.
    Section 17.655 also issued under 38 U.S.C. 501(a), 7304, 7405.
    Section 17.3200 also issued under 38 U.S.C. 1162, 1701, 1707, 1710, 
1714, 1717, 3901.
    Section 17.3210 also issued under 38 U.S.C. 1701, 1710.
    Section 17.3220 also issued under 38 U.S.C. 1701(6)(F), 1710.
    Section 17.3230 also issued under 38 U.S.C. 1701(6)(F), 1710, 
1714(a).
    Section 17.3250 also issued under 38 U.S.C. 1701, 1710, 1725, 1728.
    Section 17.3500 is also issued under Pub. L. 102-139 sec. 101.
    Sections 17.4000 through 17.4040 also issued under 38 U.S.C. 1703, 
1703B, and 1703C.
    Section 17.4100 et seq. is also issued under 38 U.S.C. 1703A.
    Section 17.4600 is also issued under 38 U.S.C. 1725A.

                       Definitions and Active Duty



Sec.  17.1  Incorporation by reference.

    (a) Certain materials are incorporated by reference into this part 
with the approval of the Director of the Federal Register under 5 U.S.C. 
552(a) and 1 CFR part 51. To enforce an edition of a publication other 
than that specified in this section, VA will provide notice of the 
change in a rule in the Federal Register and the material will be made 
available to the public. All approved materials are available for 
inspection at the Department of Veterans Affairs, Office of Regulation 
Policy and Management (02REG), 810 Vermont Avenue NW., Room 1068, 
Washington, DC 20420, call 202-461-4902, or at the National Archives and 
Records Administration (NARA). For information on the availability of 
approved materials at NARA, call (202) 741-6030, or go to: http://
www.archives.gov/federal_register/code_of_federal_regulations/
ibr_locations.html.
    (b) National Fire Protection Association, 1 Batterymarch Park, 
Quincy, MA 02269. (For ordering information, call toll-free 1-800-344-
3555).
    (1) NFPA 10, Standard for Portable Fire Extinguishers (2010 
edition), Incorporation by Reference (IBR) approved for Sec. Sec.  
17.63, 17.74, and 17.81.
    (2) NFPA 13, Standard for the Installation of Sprinkler Systems 
(2010 edition), IBR approved for Sec.  17.74.

[[Page 713]]

    (3) NFPA 13D, Standard for the Installation of Sprinkler Systems in 
One- and Two-Family Dwellings and Manufactured Homes (2010 edition), IBR 
approved for Sec.  17.74.
    (4) NFPA 13R, Standard for the Installation of Sprinkler Systems in 
Residential Occupancies Up To and Including Four Stories in Height (2010 
edition), IBR approved for Sec.  17.74.
    (5) NFPA 25, Standard for the Inspection, Testing, and Maintenance 
of Water-Based Fire Protection Systems (2011 edition), IBR approved for 
Sec.  17.74.
    (6) NFPA 30, Flammable and Combustible Liquids Code (2012 edition), 
IBR approved for Sec.  17.74.
    (7) NFPA 72, National Fire Alarm and Signaling Code (2010 edition), 
IBR approved for Sec.  17.74.
    (8) NFPA 101, Life Safety Code (2012 edition), IBR approved for 
Sec. Sec.  17.63, 17.74 (chapters 1 through 11, 24, and section 33.7), 
17.81, and 17.82.
    (9) NFPA 101A, Guide on Alternative Approaches to Life Safety (2010 
edition), IBR approved for Sec.  17.63.
    (10) NFPA 720, Standard for the Installation of Carbon Monoxide (CO) 
Detection and Warning Equipment (2012 edition), IBR approved for Sec.  
17.74.

(Authority: 5 U.S.C. 552(a), 38 U.S.C. 501, 1721.)

[80 FR 44861, July 28, 2015]



Sec.  17.30  Definitions.

    When used in Department of Veterans Affairs medical regulations, 
each of the following terms shall have the meaning ascribed to it in 
this section:
    (a) Medical services. The term medical services includes, in 
addition to medical examination, treatment, and rehabilitative services:
    (1) Surgical services, dental services and appliances as authorized 
in Sec. Sec.  17.160 through 17.166, optometric and podiatric services, 
(in the case of a person otherwise receiving care or services under this 
chapter) the preventive health care services set forth in 38 U.S.C. 
1701(9), noninstitutional extended care, wheelchairs, artificial limbs, 
trusses and similar appliances, special clothing made necessary by the 
wearing of prosthetic appliances, and such other supplies or services as 
are medically determined to be reasonable and necessary.


(Authority: 38 U.S.C. 1701(6)(A)(i))

    (2) Consultation, professional counseling, marriage and family 
counseling, training, and mental health services for the members of the 
immediate family or legal guardian of the veteran or the individual in 
whose household the veteran certifies an intention to live, as necessary 
in connection with the veteran's treatment.
    (3) Transportation and incidental expenses for any person entitled 
to such benefits under the provisions of Sec.  70.10 of this chapter.


(Authority: 38 U.S.C. 1701(6))

    (b) Domiciliary care. The term domiciliary care--
    (1) Means the furnishing of:
    (i) A temporary home to a veteran, embracing the furnishing of 
shelter, food, clothing and other comforts of home, including necessary 
medical services; or
    (ii) A day hospital program consisting of intensive supervised 
rehabilitation and treatment provided in a therapeutic residential 
setting for residents with mental health or substance use disorders, and 
co-occurring medical or psychosocial needs such as homelessness and 
unemployment.
    (2) Includes travel and incidental expenses pursuant to Sec.  70.10.

(Authority: 38 U.S.C. 1701(4))

[23 FR 6498, Aug. 22, 1958]

    Editorial Note: For Federal Register citations affecting Sec.  
17.30, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  17.31  Duty periods defined.

    Definitions of duty periods applicable to eligibility for medical 
benefits are as follows:
    (a) Active military, naval, or air service includes:
    (1) Active duty.
    (2) Any period of active duty for training during which the 
individual was disabled from a disease or injury incurred or aggravated 
in line of duty.
    (3) Any period of inactive duty training during which the individual 
was

[[Page 714]]

disabled from an injury incurred or aggravated in line of duty.
    (4) Any period of inactive duty training during which the individual 
was disabled from an acute myocardial infarction, a cardiac arrest, or a 
cerebrovascular accident which occurred during such period of inactive 
duty training.
    (b) Active duty means:
    (1) Full-time duty in the Armed Forces, other than active duty for 
training.
    (2) Full-time duty, other than for training purposes, as a 
commissioned officer of the Regular or Reserve Corps of the Public 
Health Service during the following dates:
    (i) On or after July 29, 1945;
    (ii) Before July 29, 1945, under circumstances affording entitlement 
to full military benefits; or
    (3) Full-time duty as a commissioned officer of the National Oceanic 
and Atmospheric Administration or its predecessor organizations, the 
Coast and Geodetic Survey or the Environmental Science Services 
Administration, during the following dates:
    (i) On or after July 29, 1945;
    (ii) Before July 29, 1945, under the following circumstances:
    (A) While on transfer to one of the Armed Forces;
    (B) While, in time of war or national emergency declared by the 
President, assigned to duty on a project for one of the Armed Forces in 
an area determined by the Secretary of Defense to be of immediate 
military hazard; or
    (C) In the Philippine Islands on December 7, 1941, and continuously 
in such islands thereafter; or
    (4) Service as a cadet at the U.S. Military, Air Force, or Coast 
Guard Academy, or as a midshipman at the U.S. Naval Academy.
    (5) Service in Women's Army Auxiliary Corps (WAAC). Recognized 
effective March 18, 1980.
    (6) Service of any person in a group the members of which rendered 
service to the Armed Forces of the United States in a capacity 
considered civilian employment or contractual service at the time such 
service was rendered, if the Secretary of Defense:
    (i) Determines that the service of such group constituted active 
military service; and
    (ii) Issues to each member of such group a discharge from such 
service under honorable conditions where the nature and duration of the 
service of such member so warrants.
    (7) Service in American Merchant Marine in Oceangoing Service any 
time during the period December 7, 1941, to August 15, 1945. Recognized 
effective January 19, 1988.
    (8) Service by the approximately 50 Chamorro and Carolinian former 
native policemen who received military training in the Donnal area of 
central Saipan and were placed under the command of Lt. Casino of the 
6th Provisional Military Police Battalion to accompany U.S. Marines on 
active, combat-patrol activity any time during the period August 19, 
1945, to September 2, 1945. Recognized effective September 30, 1999.
    (9) Service by Civilian Crewmen of the U.S. Coast and Geodetic 
Survey (USCGS) vessels, who performed their service in areas of 
immediate military hazard while conducting cooperative operations with 
and for the U.S. Armed Forces any time during the period December 7, 
1941, to August 15, 1945. Qualifying USCGS vessels specified by the 
Secretary of the Air Force are the Derickson, Explorer, Gilbert, 
Hilgard, E. Lester Jones, Lydonia, Patton, Surveyor, Wainwright, 
Westdahl, Oceanographer, Hydrographer, or Pathfinder. Recognized 
effective April 8, 1991.
    (10) Service by Civilian Employees of Pacific Naval Air Bases who 
actively participated in Defense of Wake Island during World War II. 
Recognized effective January 22, 1981.
    (11) Service by Civilian Navy Identification Friend or Foe (IFF) 
Technicians who served in the Combat Areas of the Pacific any time 
during the period December 7, 1941, to August 15, 1945. Recognized 
effective August 2, 1988.
    (12) Service by Civilian personnel assigned to the Secret 
Intelligence Element of the Office of Strategic Services (OSS). 
Recognized effective December 27, 1982.

[[Page 715]]

    (13) Service by Engineer Field Clerks (World War I). Recognized 
effective August 31, 1979.
    (14) Service by Guam Combat Patrol. Recognized effective May 10, 
1983.
    (15) Service by Honorably discharged members of the American 
Volunteer Group (Flying Tigers) who served any time during the period 
December 7, 1941, to July 18, 1942. Recognized effective May 3, 1991.
    (16) Service by Honorably discharged members of the American 
Volunteer Guard, Eritrea Service Command who served any time during the 
period June 21, 1942, to March 31, 1943. Recognized effective June 29, 
1992.
    (17) Service by Male Civilian Ferry Pilots. Recognized effective 
July 17, 1981.
    (18) Service with the Operational Analysis Group of the Office of 
Scientific Research and Development, Office of Emergency Management, 
which served overseas with the U.S. Army Air Corps any time during the 
period December 7, 1941, to August 15, 1945. Recognized effective August 
27, 1999.
    (19) Service by Quartermaster Corps Female Clerical Employees 
serving with the American Expeditionary Forces in World War II. 
Recognized effective January 22, 1981.
    (20) Service by Quartermaster Corps Keswick Crew on Corregidor 
(World War II). Recognized effective February 7, 1984.
    (21) Service by Reconstruction Aides and Dietitians in World War I. 
Recognized effective July 6, 1981.
    (22) Service by Signal Corps Female Telephone Operators Unit of 
World War I. Recognized effective May 15, 1979.
    (23) Service by three scouts/guides, Miguel Tenorio, Penedicto 
Taisacan, and Cristino Dela Cruz, who assisted the U.S. Marines in the 
offensive operations against the Japanese on the Northern Mariana 
Islands from June 19, 1944, through September 2, 1945. Recognized 
effective September 30, 1999.
    (24) Service by U.S. civilian employees of American Airlines who 
served overseas as a result of American Airlines' Contract with the Air 
Transport Command any time during the period December 14, 1941, to 
August 14, 1945. Recognized effective October 5, 1990.
    (25) Service by U.S. civilian female employees of the U.S. Army 
Nurse Corps while serving in the Defense of Bataan and Corregidor any 
time during the period January 2, 1942, to February 3, 1945. Recognized 
effective December 13, 1993.
    (26) Service by U.S. Civilian Flight Crew and Aviation Ground 
Support Employees of Braniff Airways, who served overseas in the North 
Atlantic or under the jurisdiction of the North Atlantic Wing, Air 
Transport Command (ATC), as a result of a Contract with the ATC any time 
during the period February 26, 1942, to August 14, 1945. Recognized 
effective June 2, 1997.
    (27) Service by U.S. Civilian Flight Crew and Aviation Ground 
Support Employees of Consolidated Vultree Aircraft Corporation 
(Consairway Division), who served overseas as a result of a Contract 
with the Air Transport Command any time during the period December 14, 
1941, to August 14, 1945. Recognized effective June 29, 1992.
    (28) Service by U.S. Flight Crew and Aviation Ground Support 
Employees of Northeast Airlines Atlantic Division, who served overseas 
as a result of Northeast Airlines' Contract with the Air Transport 
Command any time during the period December 7, 1941, to August 14, 1945. 
Recognized effective June 2, 1997.
    (29) Service by U.S. Civilian Flight Crew and Aviation Ground 
Support Employees of Northwest Airlines, who served overseas as a result 
of Northwest Airlines' Contract with the Air Transport Command any time 
during the period December 14, 1941, to August 14, 1945. Recognized 
effective December 13, 1993.
    (30) Service by U.S. Civilian Flight Crew and Aviation Ground 
Support Employees of Pan American World Airways and its Subsidiaries and 
Affiliates, who served overseas as a result of Pan American's Contract 
with the Air Transport Command and Naval Air Transport Service any time 
during the period December 14, 1941, to August 14, 1945. Recognized 
effective July 16, 1992.
    (31) Service by U.S. Civilian Flight Crew and Aviation Ground 
Support Employees of Transcontinental and Western Air (TWA), Inc., who 
served overseas as a result of TWA's Contract

[[Page 716]]

with the Air Transport Command any time during the period December 14, 
1941, to August 14, 1945. The ``Flight Crew'' includes pursers. 
Recognized effective May 13, 1992.
    (32) Service by U.S. Civilian Flight Crew and Aviation Ground 
Support Employees of United Air Lines (UAL), who served overseas as a 
result of UAL's Contract with the Air Transport Command any time during 
the period December 14, 1941, to August 14, 1945. Recognized effective 
May 13, 1992.
    (33) Service by U.S. civilian volunteers who actively participated 
in the Defense of Bataan. Recognized effective February 7, 1984.
    (34) Service by U.S. civilians of the American Field Service (AFS) 
who served overseas operationally in World War I any time during the 
period August 31, 1917, to January 1, 1918. Recognized effective August 
30, 1990.
    (35) Service by U.S. civilians of the American Field Service (AFS) 
who served overseas under U.S. Armies and U.S. Army Groups in World War 
II any time during the period December 7, 1941, to May 8, 1945. 
Recognized effective August 30, 1990.
    (36) Service by U.S. Merchant Seamen who served on blockships in 
support of Operation Mulberry. Recognized effective October 18, 1985.
    (37) Service by Wake Island Defenders from Guam. Recognized 
effective April 7, 1982.
    (38) Service by Women's Air Forces Service Pilots (WASP). Recognized 
effective November 23, 1977.
    (39) Service by persons who were injured while providing aerial 
transportation of mail and serving under conditions set forth in Public 
Law 73-140.
    (40) Service in the Alaska Territorial Guard during World War II, 
for any person who the Secretary of Defense determines was honorably 
discharged.
    (41) Service by Army field clerks.
    (42) Service by Army Nurse Corps, Navy Nurse Corps, and female 
dietetic and physical therapy personnel as follows:
    (i) Female Army and Navy nurses on active service under order of the 
service department; or
    (ii) Female dietetic and physical therapy personnel, excluding 
students and apprentices, appointed with relative rank after December 
21, 1942, or commissioned after June 21, 1944.
    (43) Service by students who were enlisted men in Aviation camps 
during World War I.
    (44) Active service in the Coast Guard after January 28, 1915, while 
under the jurisdiction of the Treasury Department, the Navy Department, 
the Department of Transportation, or the Department of Homeland 
Security. This does not include temporary members of the Coast Guard 
Reserves.
    (45) Service by contract surgeons if the disability was the result 
of injury or disease contracted in the line of duty during a period of 
war while actually performing the duties of assistant surgeon or acting 
assistant surgeon with any military force in the field, or in transit, 
or in a hospital.
    (46) Service by field clerks of the Quartermaster Corps.
    (47) Service by lighthouse service personnel who were transferred to 
the service and jurisdiction of the War or Navy Departments by Executive 
Order under the Act of August 29, 1916. Effective July 1, 1939, service 
was consolidated with the Coast Guard.
    (48) Service by male nurses who were enlisted in a Medical Corps.
    (49) Service by persons having a pensionable or compensable status 
before January 1, 1959.
    (50) Service by a Commonwealth Army veteran or new Philippine Scout, 
as defined in 38 U.S.C. 1735, who resides in the United States and is a 
citizen of the United States or an alien lawfully admitted to the United 
States for permanent residence; service by Regular Philippine Scouts and 
service in the Insular Force of the Navy, Samoan Native Guard, or Samoan 
Native Band of the Navy.
    (51) Service with the Revenue Cutter Service while serving under 
direction of the Secretary of the Navy in cooperation with the Navy. 
Effective January 28, 1915, the Revenue Cutter Service was merged into 
the Coast Guard.
    (52) Service during World War I in the Russian Railway Service Corps 
as certified by the Secretary of the Army.
    (53) Service by members of training camps authorized by section 54 
of the National Defense Act (Pub. L. 64-85, 39

[[Page 717]]

Stat. 166), except for members of Student Army Training Corps Camps at 
the Presidio of San Francisco; Plattsburg, New York; Fort Sheridan, 
Illinois; Howard University, Washington, DC; Camp Perry, Ohio; and Camp 
Hancock, Georgia, from July 18, 1918, to September 16, 1918.
    (54) Service in the Women's Army Corps (WAC) after June 30, 1943.
    (55) Service in the Women's Reserve of the Navy, Marine Corps, and 
Coast Guard.
    (56) Effective July 28, 1959, service by a veteran who was 
discharged for alienage during a period of hostilities unless evidence 
affirmatively shows the veteran was discharged at his or her own 
request. A veteran who was discharged for alienage after a period of 
hostilities and whose service was honest and faithful is not barred from 
benefits if he or she is otherwise entitled. A discharge changed prior 
to January 7, 1957, to honorable by a board established under 10 U.S.C. 
1552 and 1553 will be considered as evidence that the discharge was not 
at the alien's request.
    (57) Attendance at the preparatory schools of the United States Air 
Force Academy, the United States Military Academy, or the United States 
Naval Academy for enlisted active duty members who are reassigned to a 
preparatory school without a release from active duty, and for other 
individuals who have a commitment to active duty in the Armed Forces 
that would be binding upon disenrollment from the preparatory school.
    (58) For purposes of providing medical care under chapter 17 for a 
service-connected disability, service by any person who has suffered an 
injury or contracted a disease in line of duty while en route to or 
from, or at, a place for final acceptance or entry upon active duty and:
    (i) Who has applied for enlistment or enrollment in the active 
military, naval, or air service and has been provisionally accepted and 
directed or ordered to report to a place for final acceptance into such 
service;
    (ii) Who has been selected or drafted for service in the Armed 
Forces and has reported pursuant to the call of the person's local draft 
board and before rejection; or
    (iii) Who has been called into the Federal service as a member of 
the National Guard, but has not been enrolled for the Federal service.
    Note to paragraph (b)(58): The injury or disease must be due to some 
factor relating to compliance with proper orders. Draftees and selectees 
are included when reporting for preinduction examination or for final 
induction on active duty. Such persons are not included for injury or 
disease suffered during the period of inactive duty, or period of 
waiting, after a final physical examination and prior to beginning the 
trip to report for induction. Members of the National Guard are included 
when reporting to a designated rendezvous.
    (59) Authorized travel to or from such duty or service, as described 
in this section.
    (60) The period of time immediately following the date an individual 
is discharged or released from a period of active duty, as determined by 
the Secretary concerned to have been required for that individual to 
proceed to that individual's home by the most direct route, and in any 
event until midnight of the date of such discharge or release.
    (c) Active duty for training means:
    (1) Full-time duty in the Armed Forces performed by Reserves for 
training purposes.
    (2) Full-time duty for training purposes performed as a commissioned 
officer of the Reserve Corps of the Public Health service during the 
period covered in paragraph (b)(2) of this section.
    (3) In the case of members of the Army National Guard or Air 
National Guard of any State, full-time duty under sections 316, 502, 
503, 504, or 505 of title 32 U.S.C., or the prior corresponding 
provisions of law.
    (4) Duty performed by a member of a Senior Reserve Officers' 
Training Corps program when ordered to such duty for the purpose of 
training or a practice cruise under chapter 103 of title 10 U.S.C. for a 
period of not less than four weeks and which must be completed by the 
member before the member is commissioned.
    (5) Attendance at the preparatory schools of the United States Air 
Force

[[Page 718]]

Academy, the United States Military Academy, or the United States Naval 
Academy by an individual who enters the preparatory school directly from 
the Reserves, National Guard or civilian life, unless the individual has 
a commitment to service on active duty which would be binding upon 
disenrollment from the preparatory school.
    (6) Authorized travel to or from such duty as described in paragraph 
(c) of this section if an individual, when authorized or required by 
competent authority, assumes an obligation to perform active duty for 
training and is disabled from an injury, acute myocardial infarction, a 
cardiac arrest, or a cerebrovascular accident incurred while proceeding 
directly to or returning directly from such active duty for training. 
Authorized travel should take into account:
    (i) The hour on which such individual began so to proceed or to 
return;
    (ii) The hour on which such individual was scheduled to arrive for, 
or on which such individual ceased to perform, such duty;
    (iii) The method of travel employed;
    (iv) The itinerary;
    (v) The manner in which the travel was performed; and
    (vi) The immediate cause of disability.
    (Note to paragraph (c)(6): Active duty for training does not include 
duty performed as a temporary member of the Coast Guard Reserve.)
    (d) Inactive duty training means:
    (1) Duty (other than full-time duty) prescribed for Reserves 
(including commissioned officers of the Reserve Corps of the Public 
Health Service) by the Secretary concerned under section 206, title 37 
U.S.C., or any other provision of law;
    (2) Special additional duties authorized for Reserves (including 
commissioned officers of the Reserve Corps of the Public Health Service) 
by an authority designated by the Secretary concerned and performed by 
them on a voluntary basis in connection with the prescribed training or 
maintenance activities of the units to which they are assigned.
    (3) Duty (other than full-time duty) for members of the National 
Guard or Air National Guard of any State under the provisions of law 
stated in paragraph (c)(3) of this section.
    (4) Training (other than active duty for training) by a member of, 
or applicant for membership (as defined in 5 U.S.C. 8140(g)) in, the 
Senior Reserve Officers' Training Corps prescribed under chapter 103 of 
title 10 U.S.C.
    (5) Inactive duty for training does not include work or study 
performed in connection with correspondence courses, or attendance at an 
educational institution in an inactive status, or duty performed as a 
temporary member of the Coast Guard Reserve.
    (6) Travel to or from such duty as described in this paragraph (d) 
if an individual, when authorized or required by competent authority, 
assumes an obligation to perform inactive duty training and is disabled 
from an injury, acute myocardial infarction, a cardiac arrest, or a 
cerebrovascular accident incurred while proceeding directly to or 
returning directly from such inactive duty training. Authorized travel 
should take into account:
    (i) The hour on which such individual began so to proceed or to 
return;
    (ii) The hour on which such individual was scheduled to arrive for, 
or on which such individual ceased to perform, such duty;
    (iii) The method of travel employed;
    (iv) The itinerary;
    (v) The manner in which the travel was performed; and
    (vi) The immediate cause of disability.

(Authority: 38 U.S.C. 101, 106, 501, 1734 and 1735.)

[34 FR 9339, June 13, 1969, as amended at 45 FR 6934, Jan. 31, 1980; 45 
FR 43169, June 26, 1980; 48 FR 56580, Dec. 22, 1983; 61 FR 21965, May 
13, 1996; 75 FR 54497, Sept. 8, 2010; 78 FR 78260, Dec. 26, 2013]

                      Protection of Patient Rights



Sec.  17.32  Informed consent and advance directives.

    (a) Definitions. The following definitions are applicable for 
purposes of this section:
    Advance directive. A written statement by a person who has decision-
making capacity regarding preferences about future health care decisions 
if

[[Page 719]]

that person becomes unable to make those decisions, in any of the 
following:
    (i) Durable power of attorney for health care. A durable power of 
attorney for health care (DPAHC) is a type of advance directive in which 
an individual designates another person as an agent to make health care 
decisions on the individual's behalf.
    (ii) Living will. A living will is a type of advance directive in 
which an individual documents personal preferences regarding future 
treatment options. A living will typically includes preferences about 
life-sustaining treatment, but it may also include preferences about 
other types of health care.
    (iii) Mental health (or psychiatric) advance directive. A mental 
health or psychiatric advance directive is executed by patients whose 
future decision-making capacity is at risk due to mental illness. In 
this type of directive, the individual indicates future mental health 
treatment preferences.
    (iv) State-authorized advance directive. A state-authorized advance 
directive is a non-VA DPAHC, living will, mental health directive, or 
other advance directive document that is legally recognized by a state. 
The validity of state-authorized advance directives is determined 
pursuant to applicable state law. For the purposes of this section, 
``applicable state law'' means the law of the state where the advance 
directive was signed, the state where the patient resided when the 
advance directive was signed, the state where the patient now resides, 
or the state where the patient is receiving treatment. VA will resolve 
any conflict between those state laws regarding the validity of the 
advance directive by following the law of the state that gives effect to 
the wishes expressed by the patient in the advance directive.
    (v) Department of Defense (DoD) advance medical directive. A DoD 
advance medical directive is executed for members of the armed services 
or military dependents pursuant to 10 U.S.C. 1044C. It may include a 
durable power of attorney for health care or a living will. Federal law 
exempts such advance directives from any requirement of form, substance, 
formality, or recording that is provided for under the laws of an 
individual state. Federal law requires that this type of advance 
directive be given the same legal effect as an advance directive 
prepared and executed in accordance with the laws of the state 
concerned.
    (vi) VA Advance Directive. A VA Advance Directive is completed on a 
form specified by VA. In VA, this form can be used by patients to 
designate a health care agent and to document treatment preferences, 
including medical care, surgical care, and mental health care.
    Close friend. Any person eighteen years or older who has shown care 
and concern for the welfare of the patient, who is familiar with the 
patient's activities, health, religious beliefs and values, and who has 
presented a signed written statement for the record that describes that 
person's relationship to and familiarity with the patient.
    Decision-making capacity. The ability to understand and appreciate 
the nature and consequences of health care treatment decisions, and the 
ability to formulate a judgment and communicate a clear decision 
concerning health care treatments
    Health care agent. An individual named by the patient in a durable 
power of attorney for health care (DPAHC) to make health care decisions 
on the patient's behalf, including decisions regarding the use of life-
sustaining treatments, when the patient can no longer do so.
    Legal guardian. A person appointed by a court of appropriate 
jurisdiction to make decisions, including medical decisions, for an 
individual who has been judicially determined to be incompetent.
    Practitioner. A practitioner is any physician, dentist, or health 
care professional granted specific clinical privileges to perform the 
treatment or procedure. The term practitioner also includes:
    (i) Medical and dental residents, regardless of whether they have 
been granted specific clinical privileges; and
    (ii) Other health care professionals whose scope of practice 
agreement or other formal delineation of job responsibility specifically 
permits them to obtain informed consent, and who are appropriately 
trained and authorized

[[Page 720]]

to perform the procedure or to provide the treatment for which consent 
is being obtained.
    Signature consent. The documentation of informed consent with the 
signature of the patient or surrogate and practitioner on a form 
prescribed by VA for that purpose.
    State-authorized portable orders. Specialized forms or identifiers 
(e.g., Do Not Attempt Resuscitation (DNAR) bracelets or necklaces) 
authorized by state law or a state medical board or association, that 
translate a patient's preferences with respect to life-sustaining 
treatment decisions into standing portable medical orders.
    Surrogate. An individual authorized under this section to make 
health care decisions on behalf of a patient who lacks decision-making 
capacity. The term includes a health care agent, legal guardian, next-
of-kin, or close friend.
    (b) Informed consent. Patients receiving health care from VA have 
the right to accept or refuse any medical treatment or procedure 
recommended to them. Except as otherwise provided in this section, no 
medical treatment or procedure may be performed without the prior, 
voluntary informed consent of the patient.
    (1) In order to give informed consent, the patient must have 
decision-making capacity.
    (2) In the event that the patient lacks decision-making capacity, 
the requirements of this section are applicable to consent for 
treatments or procedures obtained from a surrogate acting on behalf of 
the patient.
    (c) General requirements for informed consent. Informed consent is 
the process by which the practitioner discloses to and discusses 
appropriate information with a patient so that the patient may make a 
voluntary choice about whether to accept the proposed diagnostic or 
therapeutic procedure or course of treatment. Appropriate information is 
information that a reasonable person in the patient's situation would 
expect to receive in order to make an informed choice about whether or 
not to undergo the treatment or procedure. (Appropriate information 
includes tests that yield information that is extremely sensitive or 
that may have a high risk of significant consequence (e.g., physical, 
social, psychological, legal, or economic) that a reasonable person 
would want to know and consider as part of his or her consent decision.) 
The specific information and level of detail required will vary 
depending on the nature of the treatment or procedure.
    (1) The informed consent discussion should be conducted in person 
with the patient whenever practical. If it is impractical to conduct the 
discussion in person, or the patient expresses a preference for 
communication through another modality, the discussion may be conducted 
by telephone, through video conference, or by other VA-approved 
electronic communication methods.
    (2) The practitioner must explain in language understandable to the 
patient each of the following, as appropriate to the treatment or 
procedure in question: The nature of the proposed procedure or 
treatment; expected benefits; reasonably foreseeable associated risks, 
complications or side effects; reasonable and available alternatives; 
and anticipated results if nothing is done.
    (3) The patient must be given the opportunity to ask questions, to 
indicate comprehension of the information provided, and to grant or 
withhold consent freely without coercion.
    (4) The practitioner must advise the patient if the proposed 
treatment is novel or unorthodox.
    (5) The patient may withhold or revoke consent at any time.
    (6) The practitioner may delegate to other trained personnel 
responsibility for providing the patient with clinical information 
needed for the patient to make a fully informed consent decision but 
must personally verify with the patient that the patient has been 
appropriately informed and voluntarily consents to the treatment or 
procedure.
    (7) Practitioners may provide necessary medical care in emergency 
situations without the express consent of the patient when all of the 
following apply:
    (i) Immediate medical care is necessary to preserve life or prevent 
serious impairment of the health of the patient.
    (ii) The patient is unable to consent.

[[Page 721]]

    (iii) The practitioner determines that the patient has no surrogate 
or that waiting to obtain consent from the surrogate would increase the 
hazard to the life or health of the patient.
    (d) Documentation of informed consent. (1) The informed consent 
process must be appropriately documented in the health record. For 
treatments and procedures that are low risk and within broadly accepted 
standards of medical practice, a progress note describing the clinical 
encounter and the treatment plan are sufficient to document that 
informed consent was obtained for such treatments or procedures. For 
tests that provide information that is extremely sensitive or that may 
have a high risk of significant consequences (e.g., physical, social, 
psychological, legal, or economic) that a patient might reasonably want 
to consider as part of the consent decision, the health record must 
specifically document that the patient or surrogate consented to the 
specific test.
    (2) The patient's and practitioner's signature on a form prescribed 
by VA for that purpose is required for all diagnostic and therapeutic 
treatments or procedures that meet any of the following criteria:
    (i) Require the use of sedation;
    (ii) Require anesthesia or narcotic analgesia;
    (iii) Are considered to produce significant discomfort to the 
patient;
    (iv) Have a significant risk of complication or morbidity; or
    (v) Require injections of any substance into a joint space or body 
cavity.
    (3) Consent for treatments and procedures that require signature 
consent must be documented in the health record on a form prescribed by 
VA for that purpose, or as otherwise specified in this paragraph (d).
    (i) If the patient or surrogate is unable to execute a signature on 
the form due to a physical impairment, the patient or surrogate may, in 
lieu of a signature, sign the consent form with an ``X'', thumbprint, or 
stamp. Two adult witnesses must witness the act of signing and sign the 
consent form. By signing, the witnesses are attesting only to the fact 
that they saw the patient or surrogate sign the form. As an alternative 
to such a patient or surrogate using a duly witnessed ``X'', thumbprint, 
or stamp to sign the form, a designated third party may sign the form if 
acting at the direction of the patient or surrogate and in the presence 
of the patient or surrogate. The signed form must be filed in the 
patient's health record.
    (ii) A properly executed VA-authorized consent form is valid for a 
period of 60 calendar days. If, however, the treatment plan involves 
multiple treatments or procedures, it will not be necessary to repeat 
the informed consent discussion and documentation so long as the course 
of treatment proceeds as planned, even if treatment extends beyond the 
60-day period. If there is a change in the patient's condition that 
might alter the diagnostic or therapeutic decision about upcoming or 
continuing treatment, the practitioner must initiate a new informed 
consent process and, if needed, complete a new signature consent form 
with the patient.
    (iii) When signature consent is required, but it is not practicable 
to obtain the signature in person following the informed consent 
discussion, a signed VA consent form transmitted by mail, facsimile, in 
by secure electronic mail, or other VA-approved modalities and scanned 
into the record, is adequate to proceed with treatment or procedure.
    (iv) When signature consent is required, but it is not practicable 
to obtain the signed consent form, the informed consent conversation 
conducted by telephone or video conference must be audiotaped, 
videotaped, or witnessed by a second VA employee in lieu of the signed 
consent form. The practitioner must document the details of the 
conversation in the medical record. If someone other than the patient is 
giving consent, the name of the person giving consent and the authority 
of that person to act as surrogate must be adequately identified in the 
medical record.
    (e) Patients who lack decision-making capacity--(1) Identifying a 
surrogate decision maker. If the practitioner who has primary 
responsibility for the patient determines that the patient lacks 
decision-making capacity and is unlikely

[[Page 722]]

to regain it within a reasonable period of time, informed consent must 
be obtained from the surrogate. Patients who are incapable of giving 
consent as a matter of law will be deemed to lack decision-making 
capacity for the purposes of this section.
    (i) The following persons are authorized to act as a surrogate to 
consent on behalf of a patient who lacks decision-making capacity in the 
following order of priority:
    (A) Health care agent;
    (B) Legal guardian;
    (C) Next-of-kin: a close relative of the patient eighteen years of 
age or older in the following priority: Spouse, child, parent, sibling, 
grandparent, or grandchild; or
    (D) Close friend.
    (ii) A surrogate generally assumes the same rights and 
responsibilities as the patient in the informed consent process. The 
surrogate's decision must be based on his or her knowledge of what the 
patient would have wanted; that is, substituted judgment, or, if the 
patient's specific values and wishes are unknown, the surrogate's 
decision must be based on the patient's best interest.
    (2) Consent for a patient without a surrogate. (i) If none of the 
surrogates listed in paragraph (e)(1) of this section is available, a 
practitioner may either request the assistance of District Chief Counsel 
to obtain a legal guardian for health care or follow the procedures 
outlined in paragraph (e)(2)(ii) of this section.
    (ii) Facilities may use the following process to make treatment 
decisions for patients who lack decision-making capacity and have no 
surrogate.
    (A) For treatments and procedures that involve minimal risk, the 
practitioner must verify that no authorized surrogate can be located, or 
that the surrogate is not available. The practitioner must attempt to 
explain the nature and purpose of the proposed treatment to the patient 
and enter this information in the health record.
    (B) For procedures that require signature consent, the practitioner 
must certify that the patient has no surrogate to the best of their 
knowledge. The attending physician and the Chief of Service (or 
designee) must indicate their approval of the treatment decision in 
writing. Any decision to withhold or withdraw life-sustaining treatment 
for such patients must be reviewed by a multi-disciplinary committee 
appointed by the facility Director, unless the patient has valid 
standing orders regarding life-sustaining treatment, such as state-
authorized portable orders. The committee functions as the patient's 
advocate and may not include members of the treatment team. The 
committee must submit its findings and recommendations in a written 
report to the Chief of Staff who must note his or her approval of the 
report in writing. The facility Director must be informed about the case 
and results of the review and may concur with the decision to withhold 
or withdraw life-sustaining treatment, delegate final decision-making 
authority to the facility Chief of Staff, or request further review by 
District Chief Counsel.
    (f) Special consent situations. (1) In the case of involuntarily 
committed patients where the forced administration of psychotropic 
medication is against the will of a patient (or the surrogate does not 
consent), the following procedural protections must be provided:
    (i) The patient or surrogate must be allowed to consult with 
independent specialists, legal counsel or other interested parties 
concerning the treatment with psychotropic medication. Any 
recommendation to administer or continue medication must be reviewed by 
a multi-disciplinary committee appointed by the facility Director for 
this purpose.
    (ii) The multi-disciplinary committee must include a psychiatrist or 
a physician who has psychopharmacology privileges. The facility Director 
must concur with the committee's recommendation to administer 
psychotropic medications contrary to the patient's or surrogate's 
wishes.
    (iii) Continued administration of psychotropic medication must be 
reviewed every 30 days. The patient (or a representative on the 
patient's behalf) may appeal the treatment decision to a court of 
appropriate jurisdiction.

[[Page 723]]

    (2) The patient must be informed if a proposed course of treatment 
or procedure involves approved medical research in whole or in part. If 
so, the patient's separate informed consent must be obtained for the 
components that constitute research pursuant to the informed consent 
requirements for human-subjects research set forth in part 16 of this 
title.
    (g) Advance directives--(1) General. To the extent consistent with 
applicable Federal law, VA policy, and generally accepted standards of 
medical practice, VA will follow the wishes of a patient expressed in a 
valid advance directive when the practitioner determines and documents 
in the patient's health record that the patient lacks decision-making 
capacity and is unlikely to regain it within a reasonable period of 
time. An advance directive that is valid in one or more states under 
applicable law, including a mental health (or psychiatric) advance 
directive, a valid Department of Defense advance medical directive, or a 
valid VA Advance Directive will be recognized throughout the VA health 
care system, except for components therein that are inconsistent with 
applicable Federal law, VA policy, or generally accepted standards of 
medical practice.
    (2) Signing and witness requirements. (i) A VA Advance Directive 
must be signed by the patient. If the patient is unable to sign a VA 
Advance Directive due to a physical impairment, the patient may sign the 
advance directive form with an ``X'', thumbprint, or stamp. In the 
alternative, the patient may designate a third party to sign the 
directive at the direction of the patient and in the presence of the 
patient.
    (ii) In all cases, a VA Advance Directive must be signed by the 
patient in the presence of both witnesses. Witnesses to the patient's 
signing of an advance directive are attesting by their signatures only 
to the fact that they saw the patient or designated third party sign the 
VA Advance Directive form. Neither witness may, to the witness' 
knowledge, be named as a beneficiary in the patient's estate, appointed 
as health care agent in the advance directive, or financially 
responsible for the patient's care. Nor may a witness be the designated 
third party who has signed the VA Advance Directive form at the 
direction of the patient and in the patient's presence.
    (3) Instructions in critical situations. In certain situations, a 
patient with decision-making capacity may present for care when 
critically ill and loss of decision-making capacity is imminent. In such 
situations, VA will document the patient's unambiguous verbal or non-
verbal instructions regarding preferences for future health care 
decisions. These instructions will be honored and given effect should 
the patient lose decision-making capacity before being able to complete 
a new advance directive. The patient's instructions must have been 
expressed to at least two members of the health care team. To confirm 
that the verbal or non-verbal instructions of the patient are, in fact, 
unambiguous, the substance of the patient's instructions and the names 
of at least two members of the health care team to whom they were 
expressed must be entered in the patient's electronic health record.
    (4) Revocation. A patient who has decision-making capacity may 
revoke an advance directive or instructions in a critical situation at 
any time by using any means expressing the intent to revoke.
    (5) VA policy and disputes. Neither the treatment team nor surrogate 
may override a patient's clear instructions in an advance directive or 
in instructions given in a critical situation, except that those 
portions of an advance directive or instructions given in a critical 
situation that are not consistent with applicable Federal law, VA 
policy, or generally accepted standards of medical practice will not be 
given effect.

(The information collection requirements in this section have been 
approved by the Office of Management and Budget under control number 
2900-0556)

[62 FR 53961, Oct. 17, 1997, as amended at 70 FR 71774, Nov. 30, 2005; 
71 FR 68740, Nov. 28, 2006; 72 FR 10366, Mar. 8, 2007; 74 FR 34503, July 
16, 2009; 85 FR 31701, May 27, 2020]



Sec.  17.33  Patients' rights.

    (a) General. (1) Patients have a right to be treated with dignity in 
a humane environment that affords them both reasonable protection from 
harm and

[[Page 724]]

appropriate privacy with regard to their personal needs.
    (2) Patients have a right to receive, to the extent of eligibility 
therefor under the law, prompt and appropriate treatment for any 
physical or emotional disability.
    (3) Patients have the right to the least restrictive conditions 
necessary to achieve treatment purposes.
    (4) No patient in the Department of Veterans Affairs medical care 
system, except as otherwise provided by the applicable State law, shall 
be denied legal rights solely by virtue of being voluntarily admitted or 
involuntarily committed. Such legal rights include, but are not limited 
to, the following:
    (i) The right to hold and to dispose of property except as may be 
limited in accordance with paragraph (c)(2) of this section;
    (ii) The right to execute legal instruments (e.g., will);
    (iii) The right to enter into contractual relationships;
    (iv) The right to register and vote;
    (v) The right to marry and to obtain a separation, divorce, or 
annulment;
    (vi) The right to hold a professional, occupational, or vehicle 
operator's license.
    (b) Residents and inpatients. Subject to paragraphs (c) and (d) of 
this section, patients admitted on a residential or inpatient care basis 
to the Department of Veterans Affairs medical care system have the 
following rights:
    (1) Visitations and communications. Each patient has the right to 
communicate freely and privately with persons outside the facility, 
including government officials, attorneys, and clergymen. To facilitate 
these communications each patient shall be provided the opportunity to 
meet with visitors during regularly scheduled visiting hours, convenient 
and reasonable access to public telephones for making and receiving 
phone calls, and the opportunity to send and receive unopened mail.
    (i) Communications with attorneys, law enforcement agencies, or 
government officials and representatives of recognized service 
organizations when the latter are acting as agents for the patient in a 
matter concerning Department of Veterans Affairs benefits, shall not be 
reviewed.
    (ii) A patient may refuse visitors.
    (iii) If a patient's right to receive unopened mail is restricted 
pursuant to paragraph (c) of this section, the patient shall be required 
to open the sealed mail while in the presence of an appropriate person 
for the sole purpose of ascertaining whether the mail contains 
contraband material, i.e., implements which pose significant risk of 
bodily harm to the patient or others or any drugs or medication. Any 
such material will be held for the patient or disposed of in accordance 
with instructions concerning patients' mail published by the Veterans 
Health Administration, Department of Veterans Affairs, and/or the local 
health care facility.
    (iv) Each patient shall be afforded the opportunity to purchase, at 
the patient's expense, letter writing material including stamps. In the 
event a patient needs assistance in purchasing writing material, or in 
writing, reading or sending mail, the medical facility will attempt, at 
the patient's request, to provide such assistance by means of 
volunteers, sufficient to mail at least one (1) letter each week.
    (v) All information gained by staff personnel of a medical facility 
during the course of assisting a patient in writing, reading, or sending 
mail is to be kept strictly confidential except for any disclosure 
required by law.
    (2) Clothing. Each patient has the right to wear his or her own 
clothing.
    (3) Personal Possessions. Each patient has the right to keep and use 
his or her own personal possessions consistent with available space, 
governing fire safety regulations, restrictions on noise, and 
restrictions on possession of contraband material, drugs and 
medications.
    (4) Money. Each patient has the right to keep and spend his or her 
own money and to have access to funds in his or her account in 
accordance with instructions concerning personal funds of patients 
published by the Veterans Health Administration.
    (5) Social Interaction. Each patient has the right to social 
interaction with others.

[[Page 725]]

    (6) Exercise. Each patient has the right to regular physical 
exercise and to be outdoors at regular and frequent intervals. 
Facilities and equipment for such exercise shall be provided.
    (7) Worship. The opportunity for religious worship shall be made 
available to each patient who desires such opportunity. No patient will 
be coerced into engaging in any religious activities against his or her 
desires.
    (c) Restrictions. (1) A right set forth in paragraph (b) of this 
section may be restricted within the patient's treatment plan by written 
order signed by the appropriate health care professional if--
    (i) It is determined pursuant to paragraph (c)(2) of this section 
that a valid and sufficient reason exists for a restriction, and
    (ii) The order imposing the restriction and a progress note 
detailing the indications therefor are both entered into the patient's 
permanent medical record.
    (2) For the purpose of paragraph (c) of this section, a valid and 
sufficient reason exists when, after consideration of pertinent facts, 
including the patient's history, current condition and prognosis, a 
health care professional reasonably believes that the full exercise of 
the specific right would--
    (i) Adversely affect the patient's physical or mental health,
    (ii) Under prevailing community standards, likely stigmatize the 
patient's reputation to a degree that would adversely affect the 
patient's return to independent living,
    (iii) Significantly infringe upon the rights of or jeopardize the 
health or safety of others, or
    (iv) Have a significant adverse impact on the operation of the 
medical facility, to such an extent that the patient's exercise of the 
specific right should be restricted. In determining whether a patient's 
specific right should be restricted, the health care professional 
concerned must determine that the likelihood and seriousness of the 
consequences that are expected to result from the full exercise of the 
right are so compelling as to warrant the restriction. The Chief of 
Service or Chief of Staff, as designated by local policy, should concur 
with the decision to impose such restriction. In this connection, it 
should be noted that there is no intention to imply that each of the 
reasons specified in paragraphs (c)(2)(i) through (iv) of this section 
are logically relevant to each of the rights set forth in paragraph 
(b)(1) of this section.
    (3) If it has been determined under paragraph (c)(2) of this section 
that a valid and sufficient reason exists for restricting any of the 
patient's rights set forth in paragraph (b) of this section, the least 
restrictive method for protecting the interest or interests specified in 
paragraphs (c)(2)(i) through (iv) of this section that are involved 
shall be employed.
    (4) The patient must be promptly notified of any restriction imposed 
under paragraph (c) of this section and the reasons therefor.
    (5) All restricting orders under paragraph (c) of this section must 
be reviewed at least once every 30 days by the practitioner and must be 
concurred in by the Chief of Service or Chief of Staff.
    (d) Restraint and seclusion of patients. (1) Each patient has the 
right to be free from physical restraint or seclusion except in 
situations in which there is a substantial risk of imminent harm by the 
patient to himself, herself, or others and less restrictive means of 
preventing such harm have been determined to be inappropriate or 
insufficient. Patients will be physically restrained or placed in 
seclusion only on the written order of an appropriate licensed health 
care professional. The reason for any restraint order will be clearly 
documented in the progress notes of the patient's medical record. The 
written order may be entered on the basis of telephonic authority, but 
in such an event, an appropriate licensed health care professional must 
examine the patient and sign a written order within an appropriate 
timeframe that is in compliance with current community and/or 
accreditation standards. In emergency situations, where inability to 
contact an appropriate licensed health care professional prior to 
restraint is likely to result in immediate harm to the patient or 
others, the patient may be temporarily restrained by a member of the 
staff until

[[Page 726]]

appropriate authorization can be received from an appropriate licensed 
health care professional . Use of restraints or seclusion may continue 
for a period of time that does not exceed current community and/or 
accreditation standards, within which time an appropriate licensed 
health care professional shall again be consulted to determine if 
continuance of such restraint or seclusion is required. Restraint or 
seclusion may not be used as a punishment, for the convenience of staff, 
or as a substitute for treatment programs.
    (2) While in restraint or seclusion, the patient must be seen within 
appropriate timeframes in compliance with current community and/or 
accreditation standards:
    (i) By an appropriate health care professional who will monitor and 
chart the patient's physical and mental condition; and
    (ii) By other ward personnel as frequently as is reasonable under 
existing circumstances.
    (3) Each patient in restraint or seclusion shall have bathroom 
privileges according to his or her needs.
    (4) Each patient in restraint or seclusion shall have the 
opportunity to bathe at least every twenty-four (24) hours.
    (5) Each patient in restraint or seclusion shall be provided 
nutrition and fluid appropriately.
    (e) Medication. Patients have a right to be free from unnecessary or 
excessive medication. Except in an emergency, medication will be 
administered only on a written order of an appropriate health care 
professional in that patient's medical record. The written order may be 
entered on the basis of telephonic authority received from an 
appropriate health care professional, but in such event, the written 
order must be countersigned by an appropriate health care professional 
within 24 hours of the ordering of the medication. An appropriate health 
care professional will be responsible for all medication given or 
administered to a patient. A review by an appropriate health care 
professional of the drug regimen of each inpatient shall take place at 
least every thirty (30) days. It is recognized that administration of 
certain medications will be reviewed more frequently. Medication shall 
not be used as punishment, for the convenience of the staff, or in 
quantities which interfere with the patient's treatment program.
    (f) Confidentiality. Information gained by staff from the patient or 
the patient's medical record will be kept confidential and will not be 
disclosed except in accordance with applicable law.
    (g) Patient grievances. Each patient has the right to present 
grievances with respect to perceived infringement of the rights 
described in this section or concerning any other matter on behalf of 
himself, herself or others, to staff members at the facility in which 
the patient is receiving care, other Department of Veterans Affairs 
officials, government officials, members of Congress or any other person 
without fear or reprisal.
    (h) Notice of patient's rights. Upon the admission of any patient, 
the patient or his/her representative shall be informed of the rights 
described in this section, shall be given a copy of a statement of those 
rights and shall be informed of the fact that the statement of rights is 
posted at each nursing station. All staff members assigned to work with 
patients will be given a copy of the statement of rights and these 
rights will be discussed with them by their immediate supervisor.
    (i) Other rights. The rights described in this section are in 
addition to and not in derogation of any statutory, constitutional or 
other legal rights.

(Authority: 38 U.S.C. 501, 1721)

[47 FR 55486, Dec. 10, 1982. Redesignated at 61 FR 21965, May 13, 1996, 
as amended at 70 FR 67094, Nov. 4, 2005]

                  Tentative Eligibility Determinations



Sec.  17.34  Tentative eligibility determinations.

    Subject to the provisions of Sec. Sec.  17.36 through 17.38, when an 
application for hospital care or other medical services, except 
outpatient dental care, has been filed which requires an adjudication as 
to service connection or a determination as to any other eligibility 
prerequisite which cannot immediately be established, the service 
(including

[[Page 727]]

transportation) may be authorized without further delay if it is 
determined that eligibility for care probably will be established. 
Tentative eligibility determinations under this section, however, will 
only be made if:
    (a) In emergencies. The applicant needs hospital care or other 
medical services in emergency circumstances, or
    (b) Based on discharge. The application is filed within 6 months 
after date of discharge under conditions other than dishonorable, and 
for a veteran who seeks eligibility based on a period of service that 
began after September 7, 1980, the veteran must meet the applicable 
minimum service requirements under 38 U.S.C. 5303A.

(Authority: 38 U.S.C. 501, 5303A)

[35 FR 6586, Apr. 24, 1970. Redesignated at 61 FR 21965, May 13, 1996, 
as amended at 64 FR 54212, Oct. 6, 1999; 78 FR 28142, May 14, 2013]

 Hospital or Nursing Home Care and Medical Services in Foreign Countries



Sec.  17.35  Hospital care and outpatient services in foreign countries.

    (a) Under the VA Foreign Medical Program, VA may furnish hospital 
care and outpatient services to any veteran outside of the United 
States, without regard to the veteran's citizenship:
    (1) If necessary for treatment of a service-connected disability, or 
any disability associated with and held to be aggravating a service-
connected disability;
    (2) If the care and services are furnished to a veteran 
participating in a rehabilitation program under 38 U.S.C. chapter 31 who 
requires care and services for the reasons enumerated in Sec.  
17.47(i)(2).
    (b) Under the Foreign Medical Program, the care and services 
authorized under paragraph (a) of this section are available in the 
Republic of the Philippines to a veteran who meets the requirements of 
paragraph (a) of this section. VA may also provide outpatient services 
to a veteran referenced in paragraph (a)(1) in the VA outpatient clinic 
in Manila for the treatment of such veteran's service-connected 
conditions within the limits of the clinic. Non-service connected 
conditions of a veteran who has a service-connected disability may be 
treated within the limits of the VA outpatient clinic in Manila.
    (c) Claims for payment or reimbursement for services not previously 
authorized by VA under this section are governed by Sec. Sec.  17.123-
17.127 and 17.129-17.132.

[83 FR 29448, June 25, 2018]

           Enrollment Provisions and Medical Benefits Package



Sec.  17.36  Enrollment--provision of hospital and outpatient care to veterans.

    (a) Enrollment requirement for veterans. (1) Except as otherwise 
provided in Sec.  17.37, a veteran must be enrolled in the VA healthcare 
system as a condition for receiving the 'medical benefits package' set 
forth in Sec.  17.38.

    Note to paragraph (a)(1): A veteran may apply to be enrolled at any 
time. (See Sec.  17.36(d)(1).)

    (2) Except as provided in paragraph (a)(3) of this section, a 
veteran enrolled under this section and who, if required by law to do 
so, has agreed to make any applicable copayment is eligible for VA 
hospital and outpatient care as provided in the ``medical benefits 
package'' set forth in Sec.  17.38.

    Note to paragraph (a)(2): A veteran's enrollment status will be 
recognized throughout the United States.

    (3) A veteran enrolled based on having a disorder associated with 
exposure to a toxic substance or radiation, for a disorder associated 
with service in the Southwest Asia theater of operations during the Gulf 
War (the period between August 2, 1990, and November 11, 1998), or any 
illness associated with service in combat in a war after the Gulf War or 
during a period of hostility after November 11, 1998, as provided in 38 
U.S.C. 1710(e), is eligible for VA care provided in the ``medical 
benefits package'' set forth in Sec.  17.38 for the disorder.
    (b) Categories of veterans eligible to be enrolled. The Secretary 
will determine which categories of veterans are eligible to be enrolled 
based on the following order of priority:
    (1) Veterans with a singular or combined rating of 50 percent or 
greater

[[Page 728]]

based on one or more service-connected disabilities or unemployability; 
and veterans awarded the Medal of Honor.
    (2) Veterans with a singular or combined rating of 30 percent or 40 
percent based on one or more service-connected disabilities.
    (3) Veterans who are former prisoners of war; veterans awarded the 
Purple Heart; veterans with a singular or combined rating of 10 percent 
or 20 percent based on one or more service-connected disabilities; 
veterans who were discharged or released from active military service 
for a disability incurred or aggravated in the line of duty; veterans 
who receive disability compensation under 38 U.S.C. 1151; veterans whose 
entitlement to disability compensation is suspended pursuant to 38 
U.S.C. 1151, but only to the extent that such veterans' continuing 
eligibility for that care is provided for in the judgment or settlement 
described in 38 U.S.C. 1151; veterans whose entitlement to disability 
compensation is suspended because of the receipt of military retired 
pay; and veterans receiving compensation at the 10 percent rating level 
based on multiple noncompensable service-connected disabilities that 
clearly interfere with normal employability.
    (4) Veterans who receive increased pension based on their need for 
regular aid and attendance or by reason of being permanently housebound 
and other veterans who are determined to be catastrophically disabled by 
the Chief of Staff (or equivalent clinical official) at the VA facility 
where they were examined.
    (5) Veterans not covered by paragraphs (b)(1) through (b)(4) of this 
section who are determined to be unable to defray the expenses of 
necessary care under 38 U.S.C. 1722(a).
    (6) Veterans of the Mexican border period or of World War I; 
veterans solely seeking care for a disorder associated with exposure to 
a toxic substance or radiation, for a disorder associated with service 
in the Southwest Asia theater of operations during the Gulf War (the 
period between August 2, 1990, and November 11, 1998), or for any 
illness associated with service in combat in a war after the Gulf War or 
during a period of hostility after November 11, 1998, as provided and 
limited in 38 U.S.C. 1710(e); Camp Lejeune veterans pursuant to Sec.  
17.400; and veterans with 0 percent service-connected disabilities who 
are nevertheless compensated, including veterans receiving compensation 
for inactive tuberculosis.
    (7) Veterans who agree to pay to the United States the applicable 
copayment determined under 38 U.S.C. 1710(f) and 1710(g) if their income 
for the previous year constitutes ``low income'' under the geographical 
income limits established by the U.S. Department of Housing and Urban 
Development for the fiscal year that ended on September 30 of the 
previous calendar year. For purposes of this paragraph, VA will 
determine the income of veterans (to include the income of their spouses 
and dependents) using the rules in Sec. Sec.  3.271, 3.272, 3.273, and 
3.276. After determining the veterans' income and the number of persons 
in the veterans' family (including only the spouse and dependent 
children), VA will compare their income with the current applicable 
``low-income'' income limit for the public housing and section 8 
programs in their area that the U.S. Department of Housing and Urban 
Development publishes pursuant to 42 U.S.C. 1437a(b)(2). If the 
veteran's income is below the applicable ``low-income'' income limits 
for the area in which the veteran resides, the veteran will be 
considered to have ``low income'' for purposes of this paragraph. To 
avoid a hardship to a veteran, VA may use the projected income for the 
current year of the veteran, spouse, and dependent children if the 
projected income is below the ``low income'' income limit referenced 
above. This category is further prioritized into the following 
subcategories:
    (i) Noncompensable zero percent service-connected veterans who are 
in an enrolled status on a specified date announced in a Federal 
Register document promulgated under paragraph (c) of this section and 
who subsequently do not request disenrollment;
    (ii) Nonservice-connected veterans who are in an enrolled status on 
a specified date announced in a Federal Register document promulgated 
under paragraph (c) of this section and who

[[Page 729]]

subsequently do not request disenrollment;
    (iii) Noncompensable zero percent service-connected veterans not 
included in paragraph (b)(7)(i) of this section; and
    (iv) Nonservice-connected veterans not included in paragraph 
(b)(7)(ii) of this section.
    (8) Veterans not included in priority category 4 or 7, who are 
eligible for care only if they agree to pay to the United States the 
applicable copayment determined under 38 U.S.C. 1710(f) and 1710(g). 
This category is further prioritized into the following subcategories:
    (i) Noncompensable zero percent service-connected veterans who were 
in an enrolled status on January 17, 2003, or who are moved from a 
higher priority category or subcategory due to no longer being eligible 
for inclusion in such priority category or subcategory and who 
subsequently do not request disenrollment;
    (ii) Noncompensable zero percent service-connected veterans not 
included in paragraph (b)(8)(i) of this section and whose income is not 
greater than ten percent more than the income that would permit their 
enrollment in priority category 5 or priority category 7, whichever is 
higher;
    (iii) Nonservice-connected veterans who were in an enrolled status 
on January 17, 2003, or who are moved from a higher priority category or 
subcategory due to no longer being eligible for inclusion in such 
priority category or subcategory and who subsequently do not request 
disenrollment;
    (iv) Nonservice-connected veterans not included in paragraph 
(b)(8)(iii) of this section and whose income is not greater than ten 
percent more than the income that would permit their enrollment in 
priority category 5 or priority category 7, whichever is higher;
    (v) Noncompensable zero percent service-connected veterans not 
included in paragraph (b)(8)(i) or paragraph (b)(8)(ii) of this section; 
and
    (vi) Nonservice-connected veterans not included in paragraph 
(b)(8)(iii) or paragraph (b)(8)(iv) of this section.
    (c) Federal Register notification of eligible enrollees.  (1) It is 
anticipated that each year the Secretary will consider whether to change 
the categories and subcategories of veterans eligible to be enrolled. 
The Secretary at any time may revise the categories or subcategories of 
veterans eligible to be enrolled by amending paragraph (c)(2) of this 
section. The preamble to a Federal Register document announcing which 
priority categories and subcategories are eligible to be enrolled must 
specify the projected number of fiscal year applicants for enrollment in 
each priority category, projected healthcare utilization and 
expenditures for veterans in each priority category, appropriated funds 
and other revenue projected to be available for fiscal year enrollees, 
and projected total expenditures for enrollees by priority category. The 
determination should include consideration of relevant internal and 
external factors, e.g., economic changes, changes in medical practices, 
and waiting times to obtain an appointment for care. Consistent with 
these criteria, the Secretary will determine which categories of 
veterans are eligible to be enrolled based on the order of priority 
specified in paragraph (b) of this section.
    (2) Unless changed by a rulemaking document in accordance with 
paragraph (c)(1) of this section, VA will enroll the priority categories 
of veterans set forth in Sec.  17.36(b) beginning June 15, 2009, except 
that those veterans in subcategories (v) and (vi) of priority category 8 
are not eligible to be enrolled.
    (d) Enrollment and disenrollment process--(1) Application for 
enrollment. A veteran who wishes to be enrolled must apply by submitting 
a VA Form 10-10EZ:
    (i) To a VA medical facility or by mail it to the U.S. Postal 
address on the form; or
    (ii) Online at the designated World Wide Web internet address; or
    (iii) By calling a designated telephone number and submitting 
application information verbally. To complete a telephone application, 
the veteran seeking enrollment must attest to the accuracy and 
authenticity of their verbal application for enrollment and consent to 
VA's copayment requirements and third-party billing procedures.

[[Page 730]]

    (2) Action on application. Upon receipt of a completed VA Form 10-
10EZ, a VA network or facility director, or the Deputy Under Secretary 
for Health for Operations and Management or Chief, Health Administration 
Service or equivalent official at a VA medical facility, or Director, 
Health Eligibility Center, will accept a veteran as an enrollee upon 
determining that the veteran is in a priority category eligible to be 
enrolled as set forth in Sec.  17.36(c)(2). Upon determining that a 
veteran is not in a priority category eligible to be enrolled, the VA 
network or facility director, or the Deputy Under Secretary for Health 
for Operations and Management or Chief, Health Administration Service or 
equivalent official at a VA medical facility, or Director, Health 
Eligibility Center, will inform the applicant that the applicant is 
ineligible to be enrolled.
    (3) Placement in enrollment categories. (i) Veterans will be placed 
in priority categories whether or not veterans in that category are 
eligible to be enrolled.
    (ii) A veteran will be placed in the highest priority category or 
categories for which the veteran qualifies.
    (iii) A veteran may be placed in only one priority category, except 
that a veteran placed in priority category 6 based on a specified 
disorder or illness will also be placed in priority category 7 or 
priority category 8, as applicable, if the veteran has previously agreed 
to pay the applicable copayment, for all matters not covered by priority 
category 6.
    (iv) A veteran who had been enrolled based on inclusion in priority 
category 5 and became no longer eligible for inclusion in priority 
category 5 due to failure to submit to VA a current VA Form 10-10EZ will 
be changed automatically to enrollment based on inclusion in priority 
category 6 or 8 (or more than one of these categories if the previous 
principle applies), as applicable, and be considered continuously 
enrolled. To meet the criteria for priority category 5, a veteran must 
be eligible for priority category 5 based on the information submitted 
to VA in a current VA Form 10-10EZ. To be current, after VA has sent a 
form 10-10EZ to the veteran at the veteran's last known address, the 
veteran must return the completed form (including signature) to the 
address on the return envelope within 60 days from the date VA sent the 
form to the veteran.
    (v) Veterans will be disenrolled, and reenrolled, in the order of 
the priority categories listed with veterans in priority category 1 
being the last to be disenrolled and the first to be reenrolled. 
Similarly, within priority categories 7 and 8, veterans will be 
disenrolled, and reenrolled, in the order of the priority subcategories 
listed with veterans in subcategory (i) being the last to be disenrolled 
and first to be reenrolled.
    (4) [Reserved]
    (5) Disenrollment. A veteran enrolled in the VA health care system 
under paragraph (d)(2) of this section will be disenrolled only if:
    (i) The veteran submits to a VA Medical Center or to the VA Health 
Eligibility Center, 2957 Clairmont Road, NE., Suite 200, Atlanta, 
Georgia 30329-1647, a signed and dated document stating that the veteran 
no longer wishes to be enrolled; or
    (ii) A VA network or facility director, or the Deputy Under 
Secretary for Health for Operations and Management or Chief, Health 
Administration Service or equivalent official at a VA medical facility, 
or Director, Health Eligibility Center, determines that the veteran is 
no longer in a priority category eligible to be enrolled, as set forth 
in Sec.  17.36(c)(2).
    (6) Notification of enrollment status. Notice of a decision by a VA 
network or facility director, or the Deputy Under Secretary for Health 
for Operations and Management or Chief, Health Administration Service or 
equivalent official at a VA medical facility, or Director, Health 
Eligibility Center, regarding enrollment status will be provided to the 
affected veteran by letter and will contain the reasons for the 
decision. The letter will include an effective date for any changes and 
a statement regarding appeal rights. The decision will be based on all 
information available to the decisionmaker, including the information 
contained in VA Form 10-10EZ.

[[Page 731]]

    (e) Catastrophically disabled. For purposes of this section, 
catastrophically disabled means to have a permanent severely disabling 
injury, disorder, or disease that compromises the ability to carry out 
the activities of daily living to such a degree that the individual 
requires personal or mechanical assistance to leave home or bed or 
requires constant supervision to avoid physical harm to self or others. 
This definition is met if an individual has been found by the Chief of 
Staff (or equivalent clinical official) at the VA facility where the 
individual was examined to have a permanent condition specified in 
paragraph (e)(1) of this section; to meet permanently one of the 
conditions specified in paragraph (e)(2) of this section by a clinical 
evaluation of the patient's medical records that documents that the 
patient previously met the permanent criteria and continues to meet such 
criteria (permanently) or would continue to meet such criteria 
(permanently) without the continuation of on-going treatment; or to meet 
permanently one of the conditions specified in paragraph (e)(2) of this 
section by a current medical examination that documents that the patient 
meets the permanent criteria and will continue to meet such criteria 
(permanently) or would continue to meet such criteria (permanently) 
without the continuation of on-going treatment.
    (1) Quadriplegia and quadriparesis; paraplegia; legal blindness 
defined as visual impairment of 20/200 or less visual acuity in the 
better seeing eye with corrective lenses, or a visual field restriction 
of 20 degrees or less in the better seeing eye with corrective lenses; 
persistent vegetative state; or a condition resulting from two of the 
following procedures, provided the two procedures were not on the same 
limb:
    (i) Amputation, detachment, or reamputation of or through the hand;
    (ii) Disarticulation, detachment, or reamputation of or through the 
wrist;
    (iii) Amputation, detachment, or reamputation of the forearm at or 
through the radius and ulna;
    (iv) Amputation, detachment, or disarticulation of the forearm at or 
through the elbow;
    (v) Amputation, detachment, or reamputation of the arm at or through 
the humerus;
    (vi) Disarticulation or detachment of the arm at or through the 
shoulder;
    (vii) Interthoracoscapular (forequarter) amputation or detachment;
    (viii) Amputation, detachment, or reamputation of the leg at or 
through the tibia and fibula;
    (ix) Amputation or detachment of or through the great toe;
    (x) Amputation or detachment of or through the foot;
    (xi) Disarticulation or detachment of the foot at or through the 
ankle;
    (xii) Amputation or detachment of the foot at or through malleoli of 
the tibia and fibula;
    (xiii) Amputation or detachment of the lower leg at or through the 
knee;
    (xiv) Amputation, detachment, or reamputation of the leg at or 
through the femur;
    (xv) Disarticulation or detachment of the leg at or through the hip; 
and
    (xvi) Interpelviaabdominal (hindquarter) amputation or detachment.
    (2)(i) Dependent in 3 or more Activities of Daily Living (eating, 
dressing, bathing, toileting, transferring, incontinence of bowel and/or 
bladder), with at least 3 of the dependencies being permanent with a 
rating of 1, using the Katz scale.
    (ii) A score of 2 or lower on at least 4 of the 13 motor items using 
the Functional Independence Measure.
    (iii) A score of 30 or lower using the Global Assessment of 
Functioning.
    (f) VA Form 10-10EZ. Copies of VA Form 10-10EZ are available at any 
VA medical center and at https://www.1010ez.med.va.gov/sec/vha/1010ez/.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0091)

(Authority: 38 U.S.C 101, 501, 1521, 1701, 1705, 1710, 1721, 1722)

[64 FR 54212, Oct. 6, 1999, as amended at 67 FR 35039, May 17, 2002; 67 
FR 62887, Oct. 9, 2002; 68 FR 2672, Jan. 17, 2003; 74 FR 22834, May 15, 
2009; 74 FR 48012, Sept. 21, 2009; 75 FR 52628, Aug. 27, 2010; 76 FR 
52274, Aug. 22, 2011; 79 FR 72578, Dec. 3, 2013; 79 FR 57414, Sept. 24, 
2014; 81 FR 13997, Mar. 16, 2016; 84 FR 7815, Mar. 5, 2019]

[[Page 732]]



Sec.  17.37  Enrollment not required--provision of hospital and outpatient
care to veterans.

    Even if not enrolled in the VA healthcare system:
    (a) A veteran rated for service-connected disabilities at 50 percent 
or greater will receive VA care provided for in the ``medical benefits 
package'' set forth in Sec.  17.38.
    (b) A veteran who has a service-connected disability will receive VA 
care provided for in the ``medical benefits package'' set forth in Sec.  
17.38 for that service-connected disability.
    (c) A veteran who was discharged or released from active military 
service for a disability incurred or aggravated in the line of duty will 
receive VA care provided for in the ``medical benefits package'' set 
forth in Sec.  17.38 for that disability for the 12-month period 
following discharge or release.
    (d) When there is a compelling medical need to complete a course of 
VA treatment started when the veteran was enrolled in the VA healthcare 
system, a veteran will receive that treatment.
    (e) Subject to the provisions of Sec.  21.240, a veteran 
participating in VA's vocational rehabilitation program described in 
Sec. Sec.  21.1 through 21.430 will receive VA care provided for in the 
``medical benefits package'' set forth in Sec.  17.38.
    (f) A veteran may receive care provided for in the 'medical benefits 
package' based on factors other than veteran status (e.g., a veteran who 
is a private-hospital patient and is referred to VA for a diagnostic 
test by that hospital under a sharing contract; a veteran who is a VA 
employee and is examined to determine physical or mental fitness to 
perform official duties; a Department of Defense retiree under a sharing 
agreement).
    (g) For care not provided within a State, a veteran may receive VA 
care provided for in the ``medical benefits package'' set forth in Sec.  
17.38 if authorized under the provisions of 38 U.S.C. 1724 and 38 CFR 
17.35.
    (h) Commonwealth Army veterans and new Philippine Scouts may receive 
care provided for in the ``medical benefits package'' set forth in Sec.  
17.38 if authorized under the provisions of 38 U.S.C. 1724 and 38 CFR 
17.35.
    (i) A veteran may receive certain types of VA care not included in 
the ``medical benefits package'' set forth in Sec.  17.38 if authorized 
by statute or other sections of 38 CFR (e.g., humanitarian emergency 
care for which the individual will be billed, compensation and pension 
examinations, dental care, domiciliary care, nursing home care, 
readjustment counseling, care as part of a VA-approved research project, 
seeing-eye or guide dogs, sexual trauma counseling and treatment, 
special registry examinations).
    (j) A veteran may receive an examination to determine whether the 
veteran is catastrophically disabled and therefore eligible for 
inclusion in priority category 4.
    (k) A veteran may receive care for psychosis or mental illness other 
than psychosis pursuant to 38 CFR 17.109.

(Authority: 38 U.S.C. 101, 501, 1701, 1705, 1710, 1721, 1722)

[64 FR 54217, Oct. 6, 1999, as amended at 67 FR 35039, May 17, 2002; 78 
FR 28142, May 14, 2013]



Sec.  17.38  Medical benefits package.

    (a) Subject to paragraphs (b) and (c) of this section, the following 
hospital, outpatient, and extended care services constitute the 
``medical benefits package'' (basic care and preventive care):
    (1) Basic care.
    (i) Outpatient medical, surgical, and mental healthcare, including 
care for substance abuse.
    (ii) Inpatient hospital, medical, surgical, and mental healthcare, 
including care for substance abuse.
    (iii) Prescription drugs, including over-the-counter drugs and 
medical and surgical supplies available under the VA national formulary 
system.
    (iv) Emergency care in VA facilities; and emergency care in non-VA 
facilities in accordance with sharing contracts or if authorized bySec.  
17.52(a)(3), Sec.  17.53, Sec.  17.54, Sec. Sec.  17.120 through 17.132, 
or Sec. Sec.  17.4000 through 17.4040.
    (v) Bereavement counseling as authorized in Sec.  17.98.
    (vi) Comprehensive rehabilitative services other than vocational 
services provided under 38 U.S.C. chapter 31.
    (vii) Consultation, professional counseling, marriage and family 
counseling,

[[Page 733]]

training, and mental health services for the members of the immediate 
family or legal guardian of the veteran or the individual in whose 
household the veteran certifies an intention to live, as necessary and 
appropriate, in connection with the veteran's treatment as authorized 
under 38 CFR 71.50.
    (viii) Prosthetic and rehabilitative items and services as 
authorized under Sec. Sec.  17.3200 through 17.3250, and eyeglasses and 
hearing aids as authorized under Sec.  17.149.
    (ix) Home health services authorized under 38 U.S.C. 1717 and 1720C.
    (x) Reconstructive (plastic) surgery required as a result of disease 
or trauma, but not including cosmetic surgery that is not medically 
necessary.
    (xi)(A) Hospice care, palliative care, and institutional respite 
care; and
    (B) Noninstitutional extended care services, including but not 
limited to noninstitutional geriatric evaluation, noninstitutional adult 
day health care, and noninstitutional respite care.
    (xii) Payment of beneficiary travel as authorized under 38 CFR part 
70.
    (xiii) Pregnancy and delivery services, to the extent authorized by 
law.
    (xiv) Newborn care, post delivery, for a newborn child for the date 
of birth plus seven calendar days after the birth of the child when the 
birth mother is a woman veteran enrolled in VA health care and receiving 
maternity care furnished by VA or under authorization from VA and the 
child is delivered either in a VA facility, or in another facility 
pursuant to a VA authorization for maternity care at VA expense.
    (xv) Completion of forms (e.g., Family Medical Leave forms, life 
insurance applications, Department of Education forms for loan repayment 
exemptions based on disability, non-VA disability program forms) by 
healthcare professionals based on an examination or knowledge of the 
veteran's condition, but not including the completion of forms for 
examinations if a third party customarily will pay health care 
practitioners for the examination but will not pay VA.
    (2) Preventive care, as defined in 38 U.S.C. 1701(9), which 
includes:
    (i) Periodic medical exams.
    (ii) Health education, including nutrition education.
    (iii) Maintenance of drug-use profiles, drug monitoring, and drug 
use education.
    (iv) Mental health and substance abuse preventive services.
    (v) Immunizations against infectious disease.
    (vi) Prevention of musculoskeletal deformity or other gradually 
developing disabilities of a metabolic or degenerative nature.
    (vii) Genetic counseling concerning inheritance of genetically 
determined diseases.
    (viii) Routine vision testing and eye-care services.
    (ix) Periodic reexamination of members of high-risk groups for 
selected diseases and for functional decline of sensory organs, and the 
services to treat these diseases and functional declines.
    (b) Provision of the ``medical benefits package''. Care referred to 
in the ``medical benefits package'' will be provided to individuals only 
if it is determined by appropriate health care professionals that the 
care is needed to promote, preserve, or restore the health of the 
individual and is in accord with generally accepted standards of medical 
practice.
    (1) Promote health. Care is deemed to promote health if the care 
will enhance the quality of life or daily functional level of the 
veteran, identify a predisposition for development of a condition or 
early onset of disease which can be partly or totally ameliorated by 
monitoring or early diagnosis and treatment, and prevent future disease.
    (2) Preserve health. Care is deemed to preserve health if the care 
will maintain the current quality of life or daily functional level of 
the veteran, prevent the progression of disease, cure disease, or extend 
life span.
    (3) Restoring health. Care is deemed to restore health if the care 
will restore the quality of life or daily functional level that has been 
lost due to illness or injury.
    (c) In addition to the care specifically excluded from the ``medical 
benefits package'' under paragraphs (a) and (b) of this section, the 
``medical benefits package'' does not include the following:

[[Page 734]]

    (1) Abortions and abortion counseling.
    (2) In vitro fertilization. Note: See Sec.  17.380.
    (3) Drugs, biologicals, and medical devices not approved by the Food 
and Drug Administration unless the treating medical facility is 
conducting formal clinical trials under an Investigational Device 
Exemption (IDE) or an Investigational New Drug (IND) application, or the 
drugs, biologicals, or medical devices are prescribed under a 
compassionate use exemption.
    (4) Gender alterations.
    (5) Hospital and outpatient care for a veteran who is either a 
patient or inmate in an institution of another government agency if that 
agency has a duty to give the care or services. This exclusion does not 
apply to veterans who are released from incarceration in a prison or 
jail into a temporary housing program (such as a community residential 
re-entry center or halfway house).
    (6) Membership in spas and health clubs.

[64 FR 54217, Oct. 6, 1999, as amended at 67 FR 35039, May 17, 2002; 73 
FR 36798, June 30, 2008; 75 FR 54030, Sept. 3, 2010; 76 FR 11339, Mar. 
2, 1011; 76 FR 26172, May 5, 2011; 76 FR 78571, Dec. 19, 2011; 82 FR 
6275, Jan. 19, 2017; 84 FR 26306, June 5, 2019; 86 FR 84259, Dec. 28, 
2020]



Sec.  17.39  Certain Filipino veterans.

    (a) Any Filipino Commonwealth Army veteran, including one who was 
recognized by authority of the U.S. Army as belonging to organized 
Filipino guerilla forces, or any new Philippine Scout is eligible for 
hospital care, nursing home care, and outpatient medical services within 
the United States in the same manner and subject to the same terms and 
conditions as apply to U.S. veterans, if such veteran or scout resides 
in the United States and is a citizen or lawfully admitted to the United 
States for permanent residence. For purposes of these VA health care 
benefits, the standards described in 38 CFR 3.42(c) will be accepted as 
proof of U.S. citizenship or lawful permanent residence.
    (b) Commonwealth Army Veterans, including those who were recognized 
by authority of the U.S. Army as belonging to organized Filipino 
guerilla forces, and new Philippine Scouts are not eligible for VA 
health care benefits if they do not meet the residency and citizenship 
requirements described in Sec.  3.42(c).


(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0091)


(Authority: 38 U.S.C. 501, 1734)

[71 FR 6680, Feb. 9, 2006]



Sec.  17.40  Additional services for indigents.

    In addition to the usual medical services agreed upon between the 
governments of the United States and the Republic of the Philippines to 
be made available to patients for whom the Department of Veterans 
Affairs has authorized care at the Veterans Memorial Medical Center, any 
such patient determined by the U.S. Department of Veterans Affairs to be 
indigent or without funds may be furnished toilet articles and barber 
services, including haircutting and shaving necessary for hygienic 
reasons.

[33 FR 5299, Apr. 3, 1968, as amended at 47 FR 58247, Dec. 30, 1982. 
Redesignated at 61 FR 21965, May 13, 1996]

              Examinations and Observation and Examination



Sec.  17.41  Persons eligible for hospital observation and physical
examination.

    Hospitalization for observation and physical (including mental) 
examination may be effected when requested by an authorized official, or 
when found necessary in examination of the following persons:
    (a) Claimants or beneficiaries of VA for purposes of disability 
compensation, pension, participation in a rehabilitation program under 
38 U.S.C. chapter 31, and Government insurance. (38 U.S.C. 1711(a))
    (b) Claimants or beneficiaries referred to a diagnostic center for 
study to determine the clinical identity of an obscure disorder.
    (c) Employees of the Department of Veterans Affairs when necessary 
to determine their mental or physical fitness to perform official 
duties.

[[Page 735]]

    (d) Claimants or beneficiaries of other Federal agencies:
    (1) Department of Justice--plaintiffs in Government insurance suits.
    (2) United States Civil Service Commission--annuitants or applicants 
for retirement annuity, and such examinations of prospective appointees 
as may be requested.
    (3) Office of Workers' Compensation Programs--to determine identity, 
severity, or persistence of disability.
    (4) Railroad Retirement Board--applicants for annuity under Public 
No. 162, 75th Congress.
    (5) Other Federal agencies.
    (e) Pensioners of nations allied with the United States in World War 
I and World War II, upon authorization from accredited officials of the 
respective governments.

[13 FR 7156, Nov. 27, 1948, as amended at 16 FR 12091, Nov. 30, 1951; 19 
FR 6716, Oct. 19, 1954; 32 FR 13813, Oct. 4, 1967; 39 FR 32606, Sept. 
10, 1974; 49 FR 5616, Feb. 14, 1984. Redesignated and amended at 61 FR 
21965, 21966, May 13, 1996]



Sec.  17.42  Examinations on an outpatient basis.

    Physical examinations on an outpatient basis may be furnished to 
applicants who have been tentatively determined to be eligible for 
Department of Veterans Affairs hospital or domiciliary care to determine 
their need for such care and to the same categories of persons for whom 
hospitalization for observation and examination may be authorized under 
Sec.  17.41.

[35 FR 6586, Apr. 24, 1970. Redesignated and amended at 61 FR 21965, 
21966, May 13, 1996]

               Hospital, Domiciliary and Nursing Home Care



Sec.  17.43  Persons entitled to hospital or domiciliary care.

    Hospital or domiciliary care may be provided:
    (a) Not subject to the eligibility provisions of 38 U.S.C. 1710, 
1722, and 1729, and 38 CFR 17.44 and 17.45, for:
    (1) Persons in the Armed Forces when duly referred with 
authorization therefor, may be furnished hospital care. Emergency 
treatment may be rendered, without obtaining formal authorization, to 
such persons upon their own application, when absent from their 
commands. Identification of active duty members of the uniformed 
services will be made by military identification card.
    (2) Hospital care may be provided, upon authorization, for 
beneficiaries of the Public Health Service, Office of Workers' 
Compensation Programs, and other Federal agencies.
    (3) Pensioners of nations allied with the United States in World War 
I and World War II may be supplied hospital care when duly authorized.
    (b) Emergency hospital care may be provided for:
    (1) Persons having no eligibility, as a humanitarian service.
    (2) Persons admitted because of presumed discharge or retirement 
from the Armed Forces, but subsequently found to be ineligible as such.
    (3) Employees (not potentially eligible as ex-members of the Armed 
Forces) and members of their families, when residing on reservations of 
field facilities of the Department of Veterans Affairs, and when they 
cannot feasibly obtain emergency treatment from private facilities.
    (c) Hospital care when incidental to, and to the extent necessary 
for, the use of a specialized Department of Veterans Affairs medical 
resource pursuant to a sharing agreement entered into under Sec.  
17.240, may be authorized for any person designated by the other party 
to the agreement as a patient to be benefited under the agreement.
    (d) The authorization of services under any provision of this 
section, except services for eligible veterans, is subject to charges as 
required by Sec.  17.102.

[23 FR 6498, Aug. 22, 1958, as amended at 24 FR 8327, Oct. 14, 1959; 32 
FR 6841, May 4, 1967; 34 FR 9340, June 13, 1969; 35 FR 6586, Apr. 24, 
1970; 39 FR 32606, Sept. 10, 1974. Redesignated and amended at 61 FR 
21965, 21966, May 13, 1996; 64 FR 54218, Oct. 6, 1999; 79 FR 54615, 
Sept. 12, 2014]



Sec.  17.44  Hospital care for certain retirees with chronic disability
(Executive Orders 10122, 10400 and 11733).

    Hospital care may be furnished when beds are available to members or 
former members of the uniformed services (Army, Navy, Air Force, Marine 
Corps, Coast Guard, Coast and Geodetic

[[Page 736]]

Survey, now National Oceanic and Atmospheric Administration hereinafter 
referred to as NOAA, and Public Health Service) temporarily or 
permanently retired for physical disability or receiving disability 
retirement pay who require hospital care for chronic diseases and who 
have no eligibility for hospital care under laws governing the 
Department of Veterans Affairs, or who having eligibility do not elect 
hospitalization as Department of Veterans Affairs beneficiaries. Care 
under this section is subject to the following conditions:
    (a) Persons defined in this section who are members or former 
members of the active military, naval, or air service must agree to pay 
the subsistence rate set by the Secretary of Veterans Affairs, except 
that no subsistence charge will be made for those persons who are 
members or former members of the Public Health Service, Coast Guard, 
Coast and Geodetic Survey now NOAA, and enlisted personnel of the Army, 
Navy, Marine Corps, and Air Force.
    (b) Under this section, the term chronic diseases shall include 
chronic arthritis, malignancy, psychiatric disorders, poliomyelitis with 
residuals, neurological disabilities, diseases of the nervous system, 
severe injuries to the nervous system, including quadriplegia, 
hemiplegia and paraplegia, tuberculosis, blindness and deafness 
requiring definitive rehabilitation, disability from major amputation, 
and other diseases as may be agreed upon from time to time by the Under 
Secretary for Health and designated officials of the Department of 
Defense and Department of Health and Human Services. For the purpose of 
this section, blindness is defined as corrected visual acuity of 20/200 
or less in the better eye, or corrected central visual acuity of more 
than 20/200 if there is a field defect in which the peripheral field has 
contracted to such an extent that its widest diameter subtends the 
widest diameter of the field of the better eye at an angle no greater 
than 20[deg].
    (c) In the case of persons who are former members of the Coast and 
Geodetic Survey, care may be furnished under this section even though 
their retirement for disability was from the Environmental Science 
Services Administration or NOAA.

[34 FR 9340, June 13, 1969, as amended at 39 FR 1841, Jan. 15, 1974; 47 
FR 58247, Dec. 30, 1982. Redesignated at 61 FR 21965, May 13, 1996, as 
amended at 62 FR 17072, Apr. 9, 1997]



Sec.  17.45  Hospital care for research purposes.

    Subject to Sec.  17.102(g), any person who is a bona fide volunteer 
may be admitted to a Department of Veterans Affairs hospital when the 
treatment to be rendered is part of an approved Department of Veterans 
Affairs research project and there are insufficient veteran-patients 
suitable for the project.

[35 FR 11470, July 17, 1970. Redesignated at 61 FR 21965, May 13, 1996; 
79 FR 54615, Sept. 12, 2014]



Sec.  17.46  Eligibility for hospital, domiciliary or nursing home care
of persons discharged or released from active military, naval, or air
service.

    (a) In furnishing hospital care on or before June 6, 2019, under 38 
U.S.C. 1710(a)(1), VA officials shall:
    (1) If the veteran is in immediate need of hospitalization, furnish 
care at VA facility where the veteran applies or, if that facility is 
incapable of furnishing care, arrange to admit the veteran to the 
nearest VA medical center, or Department of Defense hospital with which 
VA has a sharing agreement under 38 U.S.C. 8111, which is capable of 
providing the needed care, or if VA or DOD facilities are not available, 
arrange for care on a contract basis if authorized by 38 U.S.C. 1703 and 
38 CFR 17.52; or
    (2) If the veteran needs non-immediate hospitalization, schedule the 
veteran for admission at VA facility where the veteran applies, if the 
schedule permits, or refer the veteran for admission or scheduling for 
admission at the nearest VA medical center, or Department of Defense 
facility with which VA has a sharing agreement under 38 U.S.C. 8111.
    (b) Domiciliary care may be furnished when needed to:
    (1) Any veteran whose annual income does not exceed the maximum 
annual rate of pension payable to a veteran in need of regular aid and 
attendance, or

[[Page 737]]

    (2) Any veteran who the Secretary determines had no adequate means 
of support. An additional requirement for eligibility for domiciliary 
care is the ability of the veteran to perform the following:
    (i) Perform without assistance daily ablutions, such as brushing 
teeth; bathing; combing hair; body eliminations.
    (ii) Dress self, with a minimum of assistance.
    (iii) Proceed to and return from the dining hall without aid.
    (iv) Feed Self.
    (v) Secure medical attention on an ambulatory basis or by use of 
personally propelled wheelchair.
    (vi) Have voluntary control over body eliminations or control by use 
of an appropriate prosthesis.
    (vii) Share in some measure, however slight, in the maintenance and 
operation of the facility.
    (viii) Make rational and competent decisions as to his or her desire 
to remain or leave the facility.

[24 FR 8328, Oct. 4, 1959, as amended at 30 FR 1787, Feb. 9, 1965; 32 FR 
13813, Oct. 4, 1967; 34 FR 9340, June 13, 1969; 39 FR 1841, Jan. 15, 
1974; 45 FR 6935, Jan. 31, 1980; 51 FR 25064, July 10, 1986; 52 FR 
11259, Apr. 8, 1987; 53 FR 9627, Mar. 24, 1988; 53 FR 32391, Aug. 25, 
1988; 56 FR 5757, Feb. 13, 1991. Redesignated and amended at 61 FR 
21965, 21966, May 13, 1996; 84 FR 26306, June 5, 2019]



Sec.  17.47  Considerations applicable in determining eligibility for
hospital care, medical services, nursing home care, or domiciliary care.

    (a)(1) For applicants discharged or released for disability incurred 
or aggravated in line of duty and who are not in receipt of compensation 
for service-connected or service-aggravated disability, the official 
records of the Armed Forces relative to findings of line of duty for its 
purposes will be accepted in determining eligibility for hospital care 
or medical services. Where the official records of the Armed Forces show 
a finding of disability not incurred or aggravated in line of duty and 
evidence is submitted to the Department of Veterans Affairs which 
permits of a different finding, the decision of the Armed Forces will 
not be binding upon the Department of Veterans Affairs, which will be 
free to make its own determination of line of duty incurrence or 
aggravation upon evidence so submitted. It will be incumbent upon the 
applicant to present controverting evidence and, until such evidence is 
presented and a determination favorable to the applicant is made by the 
Department of Veterans Affairs, the finding of the Armed Forces will 
control and hospital care or medical services will not be authorized. 
Such controverting evidence, when received from an applicant, will be 
referred to the adjudicating agency which would have jurisdiction if the 
applicant was filing claim for pension or disability compensation, and 
the determination of such agency as to line of duty, which is promptly 
to be communicated to the head of the field facility receiving the 
application for hospital care or medical services , will govern the 
facility Director's disapproval or approval of such care or 
services,other eligibility requirements having been met. Where the 
official records of the Armed Forces show that the disability for which 
a veteran was discharged or released from the Armed Forces under other 
than dishonorable conditions was incurred or aggravated in the line of 
duty, such showing will be accepted for the purpose of determining his 
or her eligibility for hospital care or medical services, 
notwithstanding the fact that the Department of Veterans Affairs has 
made a determination in connection with a claim for monetary benefits 
that the disability was incurred or aggravated not in line of duty.
    (2) In those exceptional cases where the official records of the 
Armed Forces show discharge or release under other than dishonorable 
conditions because of expiration of period of enlistment or any other 
reason except disability, but also show a disability incurred or 
aggravated in line of duty during the said enlistment; and the 
disability so recorded is considered in medical judgment to be or to 
have been of such character, duration, and degree as to have justified a 
discharge or release for disability had the period of enlistment not 
expired or other reason for discharge or release been given, the Under 
Secretary for Health, upon consideration of a clear, full statement of

[[Page 738]]

circumstances, is authorized to approve hospital care or medical 
services, provided other eligibility requirements are met. A typical 
case of this kind will be one where the applicant was under treatment 
for the said disability recorded during his or her service at the time 
discharge or release was given for the reason other than disability.
    (b)(1) Under 38 U.S.C. 1710(a)(1), veterans who are receiving 
disability compensation awarded under Sec.  3.362 of this chapter, where 
a disease, injury or the aggravation of an existing disease or injury 
occurs as a result of VA examination, medical or surgical treatment, or 
of hospitalization in a VA health care facility or of participation in a 
rehabilitation program under 38 U.S.C. ch. 31, under any law 
administered by VA and not the result of his/her own willful misconduct. 
Treatment may be provided for the disability for which the compensation 
is being paid or for any other disability. Treatment under the authority 
of 38 U.S.C. 1710(a)(1) may not be authorized during any period when 
disability compensation under Sec.  3.362 of this title is not being 
paid because of the provision of Sec.  3.362(b), except to the extent 
continuing eligibility for such treatment is provided for in the 
judgment for settlement described in Sec.  3.362(b) of this title.


(Authority: 38 U.S.C. 1710(a); sec. 701, Pub. L. 98-160, Pub. L. 99-272)

    (2) For purposes of eligibility for domiciliary care, the phrase no 
adequate means of support refers to an applicant for domiciliary care 
whose annual income exceeds the annual rate of pension for a veteran in 
receipt of regular aid and attendance, as defined in 38 U.S.C. 1503, but 
who is able to demonstrate to competent VA medical authority, on the 
basis of objective evidence, that deficits in health and/or functional 
status render the applicant incapable of pursuing substantially gainful 
employment, as determined by the Chief of Staff, and who is otherwise 
without the means to provide adequately for self, or be provided for in 
the community.


(Authority: 38 U.S.C. 1710(a); sec. 701, Pub. L. 98-160, Pub. L. 99-272)

    (c) A disability, disease, or defect will comprehend any acute, 
subacute, or chronic disease (or a general medical, tuberculous, or 
neuropsychiatric type) of any acute, subacute, or chronic surgical 
condition susceptible of cure or decided improvement by hospital care or 
medical services; or any condition which does not require hospital care 
or medical services for an acute or chronic condition but requires 
domiciliary care. Domiciliary care, as the term implies, is the 
provision of a temporary home, with such ambulant medical care as is 
needed. To be provided with domiciliary care, the applicant must 
consistently have a disability, disease, or defect which is essentially 
chronic in type and is producing disablement of such degree and probable 
persistency as will incapacitate from earning a living for a prospective 
period.


(Authority: 38 U.S.C. 1701, 1710)

    (d)(1) For purposes of determining eligibility for hospital care, 
medical services, or nursing home care under Sec.  17.47(a), a veteran 
will be determined unable to defray the expenses of necessary care if 
the veteran agrees to provide verifiable evidence, as determined by the 
Secretary, that:
    (i) The veteran is eligible to receive medical assistance under a 
State plan approved under title XIX of the Social Security Act;


(Authority: 42 U.S.C. 1396 et seq.)

    (ii) The veteran is in receipt of pension under 38 U.S.C. 1521; or
    (iii) The veteran's attributable income does not exceed $15,000 if 
the veteran has no dependents, $18,000 if the veteran has one dependent, 
plus $1,000 for each additional dependent.


(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

    (2) For purposes of determining eligibility for hospital care, 
medical services, or nursing home care under Sec.  17.47(c), a veteran 
will be determined eligible for necessary care if the veteran agrees to 
provide verifiable evidence, as determined by the Secretary, that: The 
veteran's attributable income does not exceed $20,000 if the veteran has 
no dependents, $25,000 if the

[[Page 739]]

veteran has one dependent, plus $1,000 for each additional dependent.


(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

    (3) Effective on January 1 of each year after calendar year 1986, 
the amounts set forth in paragraph (d)(1) and (2) of this section shall 
be increased by the percentage by which the maximum rates of pension 
were increased under 38 U.S.C. 5312(a), during the preceding year.


(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

    (4) Determinations with respect to attributable income made under 
paragraph (d)(1) and (2) of this section, shall be made in the same 
manner, including the same sources of income and exclusions from income, 
as determinations with respect to income are made for determining 
eligibility for pension under Sec. Sec.  3.271 and 3.272 of this title. 
The term attributable income means income of a veteran for the calendar 
year preceding application for care, determined in the same manner as 
the manner in which a determination is made of the total amount of 
income by which the rate of pension for such veteran under 38 U.S.C. 
1521 would be reduced if such veteran were eligible for pension under 
that section.


(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

    (5) In order to avoid hardship VA may determine that a veteran is 
eligible for care notwithstanding that the veteran does not meet the 
income requirements established in paragraph (d)(1)(iii) or (d)(2) of 
this section, if projections of the veteran's income for the year 
following application for care are substantially below the income 
requirements established in paragraph (d)(1)(iii) or (d)(2) of this 
section.


(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

    (e)(1) If VA determines that an individual was incorrectly charged a 
copayment, VA will refund the amount of any copayment actually paid by 
that individual.


(Authority: 38 U.S.C. 501; sec. 19011, Pub. L. 99-272)

    (2) In the event a veteran provided inaccurate information on an 
application and is incorrectly deemed eligible for care under 38 U.S.C. 
1710(a)(1) or (a)(2) rather than 38 U.S.C. 1710(a)(3), VA shall 
retroactively bill the veteran for the applicable copayment.


(Authority: 38 U.S.C. 501 and 1710; sec. 19011, Pub. L. 99-272)

    (f) If a veteran who receives hospital, nursing home, or outpatient 
care under 38 U.S.C. 1710(a)(3) by virtue of the veteran's eligibility 
for hospital care and medical services under 38 U.S.C. 1710(a), fails to 
pay to the United States the amounts agreed to under those sections 
shall be grounds for determining, in accordance with guidelines 
promulgated by the Under Secretary for Health, that the veteran is not 
eligible to receive further care under those sections until such amounts 
have been paid in full.


(Authority: 38 U.S.C. 1710, 1721; sec. 19011, Pub. L. 99-272)

    (g)(1) Persons hospitalized and/or receiving medical services who 
have no service-connected disabilities pursuant to Sec.  17.47, and/or 
persons receiving outpatient medical services pursuant to Sec.  17.93 
who have no service-connected disabilities who it is believed may be 
eligible for hospital care and/or medical services, or reimbursement for 
the expenses of care or services for all or part of the cost thereof by 
reason of the following:
    (i) Membership in a union, fraternal or other organization, or
    (ii) Coverage under an insurance policy, or contract, medical, or 
hospital service agreement, membership, or subscription contract or 
similar arrangement under which health services for individuals are 
provided or the expenses of such services are paid, will not be 
furnished hospital care or medical services without charge therefore to 
the extent of the amount for which such parties referred to in 
paragraphs (g)(1)(i) or (g)(1)(ii) of this section, are, will become, or 
may be liable. Persons

[[Page 740]]

believed entitled to care under any of the plans discussed above will be 
required to provide such information as the Secretary may require. 
Provisions of this paragraph are effective April 7, 1986, except in the 
case of a health care policy or contract that was entered into before 
that date, the effective date shall be the day after the plan was 
modified or renewed or on which there was any change in premium or 
coverage and will apply only to care and services provided by VA after 
the date the plan was modified, renewed, or on which there was any 
change in premium or coverage.


(Authority: 38 U.S.C. 1729; sec. 19013, Pub. L. 99-272)

    (2) Persons hospitalized and/or receiving medical services for the 
treatment of nonservice-connected disabilities pursuant to Sec.  17.47, 
or persons receiving outpatient medical services pursuant to Sec.  17.93 
and who it is believed may be entitled to hospital care and/or medical 
services or to reimbursement for all or part of the cost thereof from 
any one or more of the following parties:
    (i) Workers' Compensation or employer's liability statutes, State or 
Federal;
    (ii) By reason of statutory or other relationships with third 
parties, including those liable for damages because of negligence or 
other legal wrong;
    (iii) By reason of a statute in a State, or political subdivision of 
a State;
    (A) Which requires automobile accident reparations or;
    (B) Which provides compensation or payment for medical care to 
victims suffering personal injuries as the result of a crime of personal 
violence;
    (iv) Right to maintenance and cure in admiralty;

will not be furnished hospital care or medical services without charge 
therefore to the extent of the amount for which such parties are, will 
become, or may be liable. Persons believed entitled to care under 
circumstances described in paragraph (g)(2)(ii) of this section will be 
required to complete such forms as the Secretary may require, such as a 
power of attorney and assignment. Notice of this assignment will be 
mailed promptly to the party or parties believed to be liable. When the 
amount of charges is ascertained, a bill therefore will be mailed to 
such party or parties. Persons believed entitled to care under 
circumstances described in paragraph (g)(2)(i) or (g)(2)(iii) of this 
section will be required to complete such forms as the Secretary may 
require.


(Authority: 38 U.S.C. 1729, sec. 19013, Pub. L. 99-272)

    (h) Within the limits of Department of Veterans Affairs facilities, 
any veteran who is receiving nursing home care in a hospital under the 
direct jurisdiction of the Department of Veterans Affairs, may be 
furnished medical services to correct or treat any nonservice-connected 
disability of such veteran, in addition to treatment incident to the 
disability for which the veteran is hospitalized, if the veteran is 
willing, and such services are reasonably necessary to protect the 
health of such veteran.
    (i) Participating in a rehabilitation program under 38 U.S.C. 
chapter 31 refers to any veteran
    (1) Who is eligible for and entitled to participate in a 
rehabilitation program under chapter 31.
    (i) Who is in an extended evaluation period for the purpose of 
determining feasibility, or
    (ii) For whom a rehabilitation objective has been selected, or
    (iii) Who is pursuing a rehabilitation program, or
    (iv) Who is pursuing a program of independent living, or
    (v) Who is being provided employment assistance under 38 U.S.C. 
chapter 31, and
    (2) Who is medically determined to be in need of hospital care or 
medical services (including dental) for any of the following reasons:
    (i) Make possible his or her entrance into a rehabilitation program; 
or
    (ii) Achieve the goals of the veteran's vocational rehabilitation 
program; or
    (iii) Prevent interruption of a rehabilitation program; or
    (iv) Hasten the return to a rehabilitation program of a veteran in 
interrupted or leave status; or

[[Page 741]]

    (v) Hasten the return to a rehabilitation program of a veteran 
placed in discontinued status because of illness, injury or a dental 
condition; or
    (vi) Secure and adjust to employment during the period of employment 
assistance; or
    (vii) To enable the veteran to achieve maximum independence in daily 
living.


(Authority: 38 U.S.C. 3104(a)(9); Pub. L. 96-466, sec. 101(a))

    (j) Veterans eligible for treatment under chapter 17 of 38 U.S.C. 
who are alcohol or drug abusers or who are infected with the human 
immunodeficiency virus (HIV) shall not be discriminated against in 
admission or treatment by any Department of Veterans Affairs health care 
facility solely because of their alcohol or drug abuse or dependency or 
because of their viral infection. This does not preclude the rule of 
clinical judgment in determining appropriate treatment which takes into 
account the patient's immune status and/or the infectivity of the HIV or 
other pathogens (such as tuberculosis, cytomegalovirus, 
cryptosporidiosis, etc.). Hospital Directors are responsible for 
assuring that admission criteria of all programs in the medical center 
do not discriminate solely on the basis of alcohol, drug abuse or 
infection with human immunodeficiency virus. Quality Assurance Programs 
should include indicators and monitors for nondiscrimination.


(Authority: 38 U.S.C. 7333)

    (k) In seeking medical care from VA under 38 U.S.C. 1710 or 1712, a 
veteran shall furnish such information and evidence as the Secretary may 
require to establish eligibility.

(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

[32 FR 13813, Oct. 4, 1967]

    Editorial Note: For Federal Register citations affecting Sec.  
17.47, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  17.48  Compensated Work Therapy/Transitional Residences program.

    (a) This section sets forth requirements for persons residing in 
housing under the Compensated Work Therapy/Transitional Residences 
program.
    (b) House managers shall be responsible for coordinating and 
supervising the day-to-day operations of the facilities. The local VA 
program coordinator shall select each house manager and may give 
preference to an individual who is a current or past resident of the 
facility or the program. A house manager must have the following 
qualifications:
    (1) A stable, responsible and caring demeanor;
    (2) Leadership qualities including the ability to motivate;
    (3) Effective communication skills including the ability to 
interact;
    (4) A willingness to accept feedback;
    (5) A willingness to follow a chain of command.
    (c) Each resident admitted to the Transitional Residence, except for 
a house manager, must also be in the Compensated Work Therapy program.
    (d) Each resident, except for a house manager, must bi-weekly, in 
advance, pay a fee to VA for living in the housing. The local VA program 
coordinator will establish the fee for each resident in accordance with 
the provisions of paragraph (d)(1) of this section.
    (1) The total amount of actual operating expenses of the residence 
(utilities, maintenance, furnishings, appliances, service equipment, all 
other operating costs) for the previous fiscal year plus 15 percent of 
that amount equals the total operating budget for the current fiscal 
year. The total operating budget is to be divided by the average number 
of beds occupied during the previous fiscal year and the resulting 
amount is the average yearly amount per bed. The bi-weekly fee shall 
equal 1/26th of the average yearly amount per bed, except that a 
resident shall not, on average, pay more than 30 percent of their gross 
CWT (Compensated Work Therapy) bi-weekly earnings. The VA program 
manager shall, bi-annually, conduct a review of the factors in this 
paragraph for determining resident payments. If he or she determines 
that the payments are too

[[Page 742]]

high or too low by more than 5 percent of the total operating budget, he 
or she shall recalculate resident payments under the criteria set forth 
in this paragraph, except that the calculations shall be based on the 
current fiscal year (actual amounts for the elapsed portion and 
projected amounts for the remainder).
    (2) If the revenues of a residence do not meet the expenses of the 
residence resulting in an inability to pay actual operating expenses, 
the medical center of jurisdiction shall provide the funds necessary to 
return the residence to fiscal solvency in accordance with the 
provisions of this section.
    (e) The length of stay in housing under the Compensated Work 
Therapy/Transitional Residences program is based on the individual needs 
of each resident, as determined by consensus of the resident and his/her 
VA Clinical Treatment team. However, the length of stay should not 
exceed 12 months.

(Authority: 38 U.S.C. 2032)

[70 FR 29627, May 24, 2005, as amended at 79 FR 54615, Sept. 12, 2014]



Sec.  17.49  Priorities for outpatient medical services and inpatient
hospital care.

    In scheduling appointments for outpatient medical services and 
admissions for inpatient hospital care, the Under Secretary for Health 
shall give priority to:
    (a) Veterans with service-connected disabilities rated 50 percent or 
greater based on one or more disabilities or unemployability; and
    (b) Veterans needing care for a service-connected disability.

(Authority: 38 U.S.C. 101, 501, 1705, 1710)

[67 FR 58529, Sept. 17, 2002]

  Use of Department of Defense, Public Health Service or Other Federal 
                                Hospitals



Sec.  17.50  Use of Department of Defense, Public Health Service or other
Federal hospitals with beds allocated to the Department of Veterans Affairs.

    Hospital facilities operated by the Department of Defense or the 
Public Health Service (or any other agency of the United States 
Government) may be used for the care of VA patients pursuant to 
agreements between VA and the department or agency operating the 
facility. When such an agreement has been entered into and a bed 
allocation for VA patients has been provided for in a specific hospital 
covered by the agreement, care may be authorized within the bed 
allocation for any veteran eligible under 38 U.S.C. 1710 or Sec.  17.44. 
Care in a Federal facility not operated by VA, however, shall not be 
authorized for any military retiree whose sole basis for eligibility is 
under Sec.  17.44, or, except in Alaska and Hawaii, for any retiree of 
the uniformed services suffering from a chronic disability whose 
entitlement is under Sec.  17.44 or Sec.  17.46(a)(2) regardless of 
whether he or she may have dual eligibility under other provisions of 
Sec.  17.46.

[79 FR 54615, Sept. 12, 2014]



Sec.  17.51  Emergency use of Department of Defense, Public Health Service
or other Federal hospitals.

    Hospital care in facilities operated by the Department of Defense or 
the Public Health Service (or any other agency of the U.S. Government) 
which do not have beds allocated for the care of Department of Veterans 
Affairs patients may be authorized subject to the limitations enumerated 
in Sec.  17.50 only in emergency circumstances for any veteran otherwise 
eligible for hospital care under 38 U.S.C. 1710 or 38 CFR 17.46.

[33 FR 19010, Dec. 20, 1968. Redesignated and amended at 61 FR 21965, 
21966, May 13, 1996]

                   Use of Public or Private Hospitals



Sec.  17.52  Hospital care and medical services in non-VA facilities.

    (a) When VA facilities or other government facilities are not 
capable of furnishing economical hospital care or medical services 
because of geographic inaccessibility or are not capable of furnishing 
care or services required, VA may contract with non-VA facilities for 
care in accordance with the provisions of this section. When demand is 
only for infrequent use, individual authorizations may be used. Care in 
public or private facilities, however, subject to the provisions of 
Sec. Sec.  17.53, 17.54, 17.55 and 17.56, will only

[[Page 743]]

be authorized, whether under a contract or an individual authorization, 
for--
    (1) Hospital care or medical services to a veteran for the treatment 
of--
    (i) A service-connected disability; or
    (ii) A disability for which a veteran was discharged or released 
from the active military, naval, or air service or
    (iii) A disability of a veteran who has a total disability permanent 
in nature from a service-connected disability, or
    (iv) For a disability associated with and held to be aggravating a 
service-connected disability, or
    (v) For any disability of a veteran participating in a 
rehabilitation program under 38 U.S.C. ch. 31 and when there is a need 
for hospital care or medical services for any of the reasons enumerated 
in Sec.  17.48(i).
    (2) Medical services for the treatment of any disability of--
    (i) A veteran who has a service-connected disability rated at 50 
percent or more,
    (ii) A veteran who has been furnished hospital care, nursing home 
care, domiciliary care, or medical services, and requires medical 
services to complete treatment incident to such care or services (each 
authorization for non-VA treatment needed to complete treatment may 
continue for up to 12 months, and new authorizations may be issued by VA 
as needed), and
    (iii) A veteran of the Mexican border period or World War I or who 
is in receipt of increased pension or additional compensation based on 
the need for aid and attendance or housebound benefits when it has been 
determined based on an examination by a physician employed by VA (or, in 
areas where no such physician is available, by a physician carrying out 
such function under a contract or fee arrangement), that the medical 
condition of such veteran precludes appropriate treatment in VA 
facilities;
    (3) Hospital care or medical services for the treatment of medical 
emergencies which pose a serious threat to the life or health of a 
veteran receiving hospital care or medical services in a facility over 
which the Secretary has direct jurisdiction or government facility with 
which the Secretary contracts, and for which the facility is not staffed 
or equipped to perform, and transfer to a public or private hospital 
which has the necessary staff or equipment is the only feasible means of 
providing the necessary treatment, until such time following the 
furnishing of care in the non-VA facility as the veteran can be safely 
transferred to a VA facility;
    (4) Hospital care for women veterans;
    (5) Through September 30, 1988, hospital care or medical services 
that will obviate the need for hospital admission for veterans in the 
Commonwealth of Puerto Rico, except that the dollar expenditure in 
Fiscal year 1986 cannot exceed 85% of the Fiscal year 1985 obligations, 
in Fiscal year 1987 the dollar expenditure cannot exceed 50% of the 
Fiscal year 1985 obligations and in Fiscal year 1988 the dollar 
expenditure cannot exceed 25% of the Fiscal year 1985 obligations.
    (6) Hospital care or medical services that will obviate the need for 
hospital admission for veterans in Alaska, Hawaii, Virgin Islands and 
other territories of the United States except that the annually 
determined hospital patient load and incidence of the furnishing of 
medical services to veterans hospitalized or treated at the expense of 
VA in government and non-VA facilities in each such State or territory 
shall be consistent with the patient load or incidence of the provision 
of medical services for veterans hospitalized or treated by VA within 
the 48 contiguous States.
    (7) Outpatient dental services and treatment, and related dental 
appliances, for a veteran who is a former prisoner of war and was 
detained or interned for a period of not less that 181 days.
    (8) Hospital care or medical services for the treatment of medical 
emergencies which pose a serious threat to the life or health of a 
veteran which developed during authorized travel to the hospital, or 
during authorized travel after hospital discharge preventing completion 
of travel to the originally designated point of return (and this will 
encompass any other medical services necessitated by the emergency, 
including extra ambulance or other transportation which may also be 
furnished at VA expense.

[[Page 744]]

    (9) Diagnostic services necessary for determination of eligibility 
for, or of the appropriate course of treatment in connection with, 
furnishing medical services at independent VA outpatient clinics to 
obviate the need for hospital admission.
    (10) For any disability of a veteran receiving VA contract nursing 
home care. The veteran is receiving contract nursing home care and 
requires emergency treatment in non-VA facilities.
    (11) For completion of evaluation for observation and examination 
(O&E) purposes, clinic directors or their designees will authorize 
necessary diagnostic services at non-VA facilities (on an inpatient or 
outpatient basis) in order to complete requests from VA Regional Offices 
for O&E of a person to determine eligibility for VA benefits or 
services.
    (b) The Under Secretary for Health shall only furnish care and 
treatment under paragraph (a) of this section to veterans described in 
Sec.  17.47(d).
    (1) To the extent that resources are available and are not otherwise 
required to assure that VA can furnish needed care and treatment to 
veterans described in Sec.  17.47 (a) and (c), and
    (2) If the veteran agrees to pay the United States an amount as 
determined under 38 U.S.C. 1710.
    (c) The provisions of this section shall not apply to care furnished 
by VA after June 6, 2019.

[51 FR 25066, July 10, 1986, as amended at 53 FR 32391, Aug. 25, 1988; 
54 FR 53057, Dec. 27, 1989; 58 FR 32446, June 10, 1993. Redesignated and 
amended at 61 FR 21965, 21966, May 13, 1996; 62 FR 17072, Apr. 9, 1997; 
75 FR 78915, Dec. 17, 2010; 77 FR 70895, Nov. 28, 2012; 78 FR 76063, 
Dec. 16, 2013; 79 FR 54615, Sept. 12, 2014; 84 FR 26306, June 5, 2019]



Sec.  17.53  Limitations on use of public or private hospitals.

    The admission of any patient to a private or public hospital at 
Department of Veterans Affairs expense will only be authorized if a 
Department of Veterans Affairs medical center or other Federal facility 
to which the patient would otherwise be eligible for admission is not 
feasibly available. A Department of Veterans Affairs facility may be 
considered as not feasibly available when the urgency of the applicant's 
medical condition, the relative distance of the travel involved, or the 
nature of the treatment required makes it necessary or economically 
advisable to use public or private facilities. In those instances where 
care in public or private hospitals at Department of Veterans Affairs 
expense is authorized because a Department of Veterans Affairs or other 
Federal facility was not feasibly available, as defined in this section, 
the authorization will be continued after admission only for the period 
of time required to stabilize or improve the patient's condition to the 
extent that further care is no longer required to satisfy the purpose 
for which it was initiated.

[39 FR 17223, May 14, 1974, as amended at 47 FR 58248, Dec. 30, 1982. 
Redesignated at 61 FR 21965, May 13, 1996]



Sec.  17.54  [Reserved]



Sec.  17.55  Payment for authorized public or private hospital care.

    Except as otherwise provided in this section, payment for public or 
private hospital care furnished on or before June 6, 2019, under 38 
U.S.C. 1703 and Sec.  17.52, or at any time under 38 U.S.C. 1728 and 
Sec. Sec.  17.120 and 17.128 or under 38 U.S.C. 1787 and Sec.  17.410, 
shall be based on a prospective payment system similar to that used in 
the Medicare program for paying for similar inpatient hospital services 
in the community. Payment shall be made using the Centers for Medicare & 
Medicaid Services (CMS) PRICER for each diagnosis-related group (DRG) 
applicable to the episode of care.
    (a) Payment shall be made of the full prospective payment amount per 
discharge, as determined according to the methodology in subparts D and 
G of 42 CFR part 412, as appropriate.
    (b)(1) In the case of a veteran who was transferred to another 
facility before completion of care, VA shall pay the transferring 
hospital an amount calculated by the HCFA PRICER for each patient day of 
care, not to exceed the full DRG rate as provided in paragraph (a) of 
this section. The hospital that ultimately discharges the patient will 
receive the full DRG payment.
    (2) In the case of a veteran who has transferred from a hospital 
and/or distinct part unit excluded by Medicare

[[Page 745]]

from the DRG-based prospective payment system or from a hospital that 
does not participate in Medicare, the transferring hospital will receive 
a payment for each patient day of care not to exceed the amount provided 
in paragraph (i) of this section.
    (c) VA shall pay the providing facility the full DRG-based rate or 
reasonable cost, without regard to any copayments or deductible required 
by any Federal law that is not applicable to VA.
    (d) If the cost or length of a veteran's care exceeds an applicable 
threshold amount, as determined by the HCFA PRICER program, VA shall 
pay, in addition to the amount payable under paragraph (a) of this 
section, an outlier payment calculated by the HCFA PRICER program, in 
accordance with subpart F of 42 CFR part 412.
    (e) In addition to the amount payable under paragraph (a) of this 
section, VA shall pay, for each discharge, an amount to cover the non-
Federal hospital's capital-related costs, kidney, heart and liver 
acquisition costs incurred by hospitals with approved transplantation 
centers, direct costs of medical education, and the costs of qualified 
nonphysician anesthetists in small rural hospitals. These amounts will 
be determined by the Under Secretary for Health on an annual basis and 
published in the ``Notices'' section of the Federal Register.
    (f) Payment shall be made only for those services authorized by VA.
    (g) Payments made in accordance with this section shall constitute 
payment in full and the provider or agent for the provider may not 
impose any additional charge on a veteran or his or her health care 
insurer for any inpatient services for which payment is made by the VA.
    (h) Hospitals of distinct part hospital units excluded from the 
prospective payment system by Medicare and hospitals that do not 
participate in Medicare will be paid at the national cost-to-charge 
ratio times the billed charges that are reasonable, usual, customary, 
and not in excess of rates or fees the hospital charges the general 
public for similar services in the community.
    (i) A hospital participating in an alternative payment system that 
has been granted a Federal waiver from the prospective payment system 
under the provisions of 42 U.S.C. section 1395f(b)(3) or 42 U.S.C. 
section 1395ww(c) for the purposes of Medicare payment shall not be 
subject to the payment methodology set forth in this section so long as 
such Federal waiver remains in effect.
    (j) Payments for episodes of hospital care furnished in Alaska that 
begin during the period starting on the effective date of this section 
through the 364th day thereafter will be in the amount determined by the 
HCFA PRICER plus 50 percent of the difference between the amount billed 
by the hospital and the amount determined by the PRICER. Claims for 
services provided during that period will be accepted for payment by VA 
under this paragraph (k) until December 31 of the year following the 
year in which this section became effective.
    (k) Notwithstanding other provisions of this section, VA, for public 
or private hospital care covered by this section, will pay the lesser of 
the amount determined under paragraphs (a) through (j) of this section 
or the amount negotiated with the hospital or its agent.

[55 FR 42852, Oct. 24, 1990. Redesignated and amended at 61 FR 21965, 
21966, May 13, 1996; 62 FR 17072, Apr. 9, 1997; 63 FR 39515, July 23, 
1998; 65 FR 66637, Nov. 7, 2000; 84 FR 26306, June 5, 2019]



Sec.  17.56  VA payment for inpatient and outpatient health care professional
services at non-departmental facilities and other medical charges associated
with non-VA outpatient care.

    (a) Except for health care professional services provided in the 
state of Alaska (see paragraph (b) of this section), VA will determine 
the amounts paid under Sec.  17.52 or Sec.  17.120 for health care 
professional services, and all other medical services associated with 
non-VA outpatient care, using the applicable method in this section:
    (1) If a specific amount has been negotiated with a specific 
provider, VA will pay that amount.
    (2) If an amount has not been negotiated under paragraph (a)(1) of 
this

[[Page 746]]

section, VA will pay the lowest of the following amounts:
    (i) The applicable Medicare fee schedule or prospective payment 
system amount (``Medicare rate'') for the period in which the service 
was provided (without any changes based on the subsequent development of 
information under Medicare authorities), subject to the following:
    (A) In the event of a Medicare waiver, the payment amount will be 
calculated in accordance with such waiver.
    (B) In the absence of a Medicare rate or Medicare waiver, payment 
will be the VA Fee Schedule amount for the period in which the service 
was provided. The VA Fee Schedule amount is determined by the 
authorizing VA medical facility, which ranks all billings (if the 
facility has had at least eight billings) from non-VA facilities under 
the corresponding procedure code during the previous fiscal year, with 
billings ranked from the highest to the lowest. The VA Fee Schedule 
amount is the charge falling at the 75th percentile. If the authorizing 
facility has not had at least eight such billings, then this paragraph 
does not apply.
    (ii) The amount negotiated by a repricing agent if the provider is 
participating within the repricing agent's network and VA has a contract 
with that repricing agent. For the purposes of this section, repricing 
agent means a contractor that seeks to connect VA with discounted rates 
from non-VA providers as a result of existing contracts that the non-VA 
provider may have within the commercial health care industry.
    (iii) The amount that the provider bills the general public for the 
same service.
    (b) For physician and non-physician professional services rendered 
in Alaska, VA will pay for services in accordance with a fee schedule 
that uses the Health Insurance Portability and Accountability Act 
mandated national standard coding sets. VA will pay a specific amount 
for each service for which there is a corresponding code. Under the VA 
Alaska Fee Schedule, the amount paid in Alaska for each code will be 90 
percent of the average amount VA actually paid in Alaska for the same 
services in Fiscal Year (FY) 2003. For services that VA provided less 
than eight times in Alaska in FY 2003, for services represented by codes 
established after FY 2003, and for unit-based codes prior to FY 2004, VA 
will take the Centers for Medicare and Medicaid Services' rate for each 
code and multiply it times the average percentage paid by VA in Alaska 
for Centers for Medicare and Medicaid Services-like codes. VA will 
increase the amounts on the VA Alaska Fee Schedule annually in 
accordance with the published national Medicare Economic Index (MEI). 
For those years where the annual average is a negative percentage, the 
fee schedule will remain the same as the previous year. Payment for non-
VA health care professional services in Alaska shall be the lesser of 
the amount billed or the amount calculated under this subpart.
    (c) Payments made by VA to a non-VA facility or provider under this 
section shall be considered payment in full. Accordingly, the facility 
or provider or agent for the facility or provider may not impose any 
additional charge for any services for which payment is made by VA.
    (d) In a case where a veteran has paid for emergency treatment for 
which VA may reimburse the veteran under Sec.  17.120, VA will reimburse 
the amount that the veteran actually paid. Any amounts due to the 
provider but unpaid by the veteran will be reimbursed to the provider 
under paragraphs (a) and (b) of this section.
    (e) Except for payments for care furnished under 38 U.S.C. 1725 and 
Sec.  17.1005, under 38 U.S.C. 1728 and Sec. Sec.  17.120 and 17.128, or 
under 38 U.S.C. 1787 and Sec.  17.410, the provisions of this section 
shall not apply to care furnished by VA after June 6, 2019, or care 
furnished pursuant to an agreement authorized by 38 U.S.C. 1703A.

[75 FR 78915, Dec. 17, 2010, as amended at 78 FR 26251, May 6, 2013; 78 
FR 68364, Nov. 14, 2013; 79 FR 16200, Mar. 25, 2014; 84 FR 26306, June 
5, 2019]

[[Page 747]]

              Use of Community Nursing Home Care Facilities



Sec.  17.57  Use of community nursing homes.

    (a) Nursing home care in a contract public or private nursing home 
facility may be authorized for the following: Any veteran who has been 
discharged from a hospital under the direct jurisdiction of VA and is 
currently receiving VA hospital based home health services.


(Authority: 38 U.S.C. 1720; sec. 108, Pub. L. 99-166)

    (b) To the extent that resources are available and are not otherwise 
required to assure that VA can furnish needed care and treatment to 
veterans described in 38 U.S.C. 1710(a)(1) and (a)(2), the Under 
Secretary for Health may furnish care under this paragraph to any 
veteran described in 38 U.S.C. 1710(a)(3) if the veteran agrees to pay 
the United States an amount as determined in 38 U.S.C. 1710(f).


(Authority: 38 U.S.C. 1710, 1720; sec. 19011, Pub. L. 99-272)

(Authority: 38 U.S.C. 1720(b)

[51 FR 25067, July 10, 1986. Redesignated and amended at 61 FR 21965, 
21966, May 13, 1996 and further redesignated at 63 FR 39515, July 23, 
1998; 79 FR 54615, Sept. 12, 2014]



Sec.  17.58  Evacuation of community nursing homes.

    When veterans are evacuated from a community nursing home as the 
result of an emergency, they may be relocated to another facility that 
meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1).

(Authority: 38 U.S.C. 501, 1720)

[76 FR 55571, Sept. 8, 2011]



Sec.  17.60  Extensions of community nursing home care beyond six months.

    Directors of health care facilities may authorize, for any veteran 
whose hospitalization was not primarily for a service-connected 
disability, an extension of nursing care in a public or private nursing 
home care facility at VA expense beyond six months when the need for 
nursing home care continues to exist and
    (a) Arrangements for payment of such care through a public 
assistance program (such as Medicaid) for which the veteran has applied, 
have been delayed due to unforeseen eligibility problems which can 
reasonably be expected to be resolved within the extension period, or
    (b) The veteran has made specific arrangements for private payment 
for such care, and
    (1) Such arrangements cannot be effectuated as planned because of 
unforseen, unavoidable difficulties, such as a temporary obstacle to 
liquidation of property, and
    (2) Such difficulties can reasonably be expected to be resolved 
within the extension period; or
    (c) The veteran is terminally ill and life expectancy has been 
medically determined to be less than six months.
    (d) In no case may an extension under paragraph (a) or (b) of this 
section exceed 45 days.

(Authority: 38 U.S.C. 501, 1720(a))

[53 FR 13121, Apr. 21, 1988. Redesignated at 61 FR 21965, May 13, 1996]

                       Community Residential Care

    Source: 54 FR 20842, May 15, 1989, unless otherwise noted.



Sec.  17.61  Eligibility.

    VA health care personnel may assist a veteran by referring such 
veteran for placement in a privately or publicly-owned community 
residential care facility if:
    (a) At the time of initiating the assistance:
    (1) The veteran is receiving VA medical services on an outpatient 
basis or VA medical center, domiciliary, or nursing home care; or
    (2) Such care or services were furnished the veteran within the 
preceding 12 months;
    (b) The veteran does not need hospital or nursing home care but is 
unable to live independently because of medical (including psychiatric) 
conditions and has no suitable family resources to provide needed 
monitoring, supervision, and any necessary assistance in the veteran's 
activities of daily living and instrumental activities of daily living ; 
and

[[Page 748]]

    (c) The facility has been approved in accordance with Sec.  17.63 of 
this part.

[54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 
21966, May 13, 1996; 84 FR 33696, July 15, 2019]



Sec.  17.62  Definitions.

    For the purpose of Sec. Sec.  17.61 through 17.72:
    Activities of daily living means basic daily tasks an individual 
performs as part of self-care which may be used as a measurement of the 
functional status of a person including: walking; bathing, shaving, 
brushing teeth, combing hair; dressing; eating; getting in or getting 
out of bed; and toileting.
    Approving official means the Director or, if designated by the 
Director, the Associate Director or Chief of Staff of a Department of 
Veterans Affairs Medical Center or Outpatient Clinic which has 
jurisdiction to approve a community residential care facility.
    Community residential care means the monitoring, supervision, and 
assistance, in accordance with a statement of needed care, of the 
activities of daily living activities and instrumental activities of 
daily living, of referred veterans in an approved home in the community 
by the facility's provider.
    Hearing official means the Director or, if designated by the 
Director, the Associate Director or Chief of Staff of a Department of 
Veterans Affairs Medical Center or Outpatient Clinic which has 
jurisdiction to approve a community residential care facility.
    Instrumental activities of daily living are tasks that are not 
necessary for fundamental functioning, but allow an individual to live 
independently in a community. Instrumental activities of daily living 
include: housekeeping and cleaning room; meal preparation; taking 
medications; laundry; assistance with transportation; shopping--for 
groceries, clothing or other items; ability to use the telephone; 
ability to manage finances; writing letters; and obtaining appointments.
    Oral hearing means the in person testimony of representatives of a 
community residential care facility and of VA before the hearing 
official and the review of the written evidence of record by that 
official.
    Paper hearing means a review of the written evidence of record by 
the hearing official.

[84 FR 33697, July 15, 2019]



Sec.  17.63  Approval of community residential care facilities.

    The approving official may approve a community residential care 
facility, based on the report of a VA inspection and on any findings of 
necessary interim monitoring of the facility, if that facility meets the 
following standards:
    (a) Health and safety standards. The facility must:
    (1) Meet all State and local regulations including construction, 
maintenance, and sanitation regulations;
    (2) Meet the requirements in the applicable provisions of NFPA 101 
and NFPA 101A (incorporated by reference, see Sec.  17.1) and the other 
publications referenced in those provisions. The institution shall 
provide sufficient staff to assist patients in the event of fire or 
other emergency. Any equivalencies or variances to VA requirements must 
be approved by the appropriate Veterans Health Administration Veterans 
Integrated Service Network (VISN) Director;
    (3) Have safe and functioning systems for heating and/or cooling, as 
needed (a heating or cooling system is deemed to be needed if VA 
determines that, in the county, parish, or similar jurisdiction where 
the facility is located, a majority of community residential care 
facilities or other extended care facilities have one), hot and cold 
water, electricity, plumbing, sewage, cooking, laundry, artificial and 
natural light, and ventilation.
    (4) Meet the following additional requirements, if the provisions 
for One and Two-Family Dwellings, as defined in NFPA 101, are applicable 
to the facility:
    (i) Portable fire extinguishers must be installed, inspected, and 
maintained in accordance with NFPA 10 (incorporated by reference, see 
Sec.  17.1); and
    (ii) The facility must meet the requirements in section 33.7 of NFPA 
101.
    (b) Level of care. The community residential care facility must 
provide the resident, at a minimum, a base level of care to include room 
and board; nutrition consisting of three meals per day

[[Page 749]]

and two snacks, or as required to meet special dietary needs; laundry 
services; transportation (either provided or arranged) to VA and 
healthcare appointments; and accompanying the resident to appointments 
if needed; 24-hour supervision, if indicated; and care, supervision, and 
assistance with activities of daily living and instrumental activities 
of daily living. In those cases where the resident requires more than a 
base level of care, the medically appropriate level of care must be 
provided.
    (c) Interior plan. The facility must:
    (1) Have comfortable dining areas, adequate in size for the number 
of residents;
    (2) Have confortable living room areas, adequate in size to 
accommodate a reasonable proportion of residents; and
    (3) Maintain at least one functional toilet and lavatory, and 
bathing or shower facility for every six people living in the facility, 
including provider and staff.
    (d) Laundry service. The facility must provide or arrange for 
laundry service.
    (e) Residents' bedrooms. Residents' bedrooms must:
    (1) Contain no more than four beds;
    (i) Facilities approved before August 24, 2017 may not establish any 
new resident bedrooms with more than two beds per room;
    (ii) Facilities approved after August 24, 2017 may not provide 
resident bedrooms containing more than two beds per room.
    (2) Measure, exclusive of closet space, at least 100 square feet for 
a single-resident room, or 80 square feet for each resident in a 
multiresident room; and
    (3) Contain a suitable bed for each resident and appropriate 
furniture and furnishings.
    (f) Nutrition. The facility must:
    (1) Provide a safe and sanitary food service that meets individual 
nutritional requirements and residents' preferences;
    (2) Plan menus to meet currently recommended dietary allowances;
    (g) Activities. The facility must plan and facilitate appropriate 
recreational and leisure activities to meet individual needs.
    (h) Residents' rights. The facility must have written policies and 
procedures that ensure the following rights for each resident:
    (1) Each resident has the right to:
    (i) Be informed of the rights described in this section;
    (ii) The confidentiality and nondisclosure of information obtained 
by community residential care facility staff on the residents and the 
residents' records subject to the requirements of applicable law;
    (iii) Be able to inspect the residents' own records kept by the 
community residential care facility;
    (iv) Exercise rights as a citizen; and
    (v) Voice grievances and make recommendations concerning the 
policies and procedures of the facility.
    (2) Financial affairs. Residents must be allowed to manage their own 
personal financial affairs, except when the resident has been restricted 
in this right by law. If a resident requests assistance from the 
facility in managing personal financial affairs the request must be 
documented.
    (3) Privacy. Residents must:
    (i) Be treated with respect, consideration, and dignity;
    (ii) Have access, in reasonable privacy, to a telephone within the 
facility;
    (iii) Be able to send and receive mail unopened and uncensored; and
    (iv) Have privacy of self and possessions.
    (4) Work. No resident will perform household duties, other than 
personal housekeeping tasks, unless the resident receives compensation 
for these duties or is told in advance they are voluntary and the 
patient agrees to do them.
    (5) Freedom of association. Residents have the right to:
    (i) Receive visitors and associate freely with persons and groups of 
their own choosing both within and outside the facility;
    (ii) Make contacts in the community and achieve the highest level of 
independence, autonomy, and interaction in the community of which the 
resident is capable;
    (iii) Leave and return freely to the facility, and

[[Page 750]]

    (iv) Practice the religion of their own choosing or choose to 
abstain from religious practice.
    (6) Transfer. Residents have the right to transfer to another 
facility or to an independent living situation.
    (i) Records. (1) The facility must maintain records on each resident 
in a secure place. Resident records must include a copy of all signed 
agreements with the resident. Resident records may be disclosed only 
with the permission of the resident; an authorized agent, fiduciary, or 
personal representative if the resident is not competent; or when 
required by law.
    (2) The facility must maintain and make available, upon request of 
the approving VA official, records establishing compliance with 
paragraphs (j)(1) and (2) of this section; written policies and 
procedures required under paragraph (j)(3) of this section; and, 
emergency notification procedures.
    (j) Staff requirements. (1) Sufficient, qualified staff must be on 
duty and available to care for the resident and ensure the health and 
safety of each resident.
    (2) The community residential care provider and staff must have the 
following qualifications: Adequate education, training, or experience to 
maintain the facility.
    (3) The community residential care provider must develop and 
implement written policies and procedures that prohibit mistreatment, 
neglect, and abuse of residents and misappropriation of resident 
property.
    (4) Except as provided in paragraph (j)(5)(ii) of this section, the 
community residential care provider must not employ individuals who--
    (i) Have been convicted within 7 years by a court of law of any of 
the following offenses or their equivalent in a state or territory:
    (A) Murder, attempted murder, or manslaughter;
    (B) Arson;
    (C) Assault, battery, assault and battery, assault with a dangerous 
weapon, mayhem or threats to do bodily harm;
    (D) Burglary;
    (E) Robbery;
    (F) Kidnapping;
    (G) Theft, fraud, forgery, extortion or blackmail;
    (H) Illegal use or possession of a firearm;
    (I) Rape, sexual assault, sexual battery, or sexual abuse;
    (J) Child or elder abuse, or cruelty to children or elders; or
    (K) Unlawful distribution or possession with intent to distribute a 
controlled substance; or
    (ii) Have had a finding entered within 6 months into an applicable 
State registry or with the applicable licensing authority concerning 
abuse, neglect, mistreatment of individuals or misappropriation of 
property.
    (5)(i) If the conviction by a court of law of a crime enumerated in 
paragraph (j)(4)(i) of this section occurred greater than 7 years in the 
past, or a finding was entered into an applicable State registry as 
specified in paragraph (j)(4)(ii) of this section more than 6 months in 
the past, the community residential care provider must perform an 
individual assessment of the applicant or employee to determine 
suitability for employment. The individual assessment must include 
consideration of the following factors:
    (A) The nature of the job held or sought;
    (B) The nature and gravity of the offense or offenses;
    (C) The time that has passed since the conviction and/or completion 
of the sentence;
    (D) The facts or circumstances surrounding the offense or conduct;
    (E) The number of offenses for which the individual was convicted;
    (F) The employee or applicant's age at the time of conviction, or 
release from prison;
    (G) The nexus between the criminal conduct of the person and the job 
duties of the position;
    (H) Evidence that the individual performed the same type of work, 
post-conviction, with the same or a different employer, with no known 
incidents of criminal conduct;
    (I) The length and consistency of employment history before and 
after the offense or conduct; rehabilitation efforts, including 
education or training; and,

[[Page 751]]

    (J) Employment or character references and any other information 
regarding fitness for the particular position.
    (ii) An individual assessment must be performed to determine 
suitability for employment for any conviction defined in paragraph 
(j)(8)(iv), regardless of the age of the conviction.
    (6)(i) The community residential care provider must ensure that all 
alleged violations involving mistreatment, neglect, or abuse, including 
injuries of unknown source, and misappropriation of resident property 
are reported to the approving official immediately, which means no more 
than 24 hours after the provider becomes aware of the alleged violation; 
and to other officials in accordance with State law. The report, at a 
minimum, must include--
    (A) The facility name, address, telephone number, and owner;
    (B) The date and time of the alleged violation;
    (C) A summary of the alleged violation;
    (D) The name of any public or private officials or VHA program 
offices that have been notified of the alleged violations, if any;
    (E) Whether additional investigation is necessary to provide VHA 
with more information about the alleged violation;
    (F) The name of the alleged victim;
    (G) Contact information for the resident's next of kin or other 
designated family member, agent, personal representative, or fiduciary; 
and
    (H) Contact information for a person who can provide additional 
details at the community residential care provider, including a name, 
position, location, and phone number.
    (ii) The community residential care provider must notify the 
resident's next of kin, caregiver, other designated family member, 
agent, personal representative, or fiduciary of the alleged incident 
concurrently with submission of the incident report to the approving 
official.
    (iii) The community residential care provider must have evidence 
that all alleged violations involving mistreatment, neglect, or abuse, 
including injuries of unknown source, and misappropriation of resident 
property are documented and thoroughly investigated, and must prevent 
further abuse while the investigation is in progress. The results of all 
investigations must be reported to the approving official within 5 
working days of the incident and to other officials in accordance with 
all other applicable law, and appropriate corrective action must be 
taken if the alleged violation is verified. Any corrective action taken 
by the community residential care provider as a result of such 
investigation must be reported to the approving official, and to other 
officials as required under all other applicable law.
    (iv) The community residential care provider must remove all duties 
requiring direct resident contact with veteran residents from any 
employee alleged to have violated this paragraph (j) during the 
investigation of such employee.
    (7) For purposes of this paragraph (j), the term ``employee'' 
includes a:
    (i) Non-VA health care provider at the community residential care 
facility;
    (ii) Staff member of the community residential care facility who is 
not a health care provider, including a contractor; and
    (iii) Person with direct resident access. The term ``person with 
direct resident access'' means an individual living in the facility who 
is not receiving services from the facility, who may have access to a 
resident or a resident's property, or may have one-on-one contact with a 
resident.
    (8) For purposes of this paragraph (j), an employee is considered 
``convicted'' of a criminal offense--
    (i) When a judgment of conviction has been entered against the 
individual by a Federal, State, or local court, regardless of whether 
there is an appeal pending;
    (ii) When there has been a finding of guilt against the individual 
by a Federal, State, or local court;
    (iii) When a plea of guilty or nolo contendere by the individual has 
been accepted by a Federal, State, or local court; or
    (iv) When the individual has entered into participation in a first 
offender,

[[Page 752]]

deferred adjudication, or other arrangement or program where judgment of 
conviction has been withheld.
    (9) For purposes of this paragraph (j), the terms ``abuse'' and 
``neglect'' have the same meaning set forth in 38 CFR 51.90(b).
    (k) Cost of community residential care. (1) Payment for the charges 
of community residential care is not the responsibility of the United 
States Government or VA.
    (2) The cost of community residential care should reflect the cost 
of providing the base level of care as defined in paragraph (b) of this 
section.
    (3) The resident or an authorized personal representative and a 
representative of the community residential care facility must agree 
upon the charge and payment procedures for community residential care. 
Any agreement between the resident or an authorized personal 
representative and the community residential care facility must be 
approved by the approving official. The charge for care in a community 
residential care facility must be reviewed annually by the facility and 
VA, or as required due to changes in care needs.
    (4) The charges for community residential care must be reasonable 
and comparable to the current average rate for residential care in the 
State or Region for the same level of care provided to the resident. 
Notwithstanding, any year to year increase in the charge for care in a 
community residential care facility for the same level of care may not 
exceed the annual percentage increase in the National Consumer Price 
Index (CPI) for that year. In establishing an individual residential 
rate, consideration should be given to the level of care required and 
the individual needs of the resident. The approving official may approve 
a rate:
    (i) Lower than the current average rate for residential care in the 
State or Region for the same level of care if the community residential 
care facility and the resident or authorized personal representative 
agreed to such rate, provided such lower rate does not result in a lower 
level of care than the resident requires;
    (ii) Higher than the current average rate for residential care in 
the State or Region for the same level of care if the community 
residential care facility and the resident or authorized personal 
representative agreed to such rate, and the higher rate is related to 
the individual needs of the resident which exceed the base level of care 
as defined in paragraph (b) of this section. Examples of services which 
exceed the base level of care include, but are not limited to, handling 
disbursement of funds solely at the request of the resident; fulfilling 
special dietary requests by the resident or family member; accompanying 
the resident to an activity center; assisting in or providing scheduled 
socialization activities; supervision of an unsafe smoker; bowel and 
bladder care; intervention related to behavioral issues; and 
transportation other than for VA and healthcare appointments.
    (5) The approving official may approve a deviation from the 
requirements of paragraph (k)(4) of this section if the resident chooses 
to pay more for care at a facility which exceeds the base level of care 
as defined in paragraph (b) of this section notwithstanding the 
resident's needs.

(The information collection requirements in this section have been 
approved by the Office of Management and Budget under control number 
2900-0844.)

[54 FR 20842, May 15, 1989, as amended at 54 FR 22754, May 26, 1989. 
Redesignated at 61 FR 21965, May 13, 1996, as amended at 61 FR 63720, 
Dec. 2, 1996; 69 FR 18803, Apr. 9, 2004; 74 FR 63308, Dec. 3, 2009; 76 
FR 10248, Feb. 24, 2011; 82 FR 34415, July 25, 2017; 82 FR 35451, July 
31, 2017; 84 FR 33697, July 15, 2019]



Sec.  17.64  [Reserved]



Sec.  17.65  Approvals and provisional approvals of community residential
care facilities.

    (a) An approval of a facility meeting all of the standards in 38 CFR 
17.63 based on the report of a VA inspection and any findings of 
necessary interim monitoring of the facility shall be for a 12-month 
period.
    (b) The approving official, based on the report of a VA inspection 
and on any findings of necessary interim monitoring of the facility, may 
provide a community residential care facility with a provisional 
approval if that facility does not meet one or more of the standards in 
38 CFR 17.63, provided that

[[Page 753]]

the deficiencies do not jeopardize the health or safety of the 
residents, and that the facility management and VA agree to a plan of 
correcting the deficiencies in a specified amount of time. A provisional 
approval shall not be for more than 12 months and shall not be for more 
time than VA determines is reasonable for correcting the specific 
deficiencies.
    (c) An approval may be changed to a provisional approval or 
terminated under the provisions of Sec. Sec.  17.66 through 17.71 
because of a subsequent failure to meet the standards of Sec.  17.63 and 
a provisional approval may be terminated under the provisions of 
Sec. Sec.  17.66 through 17.71 based on failure to meet the plan of 
correction or failure otherwise to meet the standards of Sec.  17.63.
    (d)(1) VA may waive one or more of the standards in 38 CFR 17.63 for 
the approval of a particular community residential care facility, 
provided that a VA safety expert certifies that the deficiency does not 
endanger the life or safety of the residents; the deficiency cannot be 
corrected as provided in paragraph (b) of this section for provisional 
approval of the community residential care facility; and granting the 
waiver is in the best interests of the veteran in the facility and VA's 
community residential care program. In order to reach the above 
determinations, the VA safety expert may request supporting 
documentation from the community residential care facility.
    (2) In those instances where a waiver is granted, the subject 
standard is deemed to have been met for purposes of approval of the 
community residential care facility under paragraphs (a) or (b) of this 
section. The waiver and date of issuance will be noted on each annual 
survey of the facility as long as the waiver remains valid and in place.
    (3) A waiver issued under this section remains valid so long as the 
community residential care facility operates continuously under this 
program without a break. VA may, on the recommendation of an approving 
official, rescind a waiver issued under this section if a VA inspector 
determines that there has been a change in circumstances and that the 
deficiency can now be corrected, or a VA safety expert finds that the 
deficiency jeopardizes the health and safety of residents.

[74 FR 63308, Dec. 3, 2009, as amended at 78 FR 32126, May 29, 2013]



Sec.  17.66  Notice of noncompliance with VA standards.

    If the hearing official determines that an approved community 
residential care facility does not comply with the standards set forth 
in Sec.  17.63 of this part, the hearing official shall notify the 
community residential care facility in writing of:
    (a) The standards which have not been met;
    (b) The date by which the standards must be met in order to avoid 
revocation of VA approval;
    (c) The community residential care facility's opportunity to request 
an oral or paper hearing under Sec.  17.67 of this part before VA 
approval is revoked; and
    (d) The date by which the hearing official must receive the 
community residential care facility's request for a hearing, which shall 
not be less than 10 calendar days and not more than 20 calendar days 
after the date of VA notice of noncompliance, unless the hearing 
official determines that noncompliance with the standards threatens the 
lives of community residential care residents in which case the hearing 
official must receive the community residential care facility's request 
for an oral or paper hearing within 36 hours of receipt of VA notice.

[54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996; 78 FR 32126, May 29, 2013]



Sec.  17.67  Request for a hearing.

    The community residential care facility operator must specify in 
writing whether an oral or paper hearing is requested. The request for 
the hearing must be sent to the hearing official. Timely receipt of a 
request for a hearing will stay the revocation of VA approval until the 
hearing official issues a written decision on the community residential 
care facility's compliance with VA standards. The hearing official may 
accept a request for a hearing received after the time limit, if the 
community residential care facility shows

[[Page 754]]

that the failure of the request to be received by the hearing official's 
office by the required date was due to circumstances beyond its control.

[54 FR 20842, May 15, 1989. Redesignated at 61 FR 21965, May 13, 1996]



Sec.  17.68  Notice and conduct of hearing.

    (a) Upon receipt of a request for an oral hearing, the hearing 
official shall:
    (1) Notify the community residential care facility operator of the 
date, time, and location for the hearing; and
    (2) Notify the community residential care facility operator that 
written statements and other evidence for the record may be submitted to 
the hearing official before the date of the hearing. An oral hearing 
shall be informal. The rules of evidence shall not be followed. 
Witnesses shall testify under oath or affirmation. A recording or 
transcript of every oral hearing shall be made. The hearing official may 
exclude irrelevant, immaterial, or unduly repetitious testimony.
    (b) Upon the receipt of a community residential care facility's 
request for a paper hearing, the hearing official shall notify the 
community residential care facility operator that written statements and 
other evidence must be submitted to the hearing official by a specified 
date in order to be considered as part of the record.
    (c) In all hearings, the community residential care facility 
operator and VA may be represented by counsel.

[54 FR 20842, May 15, 1989. Redesignated at 61 FR 21965, May 13, 1996]



Sec.  17.69  Waiver of opportunity for hearing.

    If representatives of a community residential care facility which 
receive a notice of noncompliance under Sec.  17.66 of this part fail to 
appear at an oral hearing of which they have been notified or fail to 
submit written statements for a paper hearing in accordance with Sec.  
17.68 of this part, unless the hearing official determines that their 
failure was due to circumstances beyond their control, the hearing 
official shall:
    (a) Consider the representatives of the community residential care 
facility to have waived their opportunity for a hearing; and,
    (b) Revoke VA approval of the community residential care facility 
and notify the community residential care facility of this revocation.

[54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996]



Sec.  17.70  Written decision following a hearing.

    (a) The hearing official shall issue a written decision within 20 
days of the completion of the hearing. An oral hearing shall be 
considered completed when the hearing ceases to receive in person 
testimony. A paper hearing shall be considered complete on the date by 
which written statements must be submitted to the hearing official in 
order to be considered as part of the record.
    (b) The hearing official's determination of a community residential 
care facility's noncompliance with VA standards shall be based on the 
preponderance of the evidence.
    (c) The written decision shall include:
    (1) A statement of the facts;
    (2) A determination whether the community residential care facility 
complies with the standards set forth in Sec.  17.63 of this part; and
    (3) A determination of the time period, if any, the community 
residential care facility shall have to remedy any noncompliance with VA 
standards before revocation of VA approval occurs.
    (d) The hearing official's determination of any time period under 
paragraph (c)(3) of this section shall consider the safety and health of 
the residents of the community residential care facility and the length 
of time since the community residential care facility received notice of 
the noncompliance.

[54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996]



Sec.  17.71  Revocation of VA approval.

    (a) If a hearing official determines under Sec.  17.70 of this part 
that a community residential care facility does not comply with the 
standards set forth in Sec.  17.63 of this part and determines that

[[Page 755]]

the community residential care facility shall not have further time to 
remedy the noncompliance, the hearing official shall revoke approval of 
the community residential care facility and notify the community 
residential care facility of this revocation.
    (b) Upon revocation of VA approval, VA health care personnel shall:
    (1) Cease referring veterans to the community residential care 
facility; and,
    (2) Notify any veteran residing in the community residential care 
facility of the facility's disapproval and request permission to assist 
in the veteran's removal from the facility. If a veteran has a person or 
entity authorized by law to give permission on behalf of the veteran, VA 
health care personnel shall notify that person or entity of the 
community residential care facility's disapproval and request permission 
to assist in removing the veteran from the community residential care 
facility.
    (c) If the hearing official determines that a community residential 
care facility fails to comply with the standards set forth in Sec.  
17.63 of this part and determines that the community residential care 
facility shall have an additional time period to remedy the 
noncompliance, the hearing official shall review at the end of the time 
period the evidence of the community residential care facility's 
compliance with the standards which were to have been met by the end of 
that time period and determine if the community residential care 
facility complies with the standards. If the community residential care 
facility fails to comply with these or any other standards, the 
procedures set forth in Sec. Sec.  17.66-17.71 of this part shall be 
followed.

[54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996]



Sec.  17.72  Availability of information.

    VA standards will be made available to other Federal, State and 
local agencies charged with the responsibility of licensing, or 
otherwise regulating or inspecting community residential care 
facilities.

[54 FR 20842, May 15, 1989. Redesignated at 61 FR 21965, May 13, 1996]



Sec.  17.73  Medical foster homes--general.

    (a) Purpose. Through the medical foster home program, VA recognizes 
and approves certain medical foster homes for the placement of veterans. 
The choice to become a resident of a medical foster home is a voluntary 
one on the part of each veteran. VA's role is limited to referring 
veterans to approved medical foster homes. When a veteran is placed in 
an approved home, VA will provide inspections to ensure that the home 
continues to meet the requirements of this part, as well as oversight 
and medical foster home caregiver training. If a medical foster home 
does not meet VA's criteria for approval, VA will not refer any veteran 
to the home or provide any of these services. VA may also provide 
certain medical benefits to veterans placed in medical foster homes, 
consistent with the VA program in which the veteran is enrolled.
    (b) Definitions. For the purposes of this section and Sec.  17.74:
    Labeled means that the equipment or materials have attached to them 
a label, symbol, or other identifying mark of an organization recognized 
as having jurisdiction over the evaluation and periodic inspection of 
such equipment or materials, and by whose labeling the manufacturer 
indicates compliance with appropriate standards or performance.
    Medical foster home means a private home in which a medical foster 
home caregiver provides care to a veteran resident and:
    (i) The medical foster home caregiver lives in the medical foster 
home;
    (ii) The medical foster home caregiver owns or rents the medical 
foster home; and
    (iii) There are not more than three residents receiving care 
(including veteran and non-veteran residents).
    Medical foster home caregiver means the primary person who provides 
care to a veteran resident in a medical foster home.
    Placement refers to the voluntary decision by a veteran to become a 
resident in an approved medical foster home.
    Veteran resident means a veteran residing in an approved medical 
foster

[[Page 756]]

home who meets the eligibility criteria in paragraph (c) of this 
section.
    (c) Eligibility. VA health care personnel may assist a veteran by 
referring such veteran for placement in a medical foster home if:
    (1) The veteran is unable to live independently safely or is in need 
of nursing home level care;
    (2) The veteran must be enrolled in, or agree to be enrolled in, 
either a VA Home Based Primary Care or VA Spinal Cord Injury Homecare 
program, or a similar VA interdisciplinary program designed to assist 
medically complex veterans living in the home; and
    (3) The medical foster home has been approved in accordance with 
paragraph (d) of this section.
    (d) Approval of medical foster homes. Medical foster homes will be 
approved by a VA Medical Foster Homes Coordinator based on the report of 
a VA inspection and on any findings of necessary interim monitoring of 
the medical foster home, if that home meets the standards established in 
Sec.  17.74. The approval process is governed by the process for 
approving community residential care facilities under Sec. Sec.  17.65 
through 17.72 except as follows:
    (1) Where Sec. Sec.  17.65 through 17.72 reference Sec.  17.63.
    (2) Because VA does not physically place veterans in medical foster 
homes, VA also does not assist veterans in moving out of medical foster 
homes as we do for veterans in other community residential care 
facilities under Sec.  17.72(d)(2); however, VA will assist such 
veterans in locating an approved medical foster home when relocation is 
necessary.
    (e) Duties of Medical foster home caregivers. The medical foster 
home caregiver, with assistance from relief caregivers, provides a safe 
environment, room and board, supervision, and personal assistance, as 
appropriate for each veteran.

[77 FR 5188, Feb. 2, 2012]



Sec.  17.74  Standards applicable to medical foster homes.

    (a) General. A medical foster home must:
    (1) Meet all applicable state and local regulations, including 
construction, maintenance, and sanitation regulations.
    (2) Have safe and functioning systems for heating, hot and cold 
water, electricity, plumbing, sewage, cooking, laundry, artificial and 
natural light, and ventilation. Ventilation for cook stoves is not 
required.
    (3) Except as otherwise provided in this section, meet the 
applicable provisions of chapters 1 through 11 and 24, and section 33.7 
of NFPA 101 (incorporated by reference, see Sec.  17.1), and the other 
codes and chapters identified in this section, as applicable. Existing 
buildings or installations that do not comply with the installation 
provisions of the codes or standards referenced in paragraph (b)(1) 
through (5), (b)(8), and (b)(10) of Sec.  17.1 shall be permitted to be 
continued in service, provided that the lack of conformity with these 
codes and standards does not present a serious hazard to the occupants.
    (b) Community residential care facility standards applicable to 
medical foster homes. Medical foster homes must comply with Sec.  
17.63(c), (d), (f), (h), (j) and (k).
    (c) Activities. The facility must plan and facilitate appropriate 
recreational and leisure activities.
    (d) Residents' bedrooms. Each veteran resident must have a bedroom:
    (1) With a door that closes and latches;
    (2) That contains a suitable bed and appropriate furniture; and
    (3) That is single occupancy, unless the veteran agrees to a multi-
occupant bedroom.
    (e) Windows. VA may grant provisional approval for windows used as a 
secondary means of escape that do not meet the minimum size and 
dimensions required by chapter 24 of NFPA 101 (incorporated by 
reference, see Sec.  17.1) if the windows are a minimum of 5.0 square 
feet (and at least 20 inches wide and at least 22 inches high). The 
secondary means of escape must be brought into compliance with chapter 
24 no later than 60 days after a veteran resident is placed in the home.
    (f) Special locking devices. Special locking devices that do not 
comply with section 7.2.1.5 of NFPA 101 (incorporated by reference, see 
Sec.  17.1) are permitted where the clinical needs of the

[[Page 757]]

veteran resident require specialized security measures and with the 
written approval of:
    (1) The responsible VA clinician; and
    (2) The VA fire/safety specialist or the Director of the VA Medical 
Center of jurisdiction.
    (g) Smoke and carbon monoxide (CO) detectors and smoke and CO 
alarms. Medical foster homes must comply with this paragraph (g) no 
later than 60 days after the first veteran is placed in the home. Prior 
to compliance, VA inspectors will provisionally approve a medical foster 
home for the duration of this 60-day period if the medical foster home 
mitigates risk through the use of battery-operated single station 
alarms, provided that the alarms are installed before any veteran is 
placed in the home.
    (1) Smoke detectors or smoke alarms must be provided in accordance 
with sections 24.3.4.1.1 or 24.3.4.1.2 of NFPA 101 (incorporated by 
reference, see Sec.  17.1); section 24.3.4.1.3 of NFPA 101 will not be 
used. In addition, smoke alarms must be interconnected so that the 
operation of any smoke alarm causes an alarm in all smoke alarms within 
the medical foster home. Smoke detectors or smoke alarms must not be 
installed in the kitchen or any other location subject to causing false 
alarms.
    (2) CO detectors or CO alarms must be installed in any medical 
foster home with a fuel-burning appliance, fireplace, or an attached 
garage, in accordance with NFPA 720 (incorporated by reference, see 
Sec.  17.1).
    (3) Combination CO/smoke detectors and combination CO/smoke alarms 
are permitted.
    (4) Smoke detectors and smoke alarms must initiate a signal to a 
remote supervising station to notify emergency forces in the event of an 
alarm.
    (5) Smoke and/or CO alarms and smoke and/or CO detectors, and all 
other elements of a fire alarm system, must be inspected, tested, and 
maintained in accordance with NFPA 72 (incorporated by reference, see 
Sec.  17.1) and NFPA 720 (incorporated by reference, see Sec.  17.1).
    (h) Sprinkler systems. (1) If a sprinkler system is installed, it 
must be inspected, tested, and maintained in accordance with NFPA 25 
(incorporated by reference, see Sec.  17.1), unless the sprinkler system 
is installed in accordance with NFPA 13D (incorporated by reference, see 
Sec.  17.1). If a sprinkler system is installed in accordance with NFPA 
13D, it must be inspected annually by a competent person.
    (2) If sprinkler flow or pressure switches are installed, they must 
activate notification appliances in the medical foster home, and must 
initiate a signal to the remote supervising station.
    (i) Fire extinguishers. At least one 2-A:10-B:C rated fire 
extinguisher must be visible and readily accessible on each floor, 
including basements, and must be maintained in accordance with the 
manufacturer's instructions. Portable fire extinguishers must be 
inspected, tested, and maintained in accordance with NFPA 10 
(incorporated by reference, see Sec.  17.1).
    (j) Emergency lighting. Each occupied floor must have at least one 
plug-in rechargeable flashlight, operable and readily accessible, or 
other approved emergency lighting. Such emergency lighting must be 
tested monthly and replaced if not functioning.
    (k) Fireplaces. A non-combustible hearth, in addition to protective 
glass doors or metal mesh screens, is required for fireplaces. Hearths 
and protective devices must meet all applicable state and local fire 
codes.
    (l) Portable heaters. Portable heaters may be used if they are 
maintained in good working condition and:
    (1) The heating elements of such heaters do not exceed 212 degrees 
Fahrenheit (100 degrees Celsius);
    (2) The heaters are labeled; and
    (3) The heaters have tip-over protection.
    (m) Oxygen safety. Any area where oxygen is used or stored must not 
be near an open flame and must have a posted ``No Smoking'' sign. Oxygen 
cylinders must be adequately secured or protected to prevent damage to 
cylinders. Whenever possible, transfilling of liquid oxygen must take 
place outside of the living areas of the home.
    (n) Smoking. Smoking must be prohibited in all sleeping rooms, 
including

[[Page 758]]

sleeping rooms of non-veteran residents. Ashtrays must be made of 
noncombustible materials.
    (o) Special/other hazards. (1) Extension cords must be three-
pronged, grounded, sized properly, and not present a hazard due to 
inappropriate routing, pinching, damage to the cord, or risk of 
overloading an electrical panel circuit.
    (2) Flammable or combustible liquids and other hazardous material 
must be safely and properly stored in either the original, labeled 
container or a safety can as defined by NFPA 30 (incorporated by 
reference, see Sec.  17.1).
    (p) Emergency egress and relocation drills. Operating features of 
the medical foster home must comply with section 33.7 of NFPA 101 
(incorporated by reference, see Sec.  17.1), except that section 
33.7.3.6 of NFPA 101 does not apply. Instead, VA will enforce the 
following requirements:
    (1) Before placement in a medical foster home, the veteran will be 
clinically evaluated by VA to determine whether the veteran is able to 
participate in emergency egress and relocation drills. Within 24 hours 
after arrival, each veteran resident must be shown how to respond to a 
fire alarm and evacuate the medical foster home, unless the veteran 
resident is unable to participate.
    (2) The medical foster home caregiver must demonstrate the ability 
to evacuate all occupants within three minutes to a point of safety 
outside of the medical foster home that has access to a public way, as 
defined in NFPA 101 (incorporated by reference, see Sec.  17.1).
    (3) If all occupants are not evacuated within three minutes or if a 
veteran resident is either permanently or temporarily unable to 
participate in drills, then the medical foster home will be given a 60-
day provisional approval, after which time the home must have 
established one of the following remedial options or VA will terminate 
the approval in accordance with Sec.  17.65.
    (i) The home is protected throughout with an automatic sprinkler 
system in accordance with section 9.7 of NFPA 101 (incorporated by 
reference, see Sec.  17.1) and whichever of the following apply: NFPA 13 
(incorporated by reference, see Sec.  17.1); NFPA 13R (incorporated by 
reference, see Sec.  17.1); or NFPA 13D (incorporated by reference, see 
Sec.  17.1).
    (ii) Each veteran resident who is permanently or temporarily unable 
to participate in a drill or who fails to evacuate within three minutes 
must have a bedroom located at the ground level with direct access to 
the exterior of the home that does not require travel through any other 
portion of the residence, and access to the ground level must meet the 
requirements of the Americans with Disabilities Act. The medical foster 
home caregiver's bedroom must also be on ground level.
    (4) The 60-day provisional approval under paragraph (p)(3) of this 
section may be contingent upon increased fire prevention measures, 
including but not limited to prohibiting smoking or use of a fireplace. 
However, each veteran resident who is temporarily unable to participate 
in a drill will be permitted to be excused from up to two drills within 
one 12-month period, provided that the two excused drills are not 
consecutive, and this will not be a cause for VA to not approve the 
home.
    (5) For purposes of paragraph (p), the term all occupants means 
every person in the home at the time of the emergency egress and 
relocation drill, including non-residents.
    (q) Records of compliance with this section. The medical foster home 
must comply with Sec.  17.63(i) regarding facility records, and must 
document all inspection, testing, drills and maintenance activities 
required by this section. Such documentation must be maintained for 3 
years or for the period specified by the applicable NFPA standard, 
whichever is longer. Documentation of emergency egress and relocation 
drills must include the date, time of day, length of time to evacuate 
the home, the name of each medical foster home caregiver who 
participated, the name of each resident, whether the resident 
participated, and whether the resident required assistance.
    (r) Local permits and emergency response. Where applicable, a permit 
or license must be obtained for occupancy or business by the medical 
foster home caregiver from the local building or business authority. 
When there is a home occupant who is incapable of self-

[[Page 759]]

preservation, the local fire department or response agency must be 
notified by the medical foster home within 7 days of the beginning of 
the occupant's residency.
    (s) Equivalencies. Any equivalencies to VA requirements must be in 
accordance with section 1.4.3 of NFPA 101 (incorporated by reference, 
see Sec.  17.1), and must be approved in writing by the appropriate 
Veterans Health Administration, Veterans Integrated Service Network 
(VISN) Director. A veteran living in a medical foster home when the 
equivalency is granted or who is placed there after it is granted must 
be notified in writing of the equivalencies and that he or she must be 
willing to accept such equivalencies. The notice must describe the exact 
nature of the equivalency, the requirements of this section with which 
the medical foster home is unable to comply, and explain why the VISN 
Director deemed the equivalency necessary. Only equivalencies that the 
VISN Director determines do not pose a risk to the health or safety of 
the veteran may be granted. Also, equivalencies may only be granted when 
technical requirements of this section cannot be complied with absent 
undue expense, there is no other nearby home which can serve as an 
adequate alternative, and the equivalency is in the best interest of the 
veteran.
    (t) Cost of medical foster homes. (1) Payment for the charges to 
veterans for the cost of medical foster home care is not the 
responsibility of the United States Government.
    (2) The resident or an authorized personal representative and a 
representative of the medical foster home facility must agree upon the 
charge and payment procedures for medical foster home care.
    (3) The charges for medical foster home care must be comparable to 
prices charged by other assisted living and nursing home facilities in 
the area based on the veteran's changing care needs and local 
availability of medical foster homes. (The Office of Management and 
Budget has approved the information collection requirements in this 
section under control number 2900-0777.)

[77 FR 5189, Feb. 2, 2012, as amended at 80 FR 44862, July 28, 2015]

                Use of Services of Other Federal Agencies



Sec.  17.80  Alcohol and drug dependence or abuse treatment and 
rehabilitation in residential and nonresidential facilities by contract.

    (a) Alcohol and drug dependence or abuse treatment and 
rehabilitation may be authorized by contract in nonresidential 
facilities and in residential facilities provided by halfway houses, 
therapeutic communities, psychiatric residential treatment centers and 
other community-based treatment facilities, when considered to be 
medically advantageous and cost effective for the following:
    (1) Veterans who have been or are being furnished care by 
professional staff over which the Secretary has jurisdiction and such 
transitional care is reasonably necessary to continue treatment;
    (2) Persons in the Armed Forces who, upon discharge therefrom will 
become eligible veterans, when duly referred with authorization for 
Department of Veterans Affairs medical center hospital care in 
preparation for treatment and rehabilitation in this program under the 
following limitations:
    (i) Such persons may be accepted by transfer only during the last 30 
days of such person's enlistment or tour of duty,
    (ii) The person requests transfer in writing for treatment for a 
specified period of time during the last 30 days of such person's 
enlistment period or tour of duty,
    (iii) Treatment does not extend beyond the period of time specified 
in the request unless such person requests in writing an extension for a 
further specified period of time and such request is approved by the 
Department of Veterans Affairs Medical Center Director authorizing 
treatment and rehabilitation,
    (iv) Such care and treatment will be provided as if the person were 
a veteran, subject to reimbursement by the respective military service 
for the

[[Page 760]]

costs of hospital care and control treatment provided while the person 
is an active duty member.
    (b) The maximum period for one treatment episode is limited to 60 
days. The Department of Veterans Affairs Medical Center Director may 
authorize one 30-day extension.
    (c) Any person who has been discharged or released from active 
military, naval or air service, and who, upon application for treatment 
and rehabilitative services under the authority of this section is 
determined to be legally ineligible for such treatment or rehabilitation 
services shall be:
    (1) Provided referral services to assist the person, to the maximum 
extent possible, in obtaining treatment and rehabilitation services from 
sources outside the Department of Veterans Affairs, not at Department of 
Veterans Affairs expense and,
    (2) If pertinent, advised of the right to apply to the appropriate 
military, naval or air service and the Department of Veterans Affairs 
for review of such person's discharge or release from such service.

(Authority: 38 U.S.C. 1720A)

[47 FR 57706, Dec. 28, 1982. Redesignated at 61 FR 21965, May 13, 1996, 
as amended at 61 FR 56897, Nov. 5, 1996]



Sec.  17.81  Contracts for residential treatment services for veterans
with alcohol or drug dependence or abuse disabilities.

    (a) Contracts for treatment services authorized under Sec.  17.80(a) 
may be awarded in accordance with applicable Department of Veterans 
Affairs and Federal procurement procedures. Such contracts will be 
awarded only after the quality and effectiveness, including adequate 
protection for the safety of the residents of the contractor's program, 
has been determined and then only to contractors, determined by the 
Under Secretary for Health or designee to meet the following 
requirements.
    (1) Meet fire safety requirements as follows:
    (i) The building must meet the requirements in the applicable 
provisions of NFPA 101 (incorporated by reference, see Sec.  17.1) and 
the other publications referenced in those provisions. Any equivalencies 
or variances to VA requirements must be approved by the appropriate 
Veterans Health Administration Veterans Integrated Service Network 
(VISN) Director.
    (ii) Where applicable, the home must have a current occupancy permit 
issued by the local and state governments in the jurisdiction where the 
home is located.
    (iii) All Department of Veterans Affairs sponsored residents will be 
mentally and physically capable of leaving the building, unaided, in the 
event of an emergency. Halfway house, therapeutic community and other 
residential program management must agree that all the other residents 
in any building housing veterans will also have such capability.
    (iv) There must be at least one staff member on duty 24 hours a day.
    (v) The facility must meet the following additional requirements, if 
the provisions for One and Two-Family Dwellings, as defined in NFPA 101, 
are applicable to the facility:
    (A) Portable fire extinguishers shall be installed, inspected, and 
maintained in accordance with NFPA 10 (incorporated by reference, see 
Sec.  17.1).
    (B) The facility shall meet the requirements in section 33.7 of NFPA 
101.
    (vi) An annual fire and safety inspection shall be conducted at the 
halfway house or residential facility by qualified Department of 
Veterans Affairs personnel. If a review of past Department of Veterans 
Affairs inspections or inspections made by the local authorities 
indicates that a fire and safety inspection would not be necessary, then 
the visit to the facility may be waived.
    (2) Be in compliance with existing standards of State safety codes 
and local, and/or State health and sanitation codes.
    (3) Be licensed under State or local authority.
    (4) Where applicable, be accredited by the State.
    (5) Comply with the requirements of the ``Confidentiality of Alcohol 
and Drug Abuse Patient Records'' (42 CFR part II) and the 
``Confidentiality of Certain Medical Records'' (38 U.S.C. 7332), which 
shall be part of the contract.
    (6) Demonstrate an existing capability to furnish the following:

[[Page 761]]

    (i) A supervised alcohol and drug free environment, including active 
affiliation with Alcoholics Anonymous (AA) programs.
    (ii) Staff sufficient in numbers and position qualifications to 
carry out the policies, responsibilities, and programs of the facility.
    (iii) Board and room.
    (iv) Laundry facilities for residents to do their own laundry.
    (v) Structured activities.
    (vi) Appropriate group activities, including physical activities.
    (vii) Health and personal hygiene maintenance.
    (viii) Monitoring administration of medications.
    (ix) Supportive social service.
    (x) Individual counseling as appropriate.
    (xi) Opportunities for learning/development of skills and habits 
which will enable Department of Veterans Affairs sponsored residents to 
adjust to and maintain freedom from dependence on or involvement with 
alcohol or drug abuse or dependence during or subsequent to leaving the 
facility.
    (xii) Support for the individual desire for sobriety (alcohol/drug 
abuse-free life style).
    (xiii) Opportunities for learning, testing, and internalizing 
knowledge of illness/recovery process, and for upgrading skills and 
improving personal relationships.
    (7) Data normally maintained and included in a medical record as a 
function of compliance with State or community licensing standards will 
be accessible.
    (b) Representatives of the Department of Veterans Affairs will 
inspect the facility prior to award of a contract to assure that 
prescribed requirements can be met. Inspections may also be carried out 
at such other times as deemed necessary by the Department of Veterans 
Affairs.
    (c) All requirements in this rule, and Department of Veterans 
Affairs reports of inspection of residential facilities furnishing 
treatment and rehabilitation services to eligible veterans shall to the 
extent possible, be made available to all government agencies charged 
with the responsibility of licensing or otherwise regulating or 
inspecting such institutions.
    (d) An individual case record will be created for each client which 
shall be maintained in security and confidence as required by the 
``Confidentiality of Alcohol and Drug Abuse Patient Records'' (42 CFR 
part 2) and the ``Confidentiality of Certain Medical Records'' (38 
U.S.C. 7332), and will be made available on a need to know basis to 
appropriate Department of Veterans Affairs staff members involved with 
the treatment program of the veterans concerned.
    (e) Contractors under this section shall provide reports of budget 
and case load experience upon request from a Department of Veterans 
Affairs official.

(Authority: 38 U.S.C. 1720A)

[47 FR 57707, Dec. 28, 1982. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996; 61 FR 63720, Dec. 2, 1996; 69 FR 18803, Apr. 9, 
2004; 76 FR 10249, Feb. 24, 2011]



Sec.  17.82  Contracts for outpatient services for veterans with alcohol
or drug dependence or abuse disabilities.

    (a) Contracts for treatment services authorized under Sec.  17.80 
may be awarded in accordance with applicable Department of Veterans 
Affairs and Federal procurement procedures. Such contracts will be 
awarded only after the quality and effectiveness, including adequate 
protection for the safety of the participants of the contractor's 
program, has been determined and then only to contractors determined by 
the Under Secretary for Health or designee to be fully capable of 
meeting the following standards:
    (1) The following minimum fire safety requirements must be met:
    (i) The building must meet the requirements in the applicable 
provisions of the NFPA 101 (incorporated by reference, see Sec.  17.1) 
and the other publications referenced in those provisions. Any 
equivalencies or variances to VA requirements must be approved by the 
appropriate Veterans Health Administration Veterans Integrated Service 
Network (VISN) Director.
    (ii) Where applicable, the facility must have a current occupancy 
permit

[[Page 762]]

issued by the local and state governments in the jurisdiction where the 
home is located.
    (iii) All Department of Veterans Affairs sponsored patients will be 
mentally and physically capable of leaving the building, unaided, in the 
event of an emergency.
    (iv) As a minimum, fire exit drills must be held at least quarterly, 
and a written plan for evacuation in the event of fire shall be 
developed and reviewed annually. The plan shall outline the duties, 
responsibilities and actions to be taken by the staff in the event of a 
fire emergency. This plan shall be implemented during fire exit drills.
    (v) An annual fire and safety inspection shall be conducted at the 
facility by qualified Department of Veterans Affairs personnel. If a 
review of past Department of Veterans Affairs inspections or inspections 
made by the local authorities indicates that a fire and safety 
inspection would not be necessary, then the visit to the facility may be 
waived.
    (2) Conform to existing standards of State safety codes and local 
and/or State health and sanitation codes.
    (3) Be licensed under State or local authority.
    (4) Where applicable, be accredited by the State.
    (5) Comply with the requirements of the ``Confidentiality of Alcohol 
and Drug Abuse Patient Records'' (42 CFR part 2) and the 
``Confidentiality of Certain Medical Records'' (38 U.S.C. 7332), which 
shall be part of the contract.
    (6) Demonstrate an existing capability to furnish the following:
    (i) A supervised, alcohol and drug free environment, including 
active affiliation with Alcoholics Anonymous (AA) programs.
    (ii) Staff sufficient in numbers and position qualifications to 
carry out the policies, responsibilities, and programs of the facility.
    (iii) Structured activities.
    (iv) Appropriate group activities.
    (v) Monitoring medications.
    (vi) Supportive social service.
    (vii) Individual counseling as appropriate.
    (viii) Opportunities for learning/development of skills and habits 
which will enable Department of Veterans Affairs sponsored residents to 
adjust to and maintain freedom from dependence on or involvement with 
alcohol or drug abuse or dependence during or subsequent to leaving the 
facility.
    (ix) Support for the individual desire for sobriety (alcohol/drug 
abuse-free life style).
    (x) Opportunities for learning, testing, and internalizing knowledge 
of illness/recovery process, and to upgrade skills and improve personal 
relationships.
    (7) Data normally maintained and included in a medical record as a 
function of compliance with State or community licensing standards will 
be accessible.
    (b) Representatives of the Department of Veterans Affairs will 
inspect the facility prior to award of a contract to assure that 
prescribed requirements can be met. Inspections may also be carried out 
at such other times as deemed necessary by the Department of Veterans 
Affairs.
    (c) All requirements in this rule and Department of Veterans Affairs 
reports of inspection of residential facilities furnishing treatment and 
rehabilitation services to eligible veterans shall, to the extent 
possible, be made available to all government agencies charged with the 
responsibility of licensing or otherwise regulating or inspecting such 
institutions.
    (d) An individual case record will be created for each client which 
shall be maintained in security and confidence as required by the 
``Confidentiality of Alcohol and Drug Abuse Patient Records'' (42 CFR 
part 2) and the ``Confidentiality of Certain Medical Records'' (38 
U.S.C. 7332), and will be made available on a need to know basis to 
appropriate Department of Veterans Affairs staff members involved with 
the treatment program of the veterans concerned.

(Authority: 38 U.S.C. 1720A)

[47 FR 57708, Dec. 28, 1982. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996; 61 FR 63720, Dec. 2, 1996; 62 FR 17072, Apr. 9, 
1997; 69 FR 18803, Apr. 9, 2004; 76 FR 10249, Feb. 24, 2011]

[[Page 763]]



Sec.  17.83  Limitations on payment for alcohol and drug dependence or
abuse treatment and rehabilitation.

    The authority to enter into contracts shall be effective for any 
fiscal year only to such extent or in such amounts as are provided in 
appropriation acts, and payments shall not exceed these amounts.

(Authority: Pub. L. 96-22, 38 U.S.C. 1720A)

[47 FR 57708, Dec. 28, 1982. Redesignated at 61 FR 21965, May 13, 1996]

                        Research-Related Injuries



Sec.  17.85  Treatment of research-related injuries to human subjects.

    (a) VA medical facilities shall provide necessary medical treatment 
to a research subject injured as a result of participation in a research 
project approved by a VA Research and Development Committee and 
conducted under the supervision of one or more VA employees. This 
section does not apply to:
    (1) Treatment for injuries due to noncompliance by a subject with 
study procedures, or
    (2) Research conducted for VA under a contract with an individual or 
a non-VA institution.

    Note to Sec.  17.85(a)(1) and (a)(2): Veterans who are injured as a 
result of participation in such research may be eligible for care from 
VA under other provisions of this part.

    (b) Except in the following situations, care for VA research 
subjects under this section shall be provided in VA medical facilities.
    (1) If VA medical facilities are not capable of furnishing 
economical care or are not capable of furnishing the care or services 
required, VA medical facility directors shall contract for the needed 
care.
    (2) If inpatient care must be provided to a non-veteran under this 
section, VA medical facility directors may contract for such care.
    (3) If a research subject needs treatment in a medical emergency for 
a condition covered by this section, VA medical facility directors shall 
provide reasonable reimbursement for the emergency treatment in a non-VA 
facility.
    (c) For purposes of this section, ``VA employee'' means any person 
appointed by VA as an officer or employee and acting within the scope of 
his or her appointment (VA appoints officers and employees under title 5 
and title 38 of the United States Code).

(Authority: 38 U.S.C. 501, 7303)

[63 FR 11124, Mar. 6, 1998]

              Care During Certain Disasters and Emergencies



Sec.  17.86  Provision of hospital care and medical services during certain 
disasters and emergencies under 38 U.S.C. 1785.

    (a) This section sets forth regulations regarding the provision of 
hospital care and medical services under 38 U.S.C. 1785.
    (b) During and immediately following a disaster or emergency 
referred to in paragraph (c) of this section, VA under 38 U.S.C. 1785 
may furnish hospital care and medical services to individuals (including 
those who otherwise do not have VA eligibility for such care and 
services) responding to, involved in, or otherwise affected by that 
disaster or emergency.
    (c) For purposes of this section, a disaster or emergency means:
    (1) A major disaster or emergency declared by the President under 
the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 
U.S.C. 5121 et seq.) (Stafford Act); or
    (2) A disaster or emergency in which the National Disaster Medical 
System established pursuant to section 2811(b) of the Public Health 
Service Act (42 U.S.C. 300hh-11(b)) is activated either by the Secretary 
of Health and Human Services under paragraph (3)(A) of that section or 
as otherwise authorized by law.
    (d) For purposes of paragraph (b) of this section, the terms 
hospital care and medical services have the meanings given such terms by 
38 U.S.C. 1701(5) and 1701(6).
    (e) Unless the cost of care is charged at rates agreed upon in a 
sharing agreement as described in Sec.  17.102(e), the cost of hospital 
care and medical services provided under this section to an officer or 
employee of a department or agency of the United States (other than VA) 
or to a member of the Armed Forces shall be calculated in accordance 
with the provisions of Sec.  17.102(c)

[[Page 764]]

and (h). Other individuals who receive hospital care or medical services 
under this section are responsible for the cost of the hospital care or 
medical services when charges are mandated by Federal law (including 
applicable appropriation acts) or when the cost of care or services is 
not reimbursed by other-than-VA Federal departments or agencies. When 
individuals are responsible under this section for the cost of hospital 
care or medical services, VA will bill in the amounts calculated in 
accordance with the provisions of Sec.  17.102(h), without applying the 
exception provided in the first paragraph of Sec.  17.102.
    (f) VA may furnish care and services under this section to a veteran 
without regard to whether that individual is enrolled in the VA 
healthcare system under 38 U.S.C. 1705 and Sec.  17.36 of this part.

(Authority: 38 U.S.C. 501, 1785)

[73 FR 26946, May 12, 2008]

 Vocational Training and Health-Care Eligibility Protection for Pension 
                               Recipients



Sec.  17.90  Medical care for veterans receiving vocational training under
38 U.S.C. chapter 15.

    Hospital care, nursing home care and medical services may be 
provided to any veteran who is participating in a vocational training 
program under 38 U.S.C. chapter 15.
    (a) For purposes of determining eligibility for this medical 
benefit, the term participating in a vocational training program under 
38 U.S.C. chapter 15 means the same as the term participating in a 
rehabilitation program under 38 U.S.C. chapter 31 as defined in Sec.  
17.47(i). Eligibility for such medical care will continue only while the 
veteran is participating in the vocational training program.
    (b) The term hospital care and medical services means class V dental 
care, priority III medical services, nursing home care and non-VA 
hospital care and/or fee medical/dental care if VA is unable to provide 
the required medical care economically at VA or other government 
facilities because of geographic inaccessibility or because of the 
unavailability of the required services at VA facilities.

(Authority: 38 U.S.C. 1524, 1525, 1516)

[51 FR 19330, May 29, 1986, as amended at 56 FR 3422, Jan. 30, 1991. 
Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 79 FR 
54615, Sept. 12, 2014]



Sec.  17.91  Protection of health-care eligibility.

    Any veteran whose entitlement to VA pension is terminated by reason 
of income from work or training shall, subject to paragraphs (a) and (b) 
of this section, retain for 3 years after the termination, the 
eligibility for hospital care, nursing home care and medical services 
(not including dental) which the veteran otherwise would have had if the 
pension had not been terminated as a result of the veteran's receipt of 
earnings from activity performed for remuneration or gain by the veteran 
but only if the veteran's annual income from sources other than such 
earnings would, taken alone, not result in the termination of the 
veteran's pension.
    (a) A veteran who participates in a vocational training program 
under 38 U.S.C. chapter 15 is eligible for the one-time 3 year retention 
of hospital care, nursing home care and medical services benefits at any 
time that the veteran's pension is terminated by reason of income from 
the veteran's employment.
    (b) A veteran who does not participate in a vocational training 
program under 38 U.S.C. chapter 15 is eligible for the one-time 3 year 
retention of hospital care and medical services benefits only if the 
veteran's pension is terminated by reason of income from the veteran's 
employment during the period February 1, 1985 through January 31, 1989.

(Authority: 38 U.S.C. 1524, 1525, 1516)

[51 FR 19330, May 29, 1986. Redesignated at 61 FR 21965, May 13, 1996]

                          Outpatient Treatment



Sec.  17.92  Outpatient care for research purposes.

    Subject to the provisions of Sec.  17.101, any person who is a bona 
fide volunteer may be furnished outpatient treatment when the treatment 
to be rendered is

[[Page 765]]

part of an approved Department of Veterans Affairs research project and 
there are insufficient veteran-patients suitable for the project.

[35 FR 11470, July 17, 1970. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996]



Sec.  17.93  Eligibility for outpatient services.

    (a) VA shall furnish on an ambulatory or outpatient basis medical 
services as are needed, to the following applicants under the conditions 
stated, except that applications for dental treatment must also meet the 
provisions of Sec.  17.161.


(Authority: 38 U.S.C. 1710, 1712)

    (1) For compensation and pension examinations. A compensation and 
pension examination shall be performed for any veteran who is directed 
to have such an examination by VA.


(Authority: 38 U.S.C. 111 and 501)

    (2) For adjunct treatment. Subject to the provisions of Sec. Sec.  
17.36 through 17.38, medical services on an ambulatory or outpatient 
basis shall be provided to veteans for an adjunct nonservice-connected 
condition associated with and held to be aggravating a disability from a 
disease or injury adjudicated as being service-connected.
    (b) The term ``shall furnish'' in this section and 38 U.S.C. 
1710(a)(1) and (a)(2) means that, if the veteran is in immediate need of 
outpatient medical services, VA shall furnish care at the VA facility 
where the veteran applies. If the needed medical services are not 
available there, VA shall arrange for care at the nearest VA medical 
facility or Department of Defense facility (with which VA has a sharing 
agreement) that can provide the needed care. If VA and Department of 
Defense facilities are not available, VA shall arrange for care on a fee 
basis, but only if the veteran is eligible to receive medical services 
in non-VA facilities under Sec.  17.52.

If the veteran is not in immediate need of outpatient medical services, 
VA shall schedule the veteran for care where the veteran applied, if the 
schedule there permits, or refer the veteran for scheduling to the 
nearest VA medical center or Department of Defense facility (with which 
VA has a sharing agreement).
    (c) VA may furnish on an ambulatory or outpatient basis medical 
services as needed to the following applicants, except that applications 
for dental treatment must also meet the provisions of Sec.  17.123.
    (1) For veterans participating in a rehabilitation program under 38 
U.S.C. chapter 31. Medical services on an ambulatory or outpatient basis 
may be provided as determined medically necessary for a veteran 
participating in a rehabilitation program under 38 U.S.C. chapter 31 as 
defined in Sec.  17.47(i).
    (2) [Reserved]

(Authority: 38 U.S.C. 1710, 1712)

[55 FR 20150, May 15, 1990, as amended at 58 FR 25565, Apr. 27, 1993. 
Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 64 FR 
54218, Oct. 6, 1999; 79 FR 54615, Sept. 12, 2014]



Sec.  17.94  Outpatient medical services for military retirees and 
other beneficiaries.

    Outpatient medical services for military retirees and other 
beneficiaries for which charges shall be made as required by Sec.  
17.101, may be authorized for persons properly referred by authorized 
officials of other Federal agencies for which the Secretary of Veterans 
Affairs may agree to render such service under the conditions stipulated 
by the Secretary and pensioners of nations allied with the United States 
in World War I and World War II when duly authorized.

[32 FR 13815, Oct. 4, 1967, as amended at 45 FR 6937, Jan. 31, 1980; 47 
FR 58249, Dec. 30, 1982. Redesignated and amended at 61 FR 21965, 21967, 
May 13, 1996]



Sec.  17.95  Outpatient medical services for Department of Veterans Affairs
employees and others in emergencies.

    Outpatient medical services for which charges shall be made as 
required by Sec.  17.102 may be authorized for employees of the 
Department of Veterans Affairs, their families, and the general public 
in emergencies, subject

[[Page 766]]

to conditions stipulated by the Secretary of Veterans Affairs.

(Authority: 38 U.S.C. 1784)

[47 FR 58249, Dec. 30, 1982. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996; 79 FR 54615, Sept. 12, 2014]



Sec.  17.96  Medication prescribed by non-VA physicians.

    Any prescription, which is not part of authorized Department of 
Veterans Affairs hospital or outpatient care, for drugs and medicines 
ordered by a private or non-Department of Veterans Affairs doctor of 
medicine or doctor of osteopathy duly licensed to practice in the 
jurisdiction where the prescription is written, shall be filled by a 
Department of Veterans Affairs pharmacy or a non-VA pharmacy under 
contract with VA, including non-VA pharmacy in a state home under 
contract with VA for filling prescriptions for patients in state homes, 
provided:
    (a) The prescription is for:
    (1) A veteran who by reason of being permanently housebound or in 
need of regular aid and attendance is in receipt of increased 
compensation under 38 U.S.C. chapter 11, or increased pension under 
Sec.  3.1(u) (Section 306 Pension) or Sec.  3.1(w) (Improved Pension), 
of this chapter, as a veteran of a period of war as defined by 38 U.S.C. 
101(11) (or, although eligible for such pension, is in receipt of 
compensation as the greater benefit), or
    (2) A veteran in need of regular aid and attendance who was formerly 
in receipt of increased pension as described in paragraph (a)(1) of this 
section whose pension has been discontinued solely by reason of excess 
income, but only so long as such veteran's annual income does not exceed 
the maximum annual income limitation by more than $ 1,000, and
    (b) The drugs and medicines are prescribed as specific therapy in 
the treatment of any of the veteran's illnesses or injuries.

(Authority: 38 U.S.C. 1706, 1710, 1712(d))

[68 FR 43929, July 25, 2003, as amended at 74 FR 44291, Aug. 28, 2009; 
78 FR 42456, July 16, 2013; 79 FR 54615, Sept. 12, 2014; 81 FR 46602, 
July 18, 2016]



Sec.  17.97  [Reserved]



Sec.  17.98  Mental health services.

    (a) Following the death of a veteran, bereavement counseling 
involving services defined in 38 U.S.C. 1783, may be furnished to 
persons who were receiving mental health services in connection with 
treatment of the veteran under 38 U.S.C. 1710, 1712A, 1717, or 1781, 
prior to the veteran's death, but may only be furnished in instances 
where the veteran's death had been unexpected or occurred while the 
veteran was participating in a VA hospice or similar program. 
Bereavement counseling may be provided only to assist individuals with 
the emotional and psychological stress accompanying the veteran's death, 
and only for a limited period of time, as determined by the Medical 
Center Director, but not to exceed 60 days. The Medical Center Director 
may approve a longer period of time when medically indicated.
    (b) For purposes of paragraph (a) of this section, an unexpected 
death is one which occurs when in the course of an illness the provider 
of care did not or could not have anticipated the timing of the death. 
Ordinarily, the provider of care can anticipate the patient's death and 
can inform the patient and family of the immediacy and certainty of 
death. If that has not taken place, a death can be described as 
unexpected.

(Authority: 38 U.S.C. 1783)

[53 FR 7186, Mar. 7, 1988. Redesignated and amended at 61 FR 21965, 
21967, May 13, 1996; 79 FR 54616, Sept. 12, 2014]

                    Charges, Waivers, and Collections



Sec.  17.100  Requirements for provider-based status.

    (a) Scope. This section establishes the criteria that VA uses to 
determine whether a VA medical facility is designated as provider-based 
for purposes of billing for non-service-connected and non-special 
treatment authority conditions.
    (b) Definitions. For purposes of this section:
    Community Based Outpatient Clinic (CBOC). A CBOC is a VA-operated, 
VA-funded, or VA-reimbursed site of care

[[Page 767]]

that is not located within a VA Medical Center. A CBOC can provide 
primary, specialty, subspecialty, mental health, or any combination of 
health care delivery services that can be appropriately provided in an 
outpatient setting.
    Community Living Center (CLC). A CLC is a component of the spectrum 
of long-term care that provides a skilled nursing environment and houses 
a variety of specialty programs for persons needing short and long stay 
services. VA CLCs are typically located on, or near a VA medical 
facility and are VA-owned and operated, but may be free-standing in the 
community.
    Facility. A facility is a point of care where individuals can seek 
VA health care services, to include a VA Medical Center, CBOC, Health 
Care Center, CLC, and Other Outpatient Services site.
    Health Care Center (HCC). An HCC is a VA-owned, VA-leased, VA-
contracted or shared clinic that is operational at least five days per 
week and provides primary care, mental health care, on site specialty 
services, and performs ambulatory surgery and/or invasive procedures 
that may require moderate sedation or general anesthesia.
    Main provider. A main provider (or parent facility/hospital or 
provider-based hospital (PBH)) is a provider that either creates, or 
acquires ownership of, another facility to deliver additional health 
care services under its name, ownership, and financial and 
administrative control. For example, VA Medical Centers and HCCs can be 
main providers.
    Other Outpatient Services (OOS). A site that provides outpatient 
services to veterans, but does not meet the definition of a CBOC or HCC 
per this section.
    Prospective Payment System (PPS). A Prospective Payment System (PPS) 
is a method of reimbursement in which Medicare payment is made based on 
a predetermined, fixed amount. The payment amount for a particular 
service is derived based on the classification system of that service 
(for example, Medicare Severity Diagnosis-Related Groups for inpatient 
hospital services furnished by most acute care hospitals).
    Provider-based outpatient facility (PBO). A provider-based 
outpatient facility is a provider of health care services that is either 
created by, or acquired by, a main provider for the purpose of 
furnishing additional health care services under the ownership, 
administrative, and financial control of the main provider, and meets 
the criteria outlined in this section.
    Remote location of a hospital. A remote location of a hospital is a 
CBOC, OOS Site, or HCC that is located offsite from the main facility.
    VA Medical Center (VAMC). A VAMC is a VA facility that provides at 
least two categories of care (inpatient, outpatient, residential, or 
institutional extended care).
    (c) Criteria for provider-based status. In order to be designated as 
a provider-based facility, the following criteria must be met:
    (1) Licensure. The facility seeking provider-based status and the 
main provider must operate under the same license. VA facilities are not 
licensed by States but all VA facilities are considered licensed for the 
purpose of collection and recovery by VA as part of VA's national 
organization structure and in accordance with VA standards, including 
standards established or recognized by VA's Offices of the Medical 
Inspector and Inspector General and major healthcare accreditation 
organizations.
    (2) Clinical services. The clinical services of the facility seeking 
provider-based status and the main provider must be integrated. 
Integration is demonstrated by the following:
    (i) The professional staff of the facility has clinical privileges 
at the main provider.
    (ii) The main provider maintains the same monitoring and oversight 
(i.e. credentialing and privileging) of the facility seeking provider-
based status as it does for any other department of the provider.
    (iii) The medical director of the facility seeking provider-based 
status maintains a reporting relationship with the chief medical officer 
or other similar official of the main provider that has the same 
frequency, intensity, and level of accountability that exists in the 
relationship between the medical

[[Page 768]]

director of a department of the main provider and the chief medical 
officer or other similar official of the main provider, and is under the 
same type of supervision and accountability as any other director, 
medical or otherwise, of the main provider.
    (iv) The medical staff committees or other professional committees 
at the main provider are responsible for medical activities in the 
facility seeking provider-based status, including quality assurance, 
utilization review, and the coordination and integration of services, to 
the extent practicable, between the facility seeking provider-based 
status and the main provider.
    (v) Medical records for patients treated in the facility seeking 
provider-based status are integrated into a unified retrieval system (or 
cross reference) of the main provider.
    (vi) Inpatient and outpatient services of the facility seeking 
provider-based status and the main provider are integrated, and patients 
treated at the facility who require further care have full access to all 
services of the main provider and are referred where appropriate to the 
corresponding inpatient or outpatient department or service of the main 
provider.
    (vii) Inpatient and outpatient services of the facility seeking 
provider-based status and the main provider are recognized under the 
main provider's accreditation.
    (3) Financial integration. The financial operations of the facility 
seeking provider-based status are fully integrated within the financial 
system of the main provider, as evidenced by shared income and expenses 
between the main provider and the facility. The costs of a facility that 
is a hospital department are reported in a cost center of the provider, 
costs of a facility other than a hospital department are reported in the 
appropriate cost center or cost centers of the main provider. The main 
provider's integrated health care system manpower and labor budget and 
the financial status of any facility seeking provider-based status is 
incorporated and readily identified in the main provider's integrated 
system reports.
    (4) Public awareness. The facility seeking provider-based status 
must be held out to the public (and other payers) as part of the main 
provider. Patients of the facility must be made aware that the facility 
is part of a main provider and that they will be billed accordingly. All 
literature, brochures, and public relations newsletters from the 
facility seeking provider-based status must provide the relationship 
between the main provider and the facility.
    (5) Obligations of hospital outpatient departments and hospital-
based facilities. If the facility seeking provider-based status is a 
hospital outpatient department or hospital-based facility, the facility 
must fulfill the obligations described in this paragraph:
    (i) The hospital outpatient department must comply with the 
antidumping rules of 42 CFR 489.20(l), (m), (q), and (r) and Sec.  
489.24.
    (ii) Physician services furnished in hospital outpatient departments 
or hospital-based facilities must be billed with the correct site-of-
service so that appropriate physician and practitioner payment amounts 
can be determined based on their geographical location.
    (iii) Physicians who work in hospital outpatient departments or 
hospital-based facilities are obligated to comply with the non-
discrimination provisions in 42 CFR 489.10(b).
    (iv) Hospital outpatient departments must treat all Medicare 
patients seen on an urgent/emergent basis as hospital outpatients.
    (v) In the case of a patient admitted to the hospital as an 
inpatient after receiving treatment in the hospital outpatient 
department or hospital-based facility, payments for services in the 
hospital outpatient department or hospital-based facility are subject to 
the payment window provisions applicable to PPS hospitals and to 
hospitals and units excluded from PPS set forth at 42 CFR 412.2(c)(5) 
and at 42 CFR 413.40(c)(2), respectively.
    (vi) The hospital outpatient department must meet applicable VA 
policies pertaining to hospital health and safety programs.
    (vii) VA must treat any facility that is located on the main 
hospital campus as a department of the hospital.

[[Page 769]]

    (6) Operation under the control of the main provider. The facility 
seeking provider-based status is operated under the control of the main 
provider. Control of the main provider requires:
    (i) The main provider and the facility seeking provider-based status 
have the same governing body.
    (ii) The facility seeking provider-based status is operated under 
the same organizational documents as the main provider. For example, the 
facility seeking provider-based status must be subject to common bylaws 
and operating decisions of the governing body of the main provider.
    (iii) The main provider has final responsibility for administrative 
decisions, final approval for contracts with outside parties, final 
approval for personnel actions, final responsibility for personnel 
policies (such as code of conduct), and final approval for medical staff 
appointments in the facility seeking provider-based status.
    (7) Administration and Supervision. The reporting relationship 
between the facility seeking provider-based status and the main provider 
must have the same frequency, intensity, and level of accountability 
that exists in the relationship between the main provider and one of its 
existing departments, as evidenced by compliance with all of the 
following requirements:
    (i) The facility seeking provider-based status is under the direct 
supervision of the main provider.
    (ii) The facility seeking provider-based status is operated under 
the same monitoring and oversight by the main provider as any other 
department of the provider, and is operated just as any other department 
of the provider with regard to supervision and accountability. The 
facility director or individual responsible for daily operations at the 
facility:
    (A) Maintains a reporting relationship with a manager at the main 
provider that has the same frequency, intensity, and level of 
accountability that exists in the relationship between the main provider 
and its existing departments; and
    (B) Is accountable to the governing body of the main provider, in 
the same manner as any department head of the provider.
    (iii) The following administrative functions of the facility seeking 
provider-based status are integrated with those of the main provider 
where the facility is based: Billing services, records, human resources, 
payroll, employee benefit package, salary structure, and purchasing 
services. Either the same employees or group of employees handle these 
administrative functions for the facility and the main provider, or the 
administrative functions for both the facility and the main provider are 
contracted out under the same contract agreement; or are handled under 
different contract agreements, with the contract of the facility or 
organization being managed by the main provider.
    (d) Illustrations of how the criteria are applied. (1) A VA facility 
that is seeking provider-based status that exists under contract 
arrangements, where only VA patients are seen, may be designated as 
provider-based if the provider-based requirements in this section are 
met.
    (2) A VA facility seeking provider-based status that exists under 
contract arrangements, where VA patients and non-VA patients are seen at 
the same non-VA owned facility, will have the same provider-based status 
as the non-VA owned facility that is hosting the VA facility.
    (3) A VA owned and operated facility seeking provider-based status, 
where some or all of the staff are contracted employees, may be 
designated as provider-based if the provider-based requirements in this 
section are met.

[85 FR 53174, Aug. 28, 2020]



Sec.  17.101  Collection or recovery by VA for medical care or services
provided or furnished to a veteran for a non-service connected disability.

    (a)(1) General. This section covers collection or recovery by VA, 
under 38 U.S.C. 1729, for medical care or services provided or furnished 
to a veteran:
    (i) For a nonservice-connected disability for which the veteran is 
entitled to care (or the payment of expenses of care) under a health 
plan contract;
    (ii) For a nonservice-connected disability incurred incident to the 
veteran's employment and covered under a

[[Page 770]]

worker's compensation law or plan that provides reimbursement or 
indemnification for such care and services; or
    (iii) For a nonservice-connected disability incurred as a result of 
a motor vehicle accident in a State that requires automobile accident 
reparations insurance.
    (2) Methodologies. Based on the methodologies set forth in this 
section, the charges billed will include the following types of charges, 
as appropriate: Acute inpatient facility charges; skilled nursing 
facility/sub-acute inpatient facility charges; partial hospitalization 
facility charges; outpatient facility charges; physician and other 
professional charges, including professional charges for anesthesia 
services and dental services; pathology and laboratory charges; 
observation care facility charges; ambulance and other emergency 
transportation charges; and charges for durable medical equipment, 
drugs, injectables, and other medical services, items, and supplies 
identified by HCPCS Level II codes. In addition, the charges billed for 
prescription drugs not administered during treatment will be the amount 
determined under paragraph (m) of this section. Data for calculating 
actual charge amounts based on the methodologies set forth in this 
section will either be published in a notice in the Federal Register or 
will be posted on the Internet site of the Veterans Health 
Administration Office of Community Care, currently at https://
www.va.gov/COMMUNITYCARE, under ``Payer Rates and Charges. For care for 
which VA has established a charge, VA will bill using its most recent 
published or posted charge. For care for which VA has not established a 
charge, VA will bill according to the methodology set forth in paragraph 
(a)(8) of this section.
    (3) Data sources. In this section, data sources are identified by 
name. The specific editions of these data sources used to calculate 
actual charge amounts, and information on where these data sources may 
be obtained, will be presented along with the data for calculating 
actual charge amounts, either in notices in the Federal Register or on 
the Internet site of the Veterans Health Administration Office of 
Community Care, currently at https://www.va.gov/COMMUNITYCARE, under 
``Payer Rates and Charges.
    (4) Amount of recovery or collection--third party liability. A 
third-party payer liable under a health plan contract has the option of 
paying either the billed charges described in this section or the amount 
the health plan demonstrates is the amount it would pay for care or 
services furnished by providers other than entities of the United States 
for the same care or services in the same geographic area. If the amount 
submitted by the health plan for payment is less than the amount billed, 
VA will accept the submission as payment, subject to verification at 
VA's discretion in accordance with this section. A VA employee having 
responsibility for collection of such charges may request that the third 
party health plan submit evidence or information to substantiate the 
appropriateness of the payment amount (e.g., health plan or insurance 
policies, provider agreements, medical evidence, proof of payment to 
other providers in the same geographic area for the same care and 
services VA provided).
    (5) Definitions. For purposes of this section:
    APC means Medicare Ambulatory Payment Classification.
    CMS means the Centers for Medicare and Medicaid Services.
    CPI-U means Consumer Price Index--All Urban Consumers.
    CPT code and CPT procedure code mean Current Procedural Terminology 
code, a five-digit identifier defined by the American Medical 
Association for a specified physician service or procedure.
    DME means Durable Medical Equipment.
    DRG means Diagnosis Related Group.
    FAIR Health means any of the Fair Health Charge Benchmarks products 
developed by Fair Health.
    Geographic area means a three-digit ZIP Code area, where three-digit 
ZIP Codes are the first three digits of standard U.S. Postal Service ZIP 
Codes.
    HCPCS code means a Healthcare Common Procedure Coding System Level 
II identifier, consisting of a letter followed by four digits, defined 
by

[[Page 771]]

CMS for a specified physician service, procedure, test, supply, or other 
medical service.
    ICU means Intensive Care Unit, including coronary care units.
    MarketScan means the MarketScan Commercial Claims & Encounters 
Database developed by Truven Health Analytics LLC.
    MedPAR means the Medicare Provider Analysis and Review file.
    RBRVS means Resource-Based Relative Value Scale.
    RVU means Relative Value Unit.
    Unlisted procedures mean procedures, services, items, and supplies 
that have not been defined or specified by the American Medical 
Association or CMS, and the CPT and HCPCS codes used to report such 
procedures, services, items, and supplies.
    (6) Provider-based status and charges. Facilities that have 
provider-based status by meeting the criteria in Sec.  17.100 are 
entitled to bill outpatient facility charges and professional charges. 
The professional charges for these facilities are produced by the 
methodologies set forth in this section based on facility expense RVUs. 
Facilities that do not have provider-based status because they do not 
meet the criteria in Sec.  17.100 are not permitted to bill outpatient 
facility charges and can only bill a professional charge. The 
professional charges for these facilities are produced by the 
methodologies set forth in this section based on non-facility practice 
expense RVUs.
    (7) Charges for medical care or services provided by non-VA 
providers at VA expense. When medical care or services are furnished at 
the expense of the VA by non-VA providers, the charges billed for such 
care or services will be the charges determined according to this 
section.
    (8) Charges when a new DRG or CPT/HCPCS code identifier does not 
have an established charge. When VA does not have an established charge 
for a new DRG or CPT/HCPCS code to be used in determining a billing 
charge under the applicable methodology in this section, then VA will 
establish an interim billing charge or establish an interim charge to be 
used for determining a billing charge under the applicable methodology 
in paragraphs (a)(8)(i) through (a)(8)(viii) of this section.
    (i) If a new DRG or CPT/HCPCS code identifier replaces a DRG or CPT/
HCPCS code identifier, the most recently established charge for the 
identifier being replaced will continue to be used for determining a 
billing charge under paragraphs (b), (e), (f), (g), (h), (i), (k), or 
(l) of this section until such time as VA establishes a charge for the 
new identifier.
    (ii) If medical care or service is provided or furnished at VA 
expense by a non-VA provider and a charge cannot be established under 
paragraph (a)(8)(i) of this section, then VA's billing charge for such 
care or service will be the amount VA paid to the non-VA provider 
without additional calculations under this section.
    (iii) If a new CPT/HCPCS code has been established for a prosthetic 
device or durable medical equipment subject to paragraph (l) of this 
section and a charge cannot be established under paragraphs (a)(8)(i) or 
(ii) of this section, VA's billing charge for such prosthetic device or 
durable medical equipment will be 1 and \1/2\ times VA's average actual 
cost without additional calculations under this section.
    (iv) If a new medical identifier DRG code has been assigned to a 
particular type of medical care or service and a charge cannot be 
established under paragraphs (a)(8)(i) through (iii) of this section, 
then until such time as VA establishes a charge for the new medical 
identifier DRG code, the interim charge for use in paragraph (b) of this 
section will be the average charge of all medical DRG codes that are 
within plus or minus 10 of the numerical relative weight assigned to the 
new medical identifier DRG code.
    (v) If a new surgical identifier DRG code has been assigned to a 
particular type of medical care or service and a charge cannot be 
established under paragraphs (a)(8)(i) through (iv) of this section, 
then until such time as VA establishes a charge for the new surgical 
identifier DRG code, the interim charge for use in paragraph (b) of this 
section will be the average charge of all surgical DRG codes that are 
within

[[Page 772]]

plus or minus 10 of the numerical relative weight assigned to the new 
surgical identifier DRG code.
    (vi) If a new identifier CPT/HCPCS code is assigned to a particular 
type or item of medical care or service and a charge cannot be 
established under paragraphs (a)(8)(i) through (v) of this section, then 
until such time as VA establishes a charge for the new identifier for 
use in paragraphs (e), (f), (g), (h), (i), (k), or (l) of this section, 
VA's billing charge will be the Medicare allowable charge multiplied by 
1 and \1/2\, without additional calculations under this section.
    (vii) If a new identifier CPT/HCPCS code is assigned to a particular 
type or item of medical care or service and a charge cannot be 
established under paragraphs (a)(8)(i) through (vi) of this section, 
then until such time as VA establishes a charge for the new identifier, 
the interim charge for use in paragraphs (e), (f), (g), (h), (i), (k), 
or (l) of this section will be the charge for the CPT/HCPCS code that is 
closest in characteristics to the new CPT/HCPCS code.
    (viii) If a charge cannot be established under paragraphs (a)(8)(i) 
through (a)(8)(vii) of this section, then VA will not charge under this 
section for the care or service.
    (9) Care provided under special treatment authorities. (i) 
Notwithstanding any other provisions in this section, VA will not seek 
recovery or collection of reasonable charges from a third party payer 
for:
    (A) Hospital care, medical services, and nursing home care provided 
by VA or at VA expense under 38 U.S.C. 1710(a)(2)(F) and (e).
    (B) Counseling and appropriate care and services furnished to 
veterans for psychological trauma authorized under 38 U.S.C. 1720D.
    (C) Medical examination, and hospital care, medical services, and 
nursing home care furnished to veteran for cancer of the head or neck as 
authorized under 38 U.S.C. 1720E.
    (ii) VA may continue to exercise its right to recover or collect 
reasonable charges from third parties, pursuant to this section, for the 
cost of care that VA provides to these same veterans for conditions and 
disabilities that VA determines are not covered by any of the special 
treatment authorities.
    (b) Acute inpatient facility charges. When VA provides or furnishes 
acute inpatient services within the scope of care referred to in 
paragraph (a)(1) of this section, acute inpatient facility charges 
billed for such services will be determined in accordance with the 
provisions of this paragraph. Acute inpatient facility charges consist 
of per diem charges for room and board and for ancillary services that 
vary by geographic area and by DRG. These charges are calculated as 
follows:
    (1) Formula. For each acute inpatient stay, or portion thereof, for 
which a particular DRG assignment applies, the total acute inpatient 
facility charge is the sum of the applicable charges determined pursuant 
to paragraphs (b)(1)(i), (ii), and (iii) of this section. For purposes 
of this section, standard room and board days and ICU room and board 
days are mutually exclusive: VA will bill either a standard room and 
board per diem charge or an ICU room and board per diem charge, as 
applicable, for each day of a given acute inpatient stay.
    (i) Standard room and board charges. Multiply the nationwide 
standard room and board per diem charge determined pursuant to paragraph 
(b)(2) of this section by the appropriate geographic area adjustment 
factor determined pursuant to paragraph (b)(3) of this section. The 
result constitutes the area-specific standard room and board per diem 
charge. Multiply this amount by the number of days for which standard 
room and board charges apply to obtain the total acute inpatient 
facility standard room and board charge.
    (ii) ICU room and board charges. Multiply the nationwide ICU room 
and board per diem charge determined pursuant to paragraph (b)(2) of 
this section by the appropriate geographic area adjustment factor 
determined pursuant to paragraph (b)(3) of this section. The result 
constitutes the area-specific ICU room and board per diem charge. 
Multiply this amount by the number of days for which ICU room and board 
per diem charges apply to obtain the total acute inpatient facility ICU 
room and board charge.

[[Page 773]]

    (iii) Ancillary charges. Multiply the nationwide ancillary per diem 
charge determined pursuant to paragraph (b)(2) of this section by the 
appropriate geographic area adjustment factor determined pursuant to 
paragraph (b)(3) of this section. The result constitutes the area-
specific ancillary per diem charge. Multiply this amount by the number 
of days of acute inpatient care to obtain the total acute inpatient 
facility ancillary charge.

    Note to paragraph (b)(1): If there is a change in a patient's 
condition and/or treatment during a single acute inpatient stay such 
that the DRG assignment changes (for example, a psychiatric patient who 
develops a medical or surgical problem), then calculations of acute 
inpatient facility charges will be made separately for each DRG, 
according to the number of days of care applicable for each DRG, and the 
total acute inpatient facility charge will be the sum of the total acute 
inpatient facility charges for the different DRGs.

    (2) Per diem charges. To establish a baseline, two nationwide 
average per diem amounts for each DRG are calculated, one from the 
MedPAR file and one from the MarketScan claims database, a database of 
nationwide commercial insurance claims. Average per diem charges are 
calculated based on all available charges, except for care reported for 
emergency room, ambulance, professional, and observation care. These two 
data sources may report charges for two differing periods of time; when 
this occurs, the data source charges with the earlier center date are 
trended forward to the center date of the other data source, based on 
changes to the inpatient hospital services component of the CPI-U. 
Results obtained from these two data sources are then combined into a 
single weighted average per diem charge for each DRG. The resulting 
charge for each DRG is then separated into its two components, a room 
and board component and an ancillary component, with the per diem charge 
for each component calculated by multiplying the weighted average per 
diem charge by the corresponding percentage determined pursuant to 
paragraph (b)(2)(i) of this section. The room and board per diem charge 
is further differentiated into a standard room and board per diem charge 
and an ICU room and board per diem charge by multiplying the average 
room and board charge by the corresponding DRG-specific ratios 
determined pursuant to paragraph (b)(2)(ii) of this section. The 
resulting per diem charges for standard room and board, ICU room and 
board, and ancillary services for each DRG are then each multiplied by 
the final ratio determined pursuant to paragraph (b)(2)(iii) of this 
section to reflect the nationwide 80th percentile charges. Finally, the 
resulting amounts are each trended forward from the center date of the 
trended data sources to the effective time period for the charges, as 
set forth in paragraph (b)(2)(iv) of this section. The results 
constitute the nationwide 80th percentile standard room and board, ICU 
room and board, and ancillary per diem charges.
    (i) Room and board charge and ancillary charge component 
percentages. Using only those cases from the MedPAR file for which a 
distinction between room and board charges and ancillary charges can be 
determined, the percentage of the total charges for room and board 
compared to the combined total charges for room and board and ancillary 
services, and the percentage of the total charges for ancillary services 
compared to the combined total charges for room and board and ancillary 
services, are calculated by DRG.
    (ii) Standard room and board per diem charge and ICU room and board 
per diem charge ratios. Using only those cases from the MedPAR file for 
which a distinction between room and board and ancillary charges can be 
determined, overall average per diem room and board charges are 
calculated by DRG. Then, using the same cases, an average standard room 
and board per diem charge is calculated by dividing total non-ICU room 
and board charges by total non-ICU room and board days. Similarly, an 
average ICU room and board per diem charge is calculated by dividing 
total ICU room and board charges by total ICU room and board days. 
Finally, ratios of standard room and board per diem charges to average 
overall room and board per diem charges are calculated by DRG, as are 
ratios of ICU room and board per diem

[[Page 774]]

charges to average overall room and board per diem charges.
    (iii) 80th percentile. Using cases from the MedPAR file with 
separately identifiable semi-private room rates, the ratio of the day-
weighted 80th percentile semi-private room and board per diem charge to 
the average semi-private room and board per diem charge is obtained for 
each geographic area. The geographic area-based ratios are averaged to 
obtain a final 80th percentile ratio.
    (iv) Trending forward. 80th percentile charges for each DRG, 
obtained as described in paragraph (b)(2) of this section, are trended 
forward based on changes to the inpatient hospital services component of 
the CPI-U. Actual CPI-U changes are used from the center date of the 
trended data sources through the latest available month as of the time 
the calculations are performed. The three-month average annual trend 
rate as of the latest available month is then held constant to the 
midpoint of the calendar year in which the charges are primarily 
expected to be used. The projected total CPI-U change so obtained is 
then applied to the 80th percentile charges.
    (3) Geographic area adjustment factors. For each geographic area, 
the average per diem room and board charges and ancillary charges from 
the MedPAR file are calculated for each DRG. The DRGs are separated into 
two groups, surgical and non-surgical. For each of these groups of DRGs, 
for each geographic area, average room and board per diem charges and 
ancillary per diem charges are calculated, weighted by nationwide VA 
discharges and by average lengths of stay from the combined MedPAR file 
and MarketScan claims database. This results in four average per diem 
charges for each geographic area: room and board for surgical DRGs, 
ancillary for surgical DRGs, room and board for non-surgical DRGs, and 
ancillary for non-surgical DRGs. Four corresponding national average per 
diem charges are obtained from the MedPAR file, weighted by nationwide 
VA discharges and by average lengths of stay from the combined MedPAR 
file and MarketScan claims database. Four geographic area adjustment 
factors are then calculated for each geographic area by dividing each 
geographic area average per diem charge by the corresponding national 
average per diem charge.
    (c) Skilled nursing facility/sub-acute inpatient facility charges. 
When VA provides or furnishes skilled nursing/sub-acute inpatient 
services within the scope of care referred to in paragraph (a)(1) of 
this section, skilled nursing facility/sub-acute inpatient facility 
charges billed for such services will be determined in accordance with 
the provisions of this paragraph. The skilled nursing facility/sub-acute 
inpatient facility charges are per diem charges that vary by geographic 
area. The facility charges cover care, including room and board, nursing 
care, pharmaceuticals, supplies, and skilled rehabilitation services 
(e.g., physical therapy, inhalation therapy, occupational therapy, and 
speech-language pathology), that is provided in a nursing home or 
hospital inpatient setting, is provided under a physician's orders, and 
is performed by or under the general supervision of professional 
personnel such as registered nurses, licensed practical nurses, physical 
therapists, occupational therapists, speech-language pathologists, and 
audiologists. These charges are calculated as follows:
    (1) Formula. For each stay, multiply the nationwide per diem charge 
determined pursuant to paragraph (c)(2) of this section by the 
appropriate geographic area adjustment factor determined pursuant to 
paragraph (c)(3) of this section. The result constitutes the area-
specific per diem charge. Finally, multiply the area-specific per diem 
charge by the number of days of care to obtain the total skilled nursing 
facility/sub-acute inpatient facility charge.
    (2) Per diem charge. To establish a baseline, a nationwide average 
per diem billed charge is calculated based on charges reported in the 
MedPAR skilled nursing facility file. For this purpose, the following 
MedPAR charge categories are included: room and board (private, semi-
private, and ward), physical therapy, occupational therapy, inhalation 
therapy, speech-language pathology, pharmacy, medical/surgical supplies, 
and ``other'' services.

[[Page 775]]

The following MedPAR charge categories are excluded from the calculation 
of the per diem charge and will be billed separately, using the charges 
determined as set forth in other applicable paragraphs of this section, 
when these services are provided to skilled nursing patients or sub-
acute inpatients: ICU and CCU room and board, laboratory, radiology, 
cardiology, dialysis, operating room, blood and blood administration, 
ambulance, MRI, anesthesia, durable medical equipment, emergency room, 
clinic, outpatient, professional, lithotripsy, and organ acquisition 
services. The resulting average per diem billed charge is then 
multiplied by the 80th percentile adjustment factor determined pursuant 
to paragraph (c)(2)(i) of this section to obtain a nationwide 80th 
percentile charge level. Finally, the resulting amount is trended 
forward to the effective time period for the charges, as set forth in 
paragraph (c)(2)(ii) of this section.
    (i) 80th percentile adjustment factor. Using the MedPAR skilled 
nursing facility file, the ratio of the day-weighted 80th percentile 
room and board per diem charge to the day-weighted average room and 
board per diem charge is obtained for each geographic area. The 
geographic area-based ratios are averaged to obtain the 80th percentile 
adjustment factor.
    (ii) Trending forward. The 80th percentile charge is trended forward 
based on changes to the inpatient hospital services component of the 
CPI-U. Actual CPI-U changes are used from the time period of the source 
data through the latest available month as of the time the calculations 
are performed. The three-month average annual trend rate as of the 
latest available month is then held constant to the midpoint of the 
calendar year in which the charges are primarily expected to be used. 
The projected total CPI-U change so obtained is then applied to the 80th 
percentile charge.
    (3) Geographic area adjustment factors. The average billed per diem 
charge for each geographic area is calculated from the MedPAR skilled 
nursing facility file. This amount is divided by the nationwide average 
billed charge calculated in paragraph (c)(2) of this section. The 
geographic area adjustment factor for charges for each VA facility is 
the ratio for the geographic area in which the facility is located.
    (d) Partial hospitalization facility charges. When VA provides or 
furnishes partial hospitalization services that are within the scope of 
care referred to in paragraph (a)(1) of this section, the facility 
charges billed for such services will be determined in accordance with 
the provisions of this paragraph. Partial hospitalization facility 
charges are per diem charges that vary by geographic area. These charges 
are calculated as follows:
    (1) Formula. For each partial hospitalization stay, multiply the 
nationwide per diem charge determined pursuant to paragraph (d)(2) of 
this section by the appropriate geographic area adjustment factor 
determined pursuant to paragraph (d)(3) of this section. The result 
constitutes the area-specific per diem charge. Finally, multiply the 
area-specific per diem charge by the number of days of care to obtain 
the total partial hospitalization facility charge.
    (2) Per diem charge. To establish a baseline, a nationwide median 
per diem billed charge is calculated based on charges associated with 
partial hospitalization from the outpatient facility component of the 
Medicare Standard Analytical File 5 Percent Sample. That median per diem 
billed charge is then multiplied by the 80th percentile adjustment 
factor determined pursuant to paragraph (d)(2)(i) of this section to 
obtain a nationwide 80th percentile charge level. Finally, the resulting 
amount is trended forward to the effective time period for the charges, 
as set forth in paragraph (d)(2)(ii) of this section.
    (i) 80th percentile adjustment factor. The 80th percentile 
adjustment factor for partial hospitalization facility charges is the 
same as that computed for skilled nursing facility/sub-acute inpatient 
facility charges under paragraph (c)(2)(i) of this section.
    (ii) Trending forward. The 80th percentile charge is trended forward 
based on changes to the outpatient hospital services component of the 
CPI-U. Actual CPI-U changes are used from the time period of the source 
data through

[[Page 776]]

the latest available month as of the time the calculations are 
performed. The three-month average annual trend rate as of the latest 
available month is then held constant to the midpoint of the calendar 
year in which the charges are primarily expected to be used. The 
projected total CPI-U change so obtained is then applied to the 80th 
percentile charges, as described in paragraph (d)(2) of this section.
    (3) Geographic area adjustment factors. The geographic area 
adjustment factors for partial hospitalization facility charges are the 
same as those computed for outpatient facility charges under paragraph 
(e)(4) of this section.
    (e) Outpatient facility charges. When VA provides or furnishes 
outpatient facility services that are within the scope of care referred 
to in paragraph (a)(1) of this section, the charges billed for such 
services will be determined in accordance with the provisions of this 
paragraph. Charges for outpatient facility services vary by geographic 
area and by CPT/HCPCS code. These charges apply in the situations set 
forth in paragraph (e)(1) of this section and are calculated as set 
forth in paragraph (e)(2) of this section.
    (1) Settings and circumstances in which outpatient facility charges 
apply. Outpatient facility charges consist of facility charges for 
procedures, diagnostic tests, evaluation and management services, and 
other medical services, items, and supplies provided in the following 
settings and circumstances:
    (i) Outpatient departments and clinics at VA medical centers;
    (ii) Other VA provider-based entities; and
    (iii) VA non-provider-based entities, for procedures and tests for 
which no corresponding professional charge is established under the 
provisions of paragraph (f) of this section.
    (2) Formula. For each outpatient facility charge CPT/HCPCS code, 
multiply the nationwide 80th percentile charge determined pursuant to 
paragraph (e)(3) of this section by the appropriate geographic area 
adjustment factor determined pursuant to paragraph (e)(4) of this 
section. The result constitutes the area-specific outpatient facility 
charge. When multiple surgical procedures are performed during the same 
outpatient encounter by a provider or provider team, the outpatient 
facility charges for such procedures will be reduced as set forth in 
paragraph (e)(5) of this section.
    (3) Nationwide 80th percentile charges by CPT/HCPCS code. For each 
CPT/HCPCS code for which outpatient facility charges apply, the 
nationwide 80th percentile charge is calculated as set forth in either 
paragraph (e)(3)(i) or (e)(3)(ii) of this section. The resulting amount 
is trended forward to the effective time period for the charges, as set 
forth in paragraph (e)(3)(iii) of this section. The results constitute 
the nationwide 80th percentile outpatient facility charges by CPT/HCPCS 
code.
    (i) Nationwide 80th percentile charges for CPT/HCPCS codes which 
have APC assignments. Using the outpatient facility charges reported in 
the outpatient facility component of the Medicare Standard Analytical 
File 5 Percent Sample, claim records are selected for which all charges 
can be assigned to an APC. Using this subset of the 5 Percent Sample 
data, nationwide median charge to Medicare APC payment amount ratios, by 
APC, and nationwide 80th percentile to median charge ratios, by APC, are 
computed according to the methodology set forth in paragraphs 
(e)(3)(i)(A) and (e)(3)(i)(B) of this section, respectively. The product 
of these two ratios by APC is then computed, resulting in a composite 
nationwide 80th percentile charge to Medicare APC payment amount ratio. 
This ratio is then compared to the alternate nationwide 80th percentile 
charge to Medicare APC payment amount ratio computed in paragraph 
(e)(3)(i)(C) of this section, and the lesser amount is selected and 
multiplied by the current Medicare APC payment amount. The resulting 
product is the APC-specific nationwide 80th percentile charge amount for 
each applicable CPT/HCPCS code.
    (A) Nationwide median charge to Medicare APC payment amount ratios. 
For each CPT/HCPCS code, the ratio of median billed charge to Medicare 
APC payment amount is determined. The weighted average of these ratios 
for each APC is then obtained, using the reported 5 Percent Sample 
frequencies as weights. In addition, corresponding ratios are calculated 
for each of the

[[Page 777]]

APC categories set forth in paragraph (e)(3)(i)(D) of this section, 
again using the reported 5 Percent Sample frequencies as weights. For 
APCs where the 5 Percent Sample frequencies provide a statistically 
credible result, the APC-specific weighted average nationwide median 
charge to Medicare APC payment amount ratio so obtained is accepted 
without further adjustment. However, if the 5 Percent Sample data do not 
produce statistically credible results for any specific APC, then the 
APC category-specific ratio is applied for that APC.
    (B) Nationwide 80th percentile to median charge ratios. For each 
CPT/HCPCS code, a geographically normalized nationwide 80th percentile 
billed charge amount is divided by a similarly normalized nationwide 
median billed charge amount. The weighted average of these ratios for 
each APC is then obtained, using the reported 5 Percent Sample 
frequencies as weights. In addition, corresponding ratios are calculated 
for each of the APC categories set forth in paragraph (e)(3)(i)(D) of 
this section, again using the reported 5 Percent Sample frequencies as 
weights. For APCs where the 5 Percent Sample frequencies provide a 
statistically credible result, the APC-specific weighted average 
nationwide 80th percentile to median charge ratio so obtained is 
accepted without further adjustment. However, if the 5 Percent Sample 
data do not produce statistically credible results for any specific APC, 
then the APC category-specific ratio is applied for that APC.
    (C) Alternate nationwide 80th percentile charge to Medicare APC 
payment amount ratios. A minimum 80th percentile charge to Medicare APC 
payment amount ratio is set at 6.5 for APCs with Medicare APC payment 
amounts of $25 or less. A maximum 80th percentile charge to Medicare APC 
payment amount ratio is set at 2.0 for APCs with Medicare APC payment 
amounts of $10,000 or more. Using linear interpolation with these 
endpoints, the alternate APC-specific nationwide 80th percentile charge 
to Medicare APC payment amount ratio is then computed, based on the 
Medicare APC payment amount.
    (D) APC categories for the purpose of establishing 80th percentile 
to median factors. For the purpose of the statistical methodology set 
forth in paragraph (e)(3)(i) of this section, APCs are assigned to the 
following APC categories:
    (1) Radiology.
    (2) Drugs.
    (3) Office, Home, and Urgent Care Visits.
    (4) Cardiovascular.
    (5) Emergency Room Visits.
    (6) Outpatient Psychiatry, Alcohol and Drug Abuse.
    (7) Pathology.
    (8) Surgery.
    (9) Allergy Immunotherapy, Allergy Testing, Immunizations, and 
Therapeutic Injections.
    (10) All APCs not assigned to any of the above groups.
    (ii) Nationwide 80th percentile charges for CPT/HCPCS codes which do 
not have APC assignments. Nationwide 80th percentile billed charge 
levels by CPT/HCPCS code are computed from the outpatient facility 
component of the Fair Health database, from the MarketScan claims 
database, and from the outpatient facility component of the Medicare 
Standard Analytical File 5 Percent Sample. If the Fair Health database 
contains sufficient data to provide a statistically credible 80th 
percentile charge, then that result is retained for this purpose. If the 
Fair Health database does not provide a statistically credible 80th 
percentile charge, then the result from the MarketScan database is 
retained for this purpose, provided it is statistically credible. If 
neither the Fair Health nor the MarketScan databases provide 
statistically credible results, then the nationwide 80th percentile 
billed charge computed from the 5 Percent Sample data is retained for 
this purpose. The nationwide 80th percentile charges retained from each 
of these data sources are trended forward to the effective time period 
for the charges, as set forth in paragraph (e)(3)(iii) of this section.
    (iii) Trending forward. The charges for each CPT/HCPCS code, 
obtained as described in paragraph (e)(3) of this section, are trended 
forward based on changes to the outpatient hospital

[[Page 778]]

services component of the CPI-U. Actual CPI-U changes are used from the 
time period of the source data through the latest available month as of 
the time the calculations are performed. The three-month average annual 
trend rate as of the latest available month is then held constant to the 
midpoint of the calendar year in which the charges are primarily 
expected to be used. The projected total CPI-U change so obtained is 
then applied to the 80th percentile charges, as described in paragraph 
(e)(3) of this section.
    (4) Geographic area adjustment factors. For each geographic area, a 
single adjustment factor is calculated as the arithmetic average of the 
outpatient geographic area adjustment factor published in the Milliman, 
Inc., Health Cost Guidelines (this factor constitutes the ratio of the 
level of charges for each geographic area to the nationwide level of 
charges), and a geographic area adjustment factor developed from the 
Fair Health database (see paragraph (a)(3) of this section for Data 
Sources). The Fair Health-based geographic area adjustment factors are 
calculated as the ratio of the CPT/HCPCS code weighted average charge 
level for each geographic area to the nationwide CPT/HCPCS code weighted 
average charge level.
    (5) Multiple surgical procedures. When multiple surgical procedures 
are performed during the same outpatient encounter by a provider or 
provider team as indicated by multiple surgical CPT/HCPCS procedure 
codes, then each CPT/HCPCS procedure code will be billed at 100 percent 
of the charges established under this section.
    (f) Physician and other professional charges except for anesthesia 
services and certain dental services. When VA provides or furnishes 
physician and other professional services, other than professional 
anesthesia services and certain professional dental services, within the 
scope of care referred to in paragraph (a)(1) of this section, physician 
and other professional charges billed for such services will be 
determined in accordance with the provisions of this paragraph. Charges 
for professional dental services identified by CPT code are determined 
in accordance with the provisions of this paragraph; charges for 
professional dental services identified by HCPCS Level II code are 
determined in accordance with the provisions of paragraph (h) of this 
section. Physician and other professional charges consist of charges for 
professional services that vary by geographic area, by CPT/HCPCS code, 
by site of service, and by modifier, where applicable. These charges are 
calculated as follows:
    (1) Formula. For each CPT/HCPCS code or, where applicable, each CPT/
HCPCS code and modifier combination, multiply the total geographically-
adjusted RVUs determined pursuant to paragraph (f)(2) of this section by 
the applicable geographically-adjusted conversion factor (a monetary 
amount) determined pursuant to paragraph (f)(3) of this section to 
obtain the physician charge for each CPT/HCPCS code in a particular 
geographic area. Then, multiply this charge by the appropriate factors 
for any charge-significant modifiers, determined pursuant to paragraph 
(f)(4) of this section.
    (2)(i) Total geographically-adjusted RVUs for physician services 
that have Medicare RVUs. The work expense and practice expense RVUs for 
CPT/HCPCS codes, other than the codes described in paragraphs (f)(2)(ii) 
and (f)(2)(iii) of this section, are compiled using Medicare Physician 
Fee Schedule RVUs. The sum of the geographically-adjusted work expense 
RVUs determined pursuant to paragraph (f)(2)(i)(A) of this section and 
the geographically-adjusted practice expense RVUs determined pursuant to 
paragraph (f)(2)(i)(B) of this section equals the total geographically-
adjusted RVUs.
    (A) Geographically-adjusted work expense RVUs. For each CPT/HCPCS 
code for each geographic area, the Medicare Physician Fee Schedule work 
expense RVUs are multiplied by the work expense Medicare Geographic 
Practice Cost Index. The result constitutes the geographically-adjusted 
work expense RVUs.
    (B) Geographically-adjusted practice expense RVUs. For each CPT/
HCPCS code for each geographic area, the Medicare Physician Fee Schedule 
practice expense RVUs are multiplied by the practice expense Medicare 
Geographic

[[Page 779]]

Practice Cost Index. The result constitutes the geographically-adjusted 
practice expense RVUs. In these calculations, facility practice expense 
RVUs are used to obtain geographically-adjusted practice expense RVUs 
for use by provider-based entities, and non-facility practice expense 
RVUs are used to obtain geographically-adjusted practice expense RVUs 
for use by non-provider-based entities.
    (ii) RVUs for CPT/HCPCS codes that do not have Medicare RVUs and are 
not designated as unlisted procedures. For CPT/HCPCS codes that are not 
assigned RVUs in paragraph (f)(2)(i) or (iii) of this section, total 
RVUs are developed based on various charge data sources. For these CPT/
HCPCS codes, that nationwide 80th percentile billed charges are 
obtained, where statistically credible, from the FAIR Health database. 
For any remaining CPT/HCPCS codes, the nationwide 80th percentile billed 
charges are obtained, where statistically credible, from the Part B 
component of the Medicare Standard Analytical File 5 Percent Sample. For 
each of these CPT/HCPCS codes, nationwide total RVUs are obtained by 
taking the nationwide 80th percentile billed charges obtained using the 
preceding databases and dividing by the nationwide conversion factor for 
the corresponding CPT/HCPCS code group determined pursuant to paragraphs 
(f)(3) introductory text and (f)(3)(i) of this section. For any 
remaining CPT/HCPCS codes that have not been assigned RVUs using the 
preceding data sources, the nationwide total RVUs are calculated by 
summing the work expense and non-facility practice expense RVUs found in 
Medicare ASP Pricing RBRVS. The resulting nationwide total RVUs obtained 
using these data sources are multiplied by the geographic area 
adjustment factors determined pursuant to paragraph (f)(2)(iv) of this 
section to obtain the area-specific total RVUs.
    (iii) RVUs for CPT/HCPCS codes designated as unlisted procedures. 
For CPT/HCPCS codes designated as unlisted procedures, total RVUs are 
developed based on the weighted median of the total RVUs of CPT/HCPCS 
codes within the series in which the unlisted procedure code occurs. A 
nationwide VA distribution of procedures and services is used for the 
purpose of computing the weighted median. The resulting nationwide total 
RVUs are multiplied by the geographic area adjustment factors determined 
pursuant to paragraph (f)(2)(iv) of this section to obtain the area-
specific total RVUs.
    (iv) RVU geographic area adjustment factors for CPT/HCPCS codes that 
do not have Medicare RVUs, including codes that are designated as 
unlisted procedures. The adjustment factor for each geographic area 
consists of the weighted average of the work expense and practice 
expense Medicare Geographic Practice Cost Indices for each geographic 
area using charge data for representative CPT/HCPCS codes statistically 
selected and weighted for work expense and practice expense.
    (3) Geographically-adjusted 80th percentile conversion factors. CPT/
HCPCS codes are separated into the following 23 CPT/HCPCS code groups: 
Allergy immunotherapy, allergy testing, cardiovascular, chiropractor, 
consults, emergency room visits and observation care, hearing/speech 
exams, immunizations, inpatient visits, maternity/cesarean deliveries, 
maternity/non-deliveries, maternity/normal deliveries, miscellaneous 
medical, office/home/urgent care visits, outpatient psychiatry/alcohol 
and drug abuse, pathology, physical exams, physical medicine, radiology, 
surgery, therapeutic injections, vision exams, and well-baby exams. For 
each of the 23 CPT/HCPCS code groups, representative CPT/HCPCS codes are 
statistically selected and weighted so as to give a weighted average RVU 
comparable to the weighted average RVU of the entire CPT/HCPCS code 
group (the selected CPT/HCPCS codes are set forth in the Milliman, Inc., 
Health Cost Guidelines fee survey); see paragraph (a)(3) of this section 
for Data Sources. The 80th percentile charge for each selected CPT/HCPCS 
code is obtained from the FAIR Health database. A nationwide conversion 
factor (a monetary amount) is calculated for each CPT/HCPCS code group 
as set forth in paragraph (f)(3)(i) of this section. The nationwide 
conversion factors for each of the 23 CPT/HCPCS code groups are trended 
forward to the effective time period for

[[Page 780]]

the charges, as set forth in paragraph (f)(3)(ii) of this section. The 
resulting amounts for each of the 23 groups are multiplied by geographic 
area adjustment factors determined pursuant to paragraph (f)(3)(iii) of 
this section, resulting in geographically-adjusted 80th percentile 
conversion factors for each geographic area for the 23 CPT/HCPCS code 
groups for the effective charge period.
    (i) Nationwide conversion factors. Using the nationwide 80th 
percentile charges for the selected CPT/HCPCS codes from paragraph 
(f)(3) of this section, a nationwide conversion factor is calculated for 
each of the 23 CPT/HCPCS code groups by dividing the weighted average 
charge by the weighted average RVU.
    (ii) Trending forward. The nationwide conversion factors for each of 
the 23 CPT/HCPCS code groups, obtained as described in paragraph 
(f)(3)(i) of this section, are trended forward based on changes to the 
physicians' services component of the CPI-U. Actual CPI-U changes are 
used from the time period of the source data through the latest 
available month as of the time the calculations are performed. The 
three-month average annual trend rate as of the latest available month 
is then held constant to the midpoint of the calendar year in which the 
charges are primarily expected to be used. The projected total CPI-U 
change so obtained is then applied to the 23 conversion factors.
    (iii) Geographic area adjustment factors. Using the 80th percentile 
charges for the selected CPT/HCPCS codes from paragraph (f)(3) of this 
section for each geographic area, a geographic area-specific conversion 
factor is calculated for each of the 23 CPT/HCPCS code groups by 
dividing the weighted average charge by the weighted average 
geographically-adjusted RVU. The resulting conversion factor for each 
geographic area for each of the 23 CPT/HCPCS code groups is divided by 
the corresponding nationwide conversion factor determined pursuant to 
paragraph (f)(3)(i) of this section. The resulting ratios are the 
geographic area adjustment factors for the conversion factors for each 
of the 23 CPT/HCPCS code groups for each geographic area.
    (4) Charge adjustment factors for specified CPT/HCPCS code 
modifiers. Surcharges are calculated in the following manner: From the 
Part B component of the Medicare Standard Analytical File 5 Percent 
Sample, the ratio of weighted average billed charges for CPT/HCPCS codes 
with the specified modifier to the weighted average billed charge for 
CPT/HCPCS codes with no charge modifier is calculated, using the 
frequency of procedure codes with the modifier as weights in both 
weighted average calculations. The resulting ratios constitute the 
surcharge factors for specified charge-significant CPT/HCPCS code 
modifiers.
    (5) Certain charges for providers other than physicians. When 
services for which charges are established according to the preceding 
provisions of this paragraph (f) are performed by providers other than 
physicians, the charges for those services will be as determined by the 
preceding provisions of this paragraph, except as follows:
    (i) Outpatient facility charges. When the services of providers 
other than physicians are furnished in outpatient facility settings or 
in other facilities designated as provider-based, and outpatient 
facility charges for those services have been established under 
paragraph (e) of this section, then the outpatient facility charges 
established under paragraph (e) will apply instead of the charges 
established under this paragraph (f).
    (ii) Charges for professional services. Charges for the professional 
services of the following providers will be 100 percent of the amount 
that would be charged if the care had been provided by a physician:
    (A) Nurse practitioner.
    (B) Clinical nurse specialist.
    (C) Physician Assistant.
    (D) Clinical psychologist.
    (E) Clinical social worker.
    (F) Dietitian.
    (G) Clinical pharmacist.
    (H) Marriage and family therapist.
    (I) Licensed professional mental health counselor.
    (g) Professional charges for anesthesia services. When VA provides 
or furnishes professional anesthesia services within the scope of care 
referred to in paragraph (a)(1) of this section, professional

[[Page 781]]

anesthesia charges billed for such services will be determined in 
accordance with the provisions of this paragraph. Charges for 
professional anesthesia services personally performed by 
anesthesiologists will be 100 percent of the charges determined as set 
forth in this paragraph. Charges for professional anesthesia services 
provided by non-medically directed certified registered nurse 
anesthetists will also be 100 percent of the charges determined as set 
forth in this paragraph. Charges for professional anesthesia services 
provided by medically directed certified registered nurse anesthetists 
will be 100 percent of the charges determined as set forth in this 
paragraph. Professional anesthesia charges consist of charges for 
professional services that vary by geographic area, by CPT/HCPCS code 
base units, and by number of time units. These charges are calculated as 
follows:
    (1) Formula. For each anesthesia CPT/HCPCS code, multiply the total 
anesthesia RVUs determined pursuant to paragraph (g)(2) of this section 
by the applicable geographically-adjusted conversion factor (a monetary 
amount) determined pursuant to paragraph (g)(3) of this section to 
obtain the professional anesthesia charge for each CPT/HCPCS code in a 
particular geographic area.
    (2) Total RVUs for professional anesthesia services. The total 
anesthesia RVUs for each anesthesia CPT/HCPCS code are the sum of the 
base units (as compiled by CMS) for that CPT/HCPCS code and the number 
of time units reported for the anesthesia service, where one time unit 
equals 15 minutes. For anesthesia CPT/HCPCS codes designated as unlisted 
procedures, base units are developed based on the weighted median base 
units for anesthesia CPT/HCPCS codes within the series in which the 
unlisted procedure code occurs. A nationwide VA distribution of 
procedures and services is used for the purpose of computing the 
weighted median base units.
    (3) Geographically-adjusted 80th percentile conversion factors. A 
nationwide 80th percentile conversion factor is calculated according to 
the methodology set forth in paragraph (g)(3)(i) of this section. The 
nationwide conversion factor is then trended forward to the effective 
time period for the charges, as set forth in paragraph (g)(3)(ii) of 
this section. The resulting amount is multiplied by geographic area 
adjustment factors determined pursuant to paragraph (g)(3)(iii) of this 
section, resulting in geographically-adjusted 80th percentile conversion 
factors for each geographic area for the effective charge period.
    (i) Nationwide conversion factor. Preliminary 80th percentile 
conversion factors for each area are compiled from the Fair Health 
database. Then, a preliminary nationwide weighted-average 80th 
percentile conversion factor is calculated, using as weights the 
population (census) frequencies for each geographic area as presented in 
the Milliman, Inc., Health Cost Guidelines (see paragraph (a)(3) of this 
section for Data Sources). A nationwide 80th percentile fee by CPT/HCPCS 
code is then computed by multiplying this conversion factor by the Fair 
Health base units for each CPT/HCPCS code. An adjusted 80th percentile 
conversion factor by CPT/HCPCS code is then calculated by dividing the 
nationwide 80th percentile fee for each procedure code by the anesthesia 
base units (as compiled by CMS) for that CPT/HCPCS code. Finally, a 
nationwide weighted average 80th percentile conversion factor is 
calculated using combined frequencies for billed base units and time 
units from the part B component of the Medicare Standard Analytical File 
5 Percent Sample as weights.
    (ii) Trending forward. The nationwide conversion factor, obtained as 
described in paragraph (g)(3)(i) of this section, is trended forward 
based on changes to the physicians' services component of the CPI-U. 
Actual CPI-U changes are used from the time period of the source data 
through the latest available month as of the time the calculations are 
performed. The three-month average annual trend rate as of the latest 
available month is then held constant to the midpoint of the calendar 
year in which the charges are primarily expected to be used. The 
projected total CPI-U change so obtained is then applied to the 
conversion factor.

[[Page 782]]

    (iii) Geographic area adjustment factors. The preliminary 80th 
percentile conversion factors for each geographic area described in 
paragraph (g)(3)(i) of this section are divided by the corresponding 
preliminary nationwide 80th percentile conversion factor also described 
in paragraph (g)(3)(i). The resulting ratios are the adjustment factors 
for each geographic area.
    (h) Professional charges for dental services identified by HCPCS 
Level II codes. When VA provides or furnishes outpatient dental 
professional services within the scope of care referred to in paragraph 
(a)(1) of this section, and such services are identified by HCPCS code 
rather than CPT code, the charges billed for such services will be 
determined in accordance with the provisions of this paragraph. The 
charges for dental services vary by geographic area and by HCPCS code. 
These charges are calculated as follows:
    (1) Formula. For each HCPCS dental code, multiply the nationwide 
80th percentile charge determined pursuant to paragraph (h)(2) of this 
section by the appropriate geographic area adjustment factor determined 
pursuant to paragraph (h)(3) of this section. The result constitutes the 
area-specific dental charge.
    (2) Nationwide 80th percentile charges by HCPCS code. For each HCPCS 
dental code, 80th percentile charges are extracted from various 
independent data sources, including the National Dental Advisory Service 
nationwide pricing index and the Dental FAIR Health module (see 
paragraph (a)(3) of this section for Data Sources). Charges for each 
database are then trended forward to a common date, based on actual 
changes to the dental services component of the CPI-U. Charges for each 
HCPCS dental code from each data source are combined into an average 
80th percentile charge by means of the methodology set forth in 
paragraph (h)(2)(i) of this section. HCPCS dental codes designated as 
unlisted are assigned 80th percentile charges by means of the 
methodology set forth in paragraph (h)(2)(ii) of this section. Finally, 
the resulting amounts are each trended forward to the effective time 
period for the charges, as set forth in paragraph (h)(2)(iii) of this 
section. The results constitute the nationwide 80th percentile charge 
for each HCPCS dental code.
    (i) Averaging methodology. The average charge for any particular 
HCPCS dental code is calculated by first computing a preliminary mean of 
the available charges for each code. Statistical outliers are identified 
and removed. In cases where none of the charges are removed, the average 
charge is calculated as a mean of all reported charges.
    (ii) Nationwide 80th percentile charges for HCPCS dental codes 
designated as unlisted procedures. For HCPCS dental codes designated as 
unlisted procedures, 80th percentile charges are developed based on the 
weighted median 80th percentile charge of HCPCS dental codes within the 
series in which the unlisted procedure code occurs. A nationwide VA 
distribution of procedures and services is used for the purpose of 
computing the weighted median.
    (iii) Trending forward. 80th percentile charges for each dental 
procedure code, obtained as described in paragraph (h)(2) of this 
section, are trended forward based on the dental services component of 
the CPI-U. Actual CPI-U changes are used from the time period of the 
source data through the latest available month as of the time the 
calculations are performed. The three-month average annual trend rate as 
of the latest available month is then held constant to the midpoint of 
the calendar year in which the charges are primarily expected to be 
used. The projected total CPI-U change so obtained is then applied to 
the 80th percentile charges.
    (3) Geographic area adjustment factors. A geographic adjustment 
factor (consisting of the ratio of the level of charges in a given 
geographic area to the nationwide level of charges) for each geographic 
area and dental class of service is obtained from Milliman Inc., Dental 
Health Cost Guidelines, a database of nationwide commercial insurance 
charges and relative costs; and a normalized geographic adjustment 
factor computed from the Dental FAIR Health module, as follows: Using 
local and nationwide average charges reported in the FAIR Health 
database, a local weighted average charge for each

[[Page 783]]

dental class of procedure codes is calculated using utilization 
frequencies from the Milliman Inc., Dental Health Cost Guidelines as 
weights (see paragraph (a)(3) of this section for Data Sources). 
Similarly, using nationwide average charge levels, a nationwide average 
charge by dental class of procedure codes is calculated. The normalized 
geographic adjustment factor for each dental class of procedure codes 
and for each geographic area is the ratio of the local average charge 
divided by the corresponding nationwide average charge. Finally, the 
geographic area adjustment factor is the arithmetic average of the 
corresponding factors from the data sources mentioned in the first 
sentence of this paragraph (h)(3).
    (i) Pathology and laboratory charges. When VA provides or furnishes 
pathology and laboratory services within the scope of care referred to 
in paragraph (a)(1) of this section, charges billed for such services 
will be determined in accordance with the provisions of this paragraph. 
Pathology and laboratory charges consist of charges for services that 
vary by geographic area and by CPT/HCPCS code. These charges are 
calculated as follows:
    (1) Formula. For each CPT/HCPCS code, multiply the total 
geographically-adjusted RVUs determined pursuant to paragraph (i)(2) of 
this section by the applicable geographically-adjusted conversion factor 
(a monetary amount) determined pursuant to paragraph (i)(3) of this 
section to obtain the pathology/laboratory charge for each CPT/HCPCS 
code in a particular geographic area.
    (2)(i) Total geographically-adjusted RVUs for pathology and 
laboratory services that have Medicare-based RVUs. Total RVUs are 
developed based on the Medicare Clinical Diagnostic Laboratory Fee 
Schedule (CLAB). The CLAB payment amounts are upwardly adjusted such 
that the adjusted payment amounts are, on average, equivalent to 
Medicare Physician Fee Schedule payment levels, using statistical 
comparisons to the 80th percentile derived from the Fair Health 
database. These adjusted payment amounts are then divided by the 
corresponding Medicare conversion factor to derive RVUs for each CPT/
HCPCS code. The resulting nationwide total RVUs are multiplied by the 
geographic adjustment factors determined pursuant to paragraph 
(i)(2)(iv) of this section to obtain the area-specific total RVUs.
    (ii) RVUs for CPT/HCPCS codes that do not have Medicare-based RVUs 
and are not designated as unlisted procedures. For CPT/HCPCS codes that 
are not assigned RVUs in paragraphs (i)(2)(i) or (iii) of this section, 
total RVUs are developed based on various charge data sources. For these 
CPT/HCPCS codes, the nationwide 80th percentile billed charges are 
obtained, where statistically credible, from the FAIR Health database. 
For any remaining CPT/HCPCS codes, the nationwide 80th percentile billed 
charges are obtained, where statistically credible, from the Part B 
component of the Medicare Standard Analytical File 5 Percent Sample. For 
any remaining CPT/HCPCS codes that have not been assigned RVUs using the 
preceding data sources, the nationwide total RVUs are calculated by 
summing the work expense and non-facility practice expense RVUs found in 
Medicare ASP Pricing RBRVS. The resulting nationwide total RVUs obtained 
using these data sources are multiplied by the geographic area 
adjustment factors determined pursuant to paragraph (i)(2)(iv) of this 
section to obtain the area-specific total RVUs.
    (iii) RVUs for CPT/HCPCS codes designated as unlisted procedures. 
For CPT/HCPCS codes designated as unlisted procedures, total RVUs are 
developed based on the weighted median of the total RVUs of CPT/HCPCS 
codes within the series in which the unlisted procedure code occurs. A 
nationwide VA distribution of procedures and services is used for the 
purpose of computing the weighted median. The resulting nationwide total 
RVUs are multiplied by the geographic area adjustment factors determined 
pursuant to paragraph (i)(2)(iv) of this section to obtain the area-
specific total RVUs.
    (iv) RVU geographic area adjustment factors for CPT/HCPCS codes that 
do not have Medicare RVUs, including codes that are designated as 
unlisted procedures. The adjustment factor for each

[[Page 784]]

geographic area consists of the weighted average of the work expense and 
practice expense Medicare Geographic Practice Cost Indices for each 
geographic area using charge data for representative CPT/HCPCS codes 
statistically selected and weighted for work expense and practice 
expense.
    (3) Geographically-adjusted 80th percentile conversion factors. 
Representative CPT/HCPCS codes are statistically selected and weighted 
so as to give a weighted average RVU comparable to the weighted average 
RVU of the entire pathology/laboratory CPT/HCPCS code group (the 
selected CPT/HCPCS codes are set forth in the Milliman, Inc., Health 
Cost Guidelines fee survey). The 80th percentile charge for each 
selected CPT/HCPCS code is obtained from the FAIR Health database. A 
nationwide conversion factor (a monetary amount) is calculated as set 
forth in paragraph (i)(3)(i) of this section. The nationwide conversion 
factor is trended forward to the effective time period for the charges, 
as set forth in paragraph (i)(3)(ii) of this section. The resulting 
amount is multiplied by a geographic area adjustment factor determined 
pursuant to paragraph (i)(3)(iv) of this section, resulting in the 
geographically-adjusted 80th percentile conversion factor for the 
effective charge period.
    (i) Nationwide conversion factors. Using the nationwide 80th 
percentile charges for the selected CPT/HCPCS codes from paragraph 
(i)(3) of this section, a nationwide conversion factor is calculated by 
dividing the weighted average charge by the weighted average RVU.
    (ii) Trending forward. The nationwide conversion factor, obtained as 
described in paragraph (i)(3) of this section, is trended forward based 
on changes to the physicians' services component of the CPI-U. Actual 
CPI-U changes are used from the time period of the source data through 
the latest available month as of the time the calculations are 
performed. The three-month average annual trend rate as of the latest 
available month is then held constant to the midpoint of the calendar 
year in which the charges are primarily expected to be used. The 
projected total CPI-U change so obtained is then applied to the 
pathology/laboratory conversion factor.
    (iii) Geographic area adjustment factor. Using the 80th percentile 
charges for the selected CPT/HCPCS codes from paragraph (i)(3) of this 
section for each geographic area, a geographic area-specific conversion 
factor is calculated by dividing the weighted average charge by the 
weighted average geographically-adjusted RVU. The resulting geographic 
area conversion factor is divided by the corresponding nationwide 
conversion factor determined pursuant to paragraph (i)(3)(i) of this 
section. The resulting ratios are the geographic area adjustment factors 
for pathology and laboratory services for each geographic area.
    (j) Observation care facility charges. When VA provides observation 
care within the scope of care referred to in paragraph (a)(1) of this 
section, the facility charges billed for such care will be determined in 
accordance with the provisions of this paragraph. The charges for this 
care vary by geographic area and number of hours of care. These charges 
are calculated as follows:
    (1) Formula. For each occurrence of observation care, add the 
nationwide base charge determined pursuant to paragraph (j)(2) of this 
section to the product of the number of hours in observation care and 
the hourly charge also determined pursuant to paragraph (j)(2) of this 
section. Then multiply this amount by the appropriate geographic area 
adjustment factor determined pursuant to paragraph (j)(3) of this 
section. The result constitutes the area-specific observation care 
facility charge.
    (2)(i) Nationwide 80th percentile observation care facility charges. 
To calculate nationwide base and hourly facility charges, all claims 
with observation care line items are selected from the outpatient 
facility component of the Medicare Standard Analytical File 5 Percent 
Sample. Then, using the 80th percentile observation line item charges 
for each unique hourly length of stay, a standard linear regression 
technique is used to calculate the nationwide 80th percentile base 
charge and 80th percentile hourly charge. Finally, the resulting amounts 
are each

[[Page 785]]

trended forward to the effective time period for the charges, as set 
forth in paragraph (j)(2)(ii) of this section. The results constitute 
the nationwide 80th percentile base and hourly facility charges for 
observation care.
    (ii) Trending forward. The nationwide 80th percentile base and 
hourly facility charges for observation care, obtained as described in 
paragraph (j)(2)(i) of this section, are trended forward based on 
changes to the outpatient hospital services component of the CPI-U. 
Actual CPI-U changes are used from the time period of the source data 
through the latest available month as of the time the calculations are 
performed. The three-month average annual trend rate as of the latest 
available month is then held constant to the midpoint of the calendar 
year in which the charges are primarily expected to be used. The 
projected total CPI-U change so obtained is then applied to the 80th 
percentile charges.
    (3) Geographic area adjustment factors. The geographic area 
adjustment factors for observation care facility charges are the same as 
those computed for outpatient facility charges under paragraph (e)(4) of 
this section.
    (k) Ambulance and other emergency transportation charges. When VA 
provides ambulance and other emergency transportation services that are 
within the scope of care referred to in paragraph (a)(1) of this 
section, the charges billed for such services will be determined in 
accordance with the provisions of this paragraph. The charges for these 
services vary by HCPCS code, length of trip, and geographic area. These 
charges are calculated as follows:
    (1) Formula. For each occasion of ambulance or other emergency 
transportation service, add the nationwide base charge for the 
appropriate HCPCS code determined pursuant to paragraph (k)(2)(i) of 
this section to the product of the number of miles traveled and the 
appropriate HCPCS code mileage charge determined pursuant to paragraph 
(k)(2)(ii) of this section. Then multiply this amount by the appropriate 
geographic area adjustment factor determined pursuant to paragraph 
(k)(3) of this section. The result constitutes the area-specific 
ambulance or other emergency transportation service charge.
    (2)(i) Nationwide 80th percentile all-inclusive base charge. To 
calculate a nationwide all-inclusive base charge, all ambulance and 
other emergency transportation claims are selected from the outpatient 
facility component of the Medicare Standard Analytical File 5 Percent 
Sample. Excluding professional and mileage charges, as well as all-
inclusive charges which are reported on such claims, the total charge 
per claim, including incidental supplies, is computed. Then, the 80th 
percentile amount for each HCPCS code is computed. Finally, the 
resulting amounts are each trended forward to the effective time period 
for the charges, as set forth in paragraph (k)(2)(iii) of this section. 
The results constitute the nationwide 80th percentile all-inclusive base 
charge for each HCPCS base charge code.
    (ii) Nationwide 80th percentile mileage charge. To calculate a 
nationwide mileage charge, all ambulance and other emergency 
transportation claims are selected from the outpatient facility 
component of the Medicare Standard Analytical File 5 Percent Sample. 
Excluding professional, incidental, and base charges, as well as claims 
with all-inclusive charges, the total mileage charge per claim is 
computed. This amount is divided by the number of miles reported on the 
claim. Then, the 80th percentile amount for each HCPCS code, using miles 
as weights, is computed. Finally, the resulting amounts are each trended 
forward to the effective time period for the charges, as set forth in 
paragraph (k)(2)(iii) of this section. The results constitute the 
nationwide 80th percentile mileage charge for each HCPCS mileage code.
    (iii) Trending forward. The nationwide 80th percentile charge for 
each HCPCS code, obtained as described in paragraphs (k)(2)(i) and 
(k)(2)(ii) of this section, is trended forward based on changes to the 
outpatient hospital services component of the CPI-U. Actual CPI-U 
changes are used from the time period of the source data through the 
latest available month as of the time the calculations are performed. 
The three-month average annual trend rate as of the latest available 
month is

[[Page 786]]

then held constant to the midpoint of the calendar year in which the 
charges are primarily expected to be used. The projected total CPI-U 
change so obtained is then applied to the 80th percentile charges.
    (3) Geographic area adjustment factors. The geographic area 
adjustment factors for ambulance and other emergency transportation 
charges are the same as those computed for outpatient facility charges 
under paragraph (e)(4) of this section.
    (l) Charges for durable medical equipment, drugs, injectables, and 
other medical services, items, and supplies identified by HCPCS Level II 
codes. When VA provides DME, drugs, injectables, or other medical 
services, items, or supplies that are identified by HCPCS Level II codes 
and that are within the scope of care referred to in paragraph (a)(1) of 
this section, the charges billed for such services, items, and supplies 
will be determined in accordance with the provisions of this paragraph. 
The charges for these services, items, and supplies vary by geographic 
area, by HCPCS code, and by modifier, when applicable. These charges are 
calculated as follows:
    (1) Formula. For each HCPCS code, multiply the nationwide charge 
determined pursuant to paragraphs (l)(2), (l)(3), and (l)(4) of this 
section by the appropriate geographic area adjustment factor determined 
pursuant to paragraph (l)(5) of this section. The result constitutes the 
area-specific charge.
    (2) Nationwide 80th percentile charges for HCPCS codes with RVUs. 
For each applicable HCPCS code, RVUs are compiled from the data sources 
set forth in paragraph (l)(2)(i) of this section. The RVUs are 
multiplied by the charge amount for each incremental RVU determined 
pursuant to paragraph (l)(2)(ii) of this section, and this amount is 
added to the fixed charge amount also determined pursuant to paragraph 
(l)(2)(ii) of this section. Then, for each HCPCS code, this charge is 
multiplied by the appropriate 80th percentile to median charge ratio 
determined pursuant to paragraph (l)(2)(iii) of this section. Finally, 
the resulting amount is trended forward to the effective time period for 
the charges, as set forth in paragraph (l)(2)(iv) of this section to 
obtain the nationwide 80th percentile charge.
    (i) RVUs for DME, drugs, injectables, and other medical services, 
items, and supplies. For the purpose of the statistical methodology set 
forth in paragraph (l)(2)(ii) of this section, HCPCS codes are assigned 
to the following HCPCS code groups. For the HCPCS codes in each group, 
the RVUs or amounts indicated constitute the RVUs:
    (A) Chemotherapy Drugs: Medicare ASP Pricing RBRVS Practice Expense 
RVUs.
    (B) Other Drugs: Medicare ASP Pricing RBRVS Practice Expense RVUs.
    (C) DME--Hospital Beds: Medicare DME Fee Schedule amounts.
    (D) DME--Medical/Surgical Supplies: Medicare DME Fee Schedule 
amounts.
    (E) DME--Orthotic Devices: Medicare DME Fee Schedule amounts.
    (F) DME--Oxygen and Supplies: Medicare DME Fee Schedule amounts.
    (G) DME--Wheelchairs: Medicare DME Fee Schedule amounts.
    (H) Other DME: Medicare DME Fee Schedule amounts.
    (I) Enteral/Parenteral Supplies: Medicare Parenteral and Enteral 
Nutrition Fee Schedule amounts.
    (J) Surgical Dressings and Supplies: Medicare DME Fee Schedule 
amounts.
    (K) Vision Items--Other Than Lenses: Medicare DME Fee Schedule 
amounts.
    (L) Vision Items--Lenses: Medicare DME Fee Schedule amounts.
    (M) Hearing Items: Medicare ASP Pricing RBRVS Practice Expense RVUs.
    (ii) Charge amounts. Using combined Part B and DME components of the 
Medicare Standard Analytical File 5% Sample, the median billed charge is 
calculated for each HCPCS code. A mathematical approximation methodology 
based on least squares techniques is applied to the RVUs specified for 
each of the groups set forth in paragraph (l)(2)(i) of this section, 
yielding two charge amounts for each HCPCS code group: a charge amount 
per incremental RVU, and a fixed charge amount.
    (iii) 80th Percentile to median charge ratios. Two ratios are 
obtained for each

[[Page 787]]

HCPCS code group set forth in paragraph (l)(2)(i) of this section by 
dividing the weighted average 80th percentile charge by the weighted 
average median charge derived from two data sources: Medicare data, as 
represented by the combined Part B and DME components of the Medicare 
Standard Analytical File 5% Sample; and the Fair Health database. Charge 
frequencies from the Medicare data are used as weights when calculating 
all weighted averages. For each HCPCS code group, the smaller of the two 
ratios is selected as the adjustment from median to 80th percentile 
charges.
    (iv) Trending forward. The charges for each HCPCS code, obtained as 
described in paragraph (l)(2)(iii) of this section, are trended forward 
based on changes to the medical care commodities component of the CPI-U. 
Actual CPI-U changes are used from the time period of the source data 
through the latest available month as of the time the calculations are 
performed. The three-month average annual trend rate as of the latest 
available month is then held constant to the midpoint of the calendar 
year in which the charges are primarily expected to be used. The 
projected total CPI-U change so obtained is then applied to the 80th 
percentile charges, as described in paragraph (l)(2)(iii) of this 
section.
    (3) Nationwide 80th percentile charges for HCPCS codes without RVUs. 
For each applicable HCPCS code, 80th percentile charges are extracted 
from two independent data sources: The FAIR Health database and the 
combined Part B and DME components of the Medicare Standard Analytical 
File 5 Percent Sample; and Milliman, Inc., Optimized HMO (Health 
Maintenance Organization) Data Sets (see paragraph (a)(3) of this 
section for Data Sources). Charges from each database are then trended 
forward to the effective time period for the charges, as set forth in 
paragraph (l)(3)(i) of this section. Charges for each HCPCS code from 
each data source are combined into an average 80th percentile charge by 
means of the methodology set forth in paragraph (l)(3)(ii) of this 
section. The results constitute the nationwide 80th percentile charge 
for each applicable HCPCS code.
    (i) Trending forward. The charges from each database for each HCPCS 
code, obtained as described in paragraph (l)(3) of this section, are 
trended forward based on changes to the medical care commodities 
component of the CPI-U. Actual CPI-U changes are used from the time 
period of each source database through the latest available month as of 
the time the calculations are performed. The three-month average annual 
trend rate as of the latest available month is then held constant to the 
midpoint of the calendar year in which the charges are primarily 
expected to be used. The projected total CPI-U change so obtained is 
then applied to the 80th percentile charges, as described in paragraph 
(l)(3) of this section.
    (ii) Averaging methodology. The average 80th percentile trended 
charge for any particular HCPCS code is calculated by first computing a 
preliminary mean of the available charges for each HCPCS code. 
Statistical outliers are identified and removed. In cases where none of 
the charges are removed, the average charge is calculated as a mean of 
all reported charges.
    (4) Nationwide 80th percentile charges for HCPCS codes designated as 
unlisted or unspecified. For HCPCS codes designated as unlisted or 
unspecified procedures, services, items, or supplies, 80th percentile 
charges are developed based on the weighted median 80th percentile 
charges of HCPCS codes within the series in which the unlisted or 
unspecified code occurs. A nationwide VA distribution of procedures, 
services, items, and supplies is used for the purpose of computing the 
weighted median.
    (5) Geographic area adjustment factors. For the purpose of 
geographic adjustment, HCPCS codes are combined into two groups: drugs 
and DME/supplies, as set forth in paragraph (l)(5)(i) of this section. 
The geographic area adjustment factor for each of these groups is 
calculated as the ratio of the area-specific weighted average charge 
determined pursuant to paragraph (l)(5)(ii) of this section divided by 
the nationwide weighted average charge determined pursuant to paragraph 
(l)(5)(iii) of this section.

[[Page 788]]

    (i) Combined HCPCS code groups for geographic area adjustment 
factors for DME, drugs, injectables, and other medical services, items, 
and supplies. For the purpose of the statistical methodology set forth 
in paragraph (l)(5) of this section, each of the HCPCS code groups set 
forth in paragraph (l)(2)(i) of this section is assigned to one of two 
combined HCPCS code groups, as follows:
    (A) Chemotherapy Drugs: Drugs.
    (B) Other Drugs: Drugs.
    (C) DME--Hospital Beds: DME/supplies.
    (D) DME--Medical/Surgical Supplies: DME/supplies.
    (E) DME--Orthotic Devices: DME/supplies.
    (F) DME--Oxygen and Supplies: DME/supplies.
    (G) DME--Wheelchairs: DME/supplies.
    (H) Other DME: DME/supplies.
    (I) Enteral/Parenteral Supplies: DME/supplies.
    (J) Surgical Dressings and Supplies: DME/supplies.
    (K) Vision Items--Other Than Lenses: DME/supplies.
    (L) Vision Items--Lenses: DME/supplies.
    (M) Hearing Items: DME/supplies.
    (ii) Area-specific weighted average charges. Using the median 
charges by HCPCS code from the Fair Health database for each geographic 
area and utilization frequencies by HCPCS code from the combined Part B 
and DME components of the Medicare Standard Analytical File 5 Percent 
Sample, an area-specific weighted average charge is calculated for each 
combined HCPCS code group.
    (iii) Nationwide weighted average charges. Using the area-specific 
weighted average charges determined pursuant to paragraph (l)(5)(ii) of 
this section, a nationwide weighted average charge is calculated for 
each combined HCPCS code group, using as weights the population (census) 
frequencies for each geographic area as presented in the Milliman, Inc., 
Health Cost Guidelines (see paragraph (a)(3) of this section for Data 
Sources).
    (m) Charges for prescription drugs not administered during 
treatment. Notwithstanding other provisions of this section regarding VA 
charges, when VA provides or furnishes prescription drugs not 
administered during treatment, within the scope of care referred to in 
paragraph (a)(1) of this section, charges billed separately for such 
prescription drugs will consist of the amount that equals the total of 
the actual cost to VA for the drugs and the national average of VA 
administrative costs associated with dispensing the drugs for each 
prescription. The actual VA cost of a drug will be the actual amount 
expended by the VA facility for the purchase of the specific drug. The 
administrative cost will be determined annually using VA's managerial 
cost accounting system. Under this accounting system, the average 
administrative cost is determined by adding the total VA national drug 
general overhead costs (such as costs of buildings and maintenance, 
utilities, billing, and collections) to the total VA national drug 
dispensing costs (such as costs of the labor of the pharmacy department, 
packaging, and mailing) with the sum divided by the actual number of VA 
prescriptions filled nationally. Based on this accounting system, VA 
will determine the amount of the average administrative cost annually 
for the prior fiscal year (October through September) and then apply the 
charge at the start of the next calendar year.

    Note to Sec.  17.101: The charges generated by the methodology set 
forth in this section are the same charges prescribed by the Office of 
Management and Budget for use under the Federal Medical Care Recovery 
Act, 42 U.S.C. 2651-2653.

(Authority: 38 U.S.C. 101, 501, 1701, 1705, 1710, 1720D, 1720E, 1721, 
1722, 1729)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0606)

[68 FR 70715, Dec. 19, 2003, as amended at 69 FR 1061, Jan. 7, 2004; 72 
FR 68072, Dec. 4, 2007; 75 FR 61623, Oct. 6, 2010; 83 FR 31454, July 6, 
2018; 85 FR 53176, Aug. 28, 2020; 86 FR 16053, Mar. 26, 2021]



Sec.  17.102  Charges for care or services.

    Except as provided in Sec.  17.101, charges at the indicated rates 
shall be made for Department of Veterans Affairs hospital care or 
medical services (including, but not limited to, dental services,

[[Page 789]]

supplies, medicines, orthopedic and prosthetic appliances, and 
domiciliary or nursing home care) as follows:
    (a) Furnished in error or on tentative eligibility. Charges at rates 
prescribed by the Under Secretary for Health shall be made for inpatient 
or outpatient care or services (including domiciliary care) authorized 
for any person on the basis of eligibility as a veteran or a tentative 
eligibility determination under Sec.  17.34 but he or she was 
subsequently found to have been ineligible for such care or services as 
a veteran because the military service or any other eligibility 
requirement was not met, or
    (b) Furnished in a medical emergency. Charges at rates prescribed by 
the Under Secretary for Health shall be made for any inpatient or 
outpatient care or services rendered any person in a medical emergency 
who was not eligible for such care or services as a veteran, if:
    (1) The care or services were rendered as a humanitarian service, 
under Sec.  17.43(b)(1) or Sec.  17.95 to a person neither claiming 
eligibility as a veteran nor for whom the establishment of eligibility 
as a veteran was expected, or
    (2) The person for whom care or services were rendered was a 
Department of Veterans Affairs employee or a member of a Department of 
Veterans Affairs employee's family; or
    (c) Furnished beneficiaries of the Department of Defense or other 
Federal agencies. Except as provided for in paragraph (f) of this 
section and the second sentence of this paragraph, charges at rates 
prescribed by the Office of Management and Budget shall be made for any 
inpatient or outpatient care or services authorized for a member of the 
Armed Forces on active duty or for any beneficiary or designee of any 
other Federal agency. Charges for services provided a member or former 
member of a uniformed service who is entitled to retired or retainer 
pay, or equivalent pay, will be at rates prescribed by the Secretary 
(E.O. 11609, dated July 22, 1971, 36 FR 13747), or
    (d) Furnished pensioners of allied nations. Charges at rates 
prescribed by the Under Secretary for Health shall be made for any 
inpatient or outpatient care or services rendered a pensioner of a 
nation allied with the United States in World War I and World War II; or
    (e) Furnished under sharing agreements. Charges at rates agreed upon 
in an agreement for sharing specialized medical resources shall be made 
for all medical care or services, either on an inpatient or outpatient 
basis, rendered to a person designated by the other party to the 
agreement as a patient to be benefited under the agreement; or
    (f) Furnished military retirees with chronic disability. Charges for 
subsistence at rates prescribed by the Under Secretary for Health shall 
be made for the period during which hospital care is rendered when such 
care is rendered to a member or former member of the Armed Forces 
required to pay the subsistence rate under Sec.  17.47 (b)(2) and 
(c)(2).
    (g) Furnished for research purposes. Charges will not be made for 
medical services, including transportation, furnished as part of an 
approved Department of Veterans Affairs research project, except that if 
the services are furnished to a person who is not eligible for the 
services as a veteran, the medical care appropriation shall be 
reimbursed from the research appropriation at the same rates used for 
billings under paragraph (b) of this section.
    (h) Computation of charges. The method for computing the charges 
under Sec.  17.86 and under paragraphs (a), (b), (d), (f), and (g) and 
the last sentence of paragraph (c) of this section is based on the 
Monthly Program Cost Report (MPCR), which sets forth the actual basic 
costs and per diem rates by type of inpatient care, and actual basic 
costs and rates for outpatient care visits or prescriptions filled. 
Factors for depreciation of buildings and equipment and Central Office 
overhead are added, based on accounting manual instructions. Additional 
factors are added for interest on capital investment and for standard 
fringe benefit costs covering government employee retirement and 
disability costs. The current year billing rates are projected on prior 
year actual rates by applying the budgeted percentage increase. In 
addition, based on the detail available in the MPCR, VA intends to, on 
each bill break down the all-inclusive rate

[[Page 790]]

into its three principal components; namely, physician cost, ancillary 
services cost, and nursing, room and board cost. The rates generated by 
the foregoing methodology will be published by either VA or OMB in the 
`Notices' section of the Federal Register.

(Authority: 38 U.S.C. 1729; sec. 19013, Pub. L. 99-272)

[32 FR 11382, Aug. 5, 1967, as amended at 34 FR 7807, May 16, 1969; 35 
FR 11470, July 17, 1970; 36 FR 18794, Sept. 22, 1971; 47 FR 50861, Nov. 
10, 1982; 47 FR 58249, Dec.30, 1982; 52 FR 3010, Jan. 30, 1987. 
Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 62 FR 
17072, Apr. 9, 1997. Redesignated and amended at 64 FR 22678, 22683, 
Apr. 27, 1999; 69 FR 1061, Jan. 7, 2004; 73 FR 26946, May 12, 2008]



Sec.  17.103  Referrals of compromise settlement offers.

    Any offer to compromise or settle any charges or claim for $20,000 
or less asserted by the Department of Veterans Affairs in connection 
with the medical program shall be referred as follows:
    (a) To Chief Financial Officers of the Consolidated Patient Account 
Centers. If the debt represents charges made under Sec. Sec.  17.108, 
17.110, or 17.111, the compromise offer shall be referred to the Chief 
Financial Officer of the Consolidated Patient Account Center (CPAC) for 
application of the collection standards in Sec.  1.900 et seq. of this 
chapter, provided:
    (1) The debt does not exceed $1,000, and
    (2) There has been a previous denial of waiver of the debt by the 
CPAC Committee on Waivers and Compromises.
    (b) To Regional Counsel. If the debt in any amount represents 
charges for medical services for which there is or may be a claim 
against a third party tort-feasor or under workers' compensation laws or 
Pub. L. 87-693; 76 Stat. 593 (see Sec.  1.903 of this chapter) or 
involves a claim contemplated by Sec.  1.902 of this chapter over which 
the Department of Veterans Affairs lacks jurisdiction, the compromise 
offer (or request for waiver or proposal to terminate or suspend 
collection action) shall be promptly referred to the field station 
Regional Counsel having jurisdiction in the area in which the claim 
arose, or
    (c) To Committee on Waivers and Compromises. If one of the following 
situations contemplated in paragraph (c)(1) through (3) of this section 
applies
    (1) If the debt represents charges made under Sec.  17.101(a), but 
is not of a type contemplated in paragraph (a) of this section, or
    (2) If the debt represents charges for medical services made under 
Sec.  17.101(b), or
    (3) A claim arising in connection with any transaction of the 
Veterans Health Administration for which the instructions in paragraph 
(a) or (b) of this section or in Sec.  17.105(c) are not applicable, 
then, the compromise offer should be referred for disposition under 
Sec.  1.900 et seq. of this chapter to the field station Committee on 
Waivers and Compromises which shall take final action.

[39 FR 26403, July 19, 1974, as amended at 47 FR 58250, Dec. 30, 1982. 
Redesignated and amended at 61 FR 21966, 21967, May 13, 1996; 62 FR 
17072, Apr. 9, 1997; 80 FR 23241, Apr. 27, 2015]



Sec.  17.104  Terminations and suspensions.

    Any proposal to suspend or terminate collection action on any 
charges or claim for $20,000 or less asserted by the Department of 
Veterans Affairs in connection with the medical program shall be 
referred as follows:
    (a) Of charges for medical services. If the debt represents charges 
made under Sec. Sec.  17.108, 17.110, or 17.111 questions concerning 
suspension or termination of collection action shall be referred to the 
Chief Financial Officer of the Consolidated Patient Account Center for 
application of the collection standards in Sec.  1.900 et seq. of this 
chapter, or
    (b) Of other debts. If the debt is of a type other than those 
contemplated in paragraph (a) of this section, questions concerning 
suspension or termination of collection action shall be referred in 
accordance with the same referral procedures for compromise offers 
(except the Fiscal activity shall make final determinations in 
terminations or suspensions involving claims of $150 or

[[Page 791]]

less pursuant to the provisions of Sec.  1.900 et seq. of this chapter.)

[34 FR 7807, May 16, 1969, as amended at 39 FR 26403, July 19, 1974. 
Redesignated and amended at 61 FR 21966, 21967, May 13, 1996; 80 FR 
23241, Apr. 27, 2015]



Sec.  17.105  Waivers.

    Applications or requests for waiver of debts or claims asserted by 
the Department of Veterans Affairs in connection with the medical 
program generally will be denied by the facility Fiscal activity on the 
basis there is no legal authority to waive debts, unless the question of 
waiver should be referred as follows:
    (a) Of charges for medical services. If the debt represents charges 
made under Sec.  17.102, the application or request for waiver should be 
referred for disposition under Sec.  1.900 et seq. of this chapter to 
the field facility Committee on Waivers and Compromises which shall take 
final action, or
    (b) Of claims against third persons and other claims. If the debt is 
of a type contemplated in Sec.  17.103(b), the waiver question should be 
referred in accordance with the same referral procedures for compromise 
offers in such categories of claims, or
    (c) Of charges for copayments. If the debt represents charges for 
outpatient medical care, inpatient hospital care, medication or extended 
care services copayments made under Sec. Sec.  17.108, 17.110, 17.111, 
or 17.4600, the claimant must request a waiver by submitting VA Form 
5655 (Financial Status Report) to the Consolidated Patient Account 
Center (CPAC) Chief Financial Officer. The claimant must submit this 
form within the time period provided in Sec.  1.963(b) of this chapter 
and may request a hearing under Sec.  1.966(a) of this chapter. The CPAC 
Chief Financial Officer may extend the time period for submitting a 
claim if the Chairperson of the Committee on Waivers and Compromises 
could do so under Sec.  1.963(b) of this chapter. The CPAC Chief 
Financial Officer will apply the standard ``equity and good conscience'' 
in accordance with Sec. Sec.  1.965 and 1.966(a) of this chapter, and 
may waive all or part of the claimant's debts. A decision by the CPAC 
Chief Financial Officer under this provision is final (except that the 
decision may be reversed or modified based on new and material evidence, 
fraud, a change in law or interpretation of law, or clear and 
unmistakable error shown by the evidence in the file at the time of the 
prior decision as provided in Sec.  1.969 of this chapter) and may be 
appealed in accordance with 38 CFR parts 19 and 20.
    (d) Other debts. If the debt represents any claim or charges other 
than those contemplated in paragraphs (a) and (b) of this section, and 
is a debt for which waiver has been specifically provided for by law or 
under the terms of a contract, initial action shall be taken at the 
station level for referral of the request for waiver through channels 
for action by the appropriate designated official. If, however, the 
question of waiver may also involve a concurrent opportunity to 
negotiate a compromise settlement, the application shall be referred to 
the Committee on Waivers and Compromises.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0165)

[39 FR 26403, July 19, 1974. Redesignated and amended at 61 FR 21966, 
21967, May 13, 1996; 69 FR 62204, Oct. 25, 2004; 80 FR 23241, Apr. 27, 
2015; 84 FR 26017, June 5, 2019]



Sec.  17.106  VA collection rules; third-party payers.

    (a)(1) General rule. VA has the right to recover or collect 
reasonable charges from a third-party payer for medical care and 
services provided for a nonservice-connected disability in or through 
any VA facility to a veteran who is also a beneficiary under the third-
party payer's plan. VA's right to recover or collect is limited to the 
extent that the beneficiary or a nongovernment provider of care or 
services would be eligible to receive reimbursement or indemnification 
from the third-party payer if the beneficiary were to incur the costs on 
the beneficiary's own behalf.
    (2) Definitions. For the purposes of this section:
    Automobile liability insurance means insurance against legal 
liability for health and medical expenses resulting from personal 
injuries arising from operation of a motor vehicle. Automobile liability 
insurance includes:

[[Page 792]]

    (A) Circumstances in which liability benefits are paid to an injured 
party only when the insured party's tortious acts are the cause of the 
injuries; and
    (B) Uninsured and underinsured coverage, in which there is a third-
party tortfeasor who caused the injuries (i.e., benefits are not paid on 
a no-fault basis), but the insured party is not the tortfeasor.
    Health-plan contract means any plan, policy, program, contract, or 
liability arrangement that provides compensation, coverage, or 
indemnification for expenses incurred by a beneficiary for medical care 
or services, items, products, and supplies. It includes but is not 
limited to:
    (A) Any plan offered by an insurer, reinsurer, employer, 
corporation, organization, trust, organized health care group or other 
entity.
    (B) Any plan for which the beneficiary pays a premium to an issuing 
agent as well as any plan to which the beneficiary is entitled as a 
result of employment or membership in or association with an 
organization or group.
    (C) Any Employee Retirement Income and Security Act (ERISA) plan.
    (D) Any Multiple Employer Trust (MET).
    (E) Any Multiple Employer Welfare Arrangement (MEWA).
    (F) Any Health Maintenance Organization (HMO) plan, including any 
such plan with a point-of-service provision or option.
    (G) Any individual practice association (IPA) plan.
    (H) Any exclusive provider organization (EPO) plan.
    (I) Any physician hospital organization (PHO) plan.
    (J) Any integrated delivery system (IDS) plan.
    (K) Any management service organization (MSO) plan.
    (L) Any group or individual medical services account.
    (M) Any participating provider organization (PPO) plan or any PPO 
provision or option of any third-party payer plan.
    (N) Any Medicare supplemental insurance plan.
    (O) Any automobile liability insurance plan.
    (P) Any no fault insurance plan, including any personal injury 
protection plan or medical payments benefit plan for personal injuries 
arising from the operation of a motor vehicle.
    Medicare supplemental insurance plan means an insurance, medical 
service or health-plan contract primarily for the purpose of 
supplementing an eligible person's benefit under Medicare. The term has 
the same meaning as ``Medicare supplemental policy'' in section 
1882(g)(1) of the Social Security Act (42 U.S.C. 1395, et seq.) and 42 
CFR part 403, subpart B.
    No-fault insurance means an insurance contract providing 
compensation for medical expenses relating to personal injury arising 
from the operation of a motor vehicle in which the compensation is not 
premised on who may have been responsible for causing such injury. No-
fault insurance includes personal injury protection and medical payments 
benefits in cases involving personal injuries resulting from operation 
of a motor vehicle.
    Participating provider organization means any arrangement in a 
third-party payer plan under which coverage is limited to services 
provided by a select group of providers who are members of the PPO or 
incentives (for example, reduced copayments) are provided for 
beneficiaries under the plan to receive health care services from the 
members of the PPO rather than from other providers who, although 
authorized to be paid, are not included in the PPO. However, a PPO does 
not include any organization that is recognized as a health maintenance 
organization.
    Third-party payer means an entity, other than the person who 
received the medical care or services at issue (first party) and VA who 
provided the care or services (second party), responsible for the 
payment of medical expenses on behalf of a person through insurance, 
agreement or contract. This term includes, but is not limited to the 
following:
    (A) State and local governments that provide such plans other than 
Medicaid.
    (B) Insurance underwriters or carriers.
    (C) Private employers or employer groups offering self-insured or 
partially

[[Page 793]]

self-insured medical service or health plans.
    (D) Automobile liability insurance underwriter or carrier.
    (E) No fault insurance underwriter or carrier.
    (F) Workers' compensation program or plan sponsor, underwriter, 
carrier, or self-insurer.
    (G) Any other plan or program that is designed to provide 
compensation or coverage for expenses incurred by a beneficiary for 
healthcare services or products.
    (H) A third-party administrator.
    (b) Calculating reasonable charges. (1) The ``reasonable charges'' 
subject to recovery or collection by VA under this section are 
calculated using the applicable method for such charges established by 
VA in 38 CFR 17.101.
    (2) If the third-party payer's plan includes a requirement for a 
deductible or copayment by the beneficiary of the plan, VA will recover 
or collect reasonable charges less that deductible or copayment amount.
    (c) VA's right to recover or collect is exclusive. The only way for 
a third-party payer to satisfy its obligation under this section is to 
pay the VA facility or other authorized representative of the United 
States. Payment by a third-party payer to the beneficiary does not 
satisfy the third-party's obligation under this section.
    (1) Pursuant to 38 U.S.C. 1729(b)(2), the United States may file a 
claim or institute and prosecute legal proceedings against a third-party 
payer to enforce a right of the United States under 38 U.S.C. 1729 and 
this section. Such filing or proceedings must be instituted within six 
years after the last day of the provision of the medical care or 
services for which recovery or collection is sought.
    (2) An authorized representative of the United States may 
compromise, settle or waive a claim of the United States under this 
section.
    (3) The remedies authorized for collection of indebtedness due the 
United States under 31 U.S.C. 3701, et seq., 28 CFR part 11, 31 CFR 
parts 900 through 904 and 38 CFR part 1, are available to effect 
collections under this section.
    (4) A third-party payer may not, without the consent of a U.S. 
Government official authorized to take action under 38 U.S.C. 1729 and 
this part, offset or reduce any payment due under 38 U.S.C. 1729 or this 
part on the grounds that the payer considers itself due a refund from a 
VA facility. A written request for a refund must be submitted within 18 
months from the original payment date and adjudicated separately from 
any other claims submitted to the third-party payer under 38 U.S.C. 1729 
or this part. If third-party payers do not submit requests for a refund 
within this 18-month time frame, VA will not provide a refund to third-
party payers for a paid claim for any reason.
    (d) Assignment of benefits or other submission by beneficiary not 
necessary. The obligation of the third-party payer to pay is not 
dependent upon the beneficiary executing an assignment of benefits to 
the United States. Nor is the obligation to pay dependent upon any other 
submission by the beneficiary to the third-party payer, including any 
claim or appeal. In any case in which VA makes a claim, appeal, 
representation, or other filing under the authority of this part, any 
procedural requirement in any third-party payer plan for the beneficiary 
of such plan to make the claim, appeal, representation, or other filing 
must be deemed to be satisfied. A copy of the completed VA Form 10-10EZ 
or VA Form 10-10EZR that includes a veteran's insurance declaration will 
be provided to payers upon request, in lieu of a claimant's statement or 
coordination of benefits form.
    (e) Preemption of conflicting State laws and contracts. Any 
provision of a law or regulation of a State or political subdivision 
thereof and any provision of any contract or agreement that purports to 
establish any requirement on a third-party payer that would have the 
effect of excluding from coverage or limiting payment for any medical 
care or services for which payment by the third-party payer under 38 
U.S.C. 1729 or this part is required, is preempted by 38 U.S.C. 1729(f) 
and shall have no force or effect in connection with the third-party 
payer's obligations under 38 U.S.C. 1729 or this part.
    (f) Impermissible exclusions by third-party payers. (1) Statutory 
requirement. Under 38 U.S.C. 1729(f), no provision of

[[Page 794]]

any third-party payer's plan having the effect of excluding from 
coverage or limiting payment for certain care if that care is provided 
in or through any VA facility shall operate to prevent collection by the 
United States.
    (2) General rules. The following are general rules for the 
administration of 38 U.S.C. 1729 and this part, with examples provided 
for clarification. The examples provided are not exclusive. A third-
party payer may not reduce, offset, or request a refund for payments 
made to VA under the following conditions:
    (i) Express exclusions or limitations in third-party payer plans 
that are inconsistent with 38 U.S.C. 1729 are inoperative. For example, 
a provision in a third-party payer's plan that purports to disallow or 
limit payment for services provided by a government entity or paid for 
by a government program (or similar exclusion) is not a permissible 
ground for refusing or reducing third-party payment.
    (ii) No objection, precondition or limitation may be asserted that 
defeats the statutory purpose of collecting from third-party payers. For 
example, a provision in a third-party payer's plan that purports to 
disallow or limit payment for services for which the patient has no 
obligation to pay (or similar exclusion) is not a permissible ground for 
refusing or reducing third-party payment.
    (iii) Third-party payers may not treat claims arising from services 
provided in or through VA facilities less favorably than they treat 
claims arising from services provided in other hospitals. For example, 
no provision of an employer sponsored program or plan that purports to 
make ineligible for coverage individuals who are eligible to receive VA 
medical care and services shall be permissible.
    (iv) The lack of a participation agreement or the absence of privity 
of contract between a third-party payer and VA is not a permissible 
ground for refusing or reducing third-party payment.
    (v) A provision in a third-party payer plan, other than a Medicare 
supplemental plan, that seeks to make Medicare the primary payer and the 
plan the secondary payer or that would operate to carve out of the 
plan's coverage an amount equivalent to the Medicare payment that would 
be made if the services were provided by a provider to whom payment 
would be made under Part A or Part B of Medicare is not a permissible 
ground for refusing or reducing payment as the primary payer to VA by 
the third-party payer unless the provision expressly disallows payment 
as the primary payer to all providers to whom payment would not be made 
under Medicare (including payment under Part A, Part B, a Medicare HMO, 
or a Medicare Advantage plan).
    (vi) A third-party payer may not refuse or reduce third-party 
payment to VA because VA's claim form did not report hospital acquired 
conditions (HAC) or present on admission conditions (POA). VA is exempt 
from the Medicare Inpatient prospective payment system and the Medicare 
rules for reporting POA or HAC information to third-party payers.
    (vii) Health Maintenance Organizations (HMOs) may not exclude claims 
or refuse to certify emergent and urgent services provided within the 
HMO's service area or otherwise covered non-emergency services provided 
out of the HMO's service area. In addition, opt-out or point-of-service 
options available under an HMO plan may not exclude services otherwise 
payable under 38 U.S.C. 1729 or this part.
    (viii) A third party may not reduce or refuse payment if the 
facility where the medical treatment was furnished is designated by VA 
as provider-based, but the facility does not meet the provider-based 
status requirements under 42 CFR 413.65.
    (ix) A provision in a third-party payer's plan that directs payment 
for care or services be refused or lessened because the billing is not 
presented in accordance with a specified methodology (such as a line 
item methodology) is not by itself a permissible ground for refusing or 
reducing third-party payment.
    (g) Records. Pursuant to 38 U.S.C. 1729(h), VA shall make available 
for inspection and review to representatives of third-party payers, from 
which the United States seeks payment, recovery, or collection under 38 
U.S.C. 1729,

[[Page 795]]

appropriate health care records (or copies of such records) of patients. 
However, the appropriate records will be made available only for the 
purposes of verifying the care and services which are the subject of the 
claim(s) for payment under 38 U.S.C. 1729, and for verifying that the 
care and services met the permissible criteria of the terms and 
conditions of the third-party payer's plan. Patient care records will 
not be made available under any other circumstances to any other entity. 
VA will not make available to a third-party payer any other patient or 
VA records.

(Authority: 31 U.S.C. 3711, 38 U.S.C. 501, 1729, 42 U.S.C. 2651)

[76 FR 37204, June 24, 2011, as amended at 79 FR 54616, Sept. 12, 2014; 
85 FR 53176, Aug. 28, 2020; 86 FR 16055, Mar. 26, 2021]

Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary or 
                            Nursing Home Care



Sec.  17.107  VA response to disruptive behavior of patients.

    (a) Definition. For the purposes of this section:
    VA medical facility means VA medical centers, outpatient clinics, 
and domiciliaries.
    (b) Response to disruptive patients. The time, place, and/or manner 
of the provision of a patient's medical care may be restricted by 
written order of the Chief of Staff of the VA Medical Center of 
jurisdiction or his or her designee if:
    (1) The Chief of Staff or designee determines pursuant to paragraph 
(c) of this section that the patient's behavior at a VA medical facility 
has jeopardized or could jeopardize the health or safety of other 
patients, VA staff, or guests at the facility, or otherwise interfere 
with the delivery of safe medical care to another patient at the 
facility;
    (2) The order is narrowly tailored to address the patient's 
disruptive behavior and avoid undue interference with the patient's 
care;
    (3) The order is signed by the Chief of Staff or designee, and a 
copy is entered into the patient's permanent medical record;
    (4) The patient receives a copy of the order and written notice of 
the procedure for appealing the order to the Network Director of 
jurisdiction as soon as possible after issuance; and
    (5) The order contains an effective date and any appropriate limits 
on the duration of or conditions for continuing the restrictions. The 
Chief of Staff or designee may order restrictions for a definite period 
or until the conditions for removing conditions specified in the order 
are satisfied. Unless otherwise stated, the restrictions imposed by an 
order will take effect upon issuance by the Chief of Staff or designee. 
Any order issued by the Chief of Staff or designee shall include a 
summary of the pertinent facts and the bases for the Chief of Staff's or 
designee's determination regarding the need for restrictions.
    (c) Evaluation of disruptive behavior. In making determinations 
under paragraph (b) of this section, the Chief of Staff or designee must 
consider all pertinent facts, including any prior counseling of the 
patient regarding his or her disruptive behavior or any pattern of such 
behavior, and whether the disruptive behavior is a result of the 
patient's individual fears, preferences, or perceived needs. A patient's 
disruptive behavior must be assessed in connection with VA's duty to 
provide good quality care, including care designed to reduce or 
otherwise clinically address the patient's behavior.
    (d) Restrictions. The restrictions on care imposed under this 
section may include but are not limited to:
    (1) Specifying the hours in which nonemergent outpatient care will 
be provided;
    (2) Arranging for medical and any other services to be provided in a 
particular patient care area (e.g., private exam room near an exit);
    (3) Arranging for medical and any other services to be provided at a 
specific site of care;
    (4) Specifying the health care provider, and related personnel, who 
will be involved with the patient's care;
    (5) Requiring police escort; or
    (6) Authorizing VA providers to terminate an encounter immediately 
if certain behaviors occur.

[[Page 796]]

    (e) Review of restrictions. The patient may request the Network 
Director's review of any order issued under this section within 30 days 
of the effective date of the order by submitting a written request to 
the Chief of Staff. The Chief of Staff shall forward the order and the 
patient's request to the Network Director for a final decision. The 
Network Director shall issue a final decision on this matter within 30 
days. VA will enforce the order while it is under review by the Network 
Director. The Chief of Staff will provide the patient who made the 
request written notice of the Network Director's final decision.

    Note to Sec.  17.107: Although VA may restrict the time, place, and/
or manner of care under this section, VA will continue to offer the full 
range of needed medical care to which a patient is eligible under title 
38 of the United States Code or Code of Federal Regulations. Patients 
have the right to accept or refuse treatments or procedures, and such 
refusal by a patient is not a basis for restricting the provision of 
care under this section.

(Authority: 38 U.S.C. 501, 901, 1721)

[75 FR 69883, Nov. 16, 2010. Redesignated at 76 FR 37204, June 24, 2011; 
79 FR 54616, Sept. 12, 2014]

                               Copayments



Sec.  17.108  Copayments for inpatient hospital care and outpatient
medical care.

    (a) General. This section sets forth requirements regarding 
copayments for inpatient hospital care and outpatient medical care 
provided to veterans by VA.
    (b) Copayments for inpatient hospital care. (1) Except as provided 
in paragraphs (d) or (e) of this section, a veteran, as a condition of 
receiving inpatient hospital care provided by VA (provided either 
directly by VA or obtained by VA by contract, provider agreement, or 
sharing agreement), must agree to pay VA (and is obligated to pay VA) 
the applicable copayment, as set forth in paragraph (b)(2), (b)(3), or 
(b)(4) of this section.
    (2) The copayment for inpatient hospital care shall be, during any 
365-day period, a copayment equaling the sum of:
    (i) $10 for every day the veteran receives inpatient hospital care, 
and
    (ii) The lesser of:
    (A) The sum of the inpatient Medicare deductible for the first 90 
days of care and one-half of the inpatient Medicare deductible for each 
subsequent 90 days of care (or fraction thereof) after the first 90 days 
of such care during such 365-day period, or
    (B) VA's cost of providing the care.
    (3) The copayment for inpatient hospital care for veterans enrolled 
in priority category 7 shall be 20 percent of the amount computed under 
paragraph (b)(2) of this section.
    (4) For inpatient hospital care furnished through the Veterans 
Choice Program under Sec. Sec.  17.1500 through 17.1540, or the Veterans 
Community Care Program under Sec. Sec.  17.4000 through 17.4040, the 
copayment amount at the time of furnishing such care or services by a 
non-VA entity or provider is $0. VA will determine and assess the 
veteran's copayment amount at the end of the billing process, but at no 
time will a veteran's copayment be more than the amount identified in 
paragraph (b)(2) or (3) of this section.

    Note to Sec.  17.108(b): The requirement that a veteran agree to pay 
the copayment would be met by submitting to VA a signed VA Form 10-10EZ. 
This is the application form for enrollment in the VA healthcare system 
and also is the document used for providing means-test information 
annually.

    (c) Copayments for outpatient medical care. (1) Except as provided 
in paragraphs (d), (e), or (f) of this section, a veteran, as a 
condition for receiving outpatient medical care provided by VA (provided 
either directly by VA or obtained by VA by contract, provider agreement, 
or sharing agreement), must agree to pay VA (and is obligated to pay VA) 
a copayment as set forth in paragraph (c)(2) or (c)(4) of this section.
    (2) The copayment for outpatient medical care is $15 for a primary 
care outpatient visit and $50 for a specialty care outpatient visit. If 
a veteran has more than one primary care encounter on the same day and 
no specialty care encounter on that day, the copayment amount is the 
copayment for one primary care outpatient visit. If a veteran has one or 
more primary care encounters and one or more specialty care encounters 
on the same day, the copayment amount is the copayment for one specialty 
care outpatient visit.

[[Page 797]]

    (3) For purposes of this section, a primary care visit is an episode 
of care furnished in a clinic that provides integrated, accessible 
healthcare services by clinicians who are accountable for addressing a 
large majority of personal healthcare needs, developing a sustained 
partnership with patients, and practicing in the context of family and 
community. Primary care includes, but is not limited to, diagnosis and 
management of acute and chronic biopsychosocial conditions, health 
promotion, disease prevention, overall care management, and patient and 
caregiver education. Each patient's identified primary care clinician 
delivers services in the context of a larger interdisciplinary primary 
care team. Patients have access to the primary care clinician and much 
of the primary care team without need of a referral. In contrast, 
specialty care is generally provided through referral. A specialty care 
outpatient visit is an episode of care furnished in a clinic that does 
not provide primary care, and is only provided through a referral. Some 
examples of specialty care provided at a specialty care clinic are 
radiology services requiring the immediate presence of a physician, 
audiology, optometry, magnetic resonance imagery (MRI), computerized 
axial tomography (CAT) scan, nuclear medicine studies, surgical 
consultative services, and ambulatory surgery.
    (4) For outpatient medical care furnished through the Veterans 
Choice Program under Sec. Sec.  17.1500 through 17.1540, or the Veterans 
Community Care Program under Sec. Sec.  17.4000 through 17.4040, the 
copayment amount at the time of furnishing such care or services by a 
non-VA entity or provider is $0. VA will determine and assess the 
veteran's copayment amount at the end of the billing process, but at no 
time will a veteran's copayment be more than the amount identified in 
paragraph (c)(2) of this section.

    Note to Sec.  17.108(c): The requirement that a veteran agree to pay 
the copayment would be met by submitting to VA a signed VA Form 10-10EZ. 
This is the application form for enrollment in the VA healthcare system 
and also is the document used for providing means-test information 
annually.

    (d) Veterans not subject to copayment requirements for inpatient 
hospital care or outpatient medical care. The following veterans are not 
subject to the copayment requirements of this section:
    (1) A veteran with a compensable service-connected disability.
    (2) A veteran who is a former prisoner of war.
    (3) A veteran awarded a Purple Heart.
    (4) A veteran who was discharged or released from active military 
service for a disability incurred or aggravated in the line of duty;
    (5) A veteran who receives disability compensation under 38 U.S.C. 
1151.
    (6) A veteran whose entitlement to disability compensation is 
suspended pursuant to 38 U.S.C. 1151, but only to the extent that the 
veteran's continuing eligibility for care is provided for in the 
judgment or settlement described in 38 U.S.C. 1151.
    (7) A veteran whose entitlement to disability compensation is 
suspended because of the receipt of military retirement pay.
    (8) A veteran of the Mexican border period or of World War I.
    (9) A military retiree provided care under an interagency agreement 
as defined in section 113 of Public Law 106-117, 113 Stat. 1545.
    (10) A veteran who VA determines to be unable to defray the expenses 
of necessary care under 38 U.S.C. 1722(a).
    (11) A veteran who VA determines to be catastrophically disabled, as 
defined in 38 CFR 17.36(e).
    (12) A veteran receiving care for psychosis or a mental illness 
other than psychosis pursuant to Sec.  17.109.
    (13) A veteran who was awarded the Medal of Honor.
    (e) Services not subject to copayment requirements for inpatient 
hospital care, outpatient medical care, or urgent care. The following 
are not subject to the copayment requirements under this section or, 
except for Sec.  17.108(e)(1), (2), (4), (10), and (14), the copayment 
requirements under Sec.  17.4600.
    (1) Care provided to a veteran for a noncompensable zero percent 
service-connected disability;
    (2) Care authorized under 38 U.S.C. 1710(e) for Vietnam-era 
herbicide-exposed veterans, radiation-exposed veterans, Gulf War 
veterans, post-Gulf

[[Page 798]]

War combat-exposed veterans, or Camp Lejeune veterans pursuant to Sec.  
17.400;
    (3) Special registry examinations (including any follow-up 
examinations or testing ordered as part of the special registry 
examination) offered by VA to evaluate possible health risks associated 
with military service;
    (4) Counseling and care for sexual trauma as authorized under 38 
U.S.C 1720D;
    (5) Compensation and pension examinations requested by the Veterans 
Benefits Administration;
    (6) Care provided as part of a VA-approved research project 
authorized by 38 U.S.C. 7303;
    (7) Outpatient dental care provided under 38 U.S.C. 1712;
    (8) Readjustment counseling and related mental health services 
authorized under 38 U.S.C 1712A;
    (9) Emergency treatment paid for under 38 U.S.C. 1725 or 1728;
    (10) Care or services authorized under 38 U.S.C. 1720E for certain 
veterans regarding cancer of the head or neck;
    (11) Publicly announced VA public health initiatives (e.g., health 
fairs) or an outpatient visit solely consisting of preventive screening 
and immunizations (e.g., influenza immunization, pneumonococcal 
immunization, hypertension screening, hepatitis C screening, tobacco 
screening, alcohol screening, hyperlipidemia screening, breast cancer 
screening, cervical cancer screening, screening for colorectal cancer by 
fecal occult blood testing, and education about the risks and benefits 
of prostate cancer screening);
    (12) Weight management counseling (individual and group);
    (13) Smoking cessation counseling (individual and group);
    (14) Laboratory services, flat film radiology services, and 
electrocardiograms;
    (15) Hospice care;
    (16) In-home video telehealth care; and
    (17) Mental health peer support services.
    (f) Additional care not subject to outpatient copayment. Outpatient 
care is not subject to the outpatient copayment requirements under this 
section when provided to a veteran during a day for which the veteran is 
required to make a copayment for extended care services that were 
provided either directly by VA or obtained for VA by contract.

[66 FR 63448, Dec. 6, 2001, as amended at 68 FR 60854, Oct. 24, 2003; 70 
FR 22596, May 2, 2005; 73 FR 20532, Apr. 16, 2008; 75 FR 54030, Sept. 3, 
2010; 76 FR 52274, Aug. 22, 2011; 77 FR 13198, Mar. 6, 2012; 78 FR 
28143, May 14, 2013; 79 FR 57414, Sept. 24, 2014; 79 FR 65584, Nov. 5, 
2014; 79 FR 70939, Nov. 28, 2014; 84 FR 7815, Mar. 5, 2019; 84 FR 26017, 
26306, June 5, 2019]



Sec.  17.109  Presumptive eligibility for psychosis and mental illness 
other than psychosis.

    (a) Psychosis. Eligibility for benefits under this part is 
established by this section for treatment of an active psychosis, and 
such condition is exempted from copayments under Sec. Sec.  17.108, 
17.110, and 17.111 for any veteran of World War II, the Korean conflict, 
the Vietnam era, or the Persian Gulf War who developed such psychosis:
    (1) Within 2 years after discharge or release from the active 
military, naval, or air service; and
    (2) Before the following date associated with the war or conflict in 
which he or she served:
    (i) World War II: July 26, 1949.
    (ii) Korean conflict: February 1, 1957.
    (iii) Vietnam era: May 8, 1977.
    (iv) Persian Gulf War: The end of the 2-year period beginning on the 
last day of the Persian Gulf War.
    (b) Mental illness (other than psychosis). Eligibility under this 
part is established by this section for treatment of an active mental 
illness (other than psychosis), and such condition is exempted from 
copayments under Sec. Sec.  17.108, 17.110, and 17.111 for any veteran 
of the Persian Gulf War who developed such mental illness other than 
psychosis:
    (1) Within 2 years after discharge or release from the active 
military, naval, or air service; and
    (2) Before the end of the 2-year period beginning on the last day of 
the Persian Gulf War.
    (c) No minimum service required. Eligibility for care and waiver of 
copayments will be established under this

[[Page 799]]

section without regard to the veteran's length of active-duty service.

 (Authority: 38 U.S.C. 501, 1702, 5303A)

[78 FR 28143, May 14, 2013]



Sec.  17.110  Copayments for medication.

    (a) General. This section sets forth requirements regarding 
copayments for medications provided to veterans by VA. For purposes of 
this section, the term ``medication'' means prescription and over-the-
counter medications, as determined by the Food and Drug Administration 
(FDA), but does not mean medical supplies, oral nutritional supplements, 
or medical devices. Oral nutritional supplements are commercially 
prepared nutritionally enhanced products used to supplement the intake 
of individuals who cannot meet nutrient needs by diet alone.
    (b) Copayments. (1) Copayment amount. Unless exempted under 
paragraph (c) of this section, a veteran is obligated to pay VA a 
copayment for each 30-day or less supply of medication provided by VA on 
an outpatient basis (other than medication administered during 
treatment).
    (i) For each 30-day or less supply of Tier 1 medications, the 
copayment amount is $5.
    (ii) For each 30-day or less supply of Tier 2 medications, the 
copayment amount is $8.
    (iii) For each 30-day or less supply of Tier 3 medications, the 
copayment amount is $11.
    (iv) For purposes of this section:
    (A) Multi-source medication is any one of the following:
    (1) A medication that has been and remains approved by the FDA--
    (i) Under sections 505(b)(2) or 505(j) of the Food, Drug, and 
Cosmetic Act (FDCA, 21 U.S.C. 355), and that has been granted an A-
rating in the current version of the FDA's Approved Drug Products with 
Therapeutic Equivalence Evaluations (the Orange Book); or
    (ii) Under section 351(k) of the Public Health Service Act (PHSA, 42 
U.S.C. 262), and that has been granted an I or B rating in the current 
version of the FDA's Lists of Licensed Biological Products with 
Reference Product Exclusivity and Biosimilarity or Interchangeability 
Evaluations (the Purple Book). FDA determines both therapeutic 
equivalence for drugs and interchangeability for biological products.
    (2) A medication that--
    (i) Has been and remains approved by the FDA pursuant to FDCA 
section 505(b)(1) or PHSA section 351(a);
    (ii) Which is referenced by at least one FDA-approved product that 
meets the criteria of paragraph (b)(1)(iv)(A)(1) of this section; and
    (iii) Which is covered by a contracting strategy in place with 
pricing such that it is lower in cost than other generic sources.
    (3) A medication that--
    (i) Has been and remains approved by the FDA pursuant to FDCA 
section 505(b)(1) or PHSA section 351(a); and
    (ii) Has the same active ingredient or active ingredients, works in 
the same way and in a comparable amount of time, and is determined by VA 
to be substitutable for another medication that has been and remains 
approved by the FDA pursuant to FDCA section 505(b)(1) or PHSA section 
351(a). This may include but is not limited to insulin and 
levothyroxine.
    (4) A listed drug, as defined in 21 CFR 314.3, that has been 
approved under FDCA section 505(c) and is marketed, sold, or distributed 
directly or indirectly to retail class of trade with either labeling, 
packaging (other than repackaging as the listed drug in blister packs, 
unit doses, or similar packaging for use in institutions), product code, 
labeler code, trade name, or trademark that differs from that of the 
listed drug.
    (B) Tier 1 medication means a multi-source medication that has been 
identified using the process described in paragraph (b)(2) of this 
section.
    (C) Tier 2 medication means a multi-source medication that is not 
identified using the process described in paragraph (b)(2) of this 
section.
    (D) Tier 3 medication means a medication approved by the FDA under a 
New Drug Application (NDA) or a biological product approved by the FDA 
pursuant to a biologics license agreement (BLA) that retains its patent 
protection and exclusivity and is not a multi-source medication 
identified in paragraph (b)(1)(iv)(A)(3) or (4) of this section.

[[Page 800]]

    (2) Determining Tier 1 medications. Not less than once per year, VA 
will identify a subset of multi-source medications as Tier 1 medications 
using the criteria below. Only medications that meet all of the criteria 
in paragraphs (b)(2)(i), (ii), and (iii) will be eligible to be 
considered Tier 1 medications, and only those medications that meet all 
of the criteria in paragraph (b)(2)(i) of this section will be assessed 
using the criteria in paragraphs (b)(2)(ii) and (iii).
    (i) A medication must meet all of the following criteria:
    (A) The VA acquisition cost for the medication is less than or equal 
to $10 for a 30-day supply of medication;
    (B) The medication is not a topical cream, a product used to treat 
musculoskeletal conditions, an antihistamine, or a steroid-containing 
medication;
    (C) The medication is available on the VA National Formulary;
    (D) The medication is not an antibiotic that is primarily used for 
short periods of time to treat infections; and
    (E) The medication primarily is used to either treat or manage a 
chronic condition, or to reduce the risk of adverse health outcomes 
secondary to the chronic condition, for example, medications used to 
treat high blood pressure to reduce the risks of heart attack, stroke, 
and kidney failure. For purposes of this section, conditions that 
typically are known to persist for 3 months or more will be considered 
chronic.
    (ii) The medication must be among the top 75 most commonly 
prescribed multi-source medications that meet the criteria in paragraph 
(b)(2)(i) of this section, based on the number of prescriptions issued 
for a 30-day or less supply on an outpatient basis during a fixed period 
of time.
    (iii) VA must determine that the medication identified provides 
maximum clinical value consistent with budgetary resources.
    (3) Information on Tier 1 medications. Not less than once per year, 
VA will publish a list of Tier 1 medications in the Federal Register and 
on VA's Web site at www.va.gov/health.
    (4) Veterans Choice Program. For medications furnished through the 
Veterans Choice Program under Sec. Sec.  17.1500 through 17.1540, or the 
Veterans Community Care Program under Sec. Sec.  17.4000 through 
17.4040, the copayment amount at the time the veteran fills the 
prescription is $0. VA will determine and assess the veteran's copayment 
amount at the end of the billing process, but at no time will a 
veteran's copayment be more than the amount identified in paragraphs 
(b)(1)(i) through (iii) of this section.
    (5) Copayment cap. The total amount of copayments for medications in 
a calendar year for an enrolled veteran will not exceed $700.
    (c) Medication not subject to the copayment requirements. The 
following are exempt from the copayment requirements of this section:
    (1) Medication for a veteran who has a service-connected disability 
rated 50% or more based on a service-connected disability or 
unemployability.
    (2) Medication for a veteran's service-connected disability.
    (3) Medication for a veteran whose annual income (as determined 
under 38 U.S.C. 1503) does not exceed the maximum annual rate of VA 
pension which would be payable to such veteran if such veteran were 
eligible for pension under 38 U.S.C. 1521.
    (4) Medication authorized under 38 U.S.C. 1710(e) for Vietnam-era 
herbicide-exposed veterans, radiation-exposed veterans, Persian Gulf War 
veterans, post-Persian Gulf War combat-exposed veterans, or Camp Lejeune 
veterans pursuant to Sec.  17.400.
    (5) Medication for treatment of sexual trauma as authorized under 38 
U.S.C. 1720D.
    (6) Medication for treatment of cancer of the head or neck 
authorized under 38 U.S.C. 1720E.
    (7) Medications provided as part of a VA approved research project 
authorized by 38 U.S.C. 7303.
    (8) Medication for a veteran who is a former prisoner of war.
    (9) A veteran who VA determines to be catastrophically disabled, as 
defined in 38 CFR 17.36(e).
    (10) A veteran receiving care for psychosis or a mental illness 
other than psychosis pursuant to Sec.  17.109.

[[Page 801]]

    (11) Medication for a veteran who was awarded the Medal of Honor.

[66 FR 63451, Dec. 6, 2001, as amended at 74 FR 69285, Dec. 31, 2009; 75 
FR 32672, June 9, 2010; 75 FR 54030, Sept. 3, 2010; 76 FR 52274, Aug. 
22, 2011; 76 FR 78826, Dec. 20, 2011; 77 FR 76867, Dec. 31, 2012; 78 FR 
28143, May 14, 2013; 78 FR 79317, Dec. 30, 2013; 79 FR 57414, Sept. 24, 
2014; 79 FR 63821, Oct. 27, 2014; 79 FR 65585, Nov. 5, 2014; 80 FR 
55545, Sept. 16, 2015; 81 FR 88120, Dec. 7, 2016; 81 FR 89390, Dec. 12, 
2016; 84 FR 7815, Mar. 5, 2019; 84 FR 26306, June 5, 2019]



Sec.  17.111  Copayments for extended care services.

    (a) General. This section sets forth requirements regarding 
copayments for extended care services provided to veterans by VA (either 
directly by VA or paid for by VA).
    (b) Copayments. (1) Unless exempted under paragraph (f) of this 
section, as a condition of receiving extended care services from VA, a 
veteran must agree to pay VA and is obligated to pay VA a copayment as 
specified by this section. A veteran has no obligation to pay a 
copayment for the first 21 days of extended care services that VA 
provided the veteran in any 12-month period (the 12-month period begins 
on the date that VA first provided extended care services to the 
veteran). However, for each day that extended care services are provided 
beyond the first 21 days, a veteran is obligated to pay VA the copayment 
amount set forth below to the extent the veteran has available 
resources. Available resources are based on monthly calculations, as 
determined under paragraph (d) of this section. The following sets forth 
the extended care services provided by VA and the corresponding 
copayment amount per day:
    (i) Adult day health care--$15.
    (ii) Domiciliary care--$5.
    (iii) Institutional respite care--$97.
    (iv) Institutional geriatric evaluation--$97.
    (v) Non-institutional geriatric evaluation--$15.
    (vi) Non-institutional respite care--$15.
    (vii) Nursing home care--$97.
    (2) For purposes of counting the number of days for which a veteran 
is obligated to make a copayment under this section, VA will count each 
day that adult day health care, non-institutional geriatric evaluation, 
and non-institutional respite care are provided and will count each full 
day and partial day for each inpatient stay except for the day of 
discharge.
    (3) For hospital care and medical services considered non-
institutional care furnished through the Veterans Choice Program under 
Sec. Sec.  17.1500 through 17.1540, as well as extended care services 
furnished through the Veterans Community Care Program under Sec. Sec.  
17.4000 through 17.4040, the copayment amount at the time of furnishing 
such care or services by a non-VA entity or provider is $0. VA will 
determine and assess the veteran's copayment amount at the end of the 
billing process, but at no time will a veteran's copayment be more than 
the amount identified in paragraph (b)(1) or (2) of this section.
    (c) Definitions. For purposes of this section:
    (1) Adult day health care is a therapeutic outpatient care program 
that provides medical services, rehabilitation, therapeutic activities, 
socialization, nutrition and transportation services to disabled 
veterans in a congregate setting.
    (2) Domiciliary care is defined in Sec.  17.30(b).
    (3) Extended care services means adult day health care, domiciliary 
care, institutional geriatric evaluation, noninstitutional geriatric 
evaluation, nursing home care, institutional respite care, and 
noninstitutional respite care.
    (4) Geriatric evaluation is a specialized, diagnostic/consultative 
service provided by an interdisciplinary team that is for the purpose of 
providing a comprehensive assessment, care plan, and extended care 
service recommendations.
    (5) Institutional means a setting in a hospital, domiciliary, or 
nursing home of overnight stays of one or more days.
    (6) Noninstitutional means a service that does not include an 
overnight stay.
    (7) Nursing home care means the accommodation of convalescents or 
other persons who are not acutely ill and not in need of hospital care, 
but who require nursing care and related medical

[[Page 802]]

services, if such nursing care and medical services are prescribed by, 
or are performed under the general direction of, persons duly licensed 
to provide such care (nursing services must be provided 24 hours a day). 
Such term includes services furnished in skilled nursing care 
facilities. Such term excludes hospice care.
    (8) Respite care means care which is of limited duration, is 
furnished on an intermittent basis to a veteran who is suffering from a 
chronic illness and who resides primarily at home, and is furnished for 
the purpose of helping the veteran to continue residing primarily at 
home. (Respite providers temporarily replace the caregivers to provide 
services ranging from supervision to skilled care needs.)
    (d) Effect of the veteran's financial resources on obligation to pay 
copayment. (1) A veteran is obligated to pay the copayment to the extent 
the veteran and the veteran's spouse have available resources. For 
veterans who have been receiving extended care services for 180 days or 
less, their available resources are the sum of the income of the veteran 
and the veteran's spouse, minus the sum of the veterans allowance, the 
spousal allowance, and expenses. For veterans who have been receiving 
extended care services for 181 days or more, their available resources 
are the sum of the value of the liquid assets, the fixed assets, and the 
income of the veteran and the veteran's spouse, minus the sum of the 
veterans allowance, the spousal allowance, the spousal resource 
protection amount, and (but only if the veteran--has a spouse or 
dependents residing in the community who is not institutionalized) 
expenses. When a veteran is legally separated from a spouse, available 
resources do not include spousal income, expenses, and assets or a 
spousal allowance.
    (2) For purposes of determining available resources under this 
section:
    (i) Income means current income (including, but not limited to, 
wages and income from a business (minus business expenses), bonuses, 
tips, severance pay, accrued benefits, cash gifts, inheritance amounts, 
interest income, standard dividend income from non tax deferred 
annuities, retirement income, pension income, unemployment payments, 
worker's compensation payments, black lung payments, tort settlement 
payments, social security payments, court mandated payments, payments 
from VA or any other Federal programs, and any other income). The amount 
of current income will be stated in frequency of receipt, e.g., per 
week, per month.
    (ii) Expenses means basic subsistence expenses, including current 
expenses for the following: rent/mortgage for primary residence; vehicle 
payment for one vehicle; food for veteran, veteran's spouse, and 
veteran's dependents; education for veteran, veteran's spouse, and 
veteran's dependents; court-ordered payments of veteran or veteran's 
spouse (e.g., alimony, child-support); and including the average monthly 
expenses during the past year for the following: utilities and insurance 
for the primary residence; out-of-pocket medical care costs not 
otherwise covered by health insurance; health insurance premiums for the 
veteran, veteran's spouse, and veteran's dependents; and taxes paid on 
income and personal property.
    (iii) Fixed Assets means:
    (A) Real property and other non-liquid assets; except that this does 
not include--
    (1) Burial plots;
    (2) A residence if the residence is:
    (i) The primary residence of the veteran and the veteran is 
receiving only noninstitutional extended care service; or
    (ii) The primary residence of the veteran's spouse or the veteran's 
dependents (if the veteran does not have a spouse) if the veteran is 
receiving institutional extended care service.
    (3) A vehicle if the vehicle is:
    (i) The vehicle of the veteran and the veteran is receiving only 
noninstitutional extended care service; or
    (ii) The vehicle of the veteran's spouse or the veteran's dependents 
(if the veteran does not have a spouse) if the veteran is receiving 
institutional extended care service.
    (B) [Reserved]
    (iv) Liquid assets means cash, stocks, dividends received from IRA, 
401K's and other tax deferred annuities,

[[Page 803]]

bonds, mutual funds, retirement accounts (e.g., IRA, 401Ks, annuities), 
art, rare coins, stamp collections, and collectibles of the veteran, 
spouse, and dependents. This includes household and personal items 
(e.g., furniture, clothing, and jewelry) except when the veteran's 
spouse or dependents are living in the community.
    (v) Spousal allowance is an allowance of $20 per day that is 
included only if the spouse resides in the community (not 
institutionalized).
    (vi) Spousal resource protection amount means the value of liquid 
assets equal to the Maximum Community Spouse Resource Standard published 
by the Centers for Medicare and Medicaid Services (CMS) as of January 1 
of the current calendar year if the spouse is residing in the community 
(not institutionalized).
    (vii) Veterans allowance is an allowance of $20 per day.
    (3) The maximum amount of a copayment for any month equals the 
copayment amount specified in paragraph (b)(1) of this section 
multiplied by the number of days in the month. The copayment for any 
month may be less than the amount specified in paragraph (b)(1) of this 
section if the veteran provides information in accordance with this 
section to establish that the copayment should be reduced or eliminated.
    (e) Requirement to submit information. (1) Unless exempted under 
paragraph (f) of this section, a veteran must submit to a VA medical 
facility a completed VA Form 10-10EC and documentation requested by the 
Form at the following times:
    (i) At the time of initial request for an episode of extended care 
services;
    (ii) At the time of request for extended care services after a break 
in provision of extended care services for more than 30 days; and
    (iii) Each year at the time of submission to VA of VA Form 10-10EZ.
    (2) When there are changes that might change the copayment 
obligation (i.e., changes regarding marital status, fixed assets, liquid 
assets, expenses, income (when received), or whether the veteran has a 
spouse or dependents residing in the community), the veteran must report 
those changes to a VA medical facility within 10 days of the change.
    (f) Veterans and care that are not subject to the copayment 
requirements. The following veterans and care are not subject to the 
copayment requirements of this section:
    (1) A veteran with a compensable service-connected disability.
    (2) A veteran whose annual income (determined under 38 U.S.C. 1503) 
is less than the amount in effect under 38 U.S.C. 1521(b).
    (3) Care for a veteran's noncompensable zero percent service-
connected disability.
    (4) An episode of extended care services that began on or before 
November 30, 1999.
    (5) Care authorized under 38 U.S.C. 1710(e) for Vietnam-era 
herbicide-exposed veterans, radiation-exposed veterans, Persian Gulf War 
veterans,post-Persian Gulf War combat-exposed veterans, or Camp Lejeune 
veterans pursuant to Sec.  17.400.
    (6) Care for treatment of sexual trauma as authorized under 38 
U.S.C. 1720D.
    (7) Care or services authorized under 38 U.S.C. 1720E for certain 
veterans regarding cancer of the head or neck.
    (8) A veteran who VA determines to be catastrophically disabled, as 
defined in 38 CFR 17.36(e), is exempt from copayments for adult day 
health care, non-institutional respite care, and non-institutional 
geriatric care.
    (9) A veteran receiving care for psychosis or a mental illness other 
than psychosis pursuant to Sec.  17.109.
    (10) A veteran who was awarded the Medal of Honor.

[67 FR 35040, May 17, 2002, as amended at 69 FR 39846, July 1, 2004; 76 
FR 52274, Aug. 22, 2011; 78 FR 28143, May 14, 2013; 78 FR 70864, Nov. 
27, 2013; 79 FR 57414, Sept. 24, 2014; 79 FR 65585, Nov. 5, 2014; 84 FR 
7815, Mar. 5, 2019; 84 FR 26307, June 5, 2019]

                               Ceremonies



Sec.  17.112  Services or ceremonies on Department of Veterans Affairs
hospital or center reservations.

    (a) Services or ceremonies on Department of Veterans Affairs 
hospital or center reservations are subject to the following 
limitations:
    (1) All activities must be conducted with proper decorum, and not 
interfere

[[Page 804]]

with the care and treatment of patients. Organizations must provide 
assurance that their members will obey all rules in effect at the 
hospital or center involved, and act in a dignified and proper manner;
    (2) Partisan activities are inappropriate and all activities must be 
nonpartisan in nature. An activity will be considered partisan and 
therefore inappropriate if it includes commentary in support of, or in 
opposition to, or attempts to influence, any current policy of the 
Government of the United States or any State of the United States. If 
the activity is closely related to partisan activities being conducted 
outside the hospital or center reservations, it will be considered 
partisan and therefore inappropriate.
    (b) Requests for permission to hold services or ceremonies will be 
addressed to the Secretary, or the Director of the Department of 
Veterans Affairs hospital or center involved. Such applications will 
describe the proposed activity in sufficient detail to enable a 
determination as to whether it meets the standards set forth in 
paragraph (a) of this section. If permission is granted, the Director of 
the hospital or center involved will assign an appropriate time, and 
render assistance where appropriate. No organization will be given 
exclusive permission to use the hospital or center reservation on any 
particular occasion. Where several requests are received for separate 
activities, the Director will schedule each so as to avoid overlapping 
or interference, or require appropriate modifications in the scope or 
timing of the activity.

[35 FR 2389, Feb. 3, 1970. Redesignated at 61 FR 21966, May 13, 1996, 
and further redesignated at 67 FR 35040, May 17, 2002]

   Reimbursement for Loss By Natural Disaster of Personal Effects of 
                  Hospitalized or Nursing Home Patients



Sec.  17.113  Conditions of custody.

    When the personal effects of a patient who has been or is 
hospitalized or receiving nursing home care in a Department of Veterans 
Affairs hospital or center were or are duly delivered to a designated 
location for custody and loss of such personal effects has occurred or 
occurs by fire, earthquake, or other natural disaster, either during 
such storage or during laundering, reimbursement will be made as 
provided in Sec. Sec.  17.113 and 17.114.

[39 FR 1843, Jan. 15, 1974. Redesignated and amended at 61 FR 21966, 
21967, May 13, 1996, and further redesignated at 67 FR 35039, May 17, 
2002]



Sec.  17.114  Submittal of claim for reimbursement.

    The claim for reimbursement for personal effects damaged or 
destroyed will be submitted by the patient to the Director. The patient 
will separately list and evaluate each article with a notation as to its 
condition at the time of the fire, earthquake, or other natural disaster 
i.e., whether new, worn, etc. The date of the fire, earthquake, or other 
natural disaster will be stated. It will be certified by a responsible 
official that each article listed was stored in a designated location at 
the time of loss by fire, earthquake, or other natural disaster or was 
in process of laundering. The patient will further state whether the 
loss of each article was complete or partial, permitting of some further 
use of the article. The responsible official will certify that the 
amount of reimbursement claimed on each article of personal effects is 
not in excess of the fair value thereof at time of loss. The 
certification will be prepared in triplicate, signed by the responsible 
officer who made it, and countersigned by the Director of the medical 
center. After the above papers have been secured, voucher will be 
prepared, signed, and certified, and forwarded to the Fiscal Officer for 
approval, payment to be made in accordance with fiscal procedure. The 
original list of property and certificate are to be attached to voucher.

[39 FR 1843, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984. 
Redesignated at 61 FR 21966, May 13, 1996, and further redesignated at 
67 FR 35039, May 17, 2002]



Sec.  17.115  Claims in cases of incompetent patients.

    Where the patient is insane and incompetent, the patient will not be 
required to make claim for reimbursement for personal effects lost by 
fire, earthquake, or other natural disaster

[[Page 805]]

as required under the provisions of Sec.  17.113. The responsible 
official will make claim for the patient, adding the certification in 
all details as provided for in Sec.  17.113. After countersignature of 
this certification by the Director, payment will be made as provided in 
Sec.  17.113, and the amount thereby disbursed will be turned over to 
the Director for custody.

[39 FR 1843, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984. 
Redesignated and amended at 61 FR 21966, 21967, May 13, 1996, and 
further redesignated at 67 FR 35039, May 17, 2002]

   Reimbursement to Employees for the Cost of Repairing or Replacing 
  Certain Personal Property Damaged or Destroyed by Patients or Members



Sec.  17.116  Adjudication of claims.

    Claims comprehended. Claims for reimbursing Department of Veterans 
Affairs employees for cost of repairing or replacing their personal 
property damaged or destroyed by patients or members while such 
employees are engaged in the performance of their official duties will 
be adjudicated by the Director of the medical center concerned. Such 
claims will be considered under the following conditions, both of which 
must have existed and, if either one is lacking, reimbursement or 
payment for the cost or repair of the damaged article will not be 
authorized:
    (a) The claim must be for an item of personal property normally used 
by the employee in his or her day to day employment, e.g., eyeglasses, 
hearing aids, clothing, etc., and,
    (b) Such personal property was damaged or destroyed by a patient or 
domiciliary member while the employee was engaged in the performance of 
official duties.

Reimbursement or payment as provided in this paragraph will be made in a 
fair and reasonable amount, taking into consideration the condition and 
reasonable value of the article at the time it was damaged or destroyed.

[28 FR 5083, May 22, 1963, as amended at 39 FR 1843, Jan. 15, 1974; 49 
FR 5616, Feb. 14, 1984. Redesignated and amended at 61 FR 21965, May 13, 
1996, and further redesignated at 67 FR 35039, May 17, 2002]

   Payment and Reimbursement of the Expenses of Medical Services Not 
                          Previously Authorized



Sec.  17.120  Payment or reimbursement for emergency treatment furnished
by non-VA providers to certain veterans with service-connected disabilities.

    To the extent allowable, payment or reimbursement of the expenses of 
emergency treatment, not previously authorized, in a private or public 
(or Federal) hospital not operated by the Department of Veterans 
Affairs, or of any emergency treatment not previously authorized 
including transportation will be paid on the basis of a claim timely 
filed, under the following circumstances:
    (a) For veterans with service connected disabilities. Emergency 
treatment not previously authorized was rendered to a veteran in need of 
such emergency treatment:
    (1) For an adjudicated service-connected disability;
    (2) For nonservice-connected disabilities associated with and held 
to be aggravating an adjudicated service-connected disability;
    (3) For any disability of a veteran who has a total disability 
permanent in nature resulting from a service-connected disability (does 
not apply outside of the States, Territories, and possessions of the 
United States, the District of Columbia, and the Commonwealth of Puerto 
Rico); or
    (4) For any illness, injury or dental condition in the case of a 
veteran who is participating in a rehabilitation program under 38 U.S.C. 
ch. 31 and who is medically determined to be in need of hospital care or 
medical services for any of the reasons enumerated in Sec.  17.47(i)(2); 
and


(Authority: 38 U.S.C. 1724, 1728)

    (b) In a medical emergency. Emergency treatment not previously 
authorized including medical services, professional services, ambulance 
services, ancillary care and medication (including a short course of 
medication related to and necessary for the treatment of the emergency 
condition that is provided directly to or prescribed for the patient for 
use after the emergency condition

[[Page 806]]

is stabilized and the patient is discharged) was rendered in a medical 
emergency of such nature that a prudent layperson would have reasonably 
expected that delay in seeking immediate medical attention would have 
been hazardous to life or health. This standard is met by an emergency 
medical condition manifesting itself by acute symptoms of sufficient 
severity (including severe pain) that a prudent layperson who possesses 
an average knowledge of health and medicine could reasonably expect the 
absence of immediate medical attention to result in placing the health 
of the individual in serious jeopardy, serious impairment to bodily 
functions, or serious dysfunction of any bodily organ or part. And,
    (c) When Federal facilities are unavailable. VA or other Federal 
facilities that VA has an agreement with to furnish health care services 
for veterans were not feasibly available, and an attempt to use them 
beforehand or obtain prior VA authorization for the services required 
would not have been reasonable, sound, wise, or practicable, or 
treatment had been or would have been refused.

(Authority: 38 U.S.C. 1724, 1728, 7304)

[39 FR 1844, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984; 51 
FR 8672, Mar. 13, 1986; 56 FR 3422, Jan. 30, 1991. Redesignated at 61 FR 
21966, May 13, 1996; 76 FR 79070, Dec. 21, 2011; 80 FR 79484, Dec. 22, 
2015; 85 FR 84259, Dec. 28, 2020]



Sec.  17.121  Limitations on payment or reimbursement of the costs of
emergency treatment not previously authorized.

    (a) Emergency Treatment. Except as provided in paragraph (b) of this 
section, VA will not approve claims for payment or reimbursement of the 
costs of emergency treatment not previously authorized for any period 
beyond the date on which the medical emergency ended. For this purpose, 
VA considers that an emergency ends when the designated VA clinician at 
the VA facility has determined that, based on sound medical judgment, 
the veteran who received emergency treatment:
    (1) Could have been transferred from the non-VA facility to a VA 
medical center (or other Federal facility that VA has an agreement with 
to furnish health care services for veterans) for continuation of 
treatment, or
    (2) Could have reported to a VA medical center (or other Federal 
facility that VA has an agreement with to furnish health care services 
for veterans) for continuation of treatment.
    (b) Continued non-emergency treatment. Claims for payment or 
reimbursement of the costs of emergency treatment not previously 
authorized may only be approved for continued, non-emergency treatment, 
if:
    (1) The non-VA facility notified VA at the time the veteran could be 
safely transferred to a VA facility (or other Federal facility that VA 
has an agreement with to furnish health care services for veterans), and 
the transfer of the veteran was not accepted; and
    (2) The non-VA facility made and documented reasonable attempts to 
request transfer of the veteran to a VA facility (or to another Federal 
facility that VA has an agreement with to furnish health care services 
for veterans), which means the non-VA facility contacted either the VA 
Transfer Coordinator, Administrative Officer of the Day, or designated 
staff responsible for accepting transfer of patients, at a local VA (or 
other Federal facility) and documented such contact in the veteran's 
progress/physicians' notes, discharge summary, or other applicable 
medical record.
    (c) Refusal of transfer. If a stabilized veteran who requires 
continued non-emergency treatment refuses to be transferred to an 
available VA facility (or other Federal facility that VA has an 
agreement with to furnish health care services for veterans), VA will 
make payment or reimbursement only for the expenses related to the 
initial evaluation and the emergency treatment furnished to the veteran 
up to the point of refusal of transfer by the veteran.

(Authority: 38 U.S.C. 1724, 1728, 7304)

[76 FR 79071, Dec. 21, 2011]



Sec.  17.122  [Reserved]



Sec.  17.123  Claimants.

    A claim for payment or reimbursement of services not previously 
authorized may be filed by the veteran who

[[Page 807]]

received the services (or his/her guardian) or by the hospital, clinic, 
or community resource which provided the services, or by a person other 
than the veteran who paid for the services.

[39 FR 1844, Jan. 15, 1974, as amended at 45 FR 53807, Aug. 13, 1980. 
Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.124  Preparation of claims.

    Claims for costs of services not previously authorized shall be on 
such forms as shall be prescribed and shall include the following:
    (a) The claimant shall specify the amount claimed and furnish bills, 
vouchers, invoices, or receipts or other documentary evidence 
establishing that such amount was paid or is owed, and
    (b) The claimant shall provide an explanation of the circumstances 
necessitating the use of community medical care, services, or supplies 
instead of Department of Veterans Affairs care, services, or supplies, 
and
    (c) The claimant shall furnish such other evidence or statements as 
are deemed necessary and requested for adjudication of the claim.

[33 FR 19011, Dec. 20, 1968, as amended at 39 FR 1844, Jan. 15, 1974. 
Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.125  Where to file claims.

    Generally, VA must preauthorize VA payment for health care services 
provided in the community when such care is provided in a State as that 
term is defined in 38 U.S.C. 101(20).
    (a) Where VA payment for such services has not been authorized in 
advance, claims for payment for such health care services provided in a 
State should be submitted to the VA medical facility nearest to where 
those services were provided.
    (b) Claims for payment for hospital care and outpatient services 
authorized under Sec.  17.35(a) and provided in Canada must be submitted 
to Veterans Affairs Canada, Foreign Countries Operations Unit, 2323 
Riverside Dr., 2nd Floor, Ottawa, Ontario, Canada K1A OP5.
    (c) All other claims for payment for hospital care and outpatient 
services authorized under Sec.  17.35(a) and provided outside a State 
must be submitted to the Foreign Medical Program, P.O. Box 469061, 
Denver, CO 80246-9061.

[83 FR 29448, June 25, 2018]



Sec.  17.126  Timely filing.

    Claims for payment or reimbursement of the expenses of medical care 
or services not previously authorized must be filed within the following 
time limits:
    (a) A claim must be filed within 2 years after the date the care or 
services were rendered (and in the case of continuous care, payment will 
not be made for any part of the care rendered more than 2 years prior to 
filing claim), or
    (b) In the case of case or services rendered prior to a VA 
adjudication allowing service-connection:
    (1) The claim must be filed within 2 years of the date the veteran 
was notified by VA of the allowance of the award of service-connection.
    (2) VA payment may be made for care related to the service-connected 
disability received only within a 2-year period prior to the date the 
veteran filed the original or reopened claim which resulted in the award 
of service-connection but never prior to the effective date of the award 
of service-connection within that 2-year period.
    (3) VA payment will never be made for any care received beyond this 
2-year period whether service connected or not.

(Authority: 38 U.S.C. 7304)

[33 FR 19012, Dec. 20, 1968, as amended at 39 FR 1844, Jan. 15, 1974; 45 
FR 53807, Aug. 13, 1980; 51 FR 8673, Mar. 13, 1986. Redesignated at 61 
FR 21966, May 13, 1996]



Sec.  17.127  Date of filing claims.

    The date of filing any claim for payment or reimbursement of the 
expenses of medical care and services not previously authorized shall be 
the postmark date of a formal claim, or the date of any preceding 
telephone call, telegram, or other communication constituting an 
informal claim.

[39 FR 1844, Jan. 15, 1974. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.128  Allowable rates and fees.

    When it has been determined that a veteran has received public or 
private

[[Page 808]]

hospital care or outpatient medical services, the expenses of which may 
be paid under Sec.  17.120 of this part, the payment of such expenses 
shall be paid in accordance with Sec. Sec.  17.55 and 17.56 of this 
part.

(Authority: Section 233, Pub. L. 99-576)

[63 FR 39515, July 23, 1998]



Sec.  17.129  Retroactive payments prohibited.

    When a claim for payment or reimbursement of expenses of services 
not previously authorized has not been timely filed in accordance with 
the provisions of Sec.  17.126, the expenses of any such care or 
services rendered prior to the date of filing the claim shall not be 
paid or reimbursed. In no event will a bill or claim be paid or allowed 
for any care or services rendered prior to the effective date of any 
law, or amendment to the law, under which eligibility for the medical 
services at Department of Veterans Affairs expense has been established.

[39 FR 1844, Jan. 15, 1974. Redesignated and amended at 61 FR 21966, 
21968, May 13, 1996]



Sec.  17.130  Payment for treatment dependent upon preference prohibited.

    No reimbursement or payment of services not previously authorized 
will be made when such treatment was procured through private sources in 
preference to available Government facilities.

[39 FR 1844, Jan. 15, 1974. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.131  Payment of abandoned claims prohibited.

    Any informal claim for the payment or reimbursement of medical 
expenses which is not followed by a formal claim, or any formal claim 
which is not followed by necessary supporting evidence, within 1 year 
from the date of the request for a formal claim or supporting evidence 
shall be deemed abandoned, and payment or reimbursement shall not be 
authorized on the basis of such abandoned claim or any future claim for 
the same expenses. For the purpose of this section, time limitations 
shall be computed from the date following the date of request for a 
formal claim or supporting evidence.

[33 FR 19012, Dec. 20, 1968. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.132  Appeals.

    When any claim for payment or reimbursement of expenses of medical 
care or services rendered in non-Department of Veterans Affairs 
facilities or from non-Department of Veterans Affairs resources has been 
disallowed, the claimant shall be notified of the reasons for the 
disallowance and of the right to initiate an appeal to the Board of 
Veterans Appeals by filing a Notice of Disagreement, and shall be 
furnished such other notices or statements as are required by part 19 of 
this chapter, governing appeals.

[33 FR 19012, Dec. 20, 1968. Redesignated at 61 FR 21966, May 13, 1996]

                    Reconsideration of Denied Claims



Sec.  17.133  Procedures.

    (a) Scope. This section sets forth reconsideration procedures 
regarding claims for benefits administered by the Veterans Health 
Administration (VHA). These procedures apply to claims for VHA benefits 
regarding decisions that are appealable to the Board of Veterans' 
Appeals (e.g., reimbursement for non-VA care not authorized in advance, 
reimbursement for beneficiary travel expenses, reimbursement for home 
improvements or structural alterations, etc.). These procedures do not 
apply when other regulations providing reconsideration procedures do 
apply (this includes CHAMPVA (38 CFR 17.270 through 17.278) and spina 
bifida (38 CFR 17.904) and any other regulations that contain 
reconsideration procedures). Also, these procedures do not apply to 
decisions made outside of VHA, such as decisions made by the Veterans 
Benefits Administration and adopted by VHA for decisionmaking. These 
procedures are not mandatory, and a claimant may choose to appeal the 
denied claim to the Board of Veterans' Appeals pursuant to 38 U.S.C. 
7105 without utilizing the provisions of this section. Submitting a 
request for

[[Page 809]]

reconsideration shall constitute a notice of disagreement for purposes 
of filing a timely notice of disagreement under 38 U.S.C. 7105(b).
    (b) Process. An individual who disagrees with the initial decision 
denying the claim in whole or in part may obtain reconsideration under 
this section by submitting a reconsideration request in writing to the 
Director of the healthcare facility of jurisdiction within one year of 
the date of the initial decision. The reconsideration decision will be 
made by the immediate supervisor of the initial VA decision-maker. The 
request must state why it is concluded that the decision is in error and 
must include any new and relevant information not previously considered. 
Any request for reconsideration that does not identify the reason for 
the dispute will be returned to the sender without further 
consideration. The request for reconsideration may include a request for 
a meeting with the immediate supervisor of the initial VA decision-
maker, the claimant, and the claimant's representative (if the claimant 
wishes to have a representative present). Such a meeting shall only be 
for the purpose of discussing the issues and shall not include formal 
procedures (e.g., presentation, cross-examination of witnesses, etc.). 
The meeting will be taped and transcribed by VA if requested by the 
claimant and a copy of the transcription shall be provided to the 
claimant. After reviewing the matter, the immediate supervisor of the 
initial VA decision-maker shall issue a written decision that affirms, 
reverses, or modifies the initial decision.

    Note to Sec.  17.133: The final decision of the immediate supervisor 
of the initial VA decision-maker will inform the claimant of further 
appellate rights for an appeal to the Board of Veterans' Appeals.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0600)

(Authority: 38 U.S.C. 511, 38 U.S.C. 7105)

[64 FR 44660, Aug. 17, 1999]

                         Delegation of Authority



Sec.  17.142  Authority to approve sharing agreements, contracts for scarce
medical specialist services and contracts for other medical services.

    The Under Secretary for Health is delegated authority to enter into
    (a) Sharing agreements authorized under 38 U.S.C. 8153 and Sec.  
17.240;
    (b) Contracts with schools and colleges of medicine, osteopathy, 
dentistry, podiatry, optometry, and nursing, clinics, and any other 
group or individual capable of furnishing such services to provide 
scarce medical specialist services at Department of Veterans Affairs 
health care facilities (including, but not limited to, services of 
physicians, dentists, podiatrists, optometrists, nurses, physicians' 
assistants, expanded function dental auxiliaries, technicians, and other 
medical support personnel); and
    (c) When a sharing agreement or contract for scarce medical 
specialist services is not warranted, contracts authorized under the 
provisions of 38 U.S.C. 8153 for medical and ancillary services. The 
authority under this section generally will be exercised by approval of 
proposed contracts or agreements negotiated at the health care facility 
level. Such approval, however, will not be necessary in the case of any 
purchase order or individual authorization for which authority has been 
delegated in 48 CFR 801.670-3. All such contracts and agreements will be 
negotiated pursuant to 48 CFR chapters 1 and 8.

(Authority: 38 U.S.C. 512, 7409, 8153)

[45 FR 6938, Jan. 31, 1980. Redesignated at 61 FR 21966, May 13, 1996, 
as amended at 62 FR 17072, Apr. 9, 1997; 79 FR 54616, Sept. 12, 2014]

                  Sensory and Other Rehabilitative Aids



Sec.  17.148  Service dogs.

    (a) Definitions. For the purposes of this section:
    Service dogs are guide or service dogs prescribed for a disabled 
veteran under this section.
    (b) Clinical requirements. VA will provide benefits under this 
section to a veteran with a service dog only if:

[[Page 810]]

    (1) The veteran is diagnosed as having a visual, hearing, or 
substantial mobility impairment; and
    (2) The VA clinical team that is treating the veteran for such 
impairment determines based upon medical judgment that it is optimal for 
the veteran to manage the impairment and live independently through the 
assistance of a trained service dog. Note: If other means (such as 
technological devices or rehabilitative therapy) will provide the same 
level of independence, then VA will not authorize benefits under this 
section.
    (3) For the purposes of this section, substantial mobility 
impairment means a spinal cord injury or dysfunction or other chronic 
impairment that substantially limits mobility. A chronic impairment that 
substantially limits mobility includes but is not limited to a traumatic 
brain injury that compromises a veteran's ability to make appropriate 
decisions based on environmental cues (i.e., traffic lights or dangerous 
obstacles) or a seizure disorder that causes a veteran to become 
immobile during and after a seizure event.
    (c) Recognized service dogs. VA will recognize, for the purpose of 
paying benefits under this section, the following service dogs:
    (1) The dog and veteran must have successfully completed a training 
program offered by an organization accredited by Assistance Dogs 
International or the International Guide Dog Federation, or both (for 
dogs that perform both service- and guide-dog assistance). The veteran 
must provide to VA a certificate showing successful completion issued by 
the accredited organization that provided such program.
    (2) Dogs obtained before September 5, 2012 will be recognized if a 
guide or service dog training organization in existence before September 
5, 2012 certifies that the veteran and dog, as a team, successfully 
completed, no later than September 5, 2013, a training program offered 
by that training organization. The veteran must provide to VA a 
certificate showing successful completion issued by the organization 
that provided such program. Alternatively, the veteran and dog will be 
recognized if they comply with paragraph (c)(1) of this section.
    (d) Authorized benefits. Except as noted in paragraph (d)(3) of this 
section, VA will provide to a veteran enrolled under 38 U.S.C. 1705 only 
the following benefits for one service dog at any given time in 
accordance with this section:
    (1) A commercially available insurance policy, to the extent 
commercially practicable, that meets the following minimum requirements:
    (i) VA, and not the veteran, will be billed for any premiums, 
copayments, or deductibles associated with the policy; however, the 
veteran will be responsible for any cost of care that exceeds the 
maximum amount authorized by the policy for a particular procedure, 
course of treatment, or policy year. If a dog requires care that may 
exceed the policy's limit, the insurer will, whenever reasonably 
possible under the circumstances, provide advance notice to the veteran.
    (ii) The policy will guarantee coverage for all treatment (and 
associated prescription medications), subject to premiums, copayments, 
deductibles or annual caps, determined to be medically necessary, 
including euthanasia, by any veterinarian who meets the requirements of 
the insurer. The veteran will not be billed for these covered costs, and 
the insurer will directly reimburse the provider.
    (iii) The policy will not exclude dogs with preexisting conditions 
that do not prevent the dog from being a service dog.
    (2) Hardware, or repairs or replacements for hardware, that are 
clinically determined to be required by the dog to perform the tasks 
necessary to assist the veteran with his or her impairment. To obtain 
such devices, the veteran must contact the Prosthetic and Sensory Aids 
Service at his or her local VA medical facility and request the items 
needed.
    (3) Payments for travel expenses associated with obtaining a dog 
under paragraph (c)(1) of this section. Travel costs will be provided 
only to a veteran who has been prescribed a service dog by a VA clinical 
team under paragraph (b) of this section. Payments will be made as if 
the veteran is an eligible beneficiary under 38 U.S.C. 111 and 38 CFR 
part 70, without regard to whether

[[Page 811]]

the veteran meets the eligibility criteria as set forth in 38 CFR part 
70. Note: VA will provide payment for travel expenses related to 
obtaining a replacement service dog, even if the veteran is receiving 
other benefits under this section for the service dog that the veteran 
needs to replace.
    (4) The veteran is responsible for procuring and paying for any 
items or expenses not authorized by this section. This means that VA 
will not pay for items such as license tags, nonprescription food, 
grooming, insurance for personal injury, non-sedated dental cleanings, 
nail trimming, boarding, pet-sitting or dog-walking services, over-the-
counter medications, or other goods and services not covered by the 
policy. The dog is not the property of VA; VA will never assume 
responsibility for, or take possession of, any service dog.
    (e) Dog must maintain ability to function as a service dog. To 
continue to receive benefits under this section, the service dog must 
maintain its ability to function as a service dog. If at any time VA 
learns from any source that the dog is medically unable to maintain that 
role, or VA makes a clinical determination that the veteran no longer 
requires the dog, VA will provide at least 30 days notice to the veteran 
before benefits will no longer be authorized.

(Authority: 38 U.S.C. 501, 1714)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0785.)

[77 FR 54381, Sept. 5, 2012]



Sec.  17.149  Sensori-neural aids.

    (a) Notwithstanding any other provision of this part, VA will 
furnish needed sensori-neural aids (i.e., eyeglasses, contact lenses, 
hearing aids) only to veterans otherwise receiving VA care or services 
and only as provided in this section.
    (b) VA will furnish needed sensori-neural aids (i.e., eyeglasses, 
contact lenses, hearing aids) to the following veterans:
    (1) Those with a compensable service-connected disability;
    (2) Those who are former prisoners of war;
    (3) Those awarded a Purple Heart;
    (4) Those in receipt of benefits under 38 U.S.C. 1151;
    (5) Those in receipt of increased pension based on the need for 
regular aid and attendance or by reason of being permanently housebound;
    (6) Those who have a visual or hearing impairment that resulted from 
the existence of another medical condition for which the veteran is 
receiving VA care, or which resulted from treatment of that medical 
condition;
    (7) Those with a significant functional or cognitive impairment 
evidenced by deficiencies in activities of daily living, but not 
including normally occurring visual or hearing impairments; and
    (8) Those visually or hearing impaired so severely that the 
provision of sensori-neural aids is necessary to permit active 
participation in their own medical treatment.
    (c) VA will furnish needed hearing aids to those veterans who have 
service-connected hearing disabilities rated 0 percent if there is 
organic conductive, mixed, or sensory hearing impairment, and loss of 
pure tone hearing sensitivity in the low, mid, or high-frequency range 
or a combination of frequency ranges which contribute to a loss of 
communication ability; however, hearing aids are to be provided only as 
needed for the service-connected hearing disability.

(Authority: 38 U.S.C. 501,1707(b)

[62 FR 30242, June 3, 1997, as amended at 69 FR 33575, June 16, 2004]



Sec.  17.150  [Reserved]



Sec.  17.151  Invalid lifts for recipients of aid and attendance allowance
or special monthly compensation.

    An invalid lift may be furnished if:
    (a) The applicant is a veteran who is receiving (1) special monthly 
compensation (including special monthly compensation based on the need 
for aid and attendance) under the provisions of 38 U.S.C. 1114(r), or 
(2) comparable compensation benefits at the rates prescribed under 38 
U.S.C. 1134, or (3) increased pension based on the need for

[[Page 812]]

aid and attendance or a greater compensation benefit rather than aid and 
attendance pension to which he or she has been adjudicated to be 
presently eligible; and
    (b) The veteran has loss, or loss of use, of both lower extremities 
and at least one upper extremity (loss of use may result from paralysis 
or other impairment to muscle power and includes all cases in which the 
veteran cannot use his or her extremities or is medically prohibited 
from doing so because of a serious disease or disability); and
    (c) The veteran has been medically determined incapable of moving 
himself or herself from his or her bed to a wheelchair, or from his or 
her wheelchair to his or her bed, without the aid of an attendant, 
because of the disability involving the use of his or her extremities; 
and
    (d) An invalid lift would be a feasible means by which the veteran 
could accomplish the necessary maneuvers between bed and wheelchair, and 
is medically determined necessary.

[33 FR 12315, Aug. 31, 1968, as amended at 36 FR 3117, Feb. 13, 1971; 54 
FR 34983, Aug. 23, 1989. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.152  Devices to assist in overcoming the handicap of deafness.

    Devices for assisting in overcoming the handicap of deafness 
(including telecaptioning television decoders) may be furnished to any 
veteran who is profoundly deaf (rated 80% or more disabled for hearing 
impairment by the Department of Veterans Affairs) and is entitled to 
compensation on account of such hearing impairment.

(Authority: 38 U.S.C. 1717(c))

[53 FR 46607, Nov. 18, 1988. Redesignated at 61 FR 21966, May 13, 1996; 
79 FR 54616, Sept. 12, 2014]



Sec.  17.153  [Reserved]



Sec.  17.154  Equipment for blind veterans.

    VA may furnish mechanical and/or electronic equipment considered 
necessary as aids to overcoming the handicap of blindness to blind 
veterans entitled to disability compensation for a service-connected 
disability.

(Authority: 38 U.S.C. 1714)

[77 FR 54382, Sept. 5, 2012]

                Automotive Equipment and Driver Training



Sec.  17.155  Minimum standards of safety and quality for automotive
adaptive equipment.

    (a) The Under Secretary for Health or designee is authorized to 
develop and establish minimum standards of safety and quality for 
adaptive equipment provided under 38 U.S.C. chapter 39.
    (b) In the performance of this function, the following 
considerations will apply:
    (1) Minimum standards of safety and quality will be developed and 
promulgated for basic adaptive equipment specifically designed to 
facilitate operation and use of standard passenger motor vehicles by 
persons who have specified types of disablement and for the installation 
of such equipment.
    (2) In those instances where custombuilt adaptive equipment is 
designed and installed to meet the peculiar needs of uniquely disabled 
persons and where the incidence of probable usage is not such as to 
justify development of formal standards, such equipment will be 
inspected and, if in order, approved for use by a qualified designee of 
the Under Secretary for Health.
    (3) Adaptive equipment, available to the general public, which is 
manufactured under standards of safety imposed by a Federal agency 
having authority to establish the same, shall be deemed to meet required 
standards for use as adaptive equipment. These include such items as 
automatic transmissions, power brakes, power steering and other 
automotive options.
    (c) For those items where specific Department of Veterans Affairs 
standards of safety and quality have not as yet been developed, or where 
such standards are otherwise provided as with custom-designed or factory 
option items, authorization of suitable adaptive equipment will not be 
delayed. Approval of such adaptive equipment, however, shall be subject 
to the judgment of designated certifying officials that it meets 
implicit standards of

[[Page 813]]

safety and quality adopted by the industry or as later developed by the 
Department of Veterans Affairs.

[40 FR 8819, Mar. 3, 1975. Redesignated at 61 FR 21966, May 13, 1996, as 
amended at 62 FR 17072, Apr. 9, 1997]



Sec.  17.156  Eligibility for automobile adaptive equipment.

    Automobile adaptive equipment may be authorized if the Under 
Secretary for Health or designee determines that such equipment is 
deemed necessary to insure that the eligible person will be able to 
operate the automobile or other conveyance in a manner consistent with 
such person's safety and so as to satisfy the applicable standards of 
licensure established by the State of such person's residency or other 
proper licensing authority.
    (a) Persons eligible for adaptive equipment are:
    (1) Veterans who are entitled to receive compensation for the loss 
or permanent loss of use of one or both feet; or the loss or permanent 
loss of use of one or both hands; or ankylosis of one or both knees, or 
one of both hips if the disability is the result of injury incurred or 
disease contracted in or aggravated by active military, naval or air 
service.
    (2) Members of the Armed Forces serving on active duty who are 
suffering from any disability described in paragraph (a)(1) of this 
section incurred or contracted during or aggravated by active military 
service are eligible to receive automobile adaptive equipment.
    (b) Payment or reimbursement of reasonable costs for the repair, 
replacement, or reinstallation of adaptive equipment deemed necessary 
for the operation of the automobile may be authorized by the Under 
Secretary for Health or designee.

(Authority: 38 U.S.C. 3902)

[53 FR 46607, Nov. 18, 1988. Redesignated at 61 FR 21966, May 13, 1996, 
as amended at 62 FR 17072, Apr. 9, 1997]



Sec.  17.157  Definition-adaptive equipment.

    The term, adaptive equipment, means equipment which must be part of 
or added to a conveyance manufactured for sale to the general public to 
make it safe for use by the claimant, and enable that person to meet the 
applicable standards of licensure. Adaptive equipment includes any term 
specified by the Under Secretary for Health or designee as ordinarily 
necessary for any of the classes of losses or combination of such losses 
specified in Sec.  17.156 of this part, or as deemed necessary in an 
individual case. Adaptive equipment includes, but is not limited to, a 
basic automatic transmission, power steering, power brakes, power window 
lifts, power seats, air-conditioning equipment when necessary for the 
health and safety of the veteran, and special equipment necessary to 
assist the eligible person into or out of the automobile or other 
conveyance, regardless of whether the automobile or other conveyance is 
to be operated by the eligible person or is to be operated for such 
person by another person; and any modification of the interior space of 
the automobile or other conveyance if needed because of the physical 
condition of such person in order for such person to enter or operate 
the vehicle.

(Authority: 38 U.S.C. 3901, 3902)

[53 FR 46608, Nov. 18, 1988. Redesignated and amended at 61 FR 21966, 
21968, May 13, 1996]



Sec.  17.158  Limitations on assistance.

    (a) An eligible person shall not be entitled to adaptive equipment 
for more than two automobiles or other conveyances at any one time or 
during any four-year period except when due to circumstances beyond 
control of such person, one of the automobiles or conveyances for which 
adaptive equipment was provided during the applicable four-year period 
is no longer available for the use of such person.
    (1) Circumstances beyond the control of the eligible person are 
those where the vehicle was lost due to fire, theft, accident, court 
action, or when repairs are so costly as to be prohibitive or a 
different vehicle is required due to a change in the eligible person's 
physical condition.
    (2) For purposes of paragraph (a)(1) of this section, an eligible 
person shall be deemed to have access to and use of an automobile or 
other conveyance for

[[Page 814]]

which the Department of Veterans Affairs has provided adaptive equipment 
if that person has sold, given or transferred the vehicle to a spouse, 
family member or other person residing in the same household as the 
eligible person, or to a business owned by such person.


(Authority: 38 U.S.C. 3903)

    (b) Eligible persons may be reimbursed for the actual cost of 
adaptive equipment subject to a dollar amount for specific items 
established from time to time by the Under Secretary for Health.


(Authority: 38 U.S.C. 3902)

    (c) Reimbursement for a repair to an item of adaptive equipment is 
limited to the current vehicles of record and only to the basic 
components authorized as automobile adaptive equipment. Reimbursable 
amounts for repairs are limited to the cost of parts and labor based on 
the amounts published in generally acceptable commercial estimating 
guides for domestic automobiles.

(Authority: 38 U.S.C. 3902)

[53 FR 46608, Nov. 18, 1988. Redesignated and amended at 61 FR 21966, 
21968, May 13, 1996]



Sec.  17.159  Obtaining vehicles for special driver training courses.

    The Secretary may obtain by purchase, lease, gift or otherwise, any 
automobile, motor vehicle, or other conveyance deemed necessary to 
conduct special driver training courses at Department of Veterans 
Affairs health care facilities. The Secretary may sell, assign, transfer 
or convey any such automobile, vehicle or conveyance to which the 
Department of Veterans Affairs holds title for such price or under such 
terms deemed appropriate by the Secretary. Any proceeds received from 
such disposition shall be credited to the applicable Department of 
Veterans Affairs appropriation.

(Authority: 38 U.S.C. 3903(e)(3))

[45 FR 6939, Jan. 31, 1980. Redesignated at 54 FR 46607, Nov. 18, 1988, 
and further redesignated at 61 FR 21966, May 13, 1996]

                             Dental Services



Sec.  17.160  Authorization of dental examinations.

    When a detailed report of dental examination is essential for a 
determination of eligibility for benefits, dental examinations may be 
authorized for the following classes of claimants or beneficiaries:
    (a) Those having a dental disability adjudicated as incurred or 
aggravated in active military, naval, or air service or those requiring 
examination to determine whether the dental disability is service 
connected.
    (b) Those having disability from disease or injury other than 
dental, adjudicated as incurred or aggravated in active military, naval, 
or air service but with an associated dental condition that is 
considered to be aggravating the basic service-connected disorder.
    (c) Those for whom a dental examination is ordered as a part of a 
general physical examination.
    (d) Those requiring dental examination during hospital, nursing 
home, or domiciliary care.
    (e) Those held to have suffered dental injury or aggravation of an 
existing dental injury, as the result of examination, hospitalization, 
or medical or surgical (including dental) treatment that had been 
awarded.
    (f) Veterans who are participating in a rehabilitation program under 
38 U.S.C. chapter 31 are entitled to such dental services as are 
professionally determined necessary for any of the reasons enumerated in 
Sec.  17.47(g).


(Authority: 38 U.S.C. 1712(b); ch. 31)

    (g) Those for whom a special dental examination is authorized by the 
Under Secretary for Health or the Assistant Chief Medical Director for 
Dentistry.
    (h) Persons defined in Sec.  17.93.

[13 FR 7162, Nov. 27, 1948, as amended at 21 FR 10388, Dec. 28, 1956; 23 
FR 6503, Aug. 22, 1958; 27 FR 11424, Nov. 20, 1962; 29 FR 1463, Jan. 29, 
1964; 30 FR 1789, Feb. 9, 1965; 32 FR 13817, Oct. 4, 1967; 33 FR 5300, 
Apr. 3, 1968; 35 FR 6586, Apr. 24, 1970; 49 FR 5617, Feb. 14, 1984. 
Redesignated and amended at 61 FR 21966, 21968, May 13, 1996; 79 FR 
54616, Sept. 12, 2014]

[[Page 815]]



Sec.  17.161  Authorization of outpatient dental treatment.

    Outpatient dental treatment may be authorized by the Chief, Dental 
Service, for beneficiaries defined in 38 U.S.C. 1712(b) and 38 CFR 17.93 
to the extent prescribed and in accordance with the applicable 
classification and provisions set forth in this section.
    (a) Class I. Those having a service-connected compensable dental 
disability or condition, may be authorized any dental treatment 
indicated as reasonably necessary to maintain oral health and 
masticatory function. There is no time limitation for making application 
for treatment and no restriction as to the number of repeat episodes of 
treatment.
    (b) Class II. (1)(i) Those having a service-connected noncompensable 
dental condition or disability shown to have been in existence at time 
of discharge or release from active service, which took place after 
September 30, 1981, may be authorized any treatment indicated as 
reasonably necessary for the one-time correction of the service-
connected noncompensable condition, but only if:
    (A) They served on active duty during the Persian Gulf War and were 
discharged or released, under conditions other than dishonorable, from a 
period of active military, naval, or air service of not less than 90 
days, or they were discharged or released under conditions other than 
dishonorable, from any other period of active military, naval, or air 
service of not less than 180 days;
    (B) Application for treatment is made within 180 days after such 
discharge or release.
    (C) The certificate of discharge or release does not bear a 
certification that the veteran was provided, within the 90-day period 
immediately before such discharge or release, a complete dental 
examination (including dental X-rays) and all appropriate dental 
treatment indicated by the examination to be needed, and
    (D) Department of Veterans Affairs dental examination is completed 
within six months after discharge or release, unless delayed through no 
fault of the veteran.
    (ii) Those veterans discharged from their final period of service 
after August 12, 1981, who had reentered active military service within 
90 days after the date of a discharge or release from a prior period of 
active military service, may apply for treatment of service-connected 
noncompensable dental conditions relating to any such periods of service 
within 180 days from the date of their final discharge or release.
    (iii) If a disqualifying discharge or release has been corrected by 
competent authority, application may be made within 180 days after the 
date of correction.
    (2)(i) Those having a service-connected noncompensable dental 
condition or disability shown to have been in existence at time of 
discharge or release from active service, which took place before 
October 1, 1981, may be authorized any treatment indicated as reasonably 
necessary for the one-time correction of the service-connected 
noncompensable condition, but only if:
    (A) They were discharged or released, under conditions other than 
dishonorable, from a period of active military, naval or air service of 
not less than 180 days.
    (B) Application for treatment is made within one year after such 
discharge or release.
    (C) Department of Veterans Affairs dental examination is completed 
within 14 months after discharge or release, unless delayed through no 
fault of the veteran.
    (ii) Those veterans discharged from their final period of service 
before August 13, 1981, who had reentered active military service within 
one year from the date of a prior discharge or release, may apply for 
treatment of service-connected noncompensable dental conditions relating 
to any such prior periods of service within one year of their final 
discharge or release.
    (iii) If a disqualifying discharge or release has been corrected by 
competent authority, application may be made within one year after the 
date of correction.


(Authority: 38 U.S.C. 1712)

    (c) Class II (a). Those having a service-connected noncompensable 
dental condition or disability adjudicated as resulting from combat 
wounds or service trauma may be authorized any

[[Page 816]]

treatment indicated as reasonably necessary for the correction of such 
service-connected noncompensable condition or disability.


(Authority: 38 U.S.C. 501; 1712(a)(1)(C))

    (d) Class II(b). Certain homeless and other enrolled veterans 
eligible for a one-time course of dental care under 38 U.S.C. 2062.


(Authority: 38 U.S.C. 2062; 38 U.S.C. 1712(a)(1)(H))

    (e) Class II(c). Those who were prisoners of war, as determined by 
the concerned military service department, may be authorized any needed 
outpatient dental treatment.

(Authority: Pub. L. 100-322; Pub. L. 108-170; 38 U.S.C. 1712(a)(1)(F))

    (f) Class IIR (Retroactive). Any veteran who had made prior 
application for and received dental treatment from the Department of 
Veterans Affairs for noncompensable dental conditions, but was denied 
replacement of missing teeth which were lost during any period of 
service prior to his/her last period of service may be authorized such 
previously denied benefits under the following conditions:
    (1) Application for such retroactive benefits is made within one 
year of April 5, 1983.
    (2) Existing Department of Veterans Affairs records reflect the 
prior denial of the claim.

All Class IIR (Retroactive) treatment authorized will be completed on a 
fee basis status.


(Authority: 38 U.S.C. 1712)

    (g) Class III. Those having a dental condition professionally 
determined to be aggravating disability from an associated service-
connected condition or disability may be authorized dental treatment for 
only those dental conditions which, in sound professional judgment, are 
having a direct and material detrimental effect upon the associated 
basic condition or disability.
    (h) Class IV. Those whose service-connected disabilities are rated 
at 100% by schedular evaluation or who are entitled to the 100% rate by 
reason of individual unemployability may be authorized any needed dental 
treatment.


(Authority: 38 U.S.C. 1712)

    (i) Class V. A veteran who is participating in a rehabilitation 
program under 38 U.S.C. chapter 31 may be authorized such dental 
services as are professionally determined necessary for any of the 
reasons enumerated in Sec.  17.47(g).


(Authority: 38 U.S.C. 1712(b); chapter 31)

    (j) Class VI. Any veterans scheduled for admission or otherwise 
receiving care and services under chapter 17 of 38 U.S.C. may receive 
outpatient dental care which is medically necessary, i.e., is for dental 
condition clinically determined to be complicating a medical condition 
currently under treatment.

(Authority: 38 U.S.C. 1712)

[20 FR 9505, Dec. 20, 1955]

    Editorial Note: For Federal Register citations affecting Sec.  
17.161, see the List of CFR Sections Affected, which appears in the 
Finding Aids section of the printed volume and at www.govinfo.gov.



Sec.  17.162  Eligibility for Class II dental treatment without rating action.

    When an application has been made for class II dental treatment 
under Sec.  17.161(b), the applicant may be deemed eligible and dental 
treatment authorized on a one-time basis without rating action if:
    (a) The examination to determine the need for dental care has been 
accomplished within the specified time limit after date of discharge or 
release unless delayed through no fault of the veteran, and sound dental 
judgment warrants a conclusion the condition originated in or was 
aggravated during service and the condition existed at the time of 
discharge or release from active service, and


(Authority: 38 U.S.C. 1712)

    (b) The treatment will not involve replacement of a missing tooth 
noted at the time of Department of Veterans Affairs examination except:
    (1) In conjunction with authorized extraction replacement, or
    (2) When a determination can be made on the basis of sound 
professional

[[Page 817]]

judgment that a tooth was extracted or lost on active duty.
    (c) Individuals whose entire tour of duty consisted of active or 
inactive duty for training shall not be eligible for treatment under 
this section.

[37 FR 6847, Apr. 5, 1972, as amended at 48 FR 16682, Apr. 19, 1983. 
Redesignated and amended at 61 FR 21966, 21968, May 13, 1996]



Sec.  17.163  Posthospital outpatient dental treatment.

    The Chief, Dental Service may authorize outpatient dental care which 
is reasonably necessary to complete treatment of a nonservice-connected 
dental condition which was begun while the veteran was receiving 
Department of Veterans Affairs authorized hospital care.

(Authority: 38 U.S.C. 1712(a)(1)(E))

[45 FR 6939, Jan. 31, 1980. Redesignated at 61 FR 21966, May 13, 1996; 
79 FR 54616, Sept. 12, 2014]



Sec.  17.164  Patient responsibility in making and keeping dental
appointments.

    Any veteran eligible for dental treatment on a one-time completion 
basis only and who has not received such treatment within 3 years after 
filing the application shall be presumed to have abandoned the claim for 
dental treatment.

[45 FR 6939, Jan. 31, 1980. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.165  Emergency outpatient dental treatment.

    When outpatient emergency dental care is provided, as a humanitarian 
service, to individuals who have no established eligibility for 
outpatient dental care, the treatment will be restricted to the 
alleviation of pain or extreme discomfort, or the remediation of a 
dental condition which is determined to be endangering life or health. 
The provision of emergency treatment to persons found ineligible for 
dental care will not entitle the applicant to further dental treatment. 
Individuals provided emergency dental care who are found to be 
ineligible for such care will be billed.

(Authority: 38 U.S.C. 501)

[50 FR 14704, Apr. 15, 1985; 50 FR 21604, May 28, 1985. Redesignated at 
61 FR 21966, May 13, 1996]



Sec.  17.166  Dental services for hospital or nursing home patients and
domiciled members.

    Persons receiving hospital, nursing home, or domiciliary care 
pursuant to the provisions of Sec. Sec.  17.46 and 17.47, will be 
furnished such dental services as are professionally determined 
necessary to the patients' or members' overall hospital, nursing home, 
or domiciliary care.

[30 FR 1790, Feb. 9, 1965. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.169  VA Dental Insurance Program for veterans and survivors and
dependents of veterans (VADIP).

    (a) General. (1) The VA Dental Insurance Program (VADIP) provides 
premium-based dental insurance coverage through which individuals 
eligible under paragraph (b) of this section may choose to obtain dental 
insurance from a participating insurer. Enrollment in VADIP does not 
affect the insured's eligibility for outpatient dental services and 
treatment, and related dental appliances, under 38 U.S.C. 1712.
    (2) The following definitions apply to this section:
    Insured means an individual, identified in paragraph (b) of this 
section, who has enrolled in an insurance plan through VADIP.
    Participating insurer means an insurance company that has contracted 
with VA to offer a premium-based dental insurance plan to veterans, 
survivors, and dependents through VADIP. There may be more than one 
participating insurer.
    (b) Covered veterans and survivors and dependents. A participating 
insurer must offer coverage to the following persons:
    (1) Any veteran who is enrolled under 38 U.S.C. 1705 in accordance 
with 38 CFR 17.36.
    (2) Any survivor or dependent of a veteran who is eligible for 
medical care under 38 U.S.C. 1781 and 38 CFR 17.271.

[[Page 818]]

    (c) Premiums, coverage, and selection of participating insurer. (1) 
Premiums. Premiums and copayments will be paid by the insured in 
accordance with the terms of the insurance plan. Premiums and copayments 
will be determined by VA through the contracting process, and will be 
adjusted on an annual basis. The participating insurer will notify all 
insureds in writing of the amount and effective date of such adjustment.
    (2) Benefits. Participating insurers must offer, at a minimum, 
coverage for the following dental care and services:
    (i) Diagnostic services.
    (A) Clinical oral examinations.
    (B) Radiographs and diagnostic imaging.
    (C) Tests and laboratory examinations.
    (ii) Preventive services.
    (A) Dental prophylaxis.
    (B) Topical fluoride treatment (office procedure).
    (C) Sealants.
    (D) Space maintenance.
    (iii) Restorative services.
    (A) Amalgam restorations.
    (B) Resin-based composite restorations.
    (iv) Endodontic services.
    (A) Pulp capping.
    (B) Pulpotomy and pulpectomy.
    (C) Root canal therapy.
    (D) Apexification and recalcification procedures.
    (E) Apicoectomy and periradicular services.
    (v) Periodontic services.
    (A) Surgical services.
    (B) Periodontal services.
    (vi) Oral surgery.
    (A) Extractions.
    (B) Surgical extractions.
    (C) Alveoloplasty.
    (D) Biopsy.
    (vii) Other services.
    (A) Palliative (emergency) treatment of dental pain.
    (B) Therapeutic drug injection.
    (C) Other drugs and/or medications.
    (D) Treatment of postsurgical complications.
    (E) Crowns.
    (F) Bridges.
    (G) Dentures.
    (3) Selection of participating insurer. VA will use the Federal 
competitive contracting process to select a participating insurer, and 
the insurer will be responsible for the administration of VADIP.
    (d) Enrollment. (1) VA, in connection with the participating 
insurer, will market VADIP through existing VA communication channels to 
notify all eligible persons of their right to voluntarily enroll in 
VADIP. The participating insurer will prescribe all further enrollment 
procedures, and VA will be responsible for confirming that a person is 
eligible under paragraph (b) of this section.
    (2) The initial period of enrollment will be for a period of 12 
calendar months, followed by month-to-month enrollment, subject to 
paragraph (e)(5) of this section, as long as the insured remains 
eligible for coverage under paragraph (b) of this section and chooses to 
continue enrollment, so long as VA continues to authorize VADIP.
    (3) The participating insurer will agree to continue to provide 
coverage to an insured who ceases to be eligible under paragraphs (b)(1) 
through (2) of this section for at least 30 calendar days after 
eligibility ceased. The insured must pay any premiums due during this 
30-day period. This 30-day coverage does not apply to an insured who is 
disenrolled under paragraph (e) of this section.
    (e) Disenrollment. (1) Insureds may be involuntarily disenrolled at 
any time for failure to make premium payments.
    (2) Insureds must be permitted to voluntarily disenroll, and will 
not be required to continue to pay any copayments or premiums, under any 
of the following circumstances:
    (i) For any reason, during the first 30 days that the beneficiary is 
covered by the plan, if no claims for dental services or benefits were 
filed by the insured.
    (ii) If the insured relocates to an area outside the jurisdiction of 
the plan that prevents the use of the benefits under the plan.
    (iii) If the insured is prevented by serious medical condition from 
being able to obtain benefits under the plan.
    (iv) If the insured would suffer severe financial hardship by 
continuing in VADIP.

[[Page 819]]

    (v) For any reason during the month-to-month coverage period, after 
the initial 12-month enrollment period.
    (3) All insured requests for voluntary disenrollment must be 
submitted to the insurer for determination of whether the insured 
qualifies for disenrollment under the criteria in paragraphs (e)(2)(i) 
through (v) of this section. Requests for disenrollment due to a serious 
medical condition or financial hardship must include submission of 
written documentation that verifies the existence of a serious medical 
condition or financial hardship. The written documentation submitted to 
the insurer must show that circumstances leading to a serious medical 
condition or financial hardship originated after the effective date 
coverage began, and will prevent the insured from maintaining the 
insurance benefits.
    (4) If the participating insurer denies a request for voluntary 
disenrollment because the insured does not meet any criterion under 
paragraphs (e)(2)(i) through (v) of this section, the participating 
insurer must issue a written decision and notify the insured of the 
basis for the denial and how to appeal. The participating insurer will 
establish the form of such appeals whether orally, in writing, or both. 
The decision and notification of appellate rights must be issued to the 
insured no later than 30 days after the request for voluntary 
disenrollment is received by the participating insurer. The appeal will 
be decided and that decision issued in writing to the insured no later 
than 30 days after the appeal is received by the participating insurer. 
An insurer's decision of an appeal is final.
    (5) Month-to-month enrollment, as described in paragraph (d)(2) of 
this section, may be subject to conditions in insurance contracts, 
whereby upon voluntarily disenrolling, an enrollee may be prevented from 
re-enrolling for a certain period of time as specified in the insurance 
contract.
    (f) Other appeals procedures. Participating insurers will establish 
and be responsible for determination and appeal procedures for all 
issues other than voluntary disenrollment.
    (g) Limited preemption of State and local law. To achieve important 
Federal interests, including but not limited to the assurance of the 
uniform delivery of benefits under VADIP and to ensure the operation of 
VADIP plans at the lowest possible cost to VADIP enrollees, paragraphs 
(b), (c)(1), (c)(2), (d), and (e)(2) through (5) of this section preempt 
conflicting State and local laws, including laws relating to the 
business of insurance. Any State or local law, or regulation pursuant to 
such law, is without any force or effect on, and State or local 
governments have no legal authority to enforce them in relation to, the 
paragraphs referenced in this paragraph or decisions made by VA or a 
participating insurer under these paragraphs.
    (The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-0789.)

[78 FR 32130, May 29, 2013, as amended at 78 FR 62443, Oct. 22, 2013; 82 
FR 16288, Apr. 4, 2017]

                                Autopsies



Sec.  17.170  Autopsies.

    (a) General. (1) Except as otherwise provided in this section, the 
Director of a VA facility may order an autopsy on a decedent who died 
while undergoing VA care authorized by Sec.  17.38 or Sec.  17.52, if 
the Director determines that an autopsy is required for VA purposes for 
the following reasons:
    (i) Completion of official records; or
    (ii) Advancement of medical knowledge.
    (2) VA may order an autopsy to be performed only if consent is first 
obtained under one of the following circumstances:
    (i) Consent is granted by the surviving spouse or next of kin of the 
decedent;
    (ii) Consent is implied where a known surviving spouse or next of 
kin does not respond within a specified period of time to VA's request 
for permission to conduct an autopsy;
    (iii) Consent is implied where a known surviving spouse or next of 
kin does not inquire after the well-being of the deceased veteran for a 
period of at least 6 months before the date of the veteran's death; or
    (iv) Consent is implied where there is no known surviving spouse or 
next of kin of the deceased veteran.

[[Page 820]]

    (b) Death resulting from crime. If it is suspected that death 
resulted from crime and if the United States has jurisdiction over the 
area where the body is found, the Director of the Department of Veterans 
Affairs facility will inform the Office of Inspector General of the 
known facts concerning the death. Thereupon the Office of Inspector 
General will transmit all such information to the United States Attorney 
for such action as may be deemed appropriate and will inquire whether 
the United States Attorney objects to an autopsy if otherwise it be 
appropriate. If the United States Attorney has no objection, the 
procedure as to autopsy will be the same as if the death had not been 
reported to him or her.
    (c) Jurisdiction. If the United States does not have exclusive 
jurisdiction over the area where the body is found the local medical 
examiner/coroner will be informed. If the local medical examiner/coroner 
declines to assume jurisdiction the procedure will be the same as is 
provided in paragraph (b) of this section. If a Federal crime is 
indicated by the evidence, the procedure of paragraph (b) of this 
section will also be followed.
    (d) Applicable law. (1) The laws of the state where the autopsy will 
be performed are to be used to identify the person who is authorized to 
grant VA permission to perform the autopsy and, if more than one person 
is identified, the order of precedence among such persons.
    (2) When the next of kin, as defined by the laws of the state where 
the autopsy will be performed, consists of a number of persons such as 
children, parents, brothers and sisters, etc., permission to perform an 
autopsy may be accepted when granted by the person in the appropriate 
class who assumes the right and duty of burial.
    (e) Death outside a VA facility. The Director of a VA facility may 
order an autopsy on a veteran who was undergoing VA care authorized by 
Sec.  17.38 or Sec.  17.52, and whose death did not occur in a VA 
facility. Such authority also includes transporting the body at VA's 
expense to the facility where the autopsy will be performed, and the 
return of the body. Consent for the autopsy will be obtained as stated 
in paragraph (d) of this section. The Director must determine that such 
autopsy is reasonably required for VA purposes for the following 
reasons:
    (1) The completion of official records; or
    (2) Advancement of medical knowledge.

(Authority: 38 U.S.C. 501, 1703, 1710)

[16 FR 5701, June 15, 1951, as amended at 18 FR 2414, Apr. 24, 1953; 24 
FR 8330, Oct. 14, 1959; 35 FR 6586, Apr. 24, 1970; 36 FR 23386, Dec. 9, 
1971; 45 FR 6939, Jan. 31, 1980. Redesignated and amended at 61 FR 
21966, 21968, May 13, 1996; 61 FR 29294, June 10, 1996; 68 FR 17551, 
Apr. 10, 2003; 77 FR 38181, June 27, 2012]

                        Veterans Canteen Service



Sec.  17.180  Delegation of authority.

    In connection with the Veterans Canteen Service, the Under Secretary 
for Health is hereby delegated authority as follows:
    (a) To exercise the powers and functions of the Secretary with 
respect to the maintenance and operation of the Veterans Canteen 
Service.
    (b) To designate the Assistant Chief Medical Director for 
Administration to administer the overall operation of the Veterans 
Canteen Service and to designate selected employees of the Veterans 
Canteen Service to perform the functions described in the enabling 
statute, 38 U.S.C. ch. 78, so as to effectively maintain and operate the 
Veterans Canteen Service.

[20 FR 337, Jan. 14, 1955, as amended at 36 FR 23386, Dec. 9, 1971; 45 
FR 6939, Jan. 31, 1980. Redesignated at 61 FR 21966, May 13, 1996, as 
amended at 62 FR 17072, Apr. 9, 1997; 79 FR 54616, Sept. 12, 2014]

(Authority: 31 U.S.C. 7501-7507)

[52 FR 23825, June 25, 1987. Redesignated at 61 FR 21966, May 13, 1996; 
80 FR 43322, July 22, 2015]

        Sharing of Medical Facilities, Equipment, and Information



Sec.  17.230  Contingency backup to the Department of Defense.

    (a) Priority care to active duty personnel. The Secretary, during 
and/or immediately following a period of war or national emergency 
declared by the Congress or the President that involves

[[Page 821]]

the use of United States Armed Forces in armed conflict, is authorized 
to furnish hospital care, nursing home care, and medical services to 
members of the Armed Forces on active duty. The Secretary may give 
higher priority in the furnishing of such care and services in VA 
facilities to members of the Armed Forces on active duty than to any 
other group of persons eligible for such care and services with the 
exception of veterans with service-connected disabilities.


(Authority: 38 U.S.C. 8111A, Pub. L. 97-174)

    (b) Contract authority. During a period in which the Secretary is 
authorized to furnish care and services to members of the Armed Forces 
under paragraph (a) of this section, the Secretary, to the extent 
authorized by the President and subject to the availability of 
appropriations or reimbursements, may authorize VA facilities to enter 
into contracts with private facilities for the provision during such 
period of hospital care and medical services for certain veterans. These 
veterans include only those who are receiving hospital care under 38 
U.S.C. 1710 or, in emergencies, for those who are eligible for treatment 
under that section, or who are receiving care under 38 U.S.C. 1710(g). 
This authorization pertains only to circumstances in which VA facilities 
are not capable of furnishing or continuing to furnish the care or 
services required because of the furnishing of care and services to 
members of the Armed Forces.

(Authority: 38 U.S.C. 8111A)

(Authority: Sec. 501 and 1720(a) of Title 38, U.S.C.)

[49 FR 5617, Feb. 14, 1984. Redesignated at 61 FR 21966, May 13, 1996; 
79 FR 54616, Sept. 12, 2014]



Sec.  17.240  Sharing health-care resources.

    Subject to such terms and conditions as the Under Secretary for 
Health shall prescribe, agreements may be entered into for sharing 
medical resources between Department health-care facilities and any 
health-care provider, or other entity or individual with geographical 
limitations determined by the Under Secretary for Health, provided:
    (a) The agreement will achieve one of the following purposes: (1) It 
will secure the use of a health-care resource which otherwise might not 
be feasibly available by providing for the mutual use or exchange of use 
of health-care resources when such an agreement will obviate the need 
for a similar resource to be installed or provided at a facility 
operated by the Department of Veterans Affairs, or
    (2) It will secure effective use of Department of Veterans Affairs 
health-care resources by providing for the mutual use, or exchange of 
use, of health-care resources in a facility operated by the Department 
of Veterans Affairs, which have been justified on the basis of veterans' 
care, but which are not utilized to their maximum effective capacity; 
and
    (b) The agreement is determined to be in the best interest of the 
prevailing standards of the Department of Veterans Affairs Medical 
Program; and
    (c) The agreement provides for reciprocal reimbursement based on a 
charge which covers the full cost of the use of health-care resources, 
incidental hospital care or other needed services, supplies used, and 
normal depreciation and amortization costs of equipment.
    (d) Reimbursement for medical care rendered to an individual who is 
entitled to hospital or medical services (Medicare) under subchapter 
XVIII of chapter 7 of title 42 U.S.C., and who has no entitlement to 
medical care from the Department of Veterans Affairs, will be made to 
such facility, or if the contract or agreement so provides, to the 
community health care facility which is party to the agreement, in 
accordance with:
    (1) Rates prescribed by the Secretary of Health and Human Services, 
after consultation with the Secretary of Veterans Affairs, and
    (2) Procedures jointly prescribed by the Secretary of Health and 
Human Services and the Secretary of Veterans Affairs to assure 
reasonable quality of

[[Page 822]]

care and service and efficient and economical utilization of resources.

(Authority: 38 U.S.C. 8153)

[32 FR 6841, May 4, 1967, as amended at 35 FR 18198, Nov. 28, 1970; 39 
FR 1846, Jan. 15, 1974; 45 FR 6940, Jan. 31, 1980; 47 FR 58250, Dec. 30, 
1982; 54 FR 34983, Aug. 23, 1989. Redesignated at 61 FR 21966, May 13, 
1996, as amended at 62 FR 17072, Apr. 9, 1997; 79 FR 54616, Sept. 12, 
2014]



Sec.  17.241  Sharing medical information services.

    (a) Agreements for exchange of information. Subject to such terms 
and conditions as the Under Secretary for Health shall prescribe, 
Directors of Department of Veterans Affairs medical centers, may enter 
into agreements with medical schools, Federal, State or local, public or 
private hospitals, research centers, and individual members of the 
medical profession, under which medical information and techniques will 
be freely exchanged and the medical information services of all parties 
to the agreement will be available for use by any party to the agreement 
under conditions specified in the agreement.
    (b) Purpose of sharing agreements. Agreements for the exchange of 
information shall be used to the maximum extent practicable to create at 
each Department of Veterans Affairs medical center which has entered 
into such an agreement, an environment of academic medicine which will 
help the hospital attract and retain highly trained and qualified 
members of the medical profession.
    (c) Use of electronic equipment. Recent developments in electronic 
equipment shall be utilized under information sharing programs to 
provide a close educational, scientific, and professional link between 
Department of Veterans Affairs medical centers and major medical 
centers.
    (d) Furnishing information services on a fee basis. The educational 
facilities and programs established at Department of Veterans Affairs 
Medical Centers and the electronic link to medical centers shall be made 
available for use by medical entities in the surrounding medical 
community which have not entered into sharing agreements with the 
Department of Veterans Affairs, in order to bring about utilization of 
all medical information in the surrounding medical community, 
particularly in remote areas, and to foster and encourage the widest 
possible cooperation and consultation among all members of the medical 
profession in the surrounding medical community.
    (e) Establishing fees for information services. Subject to such 
terms and conditions as the Under Secretary for Health shall prescribe, 
Directors of Department of Veterans Affairs medical centers shall charge 
for information and educational facilities and services made available 
under paragraph (d) of this section. The fee may be on an annual or 
other periodic basis, at rates determined, after appropriate study, to 
be fair and equitable. The financial status of any user of such services 
shall be taken into consideration in establishing the amount of the fee 
to be paid.

[32 FR 6841, May 4, 1967, as amended at 47 FR 58250, Dec. 30, 1982. 
Redesignated at 61 FR 21966, May 13, 1996, as amended at 62 FR 17072, 
Apr. 9, 1997]



Sec.  17.242  Coordination of programs with Department of Health and 
Human Services.

    Programs for sharing specialized medical resources or medical 
information services shall be coordinated to a maximum extent 
practicable, with programs carried out under part F, title XVI of the 
Public Health Service Act under the jurisdiction of the Department of 
Health and Human Services.

[32 FR 6842, May 4, 1967, as amended at 45 FR 6940, Jan. 31, 1980; 47 FR 
58250, Dec. 30, 1982. Redesignated at 61 FR 21966, May 13, 1996]

                   Grants for Exchange of Information



Sec.  17.250  Scope of the grant program.

    The provisions of Sec.  17.250 through Sec.  17.266 are applicable 
to grants under 38 U.S.C. 8155 for programs for the exchange of medical 
information. The purpose of these grants is to assist medical schools, 
hospitals, and research centers in planning and carrying out agreements 
for the exchange of medical information, techniques, and information 
services. The grant funds may be used for the employment

[[Page 823]]

of personnel, the construction of facilities, the purchasing of 
equipment, research, training or demonstration activities when necessary 
to implement exchange of information agreements.

[33 FR 6011, Apr. 19, 1968. Redesignated and amended at 61 FR 21966, 
21968, May 13, 1996]



Sec.  17.251  The Subcommittee on Academic Affairs.

    There is established within the Special Medical Advisory Group 
authorized under the provisions of 38 U.S.C. 7312 a Subcommittee on 
Academic Affairs, and the Subcommittee shall advise the Secretary, 
through the Under Secretary for Health, in matters pertinent to 
achieving the objectives of programs for exchange of medical 
information. The Subcommittee shall review each application for a grant 
and prepare a written report setting forth recommendations as to the 
final action to be taken on the application.

[42 FR 54804, Oct. 11, 1977. Redesignated at 61 FR 21966, May 13, 1996, 
as amended at 62 FR 17072, Apr. 9, 1997]



Sec.  17.252  Ex officio member of subcommittee.

    The Assistant Chief Medical Director for Academic Affairs shall be 
an ex officio member of the Subcommittee on Academic Affairs.

[42 FR 54804, Oct. 11, 1977. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.253  Applicants for grants.

    Applicants for grants generally will be persons authorized to 
represent a medical school, hospital, or research center which has in 
effect or has tentatively approved an agreement with the Department of 
Veterans Affairs to exchange medical information.

[33 FR 6011, Apr. 19, 1968. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.254  Applications.

    Each application for a grant shall be submitted to the Under 
Secretary for Health on such forms as shall be prescribed and shall 
include the following evidence, assurances, and supporting documents:
    (a) To specify amount. Each application shall show the amount of the 
grant requested, and if the grant is to be for more than one objective, 
the amounts allocated to each objective (e.g., to training, 
demonstrations, or construction) shall be specified, and
    (b) To include copy of agreement. Each application shall be 
accompanied by a copy of the agreement for the exchange of information 
or information services which the grant funds applied for will 
implement, and
    (c) To include descriptions and plans. Each application shall 
include a description of the use to which the grant funds will be 
applied in sufficient detail to show need, purpose, and justifications, 
and shall be illustrated by financial and budgetary data, and
    (d) To include cost participation information. Each application 
shall show the amount of the grant requested to be used for direct 
expenses by category of direct expenses, the amount requested for 
indirect expenses related to the direct expenses, any additional amounts 
which will be applied to the program or planning from other Federal 
agencies, and from other sources, and amounts or expenses which will be 
borne by the applicant, and
    (e) To include assurance records will be kept. Each application 
shall include sufficient assurances that the applicant shall keep 
records which fully disclose the amount and disposition of the proceeds 
of the grant, the total cost of the project or undertaking in connection 
with which the grant is made or used, the portion of the costs supplied 
by non-Federal sources, and such other records as will facilitate an 
effective audit. All such records shall be retained by the applicant 
(grantee) for a period of 3 years after the submission of the final 
expenditure report, or if litigation, claim or audit is started before 
the expiration of the 3-year period, the records shall be retained until 
all litigation, claims or audit findings involving the records have been 
resolved, and
    (f) To include assurance records will be made available. Each 
application shall include sufficient assurances the applicant will give 
the Secretary and the Comptroller General of the United States, or any 
of their authorized representatives, access to its books, documents, 
papers, and records which are

[[Page 824]]

pertinent to the grant for the purposes of audit and examination, and
    (g) To include assurance progress reports will be made. Each 
application shall include sufficient assurances the applicant will 
furnish the Under Secretary for Health periodic progress reports in 
sufficient detail showing the status of the project, planning, program, 
or system funded by the grant for which application is made, and the 
extent to which the stated objectives will have been achieved, and
    (h) To include civil rights assurances. Each application shall 
include sufficient assurances that no part of the grant funds will be 
used either by the grantee or by any contractor or subcontractor to be 
paid from grant funds for any purpose which is inconsistent with 
regulations promulgated by the Secretary (part 18 of this chapter) 
implementing title VI of the Civil Rights Act of 1964, or inconsistent 
with Executive Order 11246 (30 FR 12319) and any implementing 
regulations the Secretary of Labor may promulgate.

[33 FR 6011, Apr. 19, 1968, as amended at 36 FR 320, Jan. 9, 1971; 42 FR 
54804, Oct. 11, 1977. Redesignated and amended at 61 FR 21966, 21969, 
May 13, 1996]



Sec.  17.255  Applications for grants for programs which include 
construction projects.

    In addition to the documents and evidence required by Sec.  17.254, 
any application for a grant for the construction of any facility, 
structure or system which is part of an exchange of information program 
shall include the following:
    (a) Each application shall include complete descriptions, maps, and 
surveys of the construction site, and documentary evidence and 
explanations showing ownership, and
    (b) Each application shall include complete plans and specifications 
for the construction project, and where applicable, sufficient 
explanations of technical applications so that they may be understood by 
the layman, and
    (c) Each application shall contain assurance that the rates of pay 
for laborers and mechanics engaged in construction activities will not 
be less than the prevailing local wage rates for similar work as 
determined in accordance with the provisions of 40 U.S.C. 3141-3144, 
3146, and 3147.

[33 FR 6012, Apr. 19, 1968. Redesignated and amended at 61 FR 21966, 
21969, May 13, 1996; 79 FR 54616, Sept. 12, 2014]



Sec.  17.256  Amended or supplemental applications.

    An amended application, or an application for a supplemental grant, 
may be considered either before or after final action has been taken on 
the original application. Amended applications and applications for 
supplemental grants shall be subject to the same terms, conditions and 
requirements necessary for original applications.

[33 FR 6012, Apr. 19, 1968. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.257  Awards procedures.

    Applications for grants for planning or implementing agreements for 
the exchange of medical information or information facilities shall be 
reviewed by the Under Secretary for Health or designee. If it is 
determined approval of the grant is warranted, recommendations to that 
effect shall be made to the Secretary in writing and shall be 
accompanied by the following:
    (a) The recommendation for approval shall be accompanied by the 
written recommendation of the Subcommittee on Academic Affairs, and
    (b) The recommendation for approval shall be accompanied by the 
written draft of the certificate of award stating all conditions which 
the grantee is required to agree to under the provisions of Sec.  17.258 
and all other conditions to which it has been determined the grant will 
be subject, and
    (c) The recommendation shall include a certification that sufficient 
appropriated funds are available, and that the application for the grant 
is sufficient in all details as specified in Sec. Sec.  17.254 through 
17.256.

[33 FR 6012, Apr. 19, 1968, as amended at 42 FR 54805, Oct. 11, 1977. 
Redesignated and amended at 61 FR 21966, 21969, May 13, 1996]



Sec.  17.258  Terms and conditions to which awards are subject.

    Each certificate of award of a grant for planning or implementing an 
agreement for the exchange of information

[[Page 825]]

or information facilities shall specify that the grant is subject to the 
following terms and conditions:
    (a) Grants subject to terms of agreement for exchange of 
information. Each grant shall be subject to, and the certificate shall 
incorporate by reference, all terms, conditions, and obligations 
specified in the agreement or planning protocols which the grant will 
implement, and
    (b) Grants subject to assurances in application. Each grant shall be 
subject to all assurances made by the grantee in its application for the 
grant as required by Sec. Sec.  17.254 through 17.256, and
    (c) Grants subject to limitations on use of funds. Each grant shall 
be subject to the limitations on the use of grant funds, either for 
direct or indirect costs, as prescribed in Sec. Sec.  17.259 through 
17.261, and
    (d) Grants subject to special provisions. Each grant shall be 
subject to any special terms or conditions which may be warranted by 
circumstances applicable to individual applications, and specified in 
the certificate of award.

[33 FR 6012, Apr. 19, 1968. Redesignated and amended at 61 FR 21966, 
21969, May 13, 1996]



Sec.  17.259  Direct costs.

    Direct costs to which grant funds may be applied may include in 
proportion to time and effort spent, but are not limited to, fees and 
costs directly paid to personnel or for fringe benefits, rent, 
publications, educational programs, training, research, demonstration 
activities, or construction carried out in connection with pilot 
programs for planning or exchange of information.

[33 FR 6012, Apr. 19, 1968. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.260  Patient care costs to be excluded from direct costs.

    Grant funds for planning or implementing agreements for the exchange 
of medical information shall not be available for the payment of any 
hospital, medical, or other costs involving the care of patients except 
to the extent that such costs are determined to be incident to research, 
training, or demonstration activities carried out in connection with an 
exchange of information program.

[33 FR 6012, Apr. 19, 1968. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.261  Indirect costs.

    The grantee shall allocate expenditures as between direct and 
indirect costs according to generally accepted accounting procedures. 
The amount allocated for indirect costs may be computed on a percentage 
basis or on the basis of a negotiated lump-sum allowance. In the method 
of computation used, only indirect costs shall be included which bear a 
reasonable relationship to the planning or program funded by the grant 
and shall not exceed a percentage greater than the percentage the total 
institutional indirect cost is of the total direct salaries and wages 
paid by the institution.

[33 FR 6012, Apr. 19, 1968. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.262  Authority to approve applications discretionary.

    Notwithstanding any recommendation by the Subcommittee on Academic 
Affairs of the Special Medical Advisory Group, or any recommendation by 
the Under Secretary for Health or designee, the final determination on 
any application for a grant rests solely with the Secretary.

[42 FR 54805, Oct. 11, 1977. Redesignated and amended at 61 FR 21966, 
21969, May 13, 1996]



Sec.  17.263  Suspension and termination procedures.

    Termination of a grant means the cancellation of Department of 
Veterans Affairs sponsorship, in whole or in part, under an agreement at 
any time prior to the date of completion. Suspension of a grant is an 
action by the Department of Veterans Affairs which temporarily suspends 
Department of Veterans Affairs sponsorship under the grant pending 
corrective action by the grantee or pending a decision to terminate the 
grant by the Department of Veterans Affairs.
    (a) Posttermination appeal. The following procedures are applicable 
for reviewing postaward disputes which may

[[Page 826]]

arise in the administration of or carrying out of the Exchange of 
Medical Information Grant Program.
    (1) Reviewable decisions. The Department of Veterans Affairs 
reserves the right to terminate any grant in whole or in part at any 
time before the date of completion, whenever it determines that the 
grantee has failed to comply with conditions of the agreement, or 
otherwise failed to comply with any law, regulation, assurance, term, or 
condition applicable to the grant.
    (2) Notice. The Department of Veterans Affairs shall promptly notify 
the grantee in writing of the determination. The notice shall set forth 
the reason for the determination in sufficient detail to enable the 
grantee to respond, and shall inform the grantee of his or her 
opportunity for review by the Assistant Chief Medical Director as 
provided in this section.
    (3) Request for appeal. A grantee with respect to whom a 
determination described in paragraph (a)(1) of this section has been 
made, and who desires review, may file with the Assistant Chief Medical 
Director for Academic Affairs an application for review of such 
determination. The grantee's application for review must be post-marked 
no later than 30 days after the postmarked date of notification provided 
pursuant to paragraph (a)(2) of this section.
    (4) Contents of request. The application for review must clearly 
identify the question or questions in dispute, contain a full statement 
of the grantee's position in respect to such question or questions, and 
provide pertinent facts and reasons in support of his or her position. 
The Assistant Chief Medical Director for Academic Affairs will promptly 
send a copy of the grantee's application to the Department of Veterans 
Affairs official responsible for the determination which is to be 
reviewed.
    (5) Effect of submission. When an application for review has been 
filed no action may be taken by the Department of Veterans Affairs 
pursuant to such determination until such application has been disposed 
of, except that the filing of the application shall not affect the 
authority which the constituent agency may have to suspend the system 
under a grant during proceedings under this section or otherwise to 
withhold or defer payments under the grant.
    (6) Consideration of request. When an application for review has 
been filed with the Assistant Chief Medical Director for Academic 
Affairs, and it has been determined that the application meets the 
requirements stated in this paragraph, all background material of the 
issues shall be reviewed. If the application does not meet the 
requirements, the grantee shall be notified of the deficiencies.
    (7) Presentation of case. If the Assistant Chief Medical Director 
for Academic Affairs believes there is no dispute as to material fact, 
the resolution of which would be materially assisted by oral testimony, 
both parties shall be notified of the issues to be considered, and take 
steps to afford both parties the opportunity for presenting their cases, 
at the option of the Assistant Chief Medical Director for Academic 
Affairs, in whole or in part in writing, or in an informal conference. 
Where it is concluded that oral testimony is required to resolve a 
dispute over a material fact, both parties shall be afforded an 
opportunity to present and cross-examine witnesses at a hearing.
    (8) Decision. After both parties have presented their cases, the 
Assistant Chief Medical Director for Academic Affairs shall prepare an 
initial written decision which shall include findings of fact and 
conclusions based thereon. Copies of the decision shall be mailed 
promptly to each of the parties together with a notice informing them of 
their right to appeal the decision of the Secretary, or to the officer 
or employee to whom the Secretary has delegated such authority, by 
submitting written comments thereon within a specified reasonable time.
    (9) Final decision. Upon filing comments with the Secretary, or 
designated officer or employee, the review of the initial decision shall 
be conducted on the basis of the decision, the hearing record, if any, 
and written comments submitted by both parties. The decision shall be 
final.
    (10) Participation by a party. Either party may participate in 
person, or by counsel pursuant to the procedure set forth in this 
section.

[[Page 827]]

    (b) Termination for convenience. The Department of Veterans Affairs 
or the grantee may terminate a grant in whole or in part when both 
parties agree that the continuation of the project would not produce 
beneficial results commensurate with the further expenditure of funds. 
The two parties shall agree upon the termination conditions, including 
the effective date and, in the case of partial terminations, the portion 
to be terminated. The grantee shall not incur new obligations for the 
terminated portion after the effective date, and shall cancel as many 
outstanding obligations as possible. The Department of Veterans Affairs 
shall allow full credit to the grantee for the Department of Veterans 
Affairs share of the noncancellable obligations, properly incurred by 
the grantee prior to termination.
    (c) Suspension procedures. When a grantee has failed to comply with 
the terms of the grant agreement and conditions or standards, the 
Department of Veterans Affairs may, on reasonable notice to the grantee, 
suspend the grant and withhold further payments, prohibit the grantee 
from incurring additional obligations of funds, pending corrective 
action by the grantee, or make a decision to terminate as described in 
paragraph (a) of this section. The Department of Veterans Affairs shall 
allow all necessary and proper costs that the grantee could not 
reasonably avoid during the period of suspension provided that they meet 
the provisions of the applicable Federal cost principles.

[42 FR 54805, Oct. 11, 1977. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.264  Recoupments and releases.

    In any case where the Department of Veterans Affairs or a grantee's 
obligations under an exchange of information agreement implemented by 
grant funds are terminated, or where grant-financed equipment or 
facilities cease to be used for the purposes for which grant support was 
given, or when grant-financed property is transferred, the grantee shall 
return the proportionate value of such equipment or facility as was 
financed by the grant. When it is determined the Department of Veterans 
Affairs equitable interest is greater that proportionate value, then a 
claim in such greater amount shall be asserted. If it is determined an 
amount less than proportionate value or less than the Department of 
Veterans Affairs equitable interest should be recouped, or that the 
Department of Veterans Affairs should execute any releases, then a 
proposal concerning such a settlement or releases complete with 
explanations and justifications shall be submitted to the Assistant 
Chief Medical Director for Academic Affairs for a final determination.

[42 FR 54805, Oct. 11, 1977. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.265  Payments.

    Payments of grant funds are made to grantees through a letter-of-
credit, an advance by Treasury check, or a reimbursement by Treasury 
check, as appropriate. A letter-of-credit is an instrument certified by 
an authorized official of the Department of Veterans Affairs which 
authorizes the grantee to draw funds when needed from the Treasury, 
through a Federal Reserve bank and the grantee's commercial bank and 
shall be used by the Department of Veterans Affairs where all the 
following conditions exist:
    (a) When there is or will be a continuing relationship between the 
grantee and the Department of Veterans Affairs for at least a 12-month 
period and the total amount of advance payments expected to be received 
within that period is $250,000, or more;
    (b) When the grantee has established or demonstrated the willingness 
and ability to maintain procedures that will minimize the time elapsing 
between the transfer of funds and their disbursement by the grantee; and
    (c) When the grantee's financial management meets the standards for 
fund control and accountability. An advance by Treasury check is a 
payment made to a grantee upon its request before outlays are made by 
the grantee, or through use of predetermined payment schedules and shall 
be used by the Department of Veterans Affairs when the grantee meets all 
of the above requirements of this section except that advances will be 
less than $250,000, or for

[[Page 828]]

a period less than 12 months. Reimbursement by Treasury check is a 
payment made to a grantee upon request for reimbursement from the 
grantee and shall be the preferred method when the grantee does not meet 
the requirements of paragraphs (b) and (c) of this section. This method 
may be used on any construction agreement, or if the major portion of 
the program is accomplished through private market financing or Federal 
loans, and the Federal assistance constitutes a minor portion of the 
program. When the reimbursement method is used, the Department of 
Veterans Affairs shall make payment within 30 days after receipt of the 
billing, unless billing is improper. Unless otherwise required by law, 
payments shall not be withheld for proper charges at any time during the 
grant period unless a grantee has failed to comply with the program 
objectives, award conditions, or Federal reporting requirements; or the 
grantee is indebted.

[42 FR 54806, Oct. 11, 1977. Redesignated at 61 FR 21966, May 13, 1996]



Sec.  17.266  Copyrights and patents.

    If a grant-supported program results in copyrightable material or 
patentable inventions or discoveries, the United States Government shall 
have the right to use such publications or inventions on a royalty-free 
basis.

[33 FR 6013, Apr. 19, 1968. Redesignated at 61 FR 21966, May 13, 1996]

   Civilian Health and Medical Program of the Department of Veterans 
Affairs (CHAMPVA)--Medical Care for Survivors and Dependents of Certain 
                                Veterans

    Source: 63 FR 48102, Sept. 9, 1998, unless otherwise noted.



Sec.  17.270  General provisions.

    (a) CHAMPVA is the Civilian Health and Medical Program of the 
Department of Veterans Affairs and is administered by the Health 
Administration Center, Denver, Colorado. Pursuant to 38 U.S.C. 1781, VA 
is authorized to provide medical care in the same or similar manner and 
subject to the same or similar limitations as medical care furnished to 
certain dependents and survivors of active duty and retired members of 
the Armed Forces. The CHAMPVA program is designed to accomplish this 
purpose. Under CHAMPVA, VA shares the cost of medically necessary 
services and supplies for eligible beneficiaries as set forth in 
Sec. Sec.  17.271 through 17.278.
    (b) For purposes of Sec. Sec.  17.270 through 17.278, the 
definitions of ``child,'' ``service-connected condition/disability,'' 
``spouse,'' and ``surviving spouse'' must be those set forth further in 
38 U.S.C. 101. The term ``fiscal year'' refers to October 1, through 
September 30.

(Authority: 38 U.S.C. 501, 1781)

[63 FR 48102, Sept. 9, 1998, as amended at 73 FR 65553, Nov. 4, 2008]



Sec.  17.271  Eligibility.

    (a) General entitlement. The following persons are eligible for 
CHAMPVA benefits provided that they are not eligible under Title 10 for 
the TRICARE Program or Part A of Title XVIII of the Social Security Act 
(Medicare) except as provided in paragraph (b) of this section.
    (1) The spouse or child of a veteran who has been adjudicated by VA 
as having a permanent and total service-connected disability;
    (2) The surviving spouse or child of a veteran who died as a result 
of an adjudicated service-connected condition(s); or who at the time of 
death was adjudicated permanently and totally disabled from a service-
connected condition(s);
    (3) The surviving spouse or child of a person who died on active 
military service and in the line of duty and not due to such person's 
own misconduct; and
    (4) An eligible child who is pursuing a full-time course of 
instruction approved under 38 U.S.C. Chapter 36, and who incurs a 
disabling illness or injury while pursuing such course (between terms, 
semesters or quarters; or during a vacation or holiday period) that is 
not the result of his or her own willful misconduct and that results in 
the inability to continue or resume the chosen program of education must 
remain eligible for medical care until:

[[Page 829]]

    (i) The end of the six-month period beginning on the date the 
disability is removed; or
    (ii) The end of the two-year period beginning on the date of the 
onset of the disability; or
    (iii) The twenty-third birthday of the child, whichever occurs 
first.


(Authority: 38 U.S.C. 501, 1781)

    (b) CHAMPVA and Medicare entitlement. (1) Individuals under age 65 
who are entitled to Medicare Part A and enrolled in Medicare Part B, 
retain CHAMPVA eligibility as secondary payer to Medicare Parts A and B, 
Medicare supplemental insurance plans, and Medicare HMO plans.
    (2) Individuals age 65 or older, and not entitled to Medicare Part 
A, retain CHAMPVA eligibility.

    Note to paragraph (b)(2): If the person is not eligible for Part A 
of Medicare, a Social Security Administration ``Notice of Disallowance'' 
certifying that fact must be submitted. Additionally, if the individual 
is entitled to only Part B of Medicare, but not Part A, or Part A 
through the Premium HI provisions, a copy of the individual's Medicare 
card or other official documentation noting this must be provided.

    (3) Individuals age 65 on or after June 5, 2001, who are entitled to 
Medicare Part A and enrolled in Medicare Part B, are eligible for 
CHAMPVA as secondary payer to Medicare Parts A and B, Medicare 
supplemental insurance plans, and Medicare HMO plans for services 
received on or after October 1, 2001.
    (4) Individuals age 65 or older prior to June 5, 2001, who are 
entitled to Medicare Part A and who have not purchased Medicare Part B, 
are eligible for CHAMPVA as secondary payer to Medicare Part A and any 
other health insurance for services received on or after October 1, 
2001.
    (5) Individuals age 65 or older prior to June 5, 2001, who are 
entitled to Medicare Part A and who have purchased Medicare Part B must 
continue to carry Part B to retain CHAMPVA eligibility as secondary 
payer for services received on or after October 1, 2001.


(Authority: 38 U.S.C. 501, 1781)

    Note to Sec.  17.271: Eligibility criteria specific to Dependency 
and Indemnity Compensation (DIC) benefits are not applicable to CHAMPVA 
eligibility determinations.

[63 FR 48102, Sept. 9, 1998, as amended at 67 FR 4359, Jan. 30, 2002; 73 
FR 65553, Nov. 4, 2008]



Sec.  17.272  Benefits limitations/exclusions.

    (a) Benefits cover allowable expenses for medical services and 
supplies that are medically necessary and appropriate for the treatment 
of a condition and that are not specifically excluded from program 
coverage. Covered benefits may have limitations. The fact that a 
physician may prescribe, order, recommend, or approve a service or 
supply does not, of itself, make it medically necessary or make the 
charge an allowable expense, even though it is not listed specifically 
as an exclusion. The following are specifically excluded from program 
coverage:
    (1) Services, procedures or supplies for which the beneficiary has 
no legal obligation to pay, or for which no charge would be made in the 
absence of coverage under a health benefits plan.
    (2) Services and supplies required as a result of an occupational 
disease or injury for which benefits are payable under workers' 
compensation or similar protection plan (whether or not such benefits 
have been applied for or paid) except when such benefits are exhausted 
and are otherwise not excluded from CHAMPVA coverage.
    (3) Services and supplies that are paid directly or indirectly by a 
local, State or Federal government agency (Medicaid excluded), including 
court-ordered treatment. In the case of the following exceptions, 
CHAMPVA assumes primary payer status:
    (i) Medicaid.
    (ii) State Victims of Crime Compensation Programs.
    (4) Services and supplies that are not medically or psychologically 
necessary for the diagnosis or treatment of a covered condition 
(including mental disorder) or injury.
    (5) Radiology, laboratory, and pathological services and machine 
diagnostic testing not related to a specific illness or injury or a 
definitive set of symptoms.

[[Page 830]]

    (6) Services and supplies above the appropriate level required to 
provide necessary medical care.
    (7) Services and supplies related to an inpatient admission 
primarily to perform diagnostic tests, examinations, and procedures that 
could have been and are performed routinely on an outpatient basis.
    (8) Postpartum inpatient stay of a mother for purposes of staying 
with the newborn infant (primarily for the purpose of breast feeding the 
infant) when the infant (but not the mother) requires the extended stay; 
or continued inpatient stay of a newborn infant primarily for purposes 
of remaining with the mother when the mother (but not the newborn 
infant) requires extended postpartum inpatient stay.
    (9) Therapeutic absences from an inpatient facility or residential 
treatment center (RTC).
    (10) Custodial care.
    (11) Inpatient stays primarily for domiciliary care purposes.
    (12) Inpatient stays primarily for rest or rest cures.
    (13) Services and supplies provided as a part of, or under, a 
scientific or medical study, grant, or research program.
    (14) Services and supplies not provided in accordance with accepted 
professional medical standards or related to experimental or 
investigational procedures or treatment regimens.
    (15) Services or supplies prescribed or provided by a member of the 
beneficiary's immediate family, or a person living in the beneficiary's 
or sponsor's household.
    (16) Services and supplies that are (or are eligible to be) payable 
under another medical insurance or program, either private or 
governmental, such as coverage through employment or Medicare.
    (17) Services or supplies subject to preauthorization (see Sec.  
17.273) that were obtained without the required preauthorization; and 
services and supplies that were not provided according to the terms of 
the preauthorization.
    (18) Inpatient stays primarily to control or detain a runaway child, 
whether or not admission is to an authorized institution.
    (19) Services and supplies (to include prescription medications) in 
connection with cosmetic surgery which is performed to primarily improve 
physical appearance or for psychological purposes or to restore form 
without correcting or materially improving a bodily function.
    (20) Electrolysis.
    (21) Dental care with the following exceptions:
    (i) Dental care that is medically necessary in the treatment of an 
otherwise covered medical condition, is an integral part of the 
treatment of such medical condition, and is essential to the control of 
the primary medical condition.
    (ii) Dental care required in preparation for, or as a result of, 
radiation therapy for oral or facial cancer.
    (iii) Gingival Hyperplasia.
    (iv) Loss of jaw substance due to direct trauma to the jaw or due to 
treatment of neoplasm.
    (v) Intraoral abscess when it extends beyond the dental alveolus.
    (vi) Extraoral abscess.
    (vii) Cellulitis and osteitis which is clearly exacerbating and 
directly affecting a medical condition currently under treatment.
    (viii) Repair of fracture, dislocation, and other injuries of the 
jaw, to include removal of teeth and tooth fragments only when such 
removal is incidental to the repair of the jaw.
    (ix) Treatment for stabilization of myofascial pain dysfunction 
syndrome, also referred to as temporomandibular joint (TMJ) syndrome. 
Authorization is limited to initial radiographs, up to four office 
visits, and the construction of an occlusal splint.
    (x) Total or complete ankyloglossia.
    (xi) Adjunctive dental and orthodontic support for cleft palate.
    (xii) Prosthetic replacement of jaw due to trauma or cancer.
    (22) Nonsurgical treatment of obesity or morbid obesity for dietary 
control or weight reduction (with the exception of gastric bypass, 
gastric stapling, or gastroplasty procedures in connection with morbid 
obesity when determined to be medically necessary) including 
prescription medications.

[[Page 831]]

    (23) Services and supplies related to transsexualism or other 
similar conditions such as gender dysphoria (including, but not limited 
to, intersex surgery and psychotherapy, except for ambiguous genitalia 
which was documented to be present at birth).
    (24) Sex therapy, sexual advice, sexual counseling, sex behavior 
modification, psychotherapy for mental disorders involving sexual 
deviations (e.g., transvestic fetish), or other similar services, and 
any supplies provided in connection with therapy for sexual dysfunctions 
or inadequacies.
    (25) Removal of corns or calluses or trimming of toenails and other 
routine foot care services, except those required as a result of a 
diagnosed systemic medical disease affecting the lower limbs, such as 
severe diabetes.
    (26) Services and supplies, to include psychological testing, 
provided in connection with a specific developmental disorder. The 
following exception applies: Diagnostic and evaluative services required 
to arrive at a differential diagnosis for an otherwise eligible child 
unless the state is required to provide those services under Public Law 
94-142, Education for All Handicapped Children Act of 1975 as amended, 
see 20 U.S.C. chapter 33.
    (27) Surgery to reverse voluntary surgical sterilization procedures.
    (28) Services and supplies related to artificial insemination 
(including semen donors and semen banks), in vitro fertilization, gamete 
intrafallopian transfer and all other noncoital reproductive 
technologies.
    (29) Nonprescription contraceptives.
    (30) Diagnostic tests to establish paternity of a child; or tests to 
determine sex of an unborn child.
    (31) Preventive care (such as routine, annual, or employment-
requested physical examinations; routine screening procedures; and 
immunizations). The following exceptions apply:
    (i) Well-child care from birth to age six. Periodic health 
examinations designed for prevention, early detection, and treatment of 
disease are covered to include screening procedures, immunizations, and 
risk counseling. The following services are payable when required as 
part of a well-child care program and when rendered by the attending 
pediatrician, family physician, or a pediatric nurse practitioner.
    (A) Newborn examination, heredity and metabolic screening, and 
newborn circumcision.
    (B) Periodic health supervision visits intended to promote optimal 
health for infants and children to include the following services:
    (1) History and physical examination.
    (2) Vision, hearing, and dental screening.
    (3) Developmental appraisal to include body measurement.
    (4) Immunizations as recommended by the Centers for Disease Control 
(CDC) and Prevention Advisory Committee on Immunization Practices.
    (5) Pediatric blood lead level test.
    (6) Tuberculosis screening.
    (7) Blood pressure screening.
    (8) Measurement of hemoglobin and hematocrit for anemia.
    (9) Urinalysis.
    (C) Additional services or visits required because of specific 
findings or because the particular circumstances of the individual case 
are covered if medically necessary and otherwise authorized for benefits 
under CHAMPVA.
    (ii) Rabies vaccine following an animal bite.
    (iii) Tetanus vaccine following an accidental injury.
    (iv) Rh immune globulin.
    (v) Pap smears.
    (vi) Mammography tests.
    (vii) Genetic testing and counseling determined to be medically 
necessary.
    (viii) Chromosome analysis in cases of habitual abortion or 
infertility.
    (ix) Gamma globulin.
    (x) School-required physical examinations for beneficiaries through 
age 17 that are provided on or after October 1, 2001.
    (32) Chiropractic and naturopathic services.
    (33) Counseling services that are not medically necessary in the 
treatment of a diagnosed medical condition (such as educational 
counseling; vocational counseling; and counseling for socioeconomic 
purposes, stress management, life style modification, etc.).
    (34) Acupuncture, whether used as a therapeutic agent or as an 
anesthetic.
    (35) Hair transplants, wigs, or hairpieces, except that benefits may 
be

[[Page 832]]

extended for one wig or hairpiece per beneficiary (lifetime maximum) 
when the attending physician certifies that alopecia has resulted from 
treatment of malignant disease and the beneficiary certifies that a wig 
or hairpiece has not been obtained previously through the U.S. 
Government (including the Department of Veterans Affairs). The wig or 
hairpiece benefit does not include coverage for the following:
    (i) Maintenance, wig or hairpiece supplies, or replacement of the 
wig or hairpiece.
    (ii) Hair transplant or any other surgical procedure involving the 
attachment of hair or a wig or hairpiece to the scalp.
    (iii) Any diagnostic or therapeutic method or supply intended to 
encourage hair growth.
    (36) Self-help, academic education or vocational training services 
and supplies.
    (37) Exercise equipment, spas, whirlpools, hot tubs, swimming pools, 
health club membership or other such charges or items.
    (38) General exercise programs, even if recommended by a physician.
    (39) Services of an audiologist or speech therapist, except when 
prescribed by a physician and rendered as a part of treatment addressed 
to the physical defect itself and not to any educational or occupational 
deficit.
    (40) Eye exercises or visual training (orthoptics).
    (41) Eye and hearing examinations except when rendered in connection 
with medical or surgical treatment of a covered illness or injury or in 
connection with well-child care.
    (42) Eyeglasses, spectacles, contact lenses, or other optical 
devices with the following exceptions:
    (i) When necessary to perform the function of the human lens, lost 
as a result of intraocular surgery, ocular injury or congenital absence.
    (ii) Pinhole glasses prescribed for use after surgery for detached 
retina.
    (iii) Lenses prescribed as ``treatment'' instead of surgery for the 
following conditions:
    (A) Contact lenses used for treatment of infantile glaucoma.
    (B) Corneal or scleral lenses prescribed in connection with 
treatment of keratoconus.
    (C) Scleral lenses prescribed to retain moisture when normal tearing 
is not present or is inadequate.
    (D) Corneal or scleral lenses prescribed to reduce a corneal 
irregularity other than astigmatism.
    (iv) The specified benefits are limited to one set of lenses related 
to one qualifying eye condition as set forth in paragraphs 
(a)(42)(iii)(A) through (D) of this section. If there is a prescription 
change requiring a new set of lenses, but still related to the 
qualifying eye condition, benefits may be extended for a second set of 
lenses, subject to medical review.
    (43) Hearing aids or other auditory sensory enhancing devices.
    (44) Prostheses with the following exceptions:
    (i) Dental prostheses specifically required in connection with 
otherwise covered orthodontia directly related to the surgical 
correction of a cleft palate anomaly.
    (ii) Any prostheses, other than dental prostheses, determined to be 
medically necessary because of significant conditions resulting from 
trauma, congenital anomalies, or disease, including, but not limited to:
    (A) Artificial limbs.
    (B) Voice prostheses.
    (C) Eyes.
    (D) Items surgically inserted in the body as an integral part of a 
surgical procedure.
    (E) Ears, noses, and fingers.
    (45) Orthopedic shoes, arch supports, shoe inserts, and other 
supportive devices for the feet, including special ordered, custom-made 
built-up shoes, or regular shoes later built up with the following 
exceptions:
    (i) Shoes that are an integral part of an orthopedic brace, and 
which cannot be used separately from the brace.
    (ii) Extra-depth shoes with inserts or custom molded shoes with 
inserts for individuals with diabetes.
    (46) Services or advice rendered by telephone are excluded except 
that a diagnostic or monitoring procedure which incorporates electronic 
transmission of data or remote detection

[[Page 833]]

and measurement of a condition, activity, or function (biotelemetry) is 
covered when:
    (i) The procedure, without electronic data transmission, is a 
covered benefit; and
    (ii) The addition of electronic data transmission or biotelemetry 
improves the management of a clinical condition in defined 
circumstances; and
    (iii) The electronic data or biotelemetry device has been classified 
by the U.S. Food and Drug Administration, either separately or as part 
of a system, for use consistent with the medical condition and clinical 
management of such condition.
    (47) Air conditioners, humidifiers, dehumidifiers, and purifiers.
    (48) Elevators.
    (49) Alterations to living spaces or permanent features attached 
thereto, even when necessary to accommodate installation of covered 
durable medical equipment or to facilitate entrance or exit.
    (50) Items of clothing, even if required by virtue of an allergy 
(such as cotton fabric versus synthetic fabric and vegetable-dyed 
shoes).
    (51) Food, food substitutes, vitamins or other nutritional 
supplements, including those related to prenatal care for a home patient 
whose condition permits oral feeding.
    (52) Enuretic (bed-wetting) conditioning programs.
    (53) Autopsy and post-mortem examinations.
    (54) All camping, even when organized for a specific therapeutic 
purpose (such as diabetic camp or a camp for emotionally disturbed 
children), or when offered as a part of an otherwise covered treatment 
plan.
    (55) Housekeeping, homemaker, or attendant services, including a 
sitter or companion.
    (56) Personal comfort or convenience items, such as beauty and 
barber services, radio, television, and telephone.
    (57) Smoking cessation services and supplies.
    (58) Megavitamin psychiatric therapy; orthomolecular psychiatric 
therapy.
    (59) All transportation except for specialized transportation with 
life sustaining equipment, when medically required for the treatment of 
a covered condition.
    (60) Inpatient mental health services in excess of 30 days in any 
fiscal year (or in an admission), in the case of a patient nineteen 
years of age or older; 45 days in any fiscal year (or in an admission), 
in the case of a patient under 19 years of age; or 150 days of 
residential treatment care in any fiscal year (or in an admission) 
unless a waiver for extended coverage is granted in advance.
    (61) Outpatient mental health services in excess of 23 visits in a 
fiscal year unless a waiver for extended coverage is granted in advance.
    (62) Institutional services for partial hospitalization in excess of 
60 treatment days in any fiscal year (or in an admission) unless a 
waiver for extended coverage is granted in advance.
    (63) Detoxification in a hospital setting or rehabilitation facility 
in excess of seven days.
    (64) Outpatient substance abuse services in excess of 60 visits 
during a benefit period. A benefit period begins with the first date of 
covered service and ends 365 days later.
    (65) Family therapy for substance abuse in excess of 15 visits 
during a benefit period. A benefit period begins with the first date of 
covered service and ends 365 days later.
    (66) Services that are provided to a beneficiary who is referred to 
a provider of such services by a provider who has an economic interest 
in the facility to which the patient is referred, unless a waiver is 
granted.
    (67) Abortion except when a physician certifies that the life of the 
mother would be endangered if the fetus were carried to term.
    (68) Abortion counseling.
    (69) Aversion therapy.
    (70) Rental or purchase of biofeedback equipment.
    (71) Biofeedback therapy for treatment of ordinary muscle tension 
states (including tension headaches) or for psychosomatic conditions.
    (72) Drug maintenance programs where one addictive drug is 
substituted for another, such as methadone substituted for heroin.
    (73) Immunotherapy for malignant diseases except for treatment of 
Stage

[[Page 834]]

O and Stage A carcinoma of the bladder.
    (74) Services and supplies provided by other than a hospital, such 
as nonskilled nursing homes, intermediate care facilities, halfway 
houses, homes for the aged, or other institutions of similar purpose.
    (75) Services performed when the patient is not physically present.
    (76) Medical photography.
    (77) Special tutoring.
    (78) Surgery for psychological reasons.
    (79) Treatment of premenstrual syndrome (PMS).
    (80) Medications not requiring a prescription, except for insulin 
and related diabetic testing supplies and syringes.
    (81) Thermography.
    (82) Removal of tattoos.
    (83) Penile implant/testicular prosthesis procedures and related 
supplies for psychological impotence.
    (84) Dermabrasion of the face except in those cases where coverage 
has been authorized for reconstructive or plastic surgery required to 
restore body form following an accidental injury or to revise 
disfiguring and extensive scars resulting from neoplastic surgery.
    (85) Chemical peeling for facial wrinkles.
    (86) Panniculectomy, body sculpting procedures.
    (b) CHAMPVA-determined allowable amount.
    (1) The term allowable amount is the maximum CHAMPVA-determined 
level of payment to a hospital or other authorized institutional 
provider, a physician or other authorized individual professional 
provider, or other authorized provider for covered services. The 
CHAMPVA-allowable amount is determined prior to cost sharing and the 
application of deductibles and/or other health insurance.
    (2) A Medicare-participating hospital must accept the CHAMPVA-
determined allowable amount for inpatient services as payment-in-full. 
(Reference 42 CFR parts 489 and 1003).
    (3) An authorized provider of covered medical services or supplies 
must accept the CHAMPVA-determined allowable amount as payment-in-full.
    (4) A provider who has collected and not made appropriate refund, or 
attempts to collect from the beneficiary, any amount in excess of the 
CHAMPVA-determined allowable amount may be subject to exclusion from 
Federal benefit programs.

(Authority: 38 U.S.C. 501, 1781)

[63 FR 48102, Sept. 9, 1998, as amended at 67 FR 4359, Jan. 30, 2002; 73 
FR 65553, Nov. 4, 2008]



Sec.  17.273  Preauthorization.

    Preauthorization or advance approval is required for any of the 
following:
    (a) Non-emergent inpatient mental health and substance abuse care 
including admission of emotionally disturbed children and adolescents to 
residential treatment centers.
    (b) All admissions to a partial hospitalization program (including 
alcohol rehabilitation).
    (c) Outpatient mental health visits in excess of 23 per calendar 
year and/or more than two (2) sessions per week.
    (d) Dental care.
    (e) Durable medical equipment with a purchase or total rental price 
in excess of $2,000.
    (f) Organ transplants.

(Authority: 38 U.S.C. 501, 1781)

[63 FR 48102, Sept. 9, 1998, as amended at 74 FR 31374, July 1, 2009]



Sec.  17.274  Cost sharing.

    (a) With the exception of services obtained through VA facilities, 
CHAMPVA is a cost-sharing program in which the cost of covered services 
is shared with the beneficiary. CHAMPVA pays the CHAMPVA-determined 
allowable amount less the deductible, if applicable, and less the 
beneficiary cost share.
    (b) In addition to the beneficiary cost share, an annual (calendar 
year) outpatient deductible requirement ($50 per beneficiary or $100 per 
family) must be satisfied prior to the payment of outpatient benefits. 
There is no deductible requirement for inpatient services or for 
services provided through VA facilities.
    (c) To provide financial protection against the impact of a long-
term illness or injury, a calendar year cost limit or ``catastrophic 
cap'' has been placed on the beneficiary cost-share

[[Page 835]]

amount for covered services and supplies. Credits to the annual 
catastrophic cap are limited to the applied annual deductible(s) and the 
beneficiary cost-share amount. Costs above the CHAMPVA-allowable amount, 
as well as costs associated with non-covered services are not credited 
to the catastrophic cap computation. After a family has paid the maximum 
cost-share and deductible amounts for a calendar year, CHAMPVA will pay 
allowable amounts for the remaining covered services through the end of 
that calendar year.
    (i) Through December 31, 2001, the annual cap on cost sharing is 
$7,500 per CHAMPVA-eligible family.
    (ii) Effective January 1, 2002, the cap on cost sharing is $3,000 
per CHAMPVA-eligible family.
    (d) If the CHAMPVA benefit payment is under $1.00, payment will not 
be issued. Catastrophic cap and deductible will, however, be credited.

(Authority: 38 U.S.C. 501, 1781)

[67 FR 4359, Jan. 30, 2002, as amended at 67 FR 6875, Feb. 14, 2002]



Sec.  17.275  Claim filing deadline.

    (a) Unless an exception is granted under paragraph (b) of this 
section, claims for medical services and supplies must be filed with the 
Center no later than:
    (1) One year after the date of service; or
    (2) In the case of inpatient care, one year after the date of 
discharge; or
    (3) In the case of retroactive approval for medical services/
supplies, 180 days following beneficiary notification of authorization; 
or
    (4) In the case of retroactive approval of CHAMPVA eligibility, 180 
days following notification to the beneficiary of authorization for 
services occurring on or after the date of first eligibility.
    (b) Requests for an exception to the claim filing deadline must be 
submitted, in writing, to the Center and include a complete explanation 
of the circumstances resulting in late filing along with all available 
supporting documentation. Each request for an exception to the claim 
filing deadline willbe reviewed individually and considered on its own 
merit. The Director, Health Administration Center, or his or her 
designee may grant exceptions to the requirements in paragraph (a) of 
this section if he or she determines that there was good cause for 
missing the filing deadline. For example, when dual coverage exists 
CHAMPVA payment, if any, cannot be determined until after the primary 
insurance carrier has adjudicated the claim. In such circumstances an 
exception may be granted provided that the delay on the part of the 
primary insurance carrier is not attributable to the beneficiary. Delays 
due to provider billing procedures do not constitute a valid basis for 
an exception.

(Authority: 38 U.S.C. 501, 1781)

[63 FR 48102, Sept. 9, 1998, as amended at 73 FR 65553, Nov. 4, 2008]



Sec.  17.276  Appeal/review process.

    Notice of the initial determination regarding payment of CHAMPVA 
benefits will be provided to the beneficiary on a CHAMPVA Explanation of 
Benefits (EOB) form. The EOB form is generated by the CHAMPVA automated 
payment processing system. If a beneficiary disagrees with the 
determination concerning covered services or calculation of benefits, he 
or she may request reconsideration. Such requests must be submitted to 
the Center in writing within one year of the date of the initial 
determination. The request must state why the beneficiary believes the 
decision is in error and must include any new and relevant information 
not previously considered. Any request for reconsideration that does not 
identify the reason for dispute will be returned to the claimant without 
further consideration. After reviewing the claim and any relevant 
supporting documentation, a CHAMPVA benefits advisor will issue a 
written determination to the beneficiary that affirms, reverses or 
modifies the previous decision. If the beneficiary is still 
dissatisfied, within 90 days of the date of the decision he or she may 
make a written request for review by the Director, Health Administration 
Center, or his or her designee. The Director, Health Administration 
Center, or his or her designee will review the claim, and any relevant 
supporting documentation,

[[Page 836]]

and issue a decision in writing that affirms, reverses or modifies the 
previous decision. The decision of the Director, Health Administration 
Center, or his or her designee with respect to benefit coverage and 
computation of benefits is final.

(Authority: 38 U.S.C. 501, 1781)

    Note to Sec.  17.276: Denial of CHAMPVA benefits based on legal 
eligibility requirements may be appealed to the Board of Veterans' 
Appeals in accordance with 38 CFR part 20. Medical determinations are 
not appealable to the Board. 38 CFR 20.101.

[63 FR 48102, Sept. 9, 1998, as amended at 73 FR 65553, Nov. 4, 2008]



Sec.  17.277  Third-party liability/medical care cost recovery.

    The Center will actively pursue third-party liability/medical care 
cost recovery in accordance with applicable law.

(Authority: 42 U.S.C. 2651; 38 U.S.C. 501, 1781)

[63 FR 48102, Sept. 9, 1998, as amended at 79 FR 54616, Sept. 12, 2014]



Sec.  17.278  Confidentiality of records.

    Confidentiality of records will be maintained in accordance with 38 
CFR 1.460 through 1.582.

(Authority: 5 U.S.C. 552, 552a; 38 U.S.C. 501, 1781, 5701, 7332)

      In Vitro Fertilization and Reimbursement of Adoption Expenses



Sec.  17.380  In vitro fertilization treatment.

    (a)(1) In vitro fertilization may be provided when clinically 
appropriate to--
    (i) A veteran who has a service-connected disability that results in 
the inability of the veteran to procreate without the use of fertility 
treatment; and,
    (ii) The spouse of such veteran, as provided in Sec.  17.412.
    (2) For the purposes of this section, ``a service-connected 
disability that results in the inability of the veteran to procreate 
without the use of fertility treatment'' means, for a male veteran, a 
service-connected injury or illness that prevents the successful 
delivery of sperm to an egg; and, for a female veteran with ovarian 
function and a patent uterine cavity, a service-connected injury or 
illness that prevents the egg from being successfully fertilized by 
sperm.
    (3) In vitro fertilization treatment will be provided under this 
section when clinically appropriate and to the same extent such 
treatment is provided to a member of the Armed Forces who incurs a 
serious injury or illness on active duty pursuant to 10 U.S.C. 
1074(c)(4)(A), as described in the April 3, 2012, memorandum issued by 
the Assistant Secretary of Defense for Health Affairs on the subject of 
``Policy for Assisted Reproductive Services for the Benefit of Seriously 
or Severely Ill/Injured (Category II or III) Active Duty Service 
Members,'' and the guidance issued by the Department of Defense to 
implement such policy, including any limitations on the amount of such 
benefits available to such a member.
    (b) The time periods regarding embryo cryopreservation and storage 
set forth in part III(G) and in part IV(H) of the memorandum referenced 
in paragraph (a)(3) of this section do not apply. Embryo 
cryopreservation and storage may be provided to an individual described 
in paragraph (a)(1) of this section without limitation on the duration 
of such cryopreservation and storage.

[82 FR 6275, Jan. 19, 2017, as amended at 82 FR 11153, Feb. 21, 2017; 84 
FR 8257, Mar. 7, 2019]



Sec.  17.390  Reimbursement for qualifying adoption expenses incurred by
certain veterans.

    (a) General. A covered veteran may request reimbursement for 
qualifying adoption expenses incurred by the veteran in the adoption of 
a child under 18 years of age.
    (1) An adoption for which expenses may be reimbursed under this 
section includes an adoption by a married or single person, an infant 
adoption, an intercountry adoption, and an adoption of a child with 
special needs (as defined in section 473(c) of the Social Security Act 
(42 U.S.C. 673(c))).
    (2) Reimbursement for qualifying adoption expenses may be requested 
only for an adoption that became final after September 29, 2016, and 
must be requested:

[[Page 837]]

    (i) No later than 2 years after the adoption is final; or,
    (ii) In the case of adoption of a foreign child, no later than 2 
years from the date the certificate of United States citizenship is 
issued.
    (3) In the case of adoption of a foreign child, reimbursement for 
qualifying adoption expenses may be requested only after United States 
citizenship has been granted to the adopted child.
    (4) Reimbursement for qualifying adoption expenses may not be made 
under this section for any expense paid to or for a covered veteran 
under any other adoption benefits program administered by the Federal 
Government or under any such program administered by a State or local 
government.
    (b) Limitations. (1) Reimbursement per adopted child. No more than 
$2,000 may be reimbursed under this section to a covered veteran, or to 
two covered veterans who are spouses of each other, for expenses 
incurred in the adoption of a child. In the case of two married covered 
veterans, only one spouse may claim reimbursement for any one adoption.
    (2) Maximum reimbursement in any calendar year. No more than $5,000 
may be paid under this section to a covered veteran in any calendar 
year. In the case of two married covered veterans, the couple is limited 
to a maximum of $5,000 per calendar year.
    (c) Definitions. For the purposes of this section:
    (1) ``Covered veteran'' means a veteran with a service-connected 
disability that results in the inability of the veteran to procreate 
without the use of fertility treatment.
    (2) ``Qualifying adoption expenses'' means reasonable and necessary 
expenses that are directly related to the legal adoption of a child 
under 18 years of age, but only if such adoption is arranged by a 
qualified adoption agency. Such term does not include any expense 
incurred:
    (i) For items such as clothing, bedding, toys and books;
    (ii) For travel; or
    (iii) In connection with an adoption arranged in violation of 
Federal, State, or local law.
    (3) ``Reasonable and necessary expenses'' include:
    (i) Public and private agency fees, including adoption fees charged 
by an agency in a foreign country;
    (ii) Placement fees, including fees charged to adoptive parents for 
counseling;
    (iii) Legal fees (including court costs) or notary expenses;
    (iv) Medical expenses, including hospital expenses of the biological 
mother and medical care of the child to be adopted; and
    (v) Temporary foster care charges when payment of such charges is 
required before the adoptive child's placement.
    (4) ``Qualified adoption agency'' means any of the following:
    (i) A State or local government agency which has responsibility 
under State or local law for child placement through adoption.
    (ii) A nonprofit, voluntary adoption agency which is authorized by 
State or local law to place children for adoption.
    (iii) Any other source authorized by a State to provide adoption 
placement if the adoption is supervised by a court under State or local 
law.
    (iv) A foreign government or an agency authorized by a foreign 
government to place children for adoption, in any case in which:
    (A) The adopted child is entitled to automatic citizenship under 
section 320 of the Immigration and Nationality Act (8 U.S.C. 1431); or
    (B) A certificate of citizenship has been issued for such child 
under section 322 of that Act (8 U.S.C. 1433).
    (d) Applying for reimbursement of qualifying adoption expenses. An 
application for reimbursement must be submitted on a form prescribed for 
such purpose by VA. Information and documentation must include:
    (1) A copy of the final adoption decree, certificate or court order 
granting the adoption. For U.S. adoptions, the court order must be 
signed by a judge unless either State law or local court rules authorize 
that the adoption order may be signed by a commissioner, magistrate or 
court referee. The covered veteran must submit a full

[[Page 838]]

English translation of any foreign language document, to include the 
translator's certification that he or she is competent to translate the 
foreign language to English and that his or her translation is complete 
and correct.
    (2) For foreign adoptions, proof of U.S. citizenship of the child, 
including any of the following:
    (i) A copy of Certificate of Citizenship.
    (ii) A copy of a U.S. court order that recognizes the foreign 
adoption, or documents the re-adopting of the child in the United 
States.
    (iii) A letter from the United States Citizenship and Immigration 
Services, which states the status of the child's adoption.
    (iv) A copy of the child's U.S. passport (page with personal 
information only).
    (3) For U.S. adoptions, documentation to show that the adoption was 
handled by a qualified adoption agency or other source authorized by a 
State or local law to provide adoption placement. Acceptable forms of 
proof that the adoption was handled by a qualified adoption agency 
include:
    (i) A copy of placement agreement from the adoption agency showing 
the agreement entered into between the member and the agency.
    (ii) A letter from the adoption agency stating that the agency 
arranged the adoption and that the agency is a licensed child placing 
agency in the United States.
    (iii) Receipts for payment to the adoption agency, as well as proof, 
(e.g., a copy of the agency's web page), of the agency's status as a 
for-profit or non-profit licensed child placing agency.
    (4) For foreign adoptions, documentation to show that the adoption 
was handled by a qualified adoption agency. In addition to the forms of 
acceptable proof that the adoption was handled by a qualified adoption 
agency listed in paragraph (d)(3) of this section, the documentation 
must also include:
    (i) A document that describes the mission of the foreign agency and 
its authority from the foreign government to place children for 
adoption; and
    (ii) A placement agreement from the adoption agency or letter from 
the adoption agency stating the specific services it provided for the 
adoption.
    (5) Documentation to substantiate reasonable and necessary expenses 
paid by the covered veteran. Acceptable forms of documentation include 
receipts, cancelled checks, or a letter from the adoption agency showing 
the amount paid by the member. Receipts from a foreign entity should 
include the U.S. currency equivalency. Reconstruction of expense records 
is permissible when the original records are unavailable and the covered 
veteran submits a notarized affidavit stating the costs.
    (6) Checking or savings account information to facilitate VA 
providing reimbursement to the covered veteran under this section.
    (e) Failure to establish eligibility. If documents submitted by a 
covered veteran in support of an application for reimbursement do not 
establish eligibility for reimbursement or justify claimed expenses, VA 
will retain the application and advise the covered veteran of additional 
documentation needed. All requested documentation must be submitted to 
VA within 90 calendar days of VA request.

(The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-0860)

[83 FR 9212, Mar. 5, 2018, as amended at 84 FR 68048, Dec. 13, 2019; 85 
FR 31983, May 28, 2020]

    Hospital Care and Medical Services for Camp Lejeune Veterans and 
                                Families



Sec.  17.400  Hospital care and medical services for Camp Lejeune 
veterans.

    (a) General. In accordance with this section, VA will provide 
hospital care and medical services to Camp Lejeune veterans. Camp 
Lejeune veterans will be enrolled pursuant to Sec.  17.36(b)(6).
    (b) Definitions. For the purposes of this section:
    Camp Lejeune means any area within the borders of the U.S. Marine 
Corps Base Camp Lejeune or Marine Corps Air Station New River, North 
Carolina.
    Camp Lejeune veteran means any veteran who served at Camp Lejeune on 
active duty, as defined in 38 U.S.C. 101(21), in the Armed Forces for at 
least

[[Page 839]]

30 (consecutive or nonconsecutive) days during the period beginning on 
August 1, 1953, and ending on December 31, 1987. A veteran served at 
Camp Lejeune if he or she was stationed at Camp Lejeune, or traveled to 
Camp Lejeune as part of his or her professional duties.
    Covered illness or condition means any of the following illnesses 
and conditions:
    (i) Esophageal cancer;
    (ii) Lung cancer;
    (iii) Breast cancer;
    (iv) Bladder cancer;
    (v) Kidney cancer;
    (vi) Leukemia;
    (vii) Multiple myeloma;
    (viii) Myelodysplastic syndromes;
    (ix) Renal toxicity;
    (x) Hepatic steatosis;
    (xi) Female infertility;
    (xii) Miscarriage;
    (xiii) Scleroderma;
    (xiv) Neurobehavioral effects; and
    (xv) Non-Hodgkin's lymphoma.
    (c) Limitations. For a Camp Lejeune veteran, VA will assume that a 
covered illness or condition is attributable to the veteran's active 
duty service at Camp Lejeune unless it is clinically determined, under 
VA clinical practice guidelines, that such an illness or condition 
resulted from a cause other than such service.
    (d) Copayments--(1) Exemption. (i) Camp Lejeune veterans who served 
at Camp Lejeune between January 1, 1957, and December 31, 1987, are not 
subject to copayment requirements for hospital care and medical services 
provided for a covered illness or condition on or after August 6, 2012.
    (ii) Camp Lejeune veterans who served at Camp Lejeune between August 
1, 1953, and December 31, 1956, are not subject to copayment 
requirements for hospital care and medical services provided for a 
covered illness or condition on or after December 16, 2014.
    (2) Retroactive exemption. VA will reimburse Camp Lejeune veterans 
for any copayments paid to VA for hospital care and medical services 
provided for a covered illness or condition if either of the following 
is true:
    (i) For Camp Lejeune veterans who served at Camp Lejeune between 
January 1, 1957, and December 31, 1987, VA provided the hospital care or 
medical services to the Camp Lejeune veteran on or after August 6, 2012, 
and the veteran requested Camp Lejeune veteran status no later than 
September 24, 2016; or
    (ii) For Camp Lejeune veterans who served at Camp Lejeune between 
August 1, 1953, and December 31, 1956, VA provided the hospital care or 
medical services to the Camp Lejeune veteran on or after December 16, 
2014, and the veteran requested Camp Lejeune veteran status no later 
than July 18, 2018.

(The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-0091.)

(Authority: 38 U.S.C. 1710)

[81 FR 46605, July 18, 2016]

       Hospital Care and Medical Services for Spouses and Families



Sec.  17.410  Hospital care and medical services for Camp Lejeune 
family members.

    (a) General. In accordance with this section and subject to the 
availability of funds appropriated for such purpose, VA will provide 
payment or reimbursement for certain hospital care and medical services 
furnished to Camp Lejeune family members by non-VA health care 
providers.
    (b) Definitions. For the purposes of this section:
    Camp Lejeune has the meaning set forth in Sec.  17.400(b).
    Camp Lejeune family member means an individual who:
    (i) Resided at Camp Lejeune (or was in utero while his or her mother 
either resided at Camp Lejeune or served at Camp Lejeune under Sec.  
17.400(b)) for at least 30 (consecutive or nonconsecutive) days during 
the period beginning on August 1, 1953, and ending on December 31, 1987; 
and
    (ii) Meets one of the following criteria:
    (A) Is related to a Camp Lejeune veteran by birth;
    (B) Was married to a Camp Lejeune veteran; or
    (C) Was a legal dependent of a Camp Lejeune veteran.
    Camp Lejeune veteran has the meaning set forth in Sec.  17.400(b).

[[Page 840]]

    Health-plan contract has the meaning set forth in Sec.  17.1001(a).
    Third party has the meaning set forth in Sec.  17.1001(b).
    (c) Application. An individual may apply for benefits under this 
section by completing and submitting an application form.
    (d) Payment or reimbursement of certain medical care and hospital 
services. VA will provide payment or reimbursement for hospital care and 
medical services provided to a Camp Lejeune family member by a non-VA 
provider if all of the following are true:
    (1) The Camp Lejeune family member or provider of care or services 
has submitted a timely claim for payment or reimbursement, which means:
    (i) In the case of a Camp Lejeune family member who resided at Camp 
Lejeune between January 1, 1957, and December 31, 1987, for hospital 
care and medical services received prior to the date an application for 
benefits is filed per paragraph (c) of this section, the hospital care 
and medical services must have been provided on or after March 26, 2013, 
but no more than 2 years prior to the date that VA receives the 
application. The claim for payment or reimbursement must be received by 
VA no more than 60 days after VA approves the application;
    (ii) In the case of a Camp Lejeune family member who resided at Camp 
Lejeune between August 1, 1953, and December 31, 1956, for hospital care 
and medical services received prior to the date an application for 
benefits is filed per paragraph (c) of this section, the hospital care 
and medical services must have been provided on or after December 16, 
2014, but no more than 2 years prior to the date that VA receives the 
application. The claim for payment or reimbursement must be received by 
VA no more than 60 days after VA approves the application;
    (iii) For hospital care and medical services provided on or after 
the date an application for benefits is filed per paragraph (c) of this 
section, the claim for payment or reimbursement must be received by VA 
no more than 2 years after the later of either the date of discharge 
from a hospital or the date that medical services were rendered;
    (2) The Camp Lejeune family member's treating physician certifies 
that the claimed hospital care or medical services were provided for a 
covered illness or condition as defined in Sec.  17.400(b), and provides 
information about any co-morbidities, risk factors, or other exposures 
that may have contributed to the illness or condition;
    (3) VA makes the clinical finding, under VA clinical practice 
guidelines, that the illness or condition did not result from a cause 
other than the residence of the family member at Camp Lejeune;
    (4) VA would be authorized to provide the claimed hospital care or 
medical services to a veteran under VA's medical benefits package in 
Sec.  17.38;
    (5) The Camp Lejeune family member or hospital care or medical 
service provider has exhausted without success all claims and remedies 
reasonably available to the family member or provider against a third 
party, including health-plan contracts; and
    (6) Funds were appropriated to implement 38 U.S.C. 1787 in a 
sufficient amount to permit payment or reimbursement.
    (e) Payment or reimbursement amounts. Payments or reimbursements 
under this section will be in amounts determined in accordance with this 
paragraph (e).
    (1) If a third party is partially liable for the claimed hospital 
care or medical services, then VA will pay or reimburse the lesser of 
the amount for which the Camp Lejeune family member remains personally 
liable or the amount for which VA would pay for such care under 
Sec. Sec.  17.55 and 17.56.
    (2) If VA is the sole payer for hospital care and medical services, 
then VA will pay or reimburse in accordance with Sec. Sec.  17.55 and 
17.56, as applicable.
    (The information collection requirements have been submitted to OMB 
and are pending OMB approval.)

[82 FR 21122, May 5, 2017]



Sec.  17.412  Fertility counseling and treatment for certain spouses.

    (a)(1) VA may provide fertility counseling and treatment to a spouse 
of a veteran described in Sec.  17.380 to the extent such services are 
available to a veteran under Sec.  17.38, and consistent

[[Page 841]]

with the benefits relating to reproductive assistance provided to a 
member of the Armed Forces who incurs a serious injury or illness on 
active duty pursuant to 10 U.S.C. 1074(c)(4)(A), as described in the 
April 3, 2012, memorandum issued by the Assistant Secretary of Defense 
for Health Affairs on the subject of ``Policy for Assisted Reproductive 
Services for the Benefit of Seriously or Severely Ill/Injured (Category 
II or III) Active Duty Service Members,'' and the guidance issued by the 
Department of Defense to implement such policy, including any 
limitations on the amount of such benefits available to such a member.
    (2) VA may provide in vitro fertilization to a spouse of a veteran 
described in Sec.  17.380 when clinically appropriate and consistent 
with the benefits relating to reproductive assistance provided to a 
member of the Armed Forces who incurs a serious injury or illness on 
active duty pursuant to 10 U.S.C. 1074(c)(4)(A), as described in the 
April 3, 2012, memorandum issued by the Assistant Secretary of Defense 
for Health Affairs on the subject of ``Policy for Assisted Reproductive 
Services for the Benefit of Seriously or Severely Ill/Injured (Category 
II or III) Active Duty Service Members,'' and the guidance issued by the 
Department of Defense to implement such policy, including any 
limitations on the amount of such benefits available to such a member.
    (b) The time periods regarding embryo cryopreservation and storage 
set forth in part III(G) and in part IV(H) of the memorandum referenced 
in paragraph (a) of this section do not apply. Embryo cryopreservation 
and storage may be provided to a spouse of a covered veteran without 
limitation on the duration of such cryopreservation and storage.

[82 FR 6276, Jan. 19, 2017, as amended at 81 FR 11153, Feb. 21, 2017; 84 
FR 8257, Mar. 7, 2019]

          Authority of Health Care Providers to Practice in VA



Sec.  17.415  Full practice authority for advanced practice registered 
nurses.

    (a) Advanced practice registered nurse (APRN). For purposes of this 
section, an advanced practice registered nurse (APRN) is an individual 
who:
    (1) Has completed a nationally-accredited, graduate-level 
educational program that prepares them for one of the three APRN roles 
of Certified Nurse Practitioner (CNP), Clinical Nurse Specialist (CNS), 
or Certified Nurse-Midwife (CNM);
    (2) Has passed a national certification examination that measures 
knowledge in one of the APRN roles described in paragraph (a)(1) of this 
section;
    (3) Has obtained a license from a State licensing board in one of 
three recognized APRN roles described in paragraph (a)(1) of this 
section; and
    (4) Maintains certification and licensure as required by paragraphs 
(a)(2) and (3) of this section.
    (b) Full practice authority. For purposes of this section, full 
practice authority means the authority of an APRN to provide services 
described in paragraph (d) of this section without the clinical 
oversight of a physician, regardless of State or local law restrictions, 
when that APRN is working within the scope of their VA employment.
    (c) Granting of full practice authority. VA may grant full practice 
authority to an APRN subject to the following:
    (1) Verification that the APRN meets the requirements established in 
paragraph (a) of this section; and
    (2) Determination that the APRN has demonstrated the knowledge and 
skills necessary to provide the services described in paragraph (d) of 
this section without the clinical oversight of a physician, and is thus 
qualified to be privileged for such scope of practice.
    (d) Services provided by an APRN with full practice authority. (1) 
Subject to the limitations established in paragraph (d)(2) of this 
section, the full practice authority for each of the three APRN roles 
includes, but is not limited to, providing the following services:
    (i) A CNP has full practice authority to:
    (A) Take comprehensive histories, provide physical examinations and 
other health assessment and screening activities, diagnose, treat, and 
manage patients with acute and chronic illnesses and diseases;

[[Page 842]]

    (B) Order laboratory and imaging studies and integrate the results 
into clinical decision making;
    (C) Prescribe medication and durable medical equipment;
    (D) Make appropriate referrals for patients and families, and 
request consultations;
    (E) Aid in health promotion, disease prevention, health education, 
and counseling as well as the diagnosis and management of acute and 
chronic diseases.
    (ii) A CNS has full practice authority to provide diagnosis and 
treatment of health or illness states, disease management, health 
promotion, and prevention of illness and risk behaviors among 
individuals, families, groups, and communities within their scope of 
practice.
    (iii) A CNM has full practice authority to provide a range of 
primary health care services to women, including gynecologic care, 
family planning services, preconception care (care that women veterans 
receive before becoming pregnant, including reducing the risk of birth 
defects and other problems such as the treatment of diabetes and high 
blood pressure), prenatal and postpartum care, childbirth, and care of a 
newborn, and treating the partner of their female patients for sexually 
transmitted disease and reproductive health, if the partner is also 
enrolled in the VA healthcare system or is not required to enroll.
    (2) The full practice authority of an APRN is subject to the 
limitations imposed by the Controlled Substances Act, 21 U.S.C. 801 et 
seq., and that APRN's State licensure on the authority to prescribe, or 
administer controlled substances, as well as any other limitations on 
the provision of VA care set forth in applicable Federal law and policy.
    (e) Preemption of State and local law. To achieve important Federal 
interests, including but not limited to the ability to provide the same 
comprehensive care to veterans in all States under 38 U.S.C. 7301, this 
section preempts conflicting State and local laws relating to the 
practice of APRNs when such APRNs are working within the scope of their 
VA employment. Any State or local law, or regulation pursuant to such 
law, is without any force or effect on, and State or local governments 
have no legal authority to enforce them in relation to, activities 
performed under this section or decisions made by VA under this section.

[81 FR 90206, Dec. 14, 2016]



Sec.  17.417  Health care providers practicing via telehealth.

    (a) Definitions. The following definitions apply to this section.
    (1) Beneficiary. The term beneficiary means a veteran or any other 
individual receiving health care under title 38 of the United States 
Code.
    (2) Health care provider. The term health care provider means an 
individual who:
    (i) Is licensed, registered, or certified in a State to practice a 
health care specialty identified under 38 U.S.C. 7402(b);
    (ii) Is appointed to an occupation in the Veterans Health 
Administration that is listed in or authorized under 38 U.S.C. 7401(1) 
or (3);
    (iii) Maintains credentials (e.g., a license, registration, or 
certification) in accordance with the requirements of his or her health 
care specialty as identified under 38 U.S.C. 7402(b); and
    (iv) Is not a VA-contracted health care provider.
    (3) State. The term State means a State as defined in 38 U.S.C. 
101(20), or a political subdivision of such a State.
    (4) Telehealth. The term telehealth means the use of electronic 
information or telecommunications technologies to support clinical 
health care, patient and professional health-related education, public 
health, and health administration.
    (b) Health care provider's practice via telehealth. (1) Health care 
providers may provide telehealth services, within their scope of 
practice, functional statement, and/or in accordance with privileges 
granted to them by VA, irrespective of the State or location within a 
State where the health care provider or the beneficiary is physically 
located. Health care providers' practice is subject to the limitations 
imposed by the Controlled Substances Act, 21 U.S.C. 801, et seq., on the 
authority to prescribe or administer controlled substances, as well as 
any other limitations on the provision of VA care set

[[Page 843]]

forth in applicable Federal law and policy. This section only grants 
health care providers the ability to practice telehealth within the 
scope of their VA employment and does not otherwise grant health care 
providers additional authorities that go beyond what is required or 
authorized by Federal law and regulations or as defined in the laws and 
practice acts of the health care providers' State license, registration, 
or certification.
    (2) Situations where a health care provider's VA practice of 
telehealth may be inconsistent with a State law or State license, 
registration, or certification requirements related to telehealth 
include when:
    (i) The beneficiary and the health care provider are physically 
located in different States during the episode of care;
    (ii) The beneficiary is receiving services in a State other than the 
health care provider's State of licensure, registration, or 
certification;
    (iii) The health care provider is delivering services in a State 
other than the health care provider's State of licensure, registration, 
or certification;
    (iv) The health care provider is delivering services either on or 
outside VA property;
    (v) The beneficiary is receiving services while she or he is located 
either on or outside VA property;
    (vi) The beneficiary has or has not previously been assessed, in 
person, by the health care provider; or
    (vii) Other State requirements would prevent or impede the practice 
of health care providers delivering telehealth to VA beneficiaries.
    (c) Preemption of State law. To achieve important Federal interests, 
including, but not limited to, the ability to provide the same complete 
health care and hospital service to beneficiaries in all States under 38 
U.S.C. 7301, this section preempts conflicting State laws relating to 
the practice of health care providers when such health care providers 
are practicing telehealth within the scope of their VA employment. Any 
State law, rule, regulation or requirement pursuant to such law, is 
without any force or effect on, and State governments have no legal 
authority to enforce them in relation to, this section or decisions made 
by VA under this section.

[83 FR 21906, May 11, 2018]



Sec.  17.419  Health care professionals' practice in VA.

    (a) Definitions. The following definitions apply to this section.
    (1) Beneficiary. The term beneficiary means a veteran or any other 
individual receiving health care under title 38 of the United States 
Code.
    (2) Health care professional. The term health care professional is 
an individual who:
    (i) Is appointed to an occupation in the Veterans Health 
Administration that is listed in or authorized under 38 U.S.C. 7306, 
7401, 7405, 7406, or 7408 or title 5 of the U.S. Code;
    (ii) Is not a VA-contracted health care professional; and
    (iii) Is qualified to provide health care as follows:
    (A) Has an active, current, full, and unrestricted license, 
registration, certification, or satisfies another State requirement in a 
State;
    (B) Has other qualifications as prescribed by the Secretary for one 
of the health care professions listed under 38 U.S.C. 7402(b);
    (C) Is an employee otherwise authorized by the Secretary to provide 
health care services; or
    (D) Is under the clinical supervision of a health care professional 
that meets the requirements of subsection (a)(2)(iii)(A)-(C) of this 
section and is either:
    (i) A health professions trainee appointed under 38 U.S.C. 7405 or 
7406 participating in clinical or research training under supervision to 
satisfy program or degree requirements; or
    (ii) A health care employee, appointed under title 5 of the U.S. 
Code, 38 U.S.C. 7401(1) or (3), or 38 U.S.C. 7405 for any category of 
personnel described in 38 U.S.C. 7401(1) or (3) who must obtain an 
active, current, full and unrestricted licensure, registration, 
certification, or meet the qualification standards as defined by the 
Secretary within the specified time frame.
    (3) State. The term State means a State as defined in 38 U.S.C. 
101(20), or a political subdivision of such a State.

[[Page 844]]

    (b) Health care professional's practice. (1) When a State law or 
license, registration, certification, or other requirement prevents or 
unduly interferes with a health care professional's practice within the 
scope of their VA employment, the health care professional is required 
to abide by their Federal duties, which includes, but is not limited to, 
the following situations:
    (i) A health care professional may practice their VA health care 
profession in any State irrespective of the State where they hold a 
valid license, registration, certification, or other State 
qualification; or
    (ii) A health care professional may practice their VA health care 
profession within the scope of the VA national standard of practice as 
determined by VA.
    (2) VA health care professional's practice is subject to the 
limitations imposed by the Controlled Substances Act, 21 U.S.C. 801 et 
seq. and implementing regulations at 21 CFR 1300 et seq., on the 
authority to prescribe or administer controlled substances, as well as 
any other limitations on the provision of VA care set forth in 
applicable Federal law and policy.
    (c) Preemption of State law. Pursuant to the Supremacy Clause, U.S. 
Const. art. IV, cl. 2, and in order to achieve important Federal 
interests, including, but not limited to, the ability to provide the 
same complete health care and hospital service to beneficiaries in all 
States as required by 38 U.S.C. 7301, conflicting State laws, rules, 
regulations or requirements pursuant to such laws are without any force 
or effect, and State governments have no legal authority to enforce them 
in relation to actions by health care professionals within the scope of 
their VA employment.

[85 FR 71845, Nov. 12, 2020]

               Center for Innovation for Care and Payment



Sec.  17.450  Center for Innovation for Care and Payment.

    (a) Purpose and organization. The purpose of this section is to 
establish procedures for the Center for Innovation for Care and Payment.
    (1) The Center for Innovation for Care and Payment will be 
responsible for working across VA to carry out pilot programs to develop 
innovative approaches to testing payment and service delivery models to 
reduce expenditures while preserving or enhancing the quality of care 
furnished by VA.
    (2) The Center for Innovation for Care and Payment will not operate 
within any specific administration but will operate in VA's corporate 
portfolio to ensure the limited number of concurrent pilot programs 
under this section are not redundant of or conflicted by ongoing 
innovation efforts within any specific administration.
    (b) Definitions. The following definitions apply to this section.
    Access refers to entry into or use of VA services.
    Patient satisfaction of care and services refers to patients' rating 
of their experiences of care and services and as further defined in a 
pilot program proposal.
    Payment models refer to the types of payment, reimbursement, or 
incentives that VA deems appropriate for advancing the health and well-
being of beneficiaries.
    Pilot program refers to a pilot program conducted under this 
section.
    Quality enhancement refers to improvement or improvements in such 
factors as clinical quality, beneficiary-level outcomes, and functional 
status as documented through improvements in measurement data from a 
reliable and valid source, and as further defined in a pilot program 
proposal.
    Quality preservation refers to the maintenance of such factors as 
clinical quality, beneficiary-level outcomes, and functional status as 
documented through maintenance of measurement data from an evidence-
based source, and as further defined in a pilot program proposal.
    Reduction in expenditure refers to, but is not limited to, cost 
stabilization, cost avoidance, or decreases in long- or short-term 
spending, and as further defined in a pilot program proposal. NOTE: VA 
will also consider the proposal's potential impact on expenditures for 
other related Federal programs; however, this potential impact

[[Page 845]]

will not count against the limitation in paragraph (d)(2) of this 
section.
    Service delivery models refer to all methods or programs for 
furnishing care or services.
    (c) Geographic locations. VA will make decisions regarding the 
location of each pilot program based upon the appropriateness of testing 
a specific model in a specific area while taking efforts to ensure that 
pilot programs are operated in geographically diverse areas of the 
country. VA will include in its proposal to Congress and publish a 
document in the Federal Register identifying the geographic locations 
proposed for each pilot program, the rationale for those selections, and 
how VA believes the selected locations will address deficits in care for 
a defined population.
    (d) Limitations. In carrying out pilot programs under this section, 
VA will not:
    (1) Actively operate more than 10 pilot programs at the same time; 
and
    (2) Consistent with 38 U.S.C. 1703E(d), obligate more than $50 
million in any fiscal year in the conduct of the pilot programs 
(including all administrative and overhead costs, such as measurement, 
evaluation, and expenses to implement the pilot programs themselves) 
operated under this section, unless VA determines it to be necessary and 
submits a report to the appropriate Committees of Congress that sets 
forth the amount of, and justification for, the additional expenditure.
    (e) Waiver of authorities. In carrying out pilot programs under this 
section, VA may waive statutory provisions by adding to or removing from 
statutory text in subchapters I, II, and III of chapter 17, title 38, 
U.S.C., upon Congressional approval, including waiving any provisions of 
law in any provision codified in or included as a note to any section in 
subchapter I, II, or III of chapter 17, title 38.
    (1) Upon Congressional approval of the waiver of a provision of law 
under this section, VA will also deem waived any applicable provision of 
regulation implementing such law as identified in VA's pilot program 
proposal.
    (2) VA will publish a document in the Federal Register providing 
information about, and seeking comment on, each proposed pilot program 
upon its submission of a proposal to Congress for approval. VA will 
publish a document in the Federal Register to inform the public of any 
pilot programs that have been approved by Congress.
    (f) Notice of eligibility. VA will take reasonable actions to 
provide direct notice to veterans eligible to participate in a pilot 
program operated under this section and will provide general notice to 
other individuals eligible to participate in a pilot program. VA will 
announce its methods of providing notice to veterans, the public, and 
other individuals eligible to participate through the document it 
publishes in the Federal Register for each proposed and approved pilot 
program.
    (g) Evaluation and reporting. VA will evaluate each pilot program 
operated under this section and report its findings. Evaluations may be 
based on quantitative data, qualitative data, or both. Whenever 
appropriate, evaluations will include a survey of participants or 
beneficiaries to determine their satisfaction with the pilot program. VA 
will make the evaluation results available to the public on the VA 
Innovation Center website on the schedule identified in VA's proposal 
for the pilot program.
    (h) Expansion of pilot programs. VA may expand a pilot program 
consistent with this paragraph (h).
    (1) VA may expand the scope or duration of a pilot program if, based 
on an analysis of the data developed pursuant to paragraph (g) of this 
section for the pilot program, VA expects the pilot program to reduce 
spending without reducing the quality of care or improve the quality of 
patient care without increasing spending. Expansion may only occur if VA 
determines that expansion would not deny or limit the coverage or 
provision of benefits for individuals under 38 U.S.C. chapter 17. 
Expansion of a pilot program may not occur until 60 days after VA has 
published a document in the Federal Register and submitted an interim 
report to Congress stating its intent to expand a pilot program.
    (2) VA may expand the scope of a pilot program by modifying, among 
other elements of a pilot program, the

[[Page 846]]

range of services provided, the qualifying conditions covered, the 
geographic location of the pilot program, or the population of eligible 
participants in a manner that increases participation in or benefits 
under a pilot program.
    (3) In general, pilot programs are limited to 5 years of operation. 
VA may extend the duration of a pilot program by up to an additional 5 
years of operation. Any pilot program extended beyond its initial 5-year 
period must continue to comply with the provisions of this section 
regarding evaluation and reporting under paragraph (g) of this section.
    (i) Modification of pilot programs. The Secretary may modify 
elements of a pilot program in a manner that is consistent with the 
parameters of the Congressional approval of the waiver described in 
paragraph (e) of this section. Such modification does not require a 
submission to Congress for approval under paragraph (e) of this section.
    (j) Termination of pilot programs. If VA determines that a pilot 
program is not producing quality enhancement or quality preservation, or 
is not resulting in the reduction of expenditures, and that it is not 
possible or advisable to modify the pilot program either through 
submission of a new waiver request under paragraph (e) of this section 
or through modification under paragraph (i) of this section, VA will 
terminate the pilot program within 30 days of submitting an interim 
report to Congress that states such determination. VA will also publish 
a document in the Federal Register regarding the pilot program's 
termination.

[84 FR 57329, Oct. 25, 2019]

     Confidentiality of Healthcare Quality Assurance Review Records

    Authority: 38 U.S.C. 5705.

    Source: 59 FR 53355, Oct. 24, 1994, unless otherwise noted.



Sec.  17.500  General.

    (a) Section 5705, title 38, United States Code was enacted to 
protect the integrity of the VA's medical quality assurance program by 
making confidential and privileged certain records and documents 
generated by this program and information contained therein. Disclosure 
of quality assurance records and documents made confidential and 
privileged by 38 U.S.C. 5705 and the regulations in Sec. Sec.  17.500 
through 17.511 may only be made in accordance with the provisions of 38 
U.S.C. 5705 and those regulations.
    (b) The purpose of the regulations in Sec. Sec.  17.500 through 
17.511 is to specify and provide for the limited disclosure of those 
quality assurance documents which are confidential under the provisions 
of 38 U.S.C. 5705.
    (c) For purposes of the regulations in Sec. Sec.  17.500 through 
17.511, the VA's medical quality assurance program consists of 
systematic healthcare reviews carried out by or for VA for the purpose 
of improving the quality of medical care or improving the utilization of 
healthcare resources in VA medical facilities. These review activities 
may involve continuous or periodic data collection and may relate to 
either the structure, process, or outcome of health care provided in the 
VA.
    (d) Nothing in the regulations in Sec. Sec.  17.500 through 17.511 
shall be construed as authority to withhold any record or document from 
a committee or subcommittee of either House of Congress or any joint 
committee or subcommittee of Congress, if such record or document 
pertains to any matter within the jurisdiction of such committee or 
joint committee.
    (e) The regulations in Sec. Sec.  17.500 through 17.511 do not waive 
the sovereign immunity of the United States, and do not waive the 
confidentiality provisions and disclosure restrictions of 38 U.S.C. 
5705.

(Authority: 38 U.S.C. 5705)



Sec.  17.501  Confidential and privileged documents.

    (a) Documents and parts of documents are considered confidential and 
privileged if they were produced by or for the VA in the process of 
conducting systematic healthcare reviews for the purpose of improving 
the quality of health care or improving the utilization of healthcare 
resources in VA healthcare facilities and meet the criteria in 
paragraphs (b) and (c) of this section. The four classes of healthcare

[[Page 847]]

quality assurance reviews with examples are:
    (1) Monitoring and evaluation reviews conducted by a facility:
    (i) Medical records reviews,
    (ii) Drug usage evaluations,
    (iii) Blood usage reviews,
    (iv) Surgical case/invasive procedure reviews,
    (v) Service and program monitoring including monitoring performed by 
individual services or programs, several services or programs working 
together, or individuals from several services or programs working 
together as a team,
    (vi) Mortality and morbidity reviews,
    (vii) Infection control review and surveillance,
    (viii) Occurrence screening,
    (ix) Tort claims peer reviews (except reviews performed to satisfy 
the requirements of a governmental body or a professional health care 
organization which is licensing practitioners or monitoring their 
professional performance),
    (x) Admission and continued stay reviews,
    (xi) Diagnostic studies utilization reviews,
    (xii) Reports of special incidents (VA Form 10-2633 or similar 
forms) and follow-up documents unless developed during or as a result of 
a Board of Investigation;
    (2) Focused reviews which address specific issues or incidents and 
which are designated by the reviewing office at the outset of the review 
as protected by 38 U.S.C. 5705 and the regulations in Sec. Sec.  17.500 
through 17.511; focused reviews may be either:
    (i) Facility focused reviews;
    (ii) VA Central Office or Regional focused reviews;
    (3) VA Central Office or Regional general oversight reviews to 
assess facility compliance with VA program requirements if the reviews 
are designated by the reviewing office at the outset of the review as 
protected by 38 U.S.C. 5705 and the regulations in Sec. Sec.  17.500 
through 17.511; and
    (4) Contracted external reviews of care, specifically designated in 
the contract or agreement as reviews protected by 38 U.S.C. 5705 and the 
regulations in Sec. Sec.  17.500 through 17.511.
    (b) The Under Secretary for Health, Regional Director or facility 
Director will describe in advance in writing those quality assurance 
activities included under the classes of healthcare quality assurance 
reviews listed in paragraph (a) of this section. Only documents and 
parts of documents resulting from those activities which have been so 
described are protected by 38 U.S.C. 5705 and the regulations in 
Sec. Sec.  17.500 through 17.511. If an activity is not described in a 
VA Central Office or Regional policy document, this requirement may be 
satisfied at the facility level by description in advance of the 
activity and its designation as protected in the facility quality 
assurance plan or other policy document.
    (c) Documents and parts of documents generated by activities which 
meet the criteria in paragraphs (a) and (b) of this section shall be 
confidential and privileged only if they:
    (1) Identify, either implicitly or explicitly, individual 
practitioners, patients, or reviewers except as provided in paragraph 
(g)(6) of this section; or
    (2) Contain discussions relating to the quality of VA medical care 
or utilization of VA medical resources by healthcare evaluators during 
the course of a review of quality assurance information or data, even if 
they do not identify practitioners, patients, or reviewers; or
    (3) Are individual committee, service, or study team minutes, notes, 
reports, memoranda, or other documents either produced by healthcare 
evaluators in deliberating on the findings of healthcare reviews, or 
prepared for purposes of discussion or consideration by healthcare 
evaluators during a quality assurance review; or
    (4) Are memoranda, letters, or other documents from the medical 
facility to the Regional Director or VA Central Office which contain 
information generated by a quality assurance activity meeting the 
criteria in Sec.  17.501 (a) and (b); or
    (5) Are memoranda, letters, or other documents produced by the 
Regional Director or VA Central Office which either respond to or 
contain information generated by a quality assurance activity meeting 
the criteria in Sec.  17.501 (a) and (b).

[[Page 848]]

    (d) Documents which meet the criteria in this section are 
confidential and privileged whether they are produced at the medical 
facility, Regional or VA Central Office levels, or by external 
contractors performing healthcare quality assurance reviews.
    (e) Documents which are confidential and privileged may be in 
written, computer, electronic, photographic or any other form.
    (f) Documents which contain confidential and privileged material in 
one part, but not in others, such as Clinical Executive Board minutes, 
should be filed and maintained as if the entire document was protected 
by 38 U.S.C. 5705. This is not required if the confidential and 
privileged material is deleted.
    (g) The following records and documents and parts of records and 
documents are not confidential even if they meet the criteria in 
paragraphs (a) through (c) of this section:
    (1) Statistical information regarding VA healthcare programs or 
activities that does not implicitly or explicitly identify individual VA 
patients or VA employees or individuals involved in the quality 
assurance process;
    (2) Summary documents or records which only identify study topics, 
the period of time covered by the study, criteria, norms, and/or major 
overall findings, but which do not identify individual healthcare 
practitioners, even by implication;
    (3) The contents of Credentialing and Privileging folders as 
described in VACO policy documents (38 U.S.C. 5705-protected records 
shall not be filed in Credentialing and Privileging folders);
    (4) Records and documents developed during or as a result of Boards 
of Investigations;
    (5) Completed patient satisfaction survey questionnaires and 
findings from patient satisfaction surveys;
    (6) Records and documents which only indicate the number of patients 
treated by a practitioner, either by diagnosis or in aggregate, or 
number of procedures performed by a practitioner, either by procedure or 
in aggregate;
    (7) Records and documents developed during or as a result of reviews 
performed to satisfy the requirements of a governmental body or a 
professional healthcare organization which is licensing practitioners or 
monitoring their professional performance, e.g., National Practitioner 
Data Bank, Federation of State Medical Boards, and National Council of 
State Boards of Nursing;
    (8) Documents and reports developed during or as a result of site 
visits by the Office of the Medical Inspector except to the extent that 
the documents and reports contain information that meets the criteria 
described in this section and are produced by or for VA by other than 
the Office of Medical Inspector;
    (9) External reviews conducted by VA Central Office or a Region 
other than those designated by the reviewing office under paragraph 
(a)(2) or (a)(3) of this section as protected by 38 U.S.C. 5705 and the 
regulations in Sec. Sec.  17.500 through 17.511;
    (10) Documents and reports of Professional Standards Boards, 
Credentialing Committees, Executive Committees of Medical Staff, and 
similar bodies, insofar as the documents relate to the credentialing and 
privileging of practitioners;
    (11) Documents and reports developed during or as a result of data 
validation activities;
    (12) Documents and reports developed during or as a result of 
occupational health monitoring;
    (13) Documents and reports developed during or as a result of safety 
monitoring not directly related to the care of specified individual 
patients;
    (14) Documents and reports developed during or as a result of 
resource management activities not directly related to the care of 
specified individual patients; and
    (15) Information and records derived from patient medical records or 
facility administrative records, which are not protected by 38 U.S.C. 
5705 and the regulations in Sec. Sec.  17.500 through 17.511, may be 
sent or communicated to a third party payor who has asked for this 
information in response to a VA request for reimbursement based on 
Public Law 99-272 and Public Law 101-508. Reviews conducted at the 
request of the third party payor do not generate records protected by 38 
U.S.C.

[[Page 849]]

5705 and the regulations in Sec. Sec.  17.500 through 17.511 since the 
reviews are not undertaken as part of the VA's quality assurance 
program.

(Authority: 38 U.S.C. 5705)



Sec.  17.502  Applicability of other statutes.

    (a) Disclosure of quality assurance records and documents which are 
not confidential and privileged under 38 U.S.C. 5705 and the 
confidentiality regulations in Sec. Sec.  17.500 through 17.511 will be 
governed by the provisions of the Freedom of Information Act, and, if 
applicable, the Privacy Act and any other VA or federal confidentiality 
statutes.
    (b) When included in a quality assurance review, confidential 
records protected by other confidentiality statutes such as 5 U.S.C. 
552a (the Privacy Act), 38 U.S.C. 7332 (drug and alcohol abuse, sickle 
cell anemia, HIV infection), and 38 U.S.C. 5701 (veterans' names and 
addresses) retain whatever confidentiality protection they have under 
these laws and applicable regulations and will be handled accordingly. 
To the extent that information protected by 38 U.S.C. 5701 or 7332 or 
the Privacy Act is incorporated into quality assurance records, the 
information in the quality assurance records is still protected by these 
statutes.

(Authority: 38 U.S.C. 5705)



Sec.  17.503  Improper disclosure.

    (a) Improper disclosure is the disclosure of confidential and 
privileged healthcare quality assurance review records or documents (or 
information contained therein), as defined in Sec.  17.501, to any 
person who is not authorized access to the records or documents under 
the statute and the regulations in Sec. Sec.  17.500 through 17.511.
    (b) ``Disclosure'' means the communication, transmission, or 
conveyance in any way of any confidential and privileged quality 
assurance records or documents or information contained in them to any 
individual or organization in any form by any means.

(Authority: 38 U.S.C. 5705)



Sec.  17.504  Disclosure methods.

    (a) Disclosure of confidential and privileged quality assurance 
records and documents or the information contained therein outside VA, 
where permitted by the statute and the regulations in Sec. Sec.  17.500 
through 17.511, will always be by copies, abstracts, summaries, or 
similar records or documents prepared by the Department of Veterans 
Affairs and released to the requestor. The original confidential and 
privileged quality assurance records and documents will not be removed 
from the VA facility by any person, VA employee or otherwise, except in 
accordance with Sec.  17.508(c) or where otherwise legally required.
    (b) Disclosure of confidential and privileged quality assurance 
records and documents to authorized individuals under either Sec.  
17.508 or Sec.  17.509 shall bear the following statement: ``These 
documents or records (or information contained herein) are confidential 
and privileged under the provisions of 38 U.S.C. 5705, which provide for 
fines up to $20,000 for unauthorized disclosures thereof, and the 
implementing regulations. This material shall not be disclosed to anyone 
without authorization as provided for by that law or the regulations in 
Sec. Sec.  17.500 through 17.511.''

(Authority: 38 U.S.C. 5705)



Sec.  17.505  Disclosure authorities.

    The VA medical facility Director, Regional Director, Under Secretary 
for Health, or their designees are authorized to disclose any 
confidential and privileged quality assurance records or documents under 
their control to other agencies, organizations, or individuals where 38 
U.S.C. 5705 or the regulations in Sec. Sec.  17.500 through 17.511 
expressly provide for disclosure.

(Authority: 38 U.S.C. 5705)



Sec.  17.506  Appeal of decision by Veterans Health Administration to
deny disclosure.

    When a request for records or documents subject to the regulations 
in Sec. Sec.  17.500 through 17.511 is denied in whole or in part by the 
VA medical facility Director, Regional Director or Under Secretary for 
Health, the VA official denying the request in whole or in part will 
notify the requestor in writing of the right to appeal this decision to 
the General Counsel of the Department of Veterans Affairs within 60

[[Page 850]]

days of the date of the denial letter. The final Department decision 
will be made by the General Counsel or the Deputy General Counsel.

(Authority: 38 U.S.C. 5705)



Sec.  17.507  Employee responsibilities.

    (a) All VA employees and other individuals who have access to 
records designated as confidential and privileged under 38 U.S.C. 5705 
and the regulations in Sec. Sec.  17.500 through 17.511 will treat the 
findings, views, and actions relating to quality assurance in a 
confidential manner.
    (b) All individuals who have had access to records designated as 
confidential and privileged under 38 U.S.C. 5705 and the regulations in 
Sec. Sec.  17.500 through 17.511 will not disclose such records or 
information therein to any person or organization after voluntary or 
involuntary termination of their relationship to the VA.

(Authority: 38 U.S.C. 5705)



Sec.  17.508  Access to quality assurance records and documents within
the agency.

    (a) Access to confidential and privileged quality assurance records 
and documents within the Department pursuant to this section is 
restricted to VA employees (including consultants and contractors of VA) 
who have a need for such information to perform their government duties 
or contractual responsibilities and who are authorized access by the VA 
medical facility Director, Regional Director, the Under Secretary for 
Health, or their designees or by the regulations in Sec. Sec.  17.500 
through 17.511.
    (b) To foster continuous quality improvement, practitioners on VA 
rolls, whether paid or not, will have access to confidential and 
privileged quality assurance records and documents relating to 
evaluation of the care they provided.
    (c) Any quality assurance record or document, whether confidential 
and privileged or not, may be provided to the General Counsel or any 
attorney within the Office of General Counsel, wherever located. These 
documents may also be provided to a Department of Justice (DOJ) attorney 
who is investigating a claim or potential claim against the VA or who is 
preparing for litigation involving the VA. If necessary, such a record 
or document may be removed from the VA medical facility to the site 
where the General Counsel or any attorney within the Office of General 
Counsel or the DOJ attorney is conducting an investigation or preparing 
for litigation.
    (d) Any quality assurance record or document or the information 
contained therein, whether confidential and privileged or not, will be 
provided to the Department of Veterans Affairs Office of Inspector 
General upon request. A written request is not required.
    (e) To the extent practicable, documents accessed under paragraph 
(b) of this section will not include the identity of peer reviewers. 
Reasonable efforts will be made to edit documents so as to protect the 
identities of reviewers, but the inability to completely do so will not 
bar access under paragraph (b).
    (f) No individual shall be permitted access to confidential and 
privileged quality assurance records and documents identified in Sec.  
17.501 unless such individual has been informed of the penalties for 
unauthorized disclosure. Any misuse of confidential and privileged 
quality assurance records or documents shall be reported to the 
appropriate VHA official, e.g., Service Chief, Medical Center Director.
    (g) In general, confidential and privileged quality assurance 
records and documents will be maintained for a minimum of 3 years and 
may be held longer if needed for research studies or quality assurance 
or legal purposes.

(Authority: 38 U.S.C. 5705)



Sec.  17.509  Authorized disclosure: Non-Department of Veterans Affairs
requests.

    (a) Requests for confidential and privileged quality assurance 
records and documents from organizations or individuals outside VA must 
be made to the Department and must specify the nature and content of the 
information requested, to whom the information should be transmitted or 
disclosed, and the purpose listed in paragraphs (b) through (j) of this 
section for which the information requested

[[Page 851]]

will be used. In addition, the requestor will specify to the extent 
possible the beginning and final dates of the period for which 
disclosure or access is requested. The request must be in writing and 
signed by the requestor. Except as specified in paragraphs (b) and (c) 
of this section, these requests should be forwarded to the Director of 
the facility in possession of the records or documents for response. The 
procedures outlined in 38 U.S.C. 5701, 5 U.S.C. 552 and 552a, and 38 CFR 
1.500 through 1.582 will be followed where applicable.
    (b) Disclosure shall be made to Federal agencies upon their written 
request to permit VA's participation in healthcare programs including 
healthcare delivery, research, planning, and related activities with the 
requesting agencies. Any Federal agency may apply to the Under Secretary 
for Health for approval. If the VA decides to participate in the 
healthcare program with the requestor, the requesting agency will enter 
into an agreement with VA to ensure that the agency and its staff will 
ensure the confidentiality of any quality assurance records or documents 
shared with the agency.
    (c) Qualified persons or organizations, including academic 
institutions, engaged in healthcare program activities shall, upon 
request to and approval by the Under Secretary for Health, Regional 
Director, medical facility Director, or their designees, have access to 
confidential and privileged medical quality assurance records and 
documents to permit VA participation in a healthcare activity with the 
requestor, provided that no records or documents are removed from the VA 
facility in possession of the records.
    (d) When a request under paragraphs (b) or (c) of this section 
concerns access for research purposes, the request, together with the 
research plan or protocol, shall first be submitted to and approved by 
an appropriate VA medical facility Research and Development Committee 
and then approved by the Director of the VA medical facility. The VA 
medical facility staff together with the qualified person(s) conducting 
the research shall be responsible for the preservation of the anonymity 
of the patients, clients, and providers and shall not disseminate any 
records or documents which identify such individuals directly or 
indirectly without the individual's consent. This applies to the 
handling of data or information as well as reporting or publication of 
findings. These requirements are in addition to other applicable 
protections for the research.
    (e) Individually identified patient medical record information which 
is protected by another statute as provided in Sec.  17.502 may not be 
disclosed to a non-VA person or organization, including disclosures for 
research purposes under paragraph (d), except as provided in that 
statute.
    (f) Under paragraph (b), the Under Secretary for Health or designee 
or under paragraph (c), the Under Secretary for Health, Regional 
Director, medical facility Director, or their designees may approve a 
written request if it meets the following criteria:
    (1) Participation by VA will benefit VA patient care; or
    (2) Participation by VA will enhance VA medical research; or
    (3) Participation by VA will enhance VA health services research; or
    (4) Participation by VA will enhance VA healthcare planning or 
program development activities; or
    (5) Participation by VA will enhance related VA healthcare program 
activities; and
    (6) Access to the record by the requester is required for VA to 
participate in a healthcare program with the requester.
    (g) Protected quality assurance records or documents, including 
records pertaining to a specific individual, will for purposes 
authorized under law be disclosed to a civil or criminal law enforcement 
governmental agency or instrumentality charged under applicable law with 
the protection of public health or safety, including state licensing and 
disciplinary agencies, if a written request for such records or 
documents is received from an official of such an organization. The 
request must state the purpose authorized by law for which the records 
will be used. The Under Secretary for Health, Regional Director,

[[Page 852]]

medical facility Director, or their designees will determine the extent 
to which the information is disclosable.
    (h) Federal agencies charged with protecting the public health and 
welfare, federal and private agencies which engage in various monitoring 
and quality control activities, agencies responsible for licensure of 
individual health care facilities or programs, and similar organizations 
will be provided confidential and privileged quality assurance records 
and documents if a written request for such records or documents is 
received from an official of such an organization. The request must 
state the purpose for which the records will be used. The Under 
Secretary for Health, Regional Director, medical facility Director, or 
their designees will determine the extent to which the information is 
disclosable.
    (i) JCAHO (Joint Commission on Accreditation of Healthcare 
Organizations) survey teams and similar national accreditation agencies 
or boards and other organizations requested by VA to assess the 
effectiveness of quality assurance program activities or to consult 
regarding these programs are entitled to disclosure of confidential and 
privileged quality assurance documents with the following 
qualifications:
    (1) Accreditation agencies which are charged with assessing all 
aspects of medical facility patient care, e.g., JCAHO, may have access 
to all confidential and privileged quality assurance records and 
documents.
    (2) Accreditation agencies charged with more narrowly focused review 
(e.g., College of American Pathologists, American Association of Blood 
Banks, Nuclear Regulatory Commission, etc.) may have access only to such 
confidential and privileged records and documents as are relevant to 
their respective focus.
    (j) Confidential and privileged quality assurance records and 
documents shall be released to the General Accounting Office if such 
records or documents pertain to any matter within its jurisdiction.
    (k) Confidential and privileged quality assurance records and 
documents shall be released to both VA and non-VA healthcare personnel 
upon request to the extent necessary to meet a medical emergency 
affecting the health or safety of any individual.
    (l) For any disclosure made under paragraphs (a) through (i) of this 
section, the name of and other identifying information regarding any 
individual VA patient, employee, or other individual associated with VA 
shall be deleted from any confidential and privileged quality assurance 
record or document before any disclosure under these quality assurance 
regulations in Sec. Sec.  17.500 through 17.511 is made, if disclosure 
of such name and identifying information would constitute a clearly 
unwarranted invasion of personal privacy.
    (m) Disclosure of the confidential and privileged quality assurance 
records and documents identified in Sec.  17.501 will not be made to any 
individual or agency until that individual or agency has been informed 
of the penalties for unauthorized disclosure or redisclosure.

(Authority: 38 U.S.C. 5705)

[59 FR 53355, Oct. 24, 1994, as amended at 79 FR 54616, Sept. 12, 2014]



Sec.  17.510  Redisclosure.

    No person or entity to whom a quality assurance record or document 
has been disclosed under Sec.  17.508 or Sec.  17.509 shall make further 
disclosure of such record or document except as provided for in 38 
U.S.C. 5705 and the regulations in Sec. Sec.  17.500 through 17.511.

(Authority: 38 U.S.C. 5705)



Sec.  17.511  Penalties for violations.

    Any person who knows that a document or record is a confidential and 
privileged quality assurance document or record described in Sec. Sec.  
17.500 through 17.511 and willfully discloses such confidential and 
privileged quality assurance record or document or information contained 
therein, except as authorized by 38 U.S.C. 5705 or the regulations in 
Sec. Sec.  17.500 through 17.511, shall be fined not more than $5,000 in 
the case of a first offense and not more than $20,000 in the case of 
each subsequent offense.

(Authority: 38 U.S.C. 5705)

[[Page 853]]

               Specialty Education Loan Repayment Program

    Source: Sections 17.525 through 17.531 appear at 85 FR 45535, July 
29, 2020, unless otherwise noted.



Sec.  17.525  Purpose.

    The purpose of Sec. Sec.  17.525 through 17.531 is to establish the 
Specialty Education Loan Repayment Program (SELRP). The SELRP is an 
incentive program for certain individuals to meet VA's need for 
physicians in medical specialties for which VA determines that 
recruitment and retention of qualified personnel is difficult. 
Assistance under the SELRP may be in addition to other assistance 
available to individuals under the Educational Assistance Program under 
38 U.S.C. 7601.



Sec.  17.526  Definitions.

    The following definitions apply to Sec. Sec.  17.525 through 17.530:
    Educational loan means a loan, government or commercial, made for 
educational purposes by institutions that are subject to examination and 
supervision in their capacity as lending institutions by an agency of 
the United States or of the state in which the lender has its principal 
place of business. Loans must be for the actual costs paid for tuition, 
and other reasonable educational expenses such as living expenses, fees, 
books, supplies, educational equipment and materials, and laboratory 
expenses. Loans must be obtained from a government entity, a private 
financial institution, a school, or any other authorized entity stated 
in this definition. The following loans do not qualify for the SELRP:
    (1) Loans obtained from family members, relatives, or friends;
    (2) Loans made prior to, or after, the individual's qualifying 
education;
    (3) Any portion of a consolidated loan that is not specifically 
identified with the education and purposes for which the SELRP may be 
authorized, such as home or auto loans merged with educational loans;
    (4) Loans for which an individual incurred a service obligation for 
repayment or agreed to service for future cancellation;
    (5) Credit card debt;
    (6) Parent Plus Loans;
    (7) Loans that have been paid in full;
    (8) Loans that are in default, delinquent, not in a current payment 
status, or have been assumed by a collection agency;
    (9) Loans not obtained from a bank, credit union, savings and loan 
association, not-for-profit organization, insurance company, school, and 
other financial or credit institution which is subject to examination 
and supervision in its capacity as a lending institution by an agency of 
the United States or of the state in which the lender has its principal 
place of business;
    (10) Loans for which supporting documentation is not available;
    (11) Loans that have been consolidated with loans of other 
individuals, such as spouses, children, friends, or other family member; 
or
    (12) Home equity loans or other noneducational loans.
    SELRP means the Specialty Education Loan Repayment Program 
established in Sec. Sec.  17.525 through 17.530.
    State means a State as defined in 38 U.S.C. 101(20), or a political 
subdivision of such a State.
    VA means the Department of Veterans Affairs.



Sec.  17.527  Eligibility.

    (a) General. An individual must meet the following requirements to 
be eligible to participate in the SELRP:
    (1) Will be eligible for appointment under 38 U.S.C. 7401 to work as 
a physician in a medical specialty for which VA determines that 
recruitment or retention of qualified personnel is difficult. In 
determining staffing needs, VA will consider the anticipated needs of VA 
for a period of two to six years in the future. VA will publish these 
vacancies in a notice in the Federal Register on a yearly basis until 
vacancies are filled.
    (2) Owes any amount of principal or interest for an educational loan 
where the proceeds were used by or on behalf of the individual to pay 
costs relating to a course of medical education or training that leads 
to employment as a physician and;
    (3) Is:
    (i) Recently graduated from an accredited medical or osteopathic 
school

[[Page 854]]

and matched to an accredited residency program in a medical specialty 
designated by VA; or
    (ii) A physician in training with more than 2 years remaining in 
such training.
    (b) Applicants without a residency match. An applicant may apply for 
the SELRP before receiving a residency match during the applicant's 
senior year of medical or osteopathic school. Once the applicant is 
matched with a residency specialty stated in Sec.  17.525 and upon 
selection of the SELRP, VA must offer the applicant participation in the 
SELRP no later than 28 days after:
    (1) The applicant is matched with the residency; and
    (2) VA has published the residency in a Notice in the Federal 
Register. Such notices are published on a yearly basis until vacancies 
are filled.
    (c) Preferences. VA will give preference to eligible participants 
who:
    (1) Are, or will be, participating in residency programs in health 
care facilities that are:
    (i) Located in rural areas;
    (ii) Operated by Indian tribes, tribal organizations, or the Indian 
Health Services; or
    (iii) Are affiliated with underserved health care facilities of VA; 
or
    (2) Veterans.



Sec.  17.528  Application.

    (a) General. A complete application for the SELRP consists of a 
completed application form, letters of reference, and personal 
statement.
    (b) References. The applicant must provide the following letters of 
reference and sign a release of information form for VA to contact such 
references:
    (1) One letter of reference from the Program Director of the core 
program in which the applicant is training, which indicates that the 
applicant is in good to excellent standing, or, for individuals who have 
yet to initiate training, a letter of reference from a faculty member or 
dean;
    (2) One or more letters of reference from faculty members under 
which the applicant trained; and
    (3) One letter of reference from a peer colleague who is familiar 
with the practice and character of the applicant.
    (c) Personal statement. The personal statement must include the 
following documentation:
    (1) A cover letter that provides the following information:
    (i) Why the applicant is interested in VA employment;
    (ii) The applicant's interest in working at a particular medical 
specialty and underserved area;
    (iii) Likely career goals, including career goals in VA; and
    (iv) A brief summary of past employment or training and 
accomplishments, including any particular clinical areas of interest 
(e.g., substance abuse).
    (2) The following information must be provided on a VA form or 
online collection system and is subject to VA verification:
    (i) A summary of the applicant's educational loan, which includes 
the total loan amount and when the loan was acquired. The educational 
loan must be specific to the education that was required and used to 
qualify the applicant for appointment as a physician.
    (ii) The name of the lending agency that provided the educational 
loan.
    (3) A full curriculum vitae.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number XXXX-XXXX.)



Sec.  17.529  Award procedures.

    (a) Repayment amount. (1) VA may pay no more than $40,000 in 
educational loan repayment for each year of obligated service for a 
period not to exceed four years for a total payment of $160,000.00.
    (2) An educational loan repayment may not exceed the actual amount 
of principal and interest on an educational loan or loans.
    (b) Payment. VA will pay the participant, or the lending institution 
on behalf of the participant, directly for the principal and interest on 
the participant's educational loans. Payments will be made monthly or 
annually for each applicable service period, depending on the terms of 
the agreement. Participants must provide VA documentation that shows the 
amounts

[[Page 855]]

that were credited or posted by the lending institution to a 
participant's educational loan during an obligated service period. VA 
will issue payments after the participant commences the period of 
obligated service. Payments are exempt from Federal taxation.
    (c) Waiver of maximum amount of payment. VA may waive the 
limitations under paragraph (a)(1) of this section to participants of 
the SELRP if VA determines that there is a shortage of qualified 
employees due to either the location of where the participant will serve 
the period of obligated service or the requirements of the position that 
the participant will hold in VA. However, the waiver may not exceed the 
actual amount of the principal and the interest on the participant's 
loans payable to or for that participant.



Sec.  17.530  Agreement and obligated service.

    (a) General. In addition to any requirements under section 5379(c) 
of title 5, a participant in the SELRP must agree, in writing, to the 
following:
    (1) Obtain a license to practice medicine in a State;
    (2) Successfully complete postgraduate training leading to 
eligibility for board certification in a medical specialty;
    (3) Serve as a full-time clinical practice employee of VA for 12 
months for every $40,000.00 that the participant receives payment 
through the SELRP, however, the participant must serve for a period of 
no fewer than 24 months; and
    (4) Except as provided in paragraph (b) of this section, begin 
obligated service as a full-time VA employee no later than 60 days after 
completing residency in the medical specialty described in Sec.  
17.527(a)(1).
    (b) Obligated service. (1) General provision. A participant's 
obligated service will begin on the date on which the participant begins 
full-time permanent employment with VA in the qualifying field of 
medicine in a location determined by VA. Obligated service must be full-
time permanent employment and does not include any period of temporary 
or contractual employment.
    (2) Location and position of obligated service. VA will provide 
SELRP participants a list of qualifying medical facility locations. A 
participant may select a service location from that list. However, VA 
reserves the right to make final decisions on the location and position 
of the obligated service.
    (c) Exception to commencement of obligated service. If a participant 
receives an accredited fellowship in a medical specialty other than the 
specialty described in Sec.  17.27(a)(1), the participant may request, 
in writing, a delayed commencement of the period of obligated service 
until after the participant completes the fellowship. However, the 
period of obligated service will begin no later than 60 days after 
completion of such fellowship in the medical specialty described in 
Sec.  17.527(a)(1).



Sec.  17.531  Failure to comply with terms and conditions of agreement.

    A participant of the SELRP who fails to satisfy the period of 
obligated service will owe the United States government an amount 
determined by the formula A = B x ((T-S) / T)), where:
    (a) ``A'' is the amount the participant owes the United States 
government.
    (b) ``B'' is the sum of all payments to or for the participant under 
the SELRP.
    (c) ``T'' is the number of months in the period of obligated service 
of the participant.
    (d) ``S'' is the number of whole months of such period of obligated 
service served by the participant.

               VA Health Professional Scholarship Program

    Authority: 38 U.S.C. 7601-7619, 7633, 7634, and 7636.



Sec.  17.600  Purpose.

    The purpose of Sec. Sec.  17.600 through 17.612 is to establish the 
requirements for the award of scholarships under the VA Health 
Professional Scholarship Program (HPSP) to students pursuing a course of 
study leading to a degree in certain health care occupations, listed in 
38 U.S.C. 7401(1) and (3), to assist in providing an adequate supply of 
such personnel for VA. The HPSP allows VA

[[Page 856]]

to provide scholarship awards to facilitate recruitment and retention of 
employees in several hard-to-fill health care occupations.

(Authority: 38 U.S.C. 7601(b))

[78 FR 51069, Aug. 20, 2013]



Sec.  17.601  Definitions.

    The following definitions apply to Sec. Sec.  17.600 through 17.636:
    Acceptable level of academic standing means the level at which a 
participant may continue to attend school under the standards and 
practices of the school at which a participant is enrolled in a course 
of study for which an HPSP or VIOMPSP scholarship was awarded.
    Acceptance agreement means a signed legal document between VA and a 
participant of the HPSP or VIOMPSP that specifies the obligations of VA 
and the participant upon acceptance to the HPSP or VIOMPSP. An 
acceptance agreement must incorporate by reference, and cannot be 
inconsistent with, Sec. Sec.  17.600 through 17.612 (for HPSP 
agreements) or Sec. Sec.  17.626 through 17.636 (for VIOMPSP 
agreements), and must include:
    (1) A mobility agreement.
    (2) Agreement to accept payment of the scholarship.
    (3) Agreement to perform obligated service.
    (4) Agreement to maintain enrollment and attendance in the course of 
study for which the scholarship was awarded, and to maintain an 
acceptable level of academic standing.
    Affiliation agreement means a legal document that enables the 
clinical education of trainees at a VA or non-VA medical facility. An 
affiliation agreement is required for all education or training that 
involves direct patient contact, or contact with patient information, by 
trainees from a non-VA institution.
    Citizen of the United States means any person born, or lawfully 
naturalized, in the United States, subject to its jurisdiction and 
protection, and owing allegiance thereto.
    Credential means the licensure, registration, certification, 
required education, relevant training and experience, and current 
competence necessary to meet VA's qualification standards for employment 
in certain health care occupations.
    Degree represents the successful completion of the course of study 
for which a scholarship was awarded.
    (1) HPSP. For the purposes of the HPSP, VA recognizes the following 
degrees: a doctor of medicine; doctor of osteopathy; doctor of 
dentistry; doctor of optometry; doctor of podiatry; or an associate, 
baccalaureate, master's, or doctorate degree in another health care 
discipline needed by VA.
    (2) VIOMPSP. For the purposes of the VIOMPSP, VA recognizes a 
bachelor's, master's, education specialist or doctorate that meets the 
core curriculum and supervised practice requirements in visual 
impairment and blindness.
    Full-time student means an individual who meets the requirements for 
full time attendance as defined by the school in which they are 
enrolled.
    HPSP means the VA Health Professional Scholarship Program authorized 
by 38 U.S.C. 7601 through 7619.
    Mobility agreement means a signed legal document between VA and a 
participant of the HPSP or VIOMPSP, in which the participant agrees to 
accept assignment at a VA facility selected by VA where he or she will 
fulfill the obligated service requirement. A mobility agreement must be 
included in the participant's acceptance agreement. Relocation to 
another geographic location may be required.
    Obligated service means the period of time during which the HPSP or 
VIOMPSP participant must be employed by VA in a full-time clinical 
occupation for which the degree prepared the participant as a 
requirement of the acceptance agreement.
    Part-time student--(1) HPSP. For the purposes of the HPSP, part-time 
student means an individual who is a VA employee, and who has been 
accepted for enrollment or enrolled for study leading to a degree on a 
less than full-time basis but no less than half-time basis.
    (2) VIOMPSP. For the purposes of the VIOMPSP, part-time student 
means an individual who has been accepted for enrollment or enrolled for 
study leading to a degree on a less than full-time basis but no less 
than half-time basis.

[[Page 857]]

    Participant or scholarship program participant means an individual 
whose application to the HPSP or VIOMPSP has been approved, whose 
acceptance agreement has been consummated by VA, and who has yet to 
complete the period of obligated service or otherwise satisfy the 
obligation or financial liabilities of such agreement.
    Required fees means those fees which are charged by the school to 
all students pursuing a similar curriculum in the same school.
    Scholarship Program means the VA Health Professional Scholarship 
Program (HPSP) authorized by 38 U.S.C. 7601 through 7619.
    School means an academic institution that is accredited by a body or 
bodies recognized for accreditation by the U.S. Department of Education 
or by the Council for Higher Education Accreditation (CHEA), and that 
meets the following requirements:
    (1) For the purposes of the HPSP, offers a course of study leading 
to a degree in a health care service discipline needed by VA.
    (2) For the purposes of the VIOMPSP, offers a course of study 
leading to a degree in visual impairment or orientation and mobility.
    School year means for purposes of the HPSP and its stipend payment, 
and the VIOMPSP, all or part of the 12-month period that starts on the 
date the participant begins school as a full-time student.
    Secretary means the Secretary of Veterans Affairs or designee.
    State means one of the several States, Territories and possessions 
of the United States, the District of Columbia and the Commonwealth of 
Puerto Rico.
    Under Secretary for Health means the Under Secretary for Health of 
the Department of Veterans Affairs or designee.
    VA means the Department of Veterans Affairs.
    VA employee means an individual permanently employed by VA. A VA 
employee does not include an individual who is employed temporarily or 
on a contractual basis.
    VA health care facility means a VA medical center, independent 
outpatient clinic, domiciliary, nursing home (community living center), 
residential treatment program, and any of a variety of community based 
clinics (including community based outpatient clinics, rural health 
resource centers, primary care telehealth clinics, and Vet Centers), 
consolidated mail outpatient pharmacies, and research centers.
    VIOMPSP means the Visual Impairment and Orientation and Mobility 
Professional Scholarship Program authorized by 38 U.S.C. 7501 through 
7505.

(Authority: 38 U.S.C. 301, 7501(a)(1), 7504, 7602(a), 7604(1)(B), 7633)

[78 FR 51069, Aug. 20, 2013]



Sec.  17.602  Eligibility.

    (a) To be eligible for a scholarship under this program an applicant 
must--
    (1) Be unconditionally accepted for enrollment or be enrolled as a 
full-time student in an accredited school located in a State;
    (2) Be pursuing a degree annually designated by the Secretary for 
participation in the Scholarship Program;


(Authority: 38 U.S.C. 7602(a)(1), 7612(b)(1))

    (3) Be in a discipline or program annually designated by the 
Secretary for participation in the Scholarship Program;
    (4) Be a citizen of the United States; and
    (5) Submit an application to participate in the Scholarship Program 
together with a signed contract.
    (6) Clinical tours. An applicant for a scholarship under the HPSP 
must agree to perform clinical tours while enrolled in the course of 
education or training for which the scholarship is provided. VA will 
determine the assignments and locations of the clinical tour.


(Authority: 38 U.S.C. 7618(b))

    (b) To be eligible for a scholarship as a part-time student under 
this program, an applicant must satisfy requirements of paragraph (a) of 
this section and in addition must--
    (1) Be a full-time VA employee permanently assigned to a VA health 
care facility at the time of application and on the date when the 
scholarship is awarded;

[[Page 858]]

    (2) Remain a VA employee for the duration of the scholarship award.


(Authority: 38 U.S.C. 7612(c)(3)(B))

    (c) Any applicant who, at the time of application, owes a service 
obligation to any other entity to perform service after completion of 
the course of study is ineligible to receive a scholarship under the 
Department of Veterans Affairs Scholarship Program.

(Authority: 38 U.S.C. 7602(b))

(Approved by the Office of Management and Budget under control number 
2900-0352)

[47 FR 10810, Mar. 12, 1982, as amended at 48 FR 37399, Aug. 18, 1983; 
54 FR 28674, July 7, 1989; 78 FR 51070, Aug. 20, 2013]



Sec.  17.603  Availability of HPSP scholarships.

    (a) General. A HPSP scholarship will be awarded only when necessary 
to assist VA in alleviating shortages or anticipated shortages of 
personnel in the health professions stated in paragraph (b) of this 
section. VA will determine the existence of shortage of personnel in 
accordance with specific criteria for each health care profession. VA 
has the authority to establish the number of scholarships to be awarded 
in a fiscal year, and the number that will be awarded to full-time and 
part-time students.
    (b) Qualifying fields of education--(1) Physicians and dentists--(i) 
VA will award not less than 50 HPSP scholarships each year to 
individuals who are accepted for enrollment or are enrolled in a program 
of education or training leading to employment as a physician or dentist 
until such date as VA determines that the staffing shortage of 
physicians and dentists in VA is less than 500.
    (ii) Once the staffing shortage of physicians and dentists is less 
than 500, VA will award HPSP scholarships to individuals in an amount 
equal to not less than ten percent of the staffing shortage of 
physicians and dentists in VA.
    (2) Other health care professions. VA will grant HPSP scholarships 
in a course of study in those disciplines or programs other than 
physician or dentist where recruitment is necessary for the improvement 
of health care of veterans as listed in 38 U.S.C. 7401(1) and (3).

(Authority: 38 U.S.C. 7401(1), (3), 7612(b)(2), 7612(b)(4), and 
7603(b)(1))

[78 FR 51070, Aug. 20, 2013, as amended at 85 FR 13053, Mar. 6, 2020]



Sec.  17.604  Application for the HPSP.

    An applicant for the HPSP must submit an accurate and complete 
application, including a signed written acceptance agreement.

(Authority: 38 U.S.C. 7612(c)(1)(B))

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0793.)

[78 FR 51070, Aug. 20, 2013]



Sec.  17.605  Selection of participants.

    (a) General. In deciding which HPSP application to approve, VA will 
first consider applications submitted by applicants entering their final 
year of education or training and applicants who previously received 
HPSP scholarships and who meet the conditions of paragraph (f) of this 
section. Except for paragraph (f) of this section, applicants will be 
evaluated and selected using the criteria specified in paragraph (b) of 
this section. If there are a larger number of equally qualified 
applicants than there are awards to be made, then VA will first select 
veterans, and then use a random method as the basis for further 
selection. In selecting participants to receive awards as part-time 
students, VA may, at VA's discretion--


(Authority: 38 U.S.C. 7612(b)(5))

    (1) Award scholarships geographically to part-time students so that 
available scholarships may be distributed on a relatively equal basis to 
students working throughout the VA health care system, and/or
    (2) Award scholarships on the basis of retention needs within the VA 
health care system.


(Authority: 38 U.S.C. 7603(d))

    (b) Selection. In evaluating and selecting participants, the 
Secretary will take into consideration those factors

[[Page 859]]

determined necessary to assure effective participation in the 
Scholarship Program. The factors may include, but not be limited to--
    (1) Work/volunteer experience, including prior health care 
employment and Department of Veterans Affairs employment;
    (2) Faculty and employer recommendations;
    (3) Academic performance; and
    (4) Career goals.


(Authority: 38 U.S.C. 7633)

    (c) Selection of part-time students. Factors in addition to those 
specified in paragraph (b) of this section, which may be considered in 
awarding scholarships to part-time students may include, but are not 
limited to:
    (1) Length of service of a VA employee in a health care facility;
    (2) Honors and awards received from VA, and other sources;
    (3) VA work performance evaluation;
    (4) A recommendation for selection for a part-time scholarship from 
a VA Medical District.


(Authority: 38 U.S.C. 7452(d)(1))

    (d) Notification of approval. VA will notify the individual in 
writing that his or her application has been accepted and approved. An 
individual becomes a participant in the program upon receipt of such 
approval by VA.

    (e) Duration of scholarship award. Subject to the availability of 
funds for the Scholarship Program, the Secretary will award a 
participant a full-time scholarship under these regulations for a period 
of from 1 to 4 school years and a participant of a part-time scholarship 
for a period of 1 to 6 school years.


(Authority: 38 U.S.C. 7612(c)(1)(A) and 7614(3))

    (f) Continuation awards. Subject to the availability of funds for 
the Scholarship Program and selection, the Secretary will award a 
continuation scholarship for completion of the degree for which the 
scholarship was awarded if--
    (1) The award will not extend the total period of Scholarship 
Program support beyond 4 years for a full-time scholarship, and beyond 6 
years for a part-time scholarship; and
    (2) The participant remains eligible for continued participation in 
the Scholarship Program.

(Authority: 38 U.S.C. 7603(d))

(Approved by the Office of Management and Budget under control number 
2900-0352)

[48 FR 37399, Aug. 18, 1983, as amended at 54 FR 28674, July 7, 1989; 78 
FR 51070, Aug. 20, 2013]



Sec.  17.606  Award procedures.

    (a) Amount of scholarship. (1) A scholarship award will consist of 
(i) tuition and required fees, (ii) other educational expenses, 
including books and laboratory equipment, and (iii) except as provided 
in paragraph (a)(2) of this section, a monthly stipend, for the duration 
of the scholarship award. All such payments to scholarship participants 
are exempt from Federal taxation.


(Authority: 38 U.S.C. 7636)

    (2) No stipend may be paid to a participant who is a full-time VA 
employee.
    (3) The Secretary may determine the amount of the stipend paid to 
participants, whether part-time students or full-time students, but that 
amount may not exceed the maximum amount provided for in 38 U.S.C. 
7613(b).
    (4) In the case of a part-time student who is a part-time employee, 
the maximum stipend, if more than a nominal stipend is paid, will be 
reduced in accordance with the proportion that the number of credit 
hours carried by such participant bears to the number of credit hours 
required to be carried by a full-time student in the course of training 
being pursued by the participant.
    (5) A full stipend may be paid only for the months the part-time 
student is attending classes.


(Authority: 38 U.S.C. 7614(2))

    (6) The Secretary may make arrangements with the school in which the 
participant is enrolled for the direct payment of the amount of tuition 
and/or reasonable educational expenses on the participant's behalf.


(Authority: 38 U.S.C. 7613(c))


[[Page 860]]


    (7) A participant's eligibility for a stipend ends at the close of 
the month in which degree requirements are met.
    (b) Leave-of-absence, repeated course work. The Secretary may 
suspend scholarship payments to or on behalf of a participant if the 
school (1) approves a leave-of-absence for the participant for health, 
personal, or other reasons, or (2) requires the participant to repeat 
course work for which the Secretary previously has made payments under 
the Scholarship Program. Additional costs relating to the repeated 
course work will not be paid under this program. Any scholarship 
payments suspended under this section will be resumed by the Secretary 
upon notification by the school that the participant has returned from 
the leave-of-absense or has satisfactorily completed the repeated course 
work and is proceeding as a full-time student in the course of study for 
which the scholarship was awarded.

(Authority: 38 U.S.C. 7633)

[48 FR 37400, Aug. 18, 1983, as amended at 55 FR 40170, Oct. 2, 1990]



Sec.  17.607  Obligated service.

    (a) General. Except as provided in paragraph (d) of this section, 
each participant is obligated to provide service as a Department of 
Veterans Affairs employee in full-time clinical practice in the 
participant's discipline in an assignment or location determined by the 
Secretary.


(Authority: 38 U.S.C. 7616(a))

    (b) Beginning of service. (1)(i) Date of employment. Except as 
provided in paragraph (b)(2) of this section, a participant's obligated 
service will begin on the date VA appoints the participant as a full-
time VA employee in a clinical occupation for which the degree prepared 
the participant. VA will appoint the participant to such position as 
soon as possible, but no later than 90 days after the date that the 
participant receives his or her degree, or the date the participant 
becomes licensed in a State or becomes certified, whichever is later. VA 
will actively assist and monitor participants to ensure State licenses 
or certificates are obtained in a minimal amount of time following 
graduation. If a participant fails to obtain his or her degree, or fails 
to become licensed in a State or become certified no later than 180 days 
after receiving the degree, the participant is considered to be in 
breach of the acceptance agreement.
    (ii) Notification. VA will notify the participant of the work 
assignment and its location no later than 60 days before the date on 
which the participant must begin work.
    (iii) VA mentor. VA will ensure that the participant is assigned a 
mentor who is employed at the same facility where the participant 
performs his or her obligated service at the commencement of such 
service.
    (2) Obligated service shall begin on the degree completion date for 
a participant who, on that date, is a full-time VA employee working in a 
capacity for which the degree program prepared the participant.


(Authority: 38 U.S.C. 7616(b), 7616(c), 7618(a))

    (c) Duration of service--(1) Full-time student--(i) Physician or 
dentist. A participant who attended school as a full-time student will 
agree to serve as a full-time physician or dentist in the Veterans 
Health Administration for 18 months for each school year or part thereof 
for which a scholarship was awarded.
    (ii) Other health care profession. A participant who attended school 
as a full-time student in a health care profession other than physician 
or dentist will agree to serve as a full-time clinical employee in the 
Veterans Health Administration for 1 calendar year for each school year 
or part thereof for which a scholarship was awarded, but for no less 
than 2 years.
    (2) Part-time student. Obligated service to VA for a participant who 
attended school as a part-time student must be satisfied by full-time 
clinical employment. The period of obligated service will be reduced 
from that which a full-time student must serve under paragraph (c)(1) of 
this section in accordance with the proportion that the number of credit 
hours carried by the part-time student in any school year bears to the 
number of credit hours required to be carried by a full-time student who 
is pursuing the same degree;

[[Page 861]]

however, the period of obligated service will not be for less than 1 
year.

(Authority: 38 U.S.C. 7612(c)(1)(B), 7612(c)(3)(A), 7618(c))

    (d) Location for service. VA reserves the right to make final 
decisions on the location for service obligation. A participant who 
receives a scholarship as a full-time student must be willing to 
relocate to another geographic location to carry out his or her service 
obligation according to the participant's mobility agreement. A 
participant who received a scholarship as a part-time student may be 
allowed to serve the period of obligated service at the health care 
facility where the individual was assigned when the scholarship was 
authorized, if there is a vacant position which will satisfy the 
individual's mobility agreement at that facility.


(Authority: 38 U.S.C. 7616(a))

    (e) Creditability of advanced clinical training. No period of 
advanced clinical training will be credited toward satisfying the period 
of obligated service incurred under the Scholarship Program.

(Authority: 38 U.S.C. 7616(b)(3)(A)(ii)

[47 FR 10810, Mar. 12, 1982, as amended at 48 FR 37400, Aug. 18, 1983; 
54 FR 28675, July 7, 1989; 78 FR 51070, Aug. 20, 2013; 85 FR 13053, Mar. 
6, 2020]



Sec.  17.608  Deferment of obligated service.

    (a) Request for deferment. A participant receiving a degree from a 
school of medicine, osteopathy, dentistry, optometry, or podiatry, may 
request deferment of obligated service to complete an approved program 
of advanced clinical training. The Secretary may defer the beginning 
date of the obligated service to allow the participant to complete the 
advanced clinical training program. The period of this deferment will be 
the time designated for the specialty training.


(Authority: 38 U.S.C. 7616(b)(3)(A)(i))

    (b) Deferment requirements. Any participant whose period of 
obligated service is deferred shall be required to take all or part of 
the advanced clinical training in an accredited program in an 
educational institution having an Affiliation Agreement with a 
Department of Veterans Affairs health care facility, and such training 
will be undertaken in a Department of Veterans Affairs health-care 
facility.


(Authority: 38 U.S.C. 7616(b)(4))

    (c) Additional service obligation. A participant who has requested 
and received deferment for approved advanced clinical training may, at 
the time of approval of such deferment and at the discretion of the 
Secretary and upon the recommendation of the Under Secretary for Health, 
incur an additional period of obligated service--
    (1) At the rate of one-half of a calendar year for each year of 
approved clinical training (or a proportionate ratio thereof) if the 
training is in a specialty determined to be necessary to meet health 
care requirements of the Veterans Health Administration; Department of 
Veterans Affairs; or
    (2) At the rate of three-quarters of a calendar year for each year 
of approved graduate training (or a proportionate ratio thereof) if the 
training is in a medical specialty determined not to be necessary to 
meet the health care requirements of the Veterans Health Administration. 
Specialties necessary to meet the health care requirements of the 
Veterans Health Administration will be prescribed periodically by the 
Secretary when, and if, this provision for an additional period of 
obligated service is to be used.


(Authority: 38 U.S.C. 7616(b)(4)(B))

    (d) Altering deferment. Before altering the length or type of 
approved advanced clinical training for which the period of obligated 
service was deferred under paragraphs (a) or (b) of this section, the 
participant must request and obtain the Secretary's written approval of 
the alteration.


(Authority: 38 U.S.C. 7633)

    (e) Beginning of service after deferment. Any participant whose 
period of obligated service has been deferred under paragraph (a) or (b) 
of this section must begin the obligated service effective on the date 
of appointment under title 38 in full-time clinical practice in

[[Page 862]]

an assignment or location in a Department of Veterans Affairs health 
care facility as determined by the Secretary. The assignment will be 
made by the Secretary within 120 days prior to or no later than 30 days 
following the completion of the requested graduate training for which 
the deferment was granted. Travel and relocation regulations will apply.

(Authority: 38 U.S.C. 7616(b)(2))

[47 FR 10810, Mar. 12, 1982; 47 FR 13523, Mar. 31, 1982, as amended at 
54 FR 28675, July 7, 1989; 61 FR 21969, May 13, 1996; 79 FR 54616, Sept. 
12, 2014]



Sec.  17.609  Pay during period of obligated service.

    The initial appointment of physicians for obligated service will be 
made in a grade commensurate with qualifications as determined in 38 
U.S.C. 7404(b) A physician serving a period of obligated service is not 
eligible for incentive special pay during the first three years of such 
obligated service. A physician may be paid primary special pay at the 
discretion of the Secretary upon the recommendation of the Under 
Secretary for Health.

(Authority: 38 U.S.C. 7431-7433)

[47 FR 10810, Mar. 12, 1982, as amended at 54 FR 28676, July 7, 1989; 61 
FR 21969, May 13, 1996; 79 FR 54616, Sept. 12, 2014]



Sec.  17.610  Failure to comply with terms and conditions of participation.

    (a) If a participant, other than one described in paragraph (b) of 
this section fails to accept payment or instructs the school not to 
accept payment of the scholarship provided by the Secretary, the 
participant must, in addition to any service or other obligation 
incurred under the contract, pay to the United States the amount of 
$1,500 liquidated damages. Payment of this amount must be made within 90 
days of the date on which the participant fails to accept payment of the 
scholarship award or instructs the school not to accept payment.


(Authority: 38 U.S.C. 7617(a))

    (b) If a participant:
    (1) Fails to maintain an acceptable level of academic standing;
    (2) Is dismissed from the school for disciplinary reasons;
    (3) Voluntarily terminates the course of study or program for which 
the scholarship was awarded including in the case of a full-time 
student, a reduction of course load from full-time to part-time before 
completing the course of study or program;
    (4) Who is enrolled in a program or education or training leading to 
employment as a physician, fails to successfully complete post-graduate 
training leading to eligibility for board certification in a specialty.
    (5) Fails to become licensed to practice in the discipline for which 
the degree program prepared the participant, if applicable, in a State 
within 1 year from the date such person becomes eligible to apply for 
State licensure; or


(Authority: 38 U.S.C. 7617(b)(4))

    (6) Is a part-time student and fails to maintain employment in a 
permanent assignment in a VA health care facility while enrolled in the 
course of training being pursued; the participant must instead of 
performing any service obligation, pay to the United States an amount 
equal to all scholarship funds awarded under the written contract 
executed in accordance with Sec.  17.602. Payment of this amount must be 
made within 1 year from the date academic training terminates unless a 
longer period is necessary to avoid hardship. No interest will be 
charged on any part of this indebtedness.


(Authority: 38 U.S.C. 7617(b))

    (c) Participants who breach their contracts by failing to begin or 
complete their service obligation (for any reason) other than as 
provided for under paragraph (b) of this section are liable to repay the 
amount of all scholarship funds paid to them and to the school on their 
behalf, plus interest, multiplied by three, minus months of service 
obligation satisfied, as determined by the following formula: 
[GRAPHIC] [TIFF OMITTED] TR25SE06.021

    in which:


[[Page 863]]


`A' is the amount the United States is entitled to recover;
`[phis]' is the sum of the amounts paid to or on behalf of the applicant 
and the interest on such amounts which would be payable if, at the time 
the amounts were paid, they were loans bearing interest at the maximum 
legal prevailing rate, as determined by the Treasurer of the United 
States;
`t' is the total number of months in the applicant's period of obligated 
service; and
`s' is the number of months of the period of obligated service served by 
the participant.


The amount which the United States is entitled to recover shall be paid 
within 1 year of the date on which the applicant failed to begin or 
complete the period of obligated service, as determined by the 
Secretary.

(Authority: 38 U.S.C. 7617(c)(1)(2))

(Approved by the Office of Management and Budget under control number 
2900-0352)

[47 FR 10810, Mar. 12, 1982; 47 FR 13523, Mar. 31, 1982, as amended at 
48 FR 37400, Aug. 18, 1983; 54 FR 28676, July 7, 1989; 54 FR 46611, Nov. 
6, 1989; 61 FR 24237, May 14, 1996; 85 FR 13053, Mar. 6, 2020]



Sec.  17.611  Bankruptcy.

    Any payment obligation incurred may not be discharged in bankruptcy 
under title 11 U.S.C. until 5 years after the date on which the payment 
obligation is due. This section applies to participants in the HPSP and 
the VIOMPSP.

(Authority: 38 U.S.C. 7505(d), 7634(c))

[78 FR 51071, Aug. 20, 2013]



Sec.  17.612  Cancellation, waiver, or suspension of obligation.

    (a) General. (1) This section applies to participants in the HPSP or 
the VIOMPSP.
    (2) Any obligation of a participant for service or payment will be 
cancelled upon the death of the participant.


(Authority: 38 U.S.C. 7634(a))

    (b) Waivers or suspensions. (1) A participant may seek a waiver or 
suspension of the obligated service or payment obligation incurred under 
this program by submitting a written request to VA setting forth the 
basis, circumstances, and causes which support the requested action. 
Requests for waivers or suspensions must be submitted to VA no later 
than 1 year after the date VA notifies the participant that he or she is 
in breach of his or her acceptance agreement. A participant seeking a 
waiver or suspension must comply with requests for additional 
information from VA no later than 30 days after the date of any such 
request.
    (i) Waivers. A waiver is a permanent release by VA of the obligation 
either to repay any scholarship funds that have already been paid to or 
on behalf of the participant, or to fulfill any other acceptance 
agreement requirement. If a waiver is granted, then the waived amount of 
scholarship funds may be considered taxable income.
    (ii) Suspensions. VA may approve an initial request for a suspension 
for a period of up to 1 year. A suspension may be extended for one 
additional year, after which time the participant will be in breach of 
his or her acceptance agreement. If a suspension is approved:
    (A) VA will temporarily discontinue providing any scholarship funds 
to or on behalf of the participant while the participant's scholarship 
is in a suspended status; or
    (B) VA will temporarily delay the enforcement of acceptance 
agreement requirements.
    (2) The Secretary may waive or suspend any service or payment 
obligation incurred by a participant whenever compliance by the 
participant (i) is impossible, due to circumstances beyond the control 
of the participant or (ii) whenever the Secretary concludes that a 
waiver or suspension of compliance would be in the best interest of the 
Department of Veterans Affairs.


(Authority: 38 U.S.C. 7634(b))

    (c) Compliance by a participant with a service or payment obligation 
will be considered impossible due to circumstances beyond the control of 
the participant if the Secretary determines, on the basis of such 
information and documentation as may be required, that the participant 
suffers from a physical or mental disability resulting in permanent 
inability to perform the service or other activities which would be 
necessary to comply with the obligation.

[[Page 864]]

    (d) Waivers or suspensions of service or payment obligations, when 
not related to paragraph (c) of this section, and when considered in the 
best interest of the Department of Veterans Affairs, will be determined 
by the Secretary on an individual basis.
    (e) Eligibility to reapply for award. Any previous participant of 
any federally sponsored scholarship program who breached his or her 
acceptance agreement or similar agreement in such scholarship program is 
not eligible to apply for a HPSP or VIOMPSP. This includes participants 
who previously applied for, and received, a waiver under this section.
    (f) Finality of decisions. Decisions to approve or disapprove waiver 
requests are final and binding determinations. Such determinations are 
not subject to reconsideration or appeal.

(Authority: 38 U.S.C. 7505(c), 7634(a), 7634(b))

[47 FR 10810, Mar. 12, 1982, as amended at 78 FR 51071, Aug. 20, 2013]

    Veterans Healing Veterans Medical Access and Scholarship Program

    Veterans Healing Veterans Medical Access and Scholarship Program

    Source: Sections 17.613 through 17.618 appear at 84 FR 61551, Nov. 
13, 2019, unless otherwise noted.



Sec.  17.613  Purpose.

    The purpose of Sec. Sec.  17.613 through 17.618 is to establish the 
requirement for the Veterans Healing Veterans Medical Access and 
Scholarship Program (VHVMASP). The VHVMASP will provide funding for the 
medical education of two eligible veterans from each covered medical 
school.



Sec.  17.614  Definitions.

    The following definitions apply to Sec. Sec.  17.613 through 17.618.
    Acceptable level of academic standing means:
    (1) Maintaining a cumulative grade point average at or above 
passing, as determined by the medical school;
    (2) Completing all required courses with a passing grade;
    (3) Successfully completing the required course of study for 
graduation within four academic years;
    (4) Successfully passing the required United States Medical 
Licensing Examinations steps 1 and 2, within the timeframe for 
graduation from medical school; and
    (5) Having no final determinations of unprofessional conduct or 
behavior.
    Covered medical school means any of the following:
    (1) Texas A&M College of Medicine.
    (2) Quillen College of Medicine at East Tennessee State University.
    (3) Boonshoft School of Medicine at Wright State University.
    (4) Joan C. Edwards School of Medicine at Marshall University.
    (5) University of South Carolina School of Medicine.
    (6) Charles R. Drew University of Medicine and Science.
    (7) Howard University College of Medicine.
    (8) Meharry Medical College.
    (9) Morehouse School of Medicine.
    VA means the Department of Veterans Affairs.
    VHVMASP means the Veterans Healing Veterans Medical Access and 
Scholarship Program authorized by section 304 of the VA MISSION Act of 
2018, Public Law 115-182.



Sec.  17.615  Eligibility.

    A veteran is considered eligible to receive funding for the VHVMASP 
if such veteran meets the following criteria.
    (a) Has been discharged or released, under conditions other than 
dishonorable, from the Armed Forces for not more than 10 years before 
the date of application for admission to a covered medical school;
    (b) Is not concurrently receiving educational assistance under 
chapter 30, 31, 32, 33, 34, or 35 of title 38 United States Code or 
chapter 1606 or 1607 of title 10 United States Code at the time the 
veteran would be receiving VHVMASP funding;
    (c) Applies for admission to a covered medical school for the 
entering class of 2020;
    (d) Indicates on the application to the covered medical school that 
they would like to be considered for the VHVMASP;
    (e) Meets the minimum admissions criteria for the covered medical 
school

[[Page 865]]

to which the eligible veteran applies; and
    (f) Agrees to the terms stated in Sec.  17.617.



Sec.  17.616  Award procedures.

    (a) Distribution of funds. (1) Each covered medical school that opts 
to participate in the VHVMASP will reserve two seats in the entering 
class of 2020 for eligible veterans who receive funds for the VHVMASP. 
Funding will be awarded to two eligible veterans with the highest 
admissions ranking among veteran applicants for such entering class for 
each covered medical school.
    (2) If two or more eligible veterans do not apply for admission at a 
covered medical school for the entering class of 2020, VA will 
distribute the available funding to eligible veterans who applied, and 
are accepted, for admission at other covered medical schools.
    (b) Amount of funds. An eligible veteran will receive funding from 
the VHVMASP equal to the actual cost of the following:
    (1) Tuition at the covered medical school for which the veteran 
enrolls for a period of not more than 4 years;
    (2) Books, fees, and technical equipment;
    (3) Fees associated with the National Residency Match Program;
    (4) Two away rotations, performed during the fourth year of school, 
at a VA medical facility; and
    (5) A monthly stipend for the four-year period during which the 
eligible veteran is enrolled in a covered medical school in an amount to 
be determined by VA.



Sec.  17.617  Agreement and obligated service.

    (a) Agreement. Each eligible veteran who accepts funds from the 
VHVMASP will enter into an agreement with VA where the eligible veteran 
agrees to the following:
    (1) Maintain enrollment, attendance, and acceptable level of 
academic standing as defined by the covered medical school;
    (2) Complete post-graduate training leading to eligibility for board 
certification in a physician specialty applicable to VA;
    (3) After completion of medical school and post-graduate training, 
obtain and maintain a license to practice medicine in a State. Eligible 
veterans must ensure that State licenses are obtained in a minimal 
amount of time following completion of residency, or fellowship, if the 
veteran is enrolled in a fellowship program approved by VA. If a 
participant fails to obtain his or her degree, or fails to become 
licensed in a State no later than 90 days after completion of residency, 
or fellowship, if applicable, the participant is considered to be in 
breach of the acceptance agreement; and
    (4) Serve as a full-time clinical practice employee in VA for a 
period of four years.
    (b) Obligated service--(1) General. An eligible veteran's obligated 
service will begin on the date on which the eligible veteran begins 
full-time permanent employment with VA as a clinical practice employee. 
VA will appoint the participant to such position as soon as possible, 
but no later than 90 days after the date that the participant completes 
residency, or fellowship, if applicable, or the date the participant 
becomes licensed in a State, whichever is later.
    (2) Location and position of obligated service. VA reserves the 
right to make final decisions on the location and position of the 
obligated service.
    (The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0793.)



Sec.  17.618  Failure to comply with terms and conditions of agreement.

    (a) Participant fails to satisfy terms of agreement. If an eligible 
veteran who accepts funding for the VHVMASP breaches the terms of the 
agreement stated in Sec.  17.617, the United States is entitled to 
recover damages in an amount equal to the total amount of VHVMASP 
funding received by the eligible veteran.
    (b) Repayment period. The eligible veteran will pay the amount of 
damages that the United States is entitled to recover under this section 
in full to the United States no later than 1 year after the date of the 
breach of the agreement.

[[Page 866]]

    (c) Waivers. The Under Secretary for Health, or designee, may waive 
or suspend any service or financial liability incurred by a participant 
whenever compliance by the participant is impossible, due to 
circumstances beyond the control of the participant, or whenever the 
Under Secretary for Health, or designee, concludes that a waiver or 
suspension of compliance is in the VA's best interest.

Visual Impairment and Orientation and Mobility Professional Scholarship 
                                 Program

    Source: Sections 17.625 through 17.636 appear at 78 FR 51071, Aug. 
20, 2013, unless otherwise noted.



Sec.  17.625  Purpose.

    The purpose of Sec. Sec.  17.625 through 17.636 is to establish the 
requirements for the award of scholarships under the Visual Impairment 
and Orientation and Mobility Professional Scholarship Program (VIOMPSP) 
to students pursuing a program of study leading to a degree in visual 
impairment or orientation and mobility. The scholarship is designed to 
increase the supply of qualified Blind Rehabilitation Specialists and 
Blind Rehabilitation Outpatient Specialists available to VA. The 
scholarship will be publicized throughout educational institutions in 
the United States, with an emphasis on disseminating information to such 
institutions with high numbers of Hispanic students and to historically 
black colleges and universities.

(Authority: 38 U.S.C. 7501)



Sec.  17.626  Definitions.

    For the definitions that apply to Sec. Sec.  17.625 through 17.636, 
see Sec.  17.601.

(Authority: 38 U.S.C. 501)



Sec.  17.627  Eligibility for the VIOMPSP.

    (a) General. To be eligible for the VIOMPSP, an applicant must meet 
the following requirements:
    (1) Be unconditionally accepted for enrollment or currently enrolled 
in a program of study leading to a degree in orientation and mobility, 
low vision therapy, or vision rehabilitation therapy, or a dual degree 
(a program in which an individual becomes certified in two of the three 
professional certifications offered by the Academy for Certification of 
Visual Rehabilitation and Education Professionals) at an accredited 
educational institution that is in a State;
    (2) Be a citizen of the United States; and
    (3) Submit an application to participate in the VIOMPSP, as 
described in Sec.  17.629.
    (b) Obligated service to another entity. Any applicant who, at the 
time of application, owes a service obligation to any other entity to 
perform service after completion of the course of study is ineligible to 
receive a VIOMPSP scholarship.

(Authority: 38 U.S.C. 7501(a), 7502(a), 7504(3))



Sec.  17.628  Availability of VIOMPSP scholarships.

    VA will make awards under the VIOMPSP only when VA determines it is 
necessary to assist in alleviating shortages or anticipated shortages of 
personnel in visual impairment or orientation and mobility programs. 
VA's determination of the number of VIOMPSP scholarships to be awarded 
in a fiscal year, and the number that will be awarded to full-time and/
or part-time students, is subject to the availability of appropriations.

(Authority: 38 U.S.C. 7501(a), 7503(c)(2))



Sec.  17.629  Application for the VIOMPSP.

    (a) Application-general. Each individual desiring a VIOMPSP 
scholarship must submit an accurate and complete application, including 
a signed written acceptance agreement.
    (b) VA's duties. VA will notify applicants prior to acceptance in 
the VIOMPSP of the following information:
    (1) A fair summary of the rights and liabilities of an individual 
whose application is approved by VA and whose acceptance agreement is 
consummated by VA; and

[[Page 867]]

    (2) Full description of the terms and conditions that apply to 
participation in the VIOMPSP and service in VA.

(Authority: 38 U.S.C. 501(a), 7502(a)(2))

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0793.)



Sec.  17.630  Selection of VIOMPSP participants.

    (a) General. In deciding which VIOMPSP applications to approve, VA 
will first consider applications submitted by applicants entering their 
final year of education or training. Applicants will be evaluated and 
selected using the criteria specified in paragraph (b) of this section. 
If there are a larger number of equally qualified applicants than there 
are awards to be made, then VA will first select veterans, and then use 
a random method as the basis for further selection.
    (b) Selection criteria. In evaluating and selecting participants, VA 
will take into consideration those factors determined necessary to 
assure effective participation in the VIOMPSP. These factors will 
include, but are not limited to, the following:
    (1) Academic performance;
    (2) Work/volunteer experience, including prior rehabilitation or 
health care employment and VA employment;
    (3) Faculty and employer recommendations; or
    (4) Career goals.
    (c) Notification of approval. VA will notify the individual in 
writing that his or her application has been accepted and approved. An 
individual becomes a participant in the program upon receipt of such 
approval by VA.
    (d) Duration of VIOMPSP award. VA will award a VIOMPSP scholarship 
for a period of time equal to the number of years required to complete a 
program of study leading to a degree in orientation and mobility, low 
vision therapy, or vision rehabilitation therapy, or a dual degree. The 
number of years covered by an individual scholarship award will be based 
on the number of school years that the participant has yet to complete 
his or her degree at the time the VIOMPSP scholarship is awarded. 
Subject to the availability of funds, VA will award the VIOMPSP as 
follows:
    (1) Full-time scholarship. A full-time scholarship is awarded for a 
minimum of 1 school year to a maximum of 4 school years;
    (2) Part-time scholarships. A part-time scholarship is awarded for a 
minimum of 1 school year to a maximum of 6 school years.

(Authority: 38 U.S.C. 7504(3))



Sec.  17.631  Award procedures.

    (a) Amount of scholarship. (1) A VIOMPSP scholarship award will not 
exceed the total tuition and required fees for the program of study in 
which the applicant is enrolled. All such payments to scholarship 
participants are exempt from Federal taxation.
    (2) The total amount of assistance provided under the VIOMPSP for an 
academic year to an individual who is a full-time student may not exceed 
$15,000.00.
    (3) The total amount of assistance provided under the VIOMPSP for an 
academic year to a participant who is a part-time student shall bear the 
same ratio to the amount that would be paid under paragraph (a)(2) of 
this section if the participant were a full-time student as the 
coursework carried by the participant to full-time coursework.
    (4) The total amount of assistance provided to an individual may not 
exceed $45,000.00.
    (5) In the case of an individual enrolled in a program of study 
leading to a dual degree described in Sec.  17.627(a)(1), such tuition 
and fees will not exceed the amounts necessary for the minimum number of 
credit hours to achieve such dual degree.
    (6) Financial assistance may be provided to an individual under the 
VIOMPSP to supplement other educational assistance to the extent that 
the total amount of educational assistance received by the individual 
during an academic year does not exceed the total tuition and fees for 
such academic year.
    (7) VA will make arrangements with the school in which the 
participant is enrolled to issue direct payment for the amount of 
tuition or fees on behalf of the participant.

[[Page 868]]

    (b) Repeated course work. Additional costs relating to the repeated 
course work will not be paid under this program. VA will resume any 
scholarship payments suspended under this section upon notification by 
the school that the participant has returned from the leave-of-absence 
or has satisfactorily completed the repeated course work and is pursuing 
the course of study for which the VIOMPSP was awarded.

(Authority: 38 U.S.C. 7503, 7504(3))



Sec.  17.632  Obligated service.

    (a) General provision. Except as provided in paragraph (d) of this 
section, each participant is obligated to provide service as a full-time 
clinical VA employee in the rehabilitation practice of the participant's 
discipline in an assignment or location determined by VA.
    (b) Beginning of service. A participant's obligated service will 
begin on the date on which the participant obtains any required 
applicable credentials and when appointed as a full-time clinical VA 
employee in a position for which the degree prepared the participant. VA 
will appoint the participant to such position as soon as possible, but 
no later than 90 days after the date that the participant receives his 
or her degree, or the date the participant obtains any required 
applicable credentials, whichever is later. If a participant fails to 
obtain his or her degree, or fails to obtain any required applicable 
credentials within 180 days after receiving the degree, the participant 
is considered to be in breach of the acceptance agreement.
    (c) Duration of service. The participant will agree to serve as a 
full-time clinical VA employee for 3 calendar years which must be 
completed no later than 6 years after the participant has completed the 
program for which the scholarship was awarded and received a degree 
referenced in Sec.  17.627(a)(1).
    (d) Location and assignment of obligated service. VA reserves the 
right to make final decisions on the location and assignment of the 
obligated service. A participant who receives a scholarship must agree 
as part of the participant's mobility agreement that he or she is 
willing to accept the location and assignment where VA assigns the 
obligated service. Geographic relocation may be required.
    (e) Creditability of advanced clinical training. No period of 
advanced clinical training will be credited towards satisfying the 
period of obligated service incurred under the VIOMPSP.

(Authority: 38 U.S.C. 7504(2)(D), 7504(3))



Sec.  17.633  Deferment of obligated service.

    Deferment of obligated service under the VIOMPSP is treated in the 
same manner as deferment of obligated service under the HPSP under Sec.  
17.608.

(Authority: 38 U.S.C. 7504(3))



Sec.  17.634  Failure to comply with terms and conditions of participation.

    (a) Participant refuses to accept payment of the VIOMPSP. If a 
participant, other than one described in paragraph (b) of this section, 
refuses to accept payment or instructs the school not to accept payment 
of the VIOMPSP scholarship provided by VA, the participant must, in 
addition to any obligation incurred under the agreement, pay to the 
United States the amount of $1,500 in liquidated damages. Payment of 
this amount must be made no later than 90 days from the date that the 
participant fails to accept payment of the VIOMPSP or instructs the 
school not to accept payment.
    (b) Participant fails to complete course of study or does not obtain 
certification. A participant described in paragraphs (b)(1) through (4) 
of this section must, instead of otherwise fulfilling the terms of his 
or her acceptance agreement, pay to the United States an amount equal to 
all VIOMPSP funds awarded under the acceptance agreement. Payment of 
this amount must be made no later than 1 year after the date that the 
participant meets any of the criteria described in paragraphs (b)(1) 
through (4) of this section, unless VA determines that a longer period 
is necessary to avoid hardship. No interest will be charged on any part 
of this indebtedness. A participant will pay such amount if one of the 
following criteria is met:

[[Page 869]]

    (1) The participant fails to maintain an acceptable level of 
academic standing;
    (2) The participant is dismissed from the school for disciplinary 
reasons;
    (3) The participant, for any reason, voluntarily terminates the 
course of study or program for which the scholarship was awarded 
including a reduction of course load from full-time to part-time before 
completing the course of study or program; or
    (4) The participant fails to become certified in the discipline for 
which the degree prepared the participant, if applicable, no later than 
180 days after the date such person becomes eligible to apply for 
certification.
    (c) Participant fails to perform all or any part of their service 
obligation. (1) Participants who breach their agreements by failing to 
begin or complete their service obligation, for any reason, including 
the loss, revocation, suspension, restriction, or limitation of required 
certification, and other than provided for under paragraph (b) of this 
section, must repay the portion of all VIOMPSP funds paid to or on 
behalf of the participant, adjusted for the service that they provided. 
To calculate the unearned portion of VIOMPSP funds, subtract the number 
of months of obligated service rendered from the total months of 
obligated service owed, divide the remaining months by the total 
obligated service, then multiply by the total amount of VIOMPSP funds 
paid to or on behalf of the participant. The following formula may be 
used in determining the unearned portion:

A = P((t-s)/t) in which
``A'' is the amount the United States is entitled to recover;
``P'' is the amounts paid under the VIOMPSP, to or on behalf of the 
          participant;
``t'' is the total number of months in the participant's period of 
          obligated service; and
``s'' is the number of months of obligated service rendered.

    (2) The amount that the United States is entitled to recover will be 
paid no later than 1 year after the date the applicant failed to begin 
or complete the period of obligated service, as determined by VA.

(Authority: 38 U.S.C. 7505(a), 7505(b))



Sec.  17.635  Bankruptcy.

    Bankruptcy under the VIOMPSP is treated in the same manner as 
bankruptcy for the HPSP under Sec.  17.611.

(Authority: 38 U.S.C. 7505(c), 7505(d))



Sec.  17.636  Cancellation, waiver, or suspension of obligation.

    Cancellation, waiver, or suspension procedures under the VIOMPSP are 
the same as those procedures for the HPSP under Sec.  17.612.

(Authority: 38 U.S.C. 7505(c))

 Program for Repayment of Educational Loans for Certain VA Psychiatrists

    Source: 81 FR 66820, Sept. 29, 2016, unless otherwise noted.



Sec.  17.640  Purpose.

    The purpose of Sec. Sec.  17.640 through 17.647 is to establish the 
requirements for the program for the repayment of educational loans 
(PREL) obtained by physician residents pursuing a certification in 
psychiatry.



Sec.  17.641  Definitions.

    The following definitions apply to Sec. Sec.  17.640 through 17.647.
    Acceptance of conditions means a signed document between VA and a 
participant of the PREL, in which the participant must agree to a period 
of obligated service, to maintain an acceptable level of performance 
determined by supervisory review in the position to which VA appoints 
the participant, to terms and amount of payment, and to relocate, if 
required, to a location determined by VA at the participant's expense in 
exchange for educational loan repayments under the PREL. VA will provide 
a list of available locations for the period of obligated service in the 
acceptance of conditions. The applicant will choose the preferred 
location, in ranking order, for the completion of his or her obligated 
service from the locations on this list. However, VA will ultimately 
make the final determination as to where the applicant will perform his 
or her period of obligated service. A participant of the PREL must agree 
that

[[Page 870]]

he or she is willing to accept the location and position to which VA 
appoints the participant.
    Educational loan means a loan, government or commercial, made for 
educational purposes by institutions that are subject to examination and 
supervision in their capacity as lending institutions by an agency of 
the United States or of the state in which the lender has its principal 
place of business. Loans must be for the actual costs paid for tuition, 
and other reasonable educational expenses such as living expenses, fees, 
books, supplies, educational equipment and materials, and laboratory 
expenses. Loans must be obtained from a government entity, a private 
financial institution, a school, or any other authorized entity stated 
in this definition. The following loans do not qualify for the PREL:
    (1) Loans obtained from family members, relatives, or friends;
    (2) Loans made prior to, or after, the individual's qualifying 
education;
    (3) Any portion of a consolidated loan that is not specifically 
identified with the education and purposes for which the PREL may be 
authorized, such as home or auto loans merged with educational loans;
    (4) Loans for which an individual incurred a service obligation for 
repayment or agreed to service for future cancellation;
    (5) Credit card debt;
    (6) Parent Plus Loans;
    (7) Loans that have been paid in full;
    (8) Loans that are in default, delinquent, not in a current payment 
status, or have been assumed by a collection agency;
    (9) Loans not obtained from a bank, credit union, savings and loan 
association, not-for-profit organization, insurance company, school, and 
other financial or credit institution which is subject to examination 
and supervision in its capacity as a lending institution by an agency of 
the United States or of the state in which the lender has its principal 
place of business;
    (10) Loans for which supporting documentation is not available;
    (11) Loans that have been consolidated with loans of other 
individuals, such as spouses, children, friends, or other family member; 
or
    (12) Home equity loans or other non-educational loans.
    PREL means the program for the repayment of educational loans for 
certain VA psychiatrists established in Sec. Sec.  17.640 through 
17.647.



Sec.  17.642  Eligibility.

    (a) General. To be eligible for the PREL, an applicant must meet all 
of the following requirements:
    (1) Be a U.S. citizen or permanent resident.
    (2) Be enrolled in the final year of a post-graduate physician 
residency program leading to either a specialty qualification in 
psychiatric medicine or a subspecialty qualification of psychiatry (the 
program must be accredited by the Accreditation Council for Graduate 
Medical Education or the American Osteopathic Association, and, by the 
time of VA employment, must:
    (i) Have completed all psychiatry residency training;
    (ii) Have received a completion certificate from the Program 
Director confirming successful completion of the residency program; and
    (iii) Certify intention to apply for board certification in the 
specialty of psychiatry (through the American Board of Medical 
Specialties or the American Osteopathic Association) within two years 
after completion of residency.
    (3) Be licensed or eligible for licensure to practice medicine by 
meeting the following requirements by the time of VA employment:
    (i) Have at least one full, active, current, and unrestricted 
license that authorizes the licensee to practice in any State, 
Territory, or possession of the United States, the District of Columbia, 
or the Commonwealth of Puerto Rico;
    (ii) Document graduation from a school of medicine accredited by the 
Liaison Committee on Medical Education or the American Osteopathic 
Association; or, if an international medical graduate, verify that 
requirements for certification by the Educational Commission for Foreign 
Medical Graduates have been met.

[[Page 871]]

    (b) Simultaneous participation in another repayment program. Any 
applicant who, at the time of application, is participating in any other 
program of the Federal Government that repays the educational loans of 
the applicant is not eligible to participate in the PREL.



Sec.  17.643  Application for the PREL.

    (a) General. A complete application for the PREL consists of a 
completed application form, letters of reference, and personal 
statement.
    (b) References. The applicant must provide the following letters of 
reference and sign a release of information form for VA to contact such 
references. The letters of reference should include the following:
    (1) One letter of reference from the Program Director of the core 
psychiatry program in which the applicant trained or is training, or the 
Program Director of any psychiatry subspecialty program in which the 
applicant is training, which indicates that the applicant is in good to 
excellent standing;
    (2) One or more letters of reference from faculty members under 
which the applicant trained;
    (3) One letter of reference from a peer colleague who is familiar 
with the psychiatry practice and character of the applicant.
    (c) Personal statement. The personal statement must include the 
following documentation:
    (1) A cover letter that provides the following information:
    (i) Why the applicant is interested in VA employment;
    (ii) The applicant's interest in working at a particular VA medical 
facility;
    (iii) Likely career goals, including career goals in VA; and
    (iv) A brief summary of past employment or training and 
accomplishments, including any particular clinical areas of interest 
(e.g., substance abuse).
    (2) The following information must be provided on a VA form or 
online collection system and is subject to VA verification:
    (i) Attestation that the applicant is not participating in any other 
loan repayment program.
    (ii) A summary of the applicant's educational debt, which includes 
the total debt amount and when the debt was acquired. The health 
professional debt covered the loan must be specific to education that 
was required, used, and qualified the applicant for appointment as a 
psychiatrist.
    (iii) The name of the lending agency that provided the educational 
loan.
    (3) A full curriculum vitae.

[81 FR 66820, Sept. 29, 2016, as amended at 82 FR 4795, Jan. 17, 2017]

    Effective Date Note: At 81 FR 66820, Sept. 29, 2016, Sec.  17.643 
was added. This section contains information collection and 
recordkeeping requirements and will not become effective until approval 
has been given by the Office of Management and Budget.



Sec.  17.644  Selection of participants.

    (a) Selection criteria. In evaluating and selecting participants, VA 
will consider the following factors:
    (1) The applicant meets all of the eligibility criteria in Sec.  
17.642 and has submitted a complete application under Sec.  17.643;
    (2) The strength of the applicant's letters of reference;
    (3) The applicant is in good to excellent standing in the residency 
program, as determined from the Program Director letter of reference;
    (4) The applicant demonstrates a strong commitment to VA's mission 
and core values;
    (5) The applicant has personal career goals that match VA needs 
(i.e., to work with patients suffering from traumatic brain injury, 
substance abuse, or post-traumatic stress disorder);
    (6) The applicant's expresses a desire to work at a location that 
matches with VA needs; and
    (7) The applicant does not have any identifiable circumstances 
relating to education, training, licensure, certification and review of 
health status, previous experience, clinical privileges, professional 
references, malpractice history and adverse actions, or criminal 
violations that would adversely affect the applicant's credentialing 
process.
    (b) Selection. VA will select not less than 10 individuals who meet 
the requirements of this section to participate in the program for the 
repayment

[[Page 872]]

of educational loans for each year in which VA carries out the program.
    (c) Notification of selection. VA will notify applicants that they 
have been selected in writing. An individual becomes a participant in 
the PREL once the participant submits and VA signs the acceptance of 
conditions.

[81 FR 66820, Sept. 29, 2016, as amended at 82 FR 4796, Jan. 17, 2017]



Sec.  17.645  Award procedures.

    (a) Repayment amount. (1) VA may pay not more than $30,000 in 
educational loan repayment for each year of obligated service.
    (2) An educational loan repayment may not exceed the actual amount 
of principal and interest on an educational loan or loans.
    (b) Payment. VA will pay the participant, or the lending institution 
on behalf of the participant, directly for the principal and interest on 
the participant's educational loans. Payments will be made monthly or 
annually for each applicable service period, depending on the terms of 
the acceptance of conditions. Participants must provide VA documentation 
that shows the amounts that were credited or posted by the lending 
institution to a participant's educational loan during an obligated 
service period. VA will issue payments after the participant commences 
the period of obligated service. Payments are exempt from Federal 
taxation.



Sec.  17.646  Obligated service.

    (a) General provision. A participant's obligated service will begin 
on the date on which the participant begins full-time, permanent 
employment with VA in the field of psychiatric medicine in a location 
determined by VA. Obligated service must be full-time, permanent 
employment and does not include any period of temporary or contractual 
employment.
    (b) Duration of service. The participant will agree in the 
acceptance of conditions to serve for an obligated service period of 2 
or more calendar years.
    (c) Location and position of obligated service. VA reserves the 
right to make final decisions on the location and position of the 
obligated service.



Sec.  17.647  Failure to comply with terms and conditions of participation.

    (a) Participant fails to satisfy obligated service. A participant of 
the PREL who fails to satisfy the period of obligated service will be 
liable to the United States, in lieu of such obligated service, for the 
full amount of benefit they expected to receive in the agreement, pro-
rated for completed service days.
    (b) Repayment period. The participant will pay the amount of damages 
that the United States is entitled to recover under this section in full 
to the United States no later than 1 year after the date of the breach 
of the agreement.

                            Chaplain Services



Sec.  17.655  Ecclesiastical endorsing organizations.

    (a) Purpose. This section establishes the eligibility requirements 
that an ecclesiastical endorsing organization must meet in order to 
provide ecclesiastical endorsements of individuals who are seeking 
employment as VA chaplains or seeking to be engaged by VA under contract 
or appointed as on-facility fee basis VA chaplains under 38 U.S.C. 7405. 
Acceptance of an ecclesiastical endorsement by VA does not imply any 
approval by VA of the theology or practices of an ecclesiastical 
endorsing organization, nor does it obligate VA to employ the endorsed 
individual or any other member of the organization.
    (b) Definitions. The following definitions apply to this section:
    (1) Ecclesiastical endorsement means a written statement addressed 
to VA and signed by the designated endorsing official of an 
ecclesiastical endorsing organization certifying that an individual is 
in good standing with the faith group or denomination and, in the 
opinion of the endorsing official, is qualified to perform the full 
range of ministry, including all sacraments, rites, ordinances, rituals, 
and liturgies required by members of the faith group. Ecclesiastical 
endorsement is a condition of employment as a VA chaplain. An individual 
must obtain and maintain a full and active ecclesiastical endorsement to 
be employed as a VA chaplain.

[[Page 873]]

    (2) Ecclesiastical endorsing official means an individual who is 
authorized to provide or withdraw ecclesiastical endorsements on behalf 
of an ecclesiastical endorsing organization.
    (3) Ecclesiastical endorsing organization means an organization that 
meets the eligibility requirements of paragraph (c) of this section and 
has been properly designated as an endorsing organization in accordance 
with paragraph (e) of this section.
    (c) Eligibility to serve as an ecclesiastical endorsing 
organization. An ecclesiastical endorsing organization must meet the 
following requirements before such organization can endorse an applicant 
for VA chaplaincy:
    (1) Be organized and function exclusively or substantially to 
provide religious ministries to a lay constituency and possess authority 
to both grant and withdraw initial and subsequent ecclesiastical 
endorsements;
    (2) Have tax-exempt status as a religious organization or church 
under the Internal Revenue Code, section 501(c)(3);
    (3) Agree to abide by all Federal and VA laws, regulations, 
policies, and issuances on the qualification and endorsement of persons 
for service as VA chaplains;
    (4) Agree to notify VA in writing of any withdrawal of an existing 
ecclesiastical endorsement within ten days after the date of such 
withdrawal;
    (5) Provide VA the documents stated in paragraph (d) of this 
section;
    (6) Notify VA in writing within 30 days of any change of the name, 
address or contact information of the individual that it designates as 
its ecclesiastical endorsing official; and
    (7) An ecclesiastical endorsing organization that is part of an 
endorsing organization by which its members can be endorsed cannot 
become a separate endorsing organization without the written permission 
of the larger endorsing organization.
    (d) Request to designate ecclesiastical endorser. In order for an 
ecclesiastical endorsing organization to be recognized by VA such 
organization must submit the following:
    (1) A complete VA form that requests the designation of an 
ecclesiastical endorsing official;
    (2) A copy of an Internal Revenue Service document verifying that 
the organization currently holds a section 501(c)(3) exempt status as a 
church for Federal tax purposes from the Internal Revenue Service (IRS) 
(note ``church'' is used by the IRS not to denote a belief system, but 
to distinguish ``churches'' from other types of religious organizations; 
see IRS Instructions for Form 1023 Schedule A). Such rules stipulate 
that the particular religious beliefs of the organization are truly and 
sincerely held and that the practices and rituals associated with the 
organization's religious belief or creed are not illegal or contrary to 
clearly defined public policy. In order to determine whether a 
particular religious organization has properly acquired, and currently 
maintains, an IRS tax exempt status and does not engage in practices 
that are illegal or contrary to defined public policy, VA shall take 
appropriate steps to verify compliance with these requirements;
    (3) A document verifying that the organization shall provide 
chaplains who shall function in a pluralistic environment, and who shall 
support directly and indirectly the free exercise of religion by all 
veterans, their family members, and other persons authorized to be 
served by VA;
    (4) That it agrees to abide by all VA Directives, Instructions, and 
other guidance, regulations and policies on the qualification and 
endorsement of ministers for service as VA chaplains;
    (5) Documentation that states the structure of the organization, 
including copies of the articles of incorporation, by-laws and 
constitution, membership requirements of the organization, if any, the 
religious beliefs and practices of the organization, and the 
organization's requirements to become clergy; and
    (6) The name and address of the individual who is applying to become 
a VA chaplain.
    (e) Approval of request to designate an ecclesiastical endorsing 
official. If an ecclesiastical endorsing organization meets the 
requirements of paragraph (c) of this section and has submitted the 
documents stated in paragraph (d)

[[Page 874]]

of this section, VA will notify the organization in writing that such 
organization has been designated as an ecclesiastical endorsing 
organization. The designation will be for a period of 3 years from the 
date of notification. Once an organization is designated as an 
ecclesiastical endorsing organization, VA will accept ecclesiastical 
endorsements from that organization without requiring any further 
documentation from the organization during the 3 year period, unless VA 
receives evidence that an organization no longer meets the requirements 
of this section. VA will only take action on an initial request to 
designate an ecclesiastical endorsing official when VA receives an 
application from an individual who is seeking employment as a VA 
chaplain or is seeking to be engaged under VA contract or appointed as 
on-facility fee basis VA chaplains under 38 U.S.C. 7405.
    (f) Reporting requirement. (1) To certify that VA chaplains continue 
to be endorsed by an ecclesiastical endorsing organization, such 
organization must provide VA an alphabetical listing of individuals who 
are endorsed by that endorsing organization and are employed as VA 
chaplains or are engaged by VA under contract or appointed as on-
facility fee basis VA chaplains under 38 U.S.C. 7405 by January 1 of 
every calendar year.
    (2) In order for VA to continue to recognize an ecclesiastical 
endorsing organization, such organization must provide written 
documentation that it continues to meet the requirements of this section 
every 3 years.
    (g) Rescission of ecclesiastical endorsing organization. VA may 
rescind an organization's status as an ecclesiastical endorsing 
organization and refuse to accept ecclesiastical endorsements from such 
organization if it no longer meets the requirements of paragraph (c) of 
this section. VA will take the following steps before it rescinds the 
organization's status:
    (1) VA will give the ecclesiastical endorsing organization written 
notice stating the reasons for the rescission and give the organization 
60 days to provide a written reply addressing VA's concerns.
    (2) VA will notify the ecclesiastical endorsing organization and all 
VA chaplains endorsed by the organization in writing of its decision 
after VA reviews the evidence provided by the organization or after the 
60 day time period has expired, whichever comes first.
    (3) Ecclesiastical endorsing organizations that are notified that 
they may no longer endorse individuals for VA chaplaincy because they do 
not meet the requirements of paragraph (c) of this section must resubmit 
all of the evidence stated in paragraph (d) of this section in order to 
be reconsidered as an endorsing organization.
    (4) If an ecclesiastical endorsing organization is no longer able to 
endorse individuals for VA chaplaincy in accordance with this section, 
all ecclesiastical endorsements issued by that organization are 
considered to be withdrawn.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0852.)

[82 FR 51772, Nov. 8, 2017]

       Grants for Transportation of Veterans in Highly Rural Areas

    Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501 and as noted in 
specific sections.

    Source: 78 FR 19593, Apr. 2, 2013, unless otherwise noted.



Sec.  17.700  Purpose and scope.

    This section establishes the Grants for Transportation of Veterans 
in Highly Rural Areas program. Under this program, the Department of 
Veterans Affairs (VA) provides grants to eligible entities to assist 
veterans in highly rural areas through innovative transportation 
services to travel to VA medical centers, and to otherwise assist in 
providing transportation services in connection with the provision of VA 
medical care to these veterans.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)



Sec.  17.701  Definitions.

    For the purposes of Sec. Sec.  17.700-17.730 and any Notice of Fund 
Availability issued pursuant to such sections:

[[Page 875]]

    Applicant means an eligible entity that submits an application for a 
grant announced in a Notice of Fund Availability.
    Eligible entity means:
    (1) A Veterans Service Organization, or
    (2) A State veterans service agency.
    Grantee means an applicant that is awarded a grant under this 
section.
    Highly rural area means an area consisting of a county or counties 
having a population of less than seven persons per square mile.
    Notice of Fund Availability means a Notice of Fund Availability 
published in the Federal Register in accordance with Sec.  17.710.
    Participant means a veteran in a highly rural area who is receiving 
transportation services from a grantee.
    Provision of VA medical care means the provision of hospital or 
medical services authorized under sections 1710, 1703, and 8153 of title 
38, United States Code.
    State veterans service agency means the element of a State 
government that has responsibility for programs and activities of that 
government relating to veterans benefits.
    Subrecipient means an entity that receives grant funds from a 
grantee to perform work for the grantee in the administration of all or 
part of the grantee's program.
    Transportation services means the direct provision of 
transportation, or assistance with providing transportation, to travel 
to VA medical centers and other VA or non-VA facilities in connection 
with the provision of VA medical care.
    Veteran means a person who served in the active military, naval, or 
air service, and who was discharged or released therefrom under 
conditions other than dishonorable.
    Veterans Service Organization means an organization recognized by 
the Secretary of Veterans Affairs for the representation of veterans 
under section 5902 of title 38, United States Code.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)



Sec.  17.702  Grants--general.

    (a) One grant per highly rural area. VA may award one grant per 
fiscal year to a grantee for each highly rural area in which the grantee 
provides transportation services. Transportation services may not be 
simultaneously provided by more than one grantee in any single highly 
rural area.
    (b) Maximum amount. Grant amounts will be specified in the Notice of 
Funding Availability, but no grant will exceed $50,000.
    (c) No matching requirement. A grantee will not be required to 
provide matching funds as a condition of receiving such grant.
    (d) Veterans will not be charged. Transportation services provided 
to veterans through utilization of a grant will be free of charge.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)



Sec.  17.703  Eligibility and application.

    (a) Eligible entity. The following may be awarded a grant:
    (1) A Veterans Service Organization.
    (2) A State veterans service agency.
    (b) Initial application. To apply for an initial grant, an applicant 
must submit to VA a complete grant application package, as described in 
the Notice of Fund Availability.
    (c) Renewal application. Grantees may apply for one renewal grant 
per fiscal year, after receiving an initial grant, if the grantee's 
program will remain substantially the same. The grantee must submit to 
VA a complete renewal application as described in the Notice of Fund 
Availability.
    (d) Subrecipients. Grantees may provide grant funds to other 
entities, if such entities are identified as subrecipients in grant 
applications to perform work for grantees in the administration of all 
or part of grantees' programs.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)

(The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-0790)



Sec.  17.705  Scoring criteria and selection.

    (a) Initial grant scoring. Applications will be scored using the 
following selection criteria:

[[Page 876]]

    (1) VA will award up to 40 points based on the program's plan for 
successful implementation, as demonstrated by the following:
    (i) Program scope is defined, and applicant has specifically 
indicated the mode(s) or method(s) of transportation services to be 
provided by the applicant or identified subrecipient.
    (ii) Program budget is defined, and applicant has indicated that 
grant funds will be sufficient to completely implement the program.
    (iii) Program staffing plan is defined, and applicant has indicated 
that there will be adequate staffing for delivery of transportation 
services according to the program's scope.
    (iv) Program timeframe for implementation is defined, and applicant 
has indicated that the delivery of transportation services will be 
timely.
    (2) VA will award up to 30 points based on the program's evaluation 
plan, as demonstrated by the following:
    (i) Measurable goals for determining the success of delivery of 
transportation services.
    (ii) Ongoing assessment of paragraph (a)(2)(i), with a means of 
adjusting the program as required.
    (3) VA will award up to 20 points based on the applicant's community 
relationships in the areas to receive transportation services, as 
demonstrated by the following:
    (i) Applicant has existing relationships with state or local 
agencies or private entities, or will develop such relationships, and 
has shown these relationships will enhance the program's effectiveness.
    (ii) Applicant has established past working relationships with state 
or local agencies or private entities which have provided transportation 
services similar to those offered by the program.
    (4) VA will award up to 10 points based on the innovative aspects of 
the program, as demonstrated by the following:
    (i) How program will identify and serve veterans who otherwise would 
be unable to obtain VA medical care through conventional transportation 
resources.
    (ii) How program will use new or alternative transportation 
resources.
    (b) Initial grant selection. VA will use the following process to 
award initial grants:
    (1) VA will rank those applications that receive at least the 
minimum amount of total points and points per category set forth in the 
Notice of Fund Availability. The applications will be ranked in order 
from highest to lowest scores.
    (2) VA will use the applications' ranking as the basis for awarding 
grants. VA will award grants for the highest ranked applications for 
which funding is available.
    (c) Renewal grant scoring. Renewal applications will be scored using 
the following selection criteria:
    (1) VA will award up to 55 points based on the success of the 
grantee's program, as demonstrated by the following:
    (i) Application shows that the grantee or identified subrecipient 
provided transportation services which allowed participants to be 
provided medical care timely and as scheduled.
    (ii) Application shows that participants were satisfied with the 
transportation services provided by the grantee or identified 
subrecipient, as described in the Notice of Fund Availability.
    (2) VA will award up to 35 points based on the cost effectiveness of 
the program, as demonstrated by the following:
    (i) The grantee or identified subrecipient administered the program 
on budget.
    (ii) Grant funds were utilized in a sensible manner, as interpreted 
by information provided by the grantee to VA under Sec.  17.725(a)(1) 
through (a)(7).
    (3) VA will award up to 15 points based on the extent to which the 
program complied with:
    (i) The grant agreement.
    (ii) Applicable laws and regulations.
    (d) Renewal grant selection. VA will use the following process to 
award renewal grants:
    (1) VA will rank those applications that receive at least the 
minimum amount of total points and points per category set forth in the 
Notice of Fund Availability. The applications will be ranked in order 
from highest to lowest scores.

[[Page 877]]

    (2) VA will use the applications' ranking as the basis for awarding 
grants. VA will award grants for the highest ranked applications for 
which funding is available.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)



Sec.  17.710  Notice of Fund Availability.

    When funds are available for grants, VA will publish a Notice of 
Fund Availability in the Federal Register. The notice will identify:
    (a) The location for obtaining grant applications;
    (b) The date, time, and place for submitting completed grant 
applications;
    (c) The estimated amount and type of grant funding available;
    (d) The length of term for the grant award;
    (e) The minimum number of total points and points per category that 
an applicant or grantee must receive in order for a supportive grant to 
be funded;
    (f) The timeframes and manner for payments under the grant; and
    (g) Those areas identified by VA to be the ``highly rural areas'' in 
which grantees may provide transportation services funded under this 
rule.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)



Sec.  17.715  Grant agreements.

    (a) General. After a grantee is awarded a grant in accordance with 
Sec.  17.705(b) or Sec.  17.705(d), VA will draft a grant agreement to 
be executed by VA and the grantee. Upon execution of the grant 
agreement, VA will obligate the approved amount to the grantee. The 
grant agreement will provide that:
    (1) The grantee must operate the program in accordance with the 
provisions of this section and the grant application.
    (2) If a grantee's application identified a subrecipient, such 
subrecipient must operate the program in accordance with the provisions 
of this section and the grant application.
    (3) If a grantee's application identified that funds will be used to 
procure or operate vehicles to directly provide transportation services, 
the following requirements must be met:
    (i) Title to the vehicles must vest solely in the grantee or 
identified subrecipient, or with leased vehicles in an identified 
lender.
    (ii) The grantee or identified subrecipient must, at a minimum, 
provide motor vehicle liability insurance for the vehicles to the same 
extent they would insure vehicles procured with their own funds.
    (iii) All vehicle operators must be licensed in a U.S. State or 
Territory to operate such vehicles.
    (iv) Vehicles must be safe and maintained in accordance with the 
manufacturer's recommendations.
    (v) Vehicles must be operated in accordance with applicable 
Department of Transportation regulations concerning transit requirements 
under the Americans with Disabilities Act.
    (b) Additional requirements. Grantees and identified subrecipients 
are subject to the Uniform Administrative Requirements, Cost Principles, 
and Audit Requirements for Federal Awards under 2 CFR part 200, and 
subject to 2 CFR parts 25 and 170, if applicable.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)

[78 FR 19593, Apr. 2, 2013, as amended at 80 FR 43322, July 22, 2015]



Sec.  17.720  Payments under the grant.

    Grantees are to be paid in accordance with the timeframes and manner 
set forth in the Notice of Fund Availability.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)



Sec.  17.725  Grantee reporting requirements.

    (a) Program efficacy. All grantees who receive either an initial or 
renewed grant must submit to VA quarterly and annual reports which 
indicate the following information:
    (1) Record of time expended assisting with the provision of 
transportation services.
    (2) Record of grant funds expended assisting with the provision of 
transportation services.
    (3) Trips completed.
    (4) Total distance covered.
    (5) Veterans served.

[[Page 878]]

    (6) Locations which received transportation services.
    (7) Results of veteran satisfaction survey.
    (b) Quarterly fiscal report. All grantees who receive either an 
initial or renewal grant must submit to VA a quarterly report which 
identifies the expenditures of the funds which VA authorized and 
obligated.
    (c) Program variations. Any changes in a grantee's program 
activities which result in deviations from the grant agreement must be 
reported to VA.
    (d) Additional reporting. Additional reporting requirements may be 
requested by VA to allow VA to fully assess program effectiveness.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control numbers 2900-0709 
and 2900-0770)



Sec.  17.730  Recovery of funds by VA.

    (a) Recovery of funds. VA may recover from the grantee any funds 
that are not used in accordance with a grant agreement. If VA decides to 
recover funds, VA will issue to the grantee a notice of intent to 
recover grant funds, and grantee will then have 30 days to submit 
documentation demonstrating why the grant funds should not be recovered. 
After review of all submitted documentation, VA will determine whether 
action will be taken to recover the grant funds.
    (b) Prohibition of further grants. When VA determines action will be 
taken to recover grant funds from the grantee, the grantee is then 
prohibited from receipt of any further grant funds.

(Authority: Sec. 307, Pub. L. 111-163; 38 U.S.C. 501)

                    Transitional Housing Loan Program

    Source: 59 FR 49579, Sept. 29, 1994, unless otherwise noted.



Sec.  17.800  Purpose.

    The purpose of the Transitional Housing Loan Program regulations is 
to establish application provisions and selection criteria for loans to 
non-profit organizations for use in initial startup costs for 
transitional housing for veterans who are in (or have recently been in) 
a program for the treatment of substance abuse. This program is intended 
to increase the amount of transitional housing available for such 
veterans who need a period of supportive housing to encourage sobriety 
maintenance and reestablishment of social and community relationships.



Sec.  17.801  Definitions.

    (a) Applicant: A non-profit organization making application for a 
loan under this program.
    (b) Non-profit organization: A secular or religious organization, no 
part of the net earnings of which may inure to the benefit of any 
member, founder, contributor, or individual. The organization must 
include a voluntary board and must either maintain or designate an 
entity to maintain an accounting system which is operated in accordance 
with generally accepted accounting principles. If not named in, or 
approved under Title 38 U.S.C. (United States Code), Section 5902, a 
non-profit organization must provide VA with documentation which 
demonstrates approval as a non-profit organization under Internal 
Revenue Code, Section 501.c(3).
    (c) Recipient: A non-profit organization which has received a loan 
from VA under this program.
    (d) Veteran: A person who served in the active military, naval, or 
air service, and who was discharged or released therefrom under 
conditions other than dishonorable.

(Authority: Sec. 8 of Pub. L. 102-54, 105 Stat 271, 38 U.S.C. 501)



Sec.  17.802  Application provisions.

    (a) To obtain a loan under these Transitional Housing Loan Program 
regulations, an application must be submitted by the applicant in the 
form prescribed by VA in the application package. The completed 
application package must be submitted to the Deputy Associate Director 
for Psychiatric Rehabilitation Services, (302/111C), VA Medical Center, 
100 Emancipation Drive, Hampton, VA 23667. An application package may be 
obtained by writing to the proceeding address or telephoning (804) 722-
9961 x3628. (This is not a toll-free number)

[[Page 879]]

    (b) The application package includes exhibits to be prepared and 
submitted, including:
    (1) Information concerning the applicant's income, assets, 
liabilities and credit history,
    (2) Information for VA to verify the applicant's financial 
information,
    (3) Identification of the official(s) authorized to make financial 
transactions on behalf of the applicant,
    (4) Information concerning:
    (i) The history, purpose and composition of the applicant,
    (ii) The applicant's involvement with recovering substance abusers, 
including:
    (A) Type of services provided,
    (B) Number of persons served,
    (C) Dates during which each type of service was provided,
    (D) Names of at least two references of government or community 
groups whom the organization has worked with in assisting substance 
abusers,
    (iii) The applicant's plan for the provision of transitional housing 
to veterans including:
    (A) Means of identifying and screening potential residents,
    (B) Number of occupants intended to live in the residence for which 
the loan assistance is requested,
    (C) Residence operating policies addressing structure for democratic 
self-government, expulsion policies for nonpayment, alcohol or illegal 
drug use or disruptive behavior,
    (D) Type of technical assistance available to residents in the event 
of house management problems,
    (E) Anticipated cost of maintaining the residence, including rent 
and utilities,
    (F) Anticipated charge, per veteran, for residing in the residence,
    (G) Anticipated means of collecting rent and utilities payments from 
residents,
    (H) A description of the housing unit for which the loan is sought 
to support, including location, type of neighborhood, brief floor plan 
description, etc., and why this residence was selected for this 
endeavor.
    (iv) The applicant's plans for use of the loan proceeds.

(Authority: Sec. 8 of Pub. L. 102-54, 105 Stat. 271, 38 U.S.C. 501)



Sec.  17.803  Order of consideration.

    Loan applications will be considered on a first-come-first-serve 
basis, subject to availability of funds for loans and awards will be 
made on a first-come-first-serve basis to applicants who meet the 
criteria for receiving a loan. If no funds are available for loans, 
applications will be retained in the order of receipt for consideration 
as funds become available.

(Authority: Sec. 8 of Pub. L. 102-54, 105 Stat. 271, 38 U.S.C. 501)



Sec.  17.804  Loan approval criteria.

    Upon consideration of the application package, loan approval will be 
based on the following:
    (a) Favorable financial history and status,
    (1) A minimum of a two-year credit history,
    (2) No open liens, judgments, and no unpaid collection accounts,
    (3) No more than two instances where payments were ever delinquent 
beyond 60 days,
    (4) Net ratio: (monthly expenses divided by monthly cash flow) that 
does not exceed 40%,
    (5) Gross ratio: (total indebtedness divided by gross annual cash 
flow) that does not exceed 35%,
    (6) At least two favorable credit references,
    (b) Demonstrated ability to successfully address the needs of 
substance abusers as determined by a minimum of one year of successful 
experience in providing services, such as, provision of housing, 
vocational training, structured job seeking assistance, organized 
relapse prevention services, or similar activity. Such experience would 
involve at least twenty-five substance abusers, and would be experience 
which could be verified by VA inquiries of government or community 
groups with whom the applicant has worked in providing these services.
    (c) An acceptable plan for operating a residence designed to meet 
the conditions of a loan under this program, which will include:
    (1) Measures to ensure that residents are eligible for residency, 
i.e., are veterans, are in (or have recently been in)

[[Page 880]]

a program for the treatment of substance abuse, are financially able to 
pay their share of costs of maintaining the residence, and agree to 
abide by house rules and rent/utilities payment provisions,
    (2) Adequate rent/utilities collections to cover cost of maintaining 
the residence,
    (3) Policies that ensure democratic self-run government, including 
expulsion policies, and
    (4) Available technical assistance to residents in the event of 
house management problems.
    (d) Selection of a suitable housing unit for use as a transitional 
residence in a neighborhood with no known illegal drug activity, and 
with adequate living space for number of veterans planned for residence 
(at least one large bedroom for every three veterans, at least one 
bathroom for every four veterans, adequate common space for entire 
household)
    (e) Agreements, signed by an official authorized to bind the 
recipient, which include:
    (1) The loan payment schedule in accordance with the requirements of 
Pub. L. 102-54, with the interest rate being the same as the rate the VA 
is charged to borrow these funds from the U.S. Department of Treasury 
and with a penalty of 4% of the amount due for each failure to pay an 
installment by the date specified in the loan agreement involved, and
    (2) The applicant's intent to use proceeds of loan only to cover 
initial startup costs associated with the residence, such as security 
deposit, furnishings, household supplies, and any other initial startup 
costs.

(Authority: Sec. 8 of Pub. L. 102-54, 105 Stat. 271, 38 U.S.C. 501)



Sec.  17.805  Additional terms of loans.

    In the operation of each residence established with the assistance 
of the loan, the recipient must agree to the following:
    (a) The use of alcohol or any illegal drugs in the residence will be 
prohibited;
    (b) Any resident who violates the prohibition of alcohol or any 
illegal drugs will be expelled from the residence;
    (c) The cost of maintaining the residence, including fees for rent 
and utilities, will be paid by residents;
    (d) The residents will, through a majority vote of the residents, 
otherwise establish policies governing the conditions of the residence, 
including the manner in which applications for residence are approved;
    (e) The residence will be operated solely as a residence for not 
less than six veterans.

(Authority: Sec. 8 of Pub. L. 102-54, 105 Stat. 271, 38 U.S.C. 501)

   Health Care Benefits for Certain Children of Vietnam Veterans and 
 Veterans with Covered Service in Korea--Spina Bifida and Covered Birth 
                                 Defects

    Source: 68 FR 1010, Jan. 8, 2003, unless otherwise noted.



Sec.  17.900  Definitions.

    For purposes of Sec. Sec.  17.900 through 17.905--
    Approved health care provider means a health care provider currently 
approved by the Center for Medicare and Medicaid Services (CMS), 
Department of Defense TRICARE Program, Civilian Health and Medical 
Program of the Department of Veterans Affairs (CHAMPVA), The Joint 
Commission, or currently approved for providing health care under a 
license or certificate issued by a governmental entity with 
jurisdiction. An entity or individual will be deemed to be an approved 
health care provider only when acting within the scope of the approval, 
license, or certificate.
    Child for purposes of spina bifida means the same as individual as 
defined at Sec.  3.814(c)(3) or Sec.  3.815(c)(2) of this title and for 
purposes of covered birth defects means the same as individual as 
defined at Sec.  3.815(c)(2) of this title.
    Covered birth defect means the same as defined at Sec.  3.815(c)(3) 
of this title and also includes complications or medical conditions that 
are associated with the covered birth defect(s) according to the 
scientific literature.
    Day health care means a therapeutic program prescribed by an 
approved health care provider that provides necessary medical services, 
rehabilitation,

[[Page 881]]

therapeutic activities, socialization, nutrition, and transportation 
services in a congregate setting. Day health care may be provided as a 
component of outpatient care or respite care.
    Habilitative and rehabilitative care means such professional, 
counseling, and guidance services and such treatment programs (other 
than vocational training under 38 U.S.C. 1804 or 1814) as are necessary 
to develop, maintain, or restore, to the maximum extent practicable, the 
functioning of a disabled person.
    Health care means home care, hospital care, long-term care, nursing 
home care, outpatient care, preventive care, habilitative and 
rehabilitative care, case management, and respite care; and includes the 
training of appropriate members of a child's family or household in the 
care of the child; and the provision of such pharmaceuticals, supplies 
(including continence-related supplies such as catheters, pads, and 
diapers), equipment (including durable medical equipment), devices, 
appliances, assistive technology, direct transportation costs to and 
from approved health care providers (including any necessary costs for 
meals and lodging en route, and accompaniment by an attendant or 
attendants), and other materials as the Secretary determines necessary.
    Health care provider means any entity or individual that furnishes 
health care, including specialized clinics, health care plans, insurers, 
organizations, and institutions.
    Health-related services means homemaker or home health aide services 
furnished in the individual's home or other place of residence to the 
extent that those services provide assistance with Activities of Daily 
Living and Instrumental Activities of Daily Living that have therapeutic 
value.
    Home care means medical care, habilitative and rehabilitative care, 
preventive health services, and health-related services furnished to a 
child in the child's home or other place of residence.
    Home health aide services is a component of health-related services 
providing personal care and related support services to an individual in 
the home or other place of residence. Home health aide services may 
include assistance with Activities of Daily Living such as: Bathing; 
toileting; eating; dressing; aid in ambulating or transfers; active and 
passive exercises; assistance with medical equipment; and routine health 
monitoring. Home health aide services must be provided according to the 
individual's written plan of care and must be prescribed by an approved 
health care provider.
    Homemaker services is a component of health-related services 
encompassing certain activities that help to maintain a safe, healthy 
environment for an individual in the home or other place of residence. 
Such services contribute to the prevention, delay, or reduction of risk 
of harm or hospital, nursing home, or other institutional care. 
Homemaker services include assistance with personal care; home 
management; completion of simple household tasks; nutrition, including 
menu planning and meal preparation; consumer education; and hygiene 
education. Homemaker services may include assistance with Instrumental 
Activities of Daily Living, such as: Light housekeeping; laundering; 
meal preparation; necessary services to maintain a safe and sanitary 
environment in the areas of the home used by the individual; and 
services essential to the comfort and cleanliness of the individual and 
ensuring individual safety. Homemaker services must be provided 
according to the individual's written plan of care and must be 
prescribed by an approved health care provider.
    Hospital care means care and treatment furnished to a child who has 
been admitted to a hospital as a patient.
    Long-term care means home care, nursing home care, and respite care.
    Nursing home care means care and treatment furnished to a child who 
has been admitted to a nursing home as a resident.
    Other place of residence includes an assisted living facility or 
residential group home.
    Outpatient care means care and treatment, including day health care 
and preventive health services, furnished to a child other than hospital 
care or nursing home care.
    Preventive care means care and treatment furnished to prevent 
disability or

[[Page 882]]

illness, including periodic examinations, immunizations, patient health 
education, and such other services as the Secretary determines necessary 
to provide effective and economical preventive health care.
    Respite care means care, including day health care, furnished by an 
approved health care provider on an intermittent basis for a limited 
period to an individual who resides primarily in a private residence 
when such care will help the individual continue residing in such 
private residence.
    Spina bifida means all forms and manifestations of spina bifida 
except spina bifida occulta (this includes complications or medical 
conditions that are associated with spina bifida according to the 
scientific literature).
    Veteran with covered service in Korea for purposes of spina bifida 
means the same as defined at Sec.  3.814(c)(2) of this title.
    Vietnam veteran for purposes of spina bifida means the same as 
defined at Sec.  3.814(c)(1) or Sec.  3.815(c)(1) of this title and for 
purposes of covered birth defects means the same as defined at Sec.  
3.815(c)(1) of this title.

(Authority: 38 U.S.C. 101(2), 1802-1803, 1811-1813, 1821, 1831)

[68 FR 1010, Jan. 8, 2003, as amended at 76 FR 4249, Jan. 25, 2011; 79 
FR 54616, Sept. 12, 2014; 81 FR 19890, Apr. 6, 2016]



Sec.  17.901  Provision of health care.

    (a) Spina bifida. VA will provide a Vietnam veteran or veteran with 
covered service in Korea's child who has been determined under Sec.  
3.814 or Sec.  3.815 of this title to suffer from spina bifida with 
health care as the Secretary determines is needed. VA may inform spina 
bifida patients, parents, or guardians that health care may be available 
at not-for-profit charitable entities.
    (b) Covered birth defects. VA will provide a woman Vietnam veteran's 
child who has been determined under Sec.  3.815 of this title to suffer 
from covered birth defects (other than spina bifida) with such health 
care as the Secretary determines is needed by the child for the covered 
birth defects. However, if VA has determined for a particular covered 
birth defect that Sec.  3.815(a)(2) of this title applies (concerning 
affirmative evidence of cause other than the mother's service during the 
Vietnam era), no benefits or assistance will be provided under this 
section with respect to that particular birth defect.
    (c) Providers of care. Health care provided under this section will 
be provided directly by VA, by contract with an approved health care 
provider, or by other arrangement with an approved health care provider.
    (d) Submission of information. For purposes of Sec. Sec.  17.900 
through 17.905:
    (1) The telephone number of the Health Administration Center is 
(888) 820-1756;
    (2) The facsimile number of the Health Administration Center is 
(303) 331-7807;
    (3) The hand-delivery address of the Health Administration Center is 
3773 Cherry Creek Drive North, Denver, CO 80246; and
    (4) The mailing address of the Health Administration Center for 
claims submitted pursuant to either paragraph (a) or (b) of this section 
is P.O. Box 469065, Denver, CO 80246-9065.

(Authority: 38 U.S.C. 101(2), 1802-1803, 1811-1813, 1831)

    Note to Sec.  17.901: Under this program, beneficiaries with spina 
bifida will receive comprehensive care through the Department of 
Veterans Affairs. However, the health care benefits available under this 
section to children with other covered birth defects are not 
comprehensive, and VA will furnish them only health care services that 
are related to their covered birth defects. With respect to covered 
children suffering from spina bifida, VA is the exclusive payer for 
services paid under 17.900 through 17.905, regardless of any third party 
insurer, Medicare, Medicaid, health plan, or any other plan or program 
providing health care coverage. As to children with other covered birth 
defects, any third party insurer, Medicare, Medicaid, health plan, or 
any other plan or program providing health care coverage would be 
responsible according to its provisions for payment for health care not 
relating to the covered birth defects.

[68 FR 1010, Jan. 8, 2003, as amended at 76 FR 4249, Jan. 25, 2011]



Sec.  17.902  Preauthorization.

    (a) Preauthorization from VA is required for the following services 
or benefits under Sec. Sec.  17.900 through 17.905: Rental or purchase 
of durable medical

[[Page 883]]

equipment with a total rental or purchase price in excess of $300, 
respectively; day health care provided as outpatient care; dental 
services; homemaker services; outpatient mental health services in 
excess of 23 visits in a calendar year; substance abuse treatment; 
training; transplantation services; and travel (other than mileage at 
the General Services Administration rate for privately owned 
automobiles). Authorization will only be given in spina bifida cases 
where it is demonstrated that the care is medically necessary. In cases 
of other covered birth defects, authorization will only be given where 
it is demonstrated that the care is medically necessary and related to 
the covered birth defects. Requests for provision of health care 
requiring preauthorization shall be made to the Health Administration 
Center and may be made by telephone, facsimile, mail, or hand delivery. 
The application must contain the following:
    (1) Name of child,
    (2) Child's Social Security number,
    (3) Name of veteran,
    (4) Veteran's Social Security number,
    (5) Type of service requested,
    (6) Medical justification,
    (7) Estimated cost, and
    (8) Name, address, and telephone number of provider.
    (b) Notwithstanding the provisions of paragraph (a) of this section, 
preauthorization is not required for a condition for which failure to 
receive immediate treatment poses a serious threat to life or health. 
Such emergency care should be reported by telephone to the Health 
Administration Center within 72 hours of the emergency.

(Authority: 38 U.S.C. 101(2), 1802-1803, 1811-1813, 1831)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0219)

[68 FR 1010, Jan. 8, 2003, as amended at 76 FR 4249, Jan. 25, 2011; 81 
FR 19890, Apr. 6, 2016]



Sec.  17.903  Payment.

    (a)(1) Payment for services or benefits under Sec. Sec.  17.900 
through 17.905 will be determined utilizing the same payment 
methodologies as provided for under the Civilian Health and Medical 
Program of the Department of Veterans Affairs (CHAMPVA) (see Sec.  
17.270). For those services or benefits covered by Sec. Sec.  17.900 
through 17.905 but not covered by CHAMPVA we will use payment 
methodologies the same or similar to those used for equivalent services 
or benefits provided to veterans.
    (2) As a condition of payment, the services must have occurred:
    (i) For spina bifida, on or after October 1, 1997, and must have 
occurred on or after the date the child was determined eligible for 
benefits under Sec.  3.814 of this title.
    (ii) For covered birth defects, on or after December 1, 2001, and 
must have occurred on or after the date the child was determined 
eligible for benefits under Sec.  3.815 of this title.
    (3) Claims from approved health care providers must be filed with 
the Health Administration Center in writing (facsimile, mail, hand 
delivery, or electronically) no later than:
    (i) One year after the date of service; or
    (ii) In the case of inpatient care, one year after the date of 
discharge; or
    (iii) In the case of retroactive approval for health care, 180 days 
following beneficiary notification of eligibility.
    (4) Claims for health care provided under the provisions of 
Sec. Sec.  17.900 through 17.905 must contain, as appropriate, the 
information set forth in paragraphs (a)(4)(i) through (a)(4)(v) of this 
section.
    (i) Patient identification information:
    (A) Full name,
    (B) Address,
    (C) Date of birth, and
    (D) Social Security number.
    (ii) Provider identification information (inpatient and outpatient 
services):
    (A) Full name and address (such as hospital or physician),
    (B) Remittance address,
    (C) Address where services were rendered,
    (D) Individual provider's professional status (M.D., Ph.D., R.N., 
etc.), and
    (E) Provider tax identification number (TIN) or Social Security 
number.

[[Page 884]]

    (iii) Patient treatment information (long-term care or institutional 
services):
    (A) Dates of service (specific and inclusive),
    (B) Summary level itemization (by revenue code),
    (C) Dates of service for all absences from a hospital or other 
approved institution during a period for which inpatient benefits are 
being claimed,
    (D) Principal diagnosis established, after study, to be chiefly 
responsible for causing the patient's hospitalization,
    (E) All secondary diagnoses,
    (F) All procedures performed,
    (G) Discharge status of the patient, and
    (H) Institution's Medicare provider number.
    (iv) Patient treatment information for all other health care 
providers and ancillary outpatient services such as durable medical 
equipment, medical requisites, and independent laboratories:
    (A) Diagnosis,
    (B) Procedure code for each procedure, service, or supply for each 
date of service, and
    (C) Individual billed charge for each procedure, service, or supply 
for each date of service.
    (v) Prescription drugs and medicines and pharmacy supplies:
    (A) Name and address of pharmacy where drug was dispensed,
    (B) Name of drug,
    (C) National Drug Code (NDC) for drug provided,
    (D) Strength,
    (E) Quantity,
    (F) Date dispensed,
    (G) Pharmacy receipt for each drug dispensed (including billed 
charge), and
    (H) Diagnosis for which each drug is prescribed.
    (b) Health care payment will be provided in accordance with the 
provisions of Sec. Sec.  17.900 through 17.905. However, the following 
are specifically excluded from payment:
    (1) Care as part of a grant study or research program,
    (2) Care considered experimental or investigational,
    (3) Drugs not approved by the U.S. Food and Drug Administration for 
commercial marketing,
    (4) Services, procedures, or supplies for which the beneficiary has 
no legal obligation to pay, such as services obtained at a health fair,
    (5) Services provided outside the scope of the provider's license or 
certification, and
    (6) Services rendered by providers suspended or sanctioned by a 
Federal agency.
    (c) Payments made in accordance with the provisions of Sec. Sec.  
17.900 through 17.905 shall constitute payment in full. Accordingly, the 
health care provider or agent for the health care provider may not 
impose any additional charge for any services for which payment is made 
by VA.
    (d) Explanation of benefits (EOB)--(1) When a claim under the 
provisions of Sec. Sec.  17.900 through 17.905 is adjudicated, an EOB 
will be sent to the beneficiary or guardian and the provider. The EOB 
provides, at a minimum, the following information:
    (i) Name and address of recipient,
    (ii) Description of services and/or supplies provided,
    (iii) Dates of services or supplies provided,
    (iv) Amount billed,
    (v) Determined allowable amount,
    (vi) To whom payment, if any, was made, and
    (vii) Reasons for denial (if applicable).
    (2) [Reserved]

(Authority: 38 U.S.C. 101(2), 1802-1803, 1811-1813, 1831)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0219)

[68 FR 1010, Jan. 8, 2003, as amended at 76 FR 4249, Jan. 25, 2011; 81 
FR 19890, Apr. 6, 2016]



Sec.  17.904  Review and appeal process.

    For purposes of Sec. Sec.  17.900 through 17.905, if a health care 
provider, child, or representative disagrees with a determination 
concerning provision of health care or with a determination concerning 
payment, the person or entity may request reconsideration. Such request 
must be submitted in writing (by facsimile, mail, or hand delivery)

[[Page 885]]

within one year of the date of the initial determination to the Health 
Administration Center (Attention: Chief, Benefit and Provider Services). 
The request must state why it is believed that the decision is in error 
and must include any new and relevant information not previously 
considered. Any request for reconsideration that does not identify the 
reason for dispute will be returned to the sender without further 
consideration. After reviewing the matter, including any relevant 
supporting documentation, a benefits advisor will issue a written 
determination (with a statement of findings and reasons) to the person 
or entity seeking reconsideration that affirms, reverses, or modifies 
the previous decision. If the person or entity seeking reconsideration 
is still dissatisfied, within 90 days of the date of the decision he or 
she may submit in writing (by facsimile, mail, or hand delivery) to the 
Health Administration Center (Attention: Director) a request for review 
by the Director, Health Administration Center. The Director will review 
the claim and any relevant supporting documentation and issue a decision 
in writing (with a statement of findings and reasons) that affirms, 
reverses, or modifies the previous decision. An appeal under this 
section would be considered as filed at the time it was delivered to the 
VA or at the time it was released for submission to the VA (for example, 
this could be evidenced by the postmark, if mailed).

    Note to Sec.  17.904: The final decision of the Director will inform 
the claimant of further appellate rights for an appeal to the Board of 
Veterans' Appeals.

(Authority: 38 U.S.C. 101(2), 1802-1803, 1811-1813, 1831)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0219)

[68 FR 1010, Jan. 8, 2003, as amended at 76 FR 4250, Jan. 25, 2011; 81 
FR 19891, Apr. 6, 2016]



Sec.  17.905  Medical records.

    Copies of medical records generated outside VA that relate to 
activities for which VA is asked to provide payment or that VA 
determines are necessary to adjudicate claims under Sec. Sec.  17.900 
through 17.905 must be provided to VA at no cost.

(Authority: 38 U.S.C. 101(2), 1802-1803, 1811-1813, 1831)

[68 FR 1010, Jan. 8, 2003, as amended at 76 FR 4250, Jan. 25, 2011]

Payment or Reimbursement for Emergency Services for Nonservice-Connected 
                     Conditions in Non-VA Facilities

    Source: 66 FR 36470, July 12, 2001, unless otherwise noted.



Sec.  17.1000  Payment or reimbursement for emergency services for 
nonservice-connected conditions in non-VA facilities.

    Sections 17.1000 through 17.1008 constitute the requirements under 
38 U.S.C. 1725 that govern VA payment or reimbursement for non-VA 
emergency services furnished to a veteran for nonservice-connected 
conditions.


(Authority: 38 U.S.C. 1725)

    Note to Sec.  17.1000: In cases where a patient is admitted for 
inpatient care, health care providers furnishing emergency treatment who 
believe they may have a basis for filing a claim with VA for payment 
under 38 U.S.C. 1725 should contact VA within 48-hours after admission 
for emergency treatment. Such contact is not a condition of VA payment. 
However, the contact will assist the provider in understanding the 
conditions for payment. The contact may also assist the provider in 
planning for transfer of the veteran after stabilization.

[66 FR 36470, July 12, 2001, as amended at 68 FR 3404, Jan. 24, 2003]



Sec.  17.1001  Definitions.

    For purposes of Sec. Sec.  17.1000 through 17.1008:
    (a) The term health-plan contract means any of the following:
    (1) An insurance policy or contract, medical or hospital service 
agreement, membership or subscription contract, or similar arrangement 
under which health services for individuals are provided or the expenses 
of such services are paid;
    (2) An insurance program described in section 1811 of the Social 
Security Act (42 U.S.C. 1395c) or established by section 1831 of that 
Act (42 U.S.C. 1395j);

[[Page 886]]

    (3) A State plan for medical assistance approved under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.);
    (4) A workers' compensation law or plan described in section 38 
U.S.C. 1729(a)(2)(A); or
    (b) The term third party means any of the following:
    (1) A Federal entity;
    (2) A State or political subdivision of a State;
    (3) An employer or an employer's insurance carrier;
    (4) An automobile accident reparations insurance carrier; or
    (5) A person or entity obligated to provide, or to pay the expenses 
of, health services under a health-plan contract.
    (c) The term duplicate payment means payment made, in whole or in 
part, for the same emergency services for which VA reimbursed or made 
payment.
    (d) The term stabilized means that no material deterioration of the 
emergency medical condition is likely, within reasonable medical 
probability, to occur if the veteran is discharged or transferred to a 
VA or other Federal facility that VA has an agreement with to furnish 
health care services for veterans.
    (e) The term VA medical facility of jurisdiction means the nearest 
VA medical facility to where the emergency service was provided.

(Authority: 38 U.S.C. 1725)

[66 FR 36470, July 12, 2001, as amended at 76 FR 79071, Dec. 21, 2011; 
77 FR 23617, Apr. 20, 2012]



Sec.  17.1002  Substantive conditions for payment or reimbursement.

    Payment or reimbursement under 38 U.S.C. 1725 for emergency 
treatment (including medical services, professional services, ambulance 
services, ancillary care and medication (including a short course of 
medication related to and necessary for the treatment of the emergency 
condition that is provided directly to or prescribed for the patient for 
use after the emergency condition is stabilized and the patient is 
discharged)) will be made only if all of the following conditions are 
met:
    (a) The emergency services were provided in a hospital emergency 
department or a similar facility held out as providing emergency care to 
the public;
    (b) The claim for payment or reimbursement for the initial 
evaluation and treatment is for a condition of such a nature that a 
prudent layperson would have reasonably expected that delay in seeking 
immediate medical attention would have been hazardous to life or health 
(this standard would be met if there were an emergency medical condition 
manifesting itself by acute symptoms of sufficient severity (including 
severe pain) that a prudent layperson who possesses an average knowledge 
of health and medicine could reasonably expect the absence of immediate 
medical attention to result in placing the health of the individual in 
serious jeopardy, serious impairment to bodily functions, or serious 
dysfunction of any bodily organ or part);
    (c) A VA or other Federal facility/provider that VA has an agreement 
with to furnish health care services for veterans was not feasibly 
available and an attempt to use them beforehand would not have been 
considered reasonable by a prudent layperson (as an example, these 
conditions would be met by evidence establishing that a veteran was 
brought to a hospital in an ambulance and the ambulance personnel 
determined the nearest available appropriate level of care was at a non-
VA medical center);
    (d) At the time the emergency treatment was furnished, the veteran 
was enrolled in the VA health care system and had received medical 
services under authority of 38 U.S.C. chapter 17 within the 24-month 
period preceding the furnishing of such emergency treatment;
    (e) The veteran is financially liable to the provider of emergency 
treatment for that treatment;
    (f) The veteran does not have coverage under a health-plan contract 
that would fully extinguish the medical liability for the emergency 
treatment (this condition cannot be met if the veteran has coverage 
under a health-plan contract but payment is barred because of a failure 
by the veteran or the provider to comply with

[[Page 887]]

the provisions of that health-plan contract, e.g., failure to submit a 
bill or medical records within specified time limits, or failure to 
exhaust appeals of the denial of payment);
    (g) If the condition for which the emergency treatment was furnished 
was caused by an accident or work-related injury, the claimant has 
exhausted without success all claims and remedies reasonably available 
to the veteran or provider against a third party for payment of such 
treatment; and the veteran has no contractual or legal recourse against 
a third party that could reasonably be pursued for the purpose of 
extinguishing, in whole, the veteran's liability to the provider; and
    (h) The veteran is not eligible for reimbursement under 38 U.S.C. 
1728 for the emergency treatment provided (38 U.S.C. 1728 authorizes VA 
payment or reimbursement for emergency treatment to a limited group of 
veterans, primarily those who receive emergency treatment for a service-
connected disability).

(Authority: 38 U.S.C. 1725)

[66 FR 36470, July 12, 2001, as amended at 68 FR 3404, Jan. 24, 2003; 76 
FR 79071, Dec. 21, 2011; 77 FR 23617, Apr. 20, 2012; 80 FR 79484, Dec. 
22, 2015; 83 FR 979, Jan. 9, 2018]



Sec.  17.1003  Emergency transportation.

    Notwithstanding the provisions of Sec.  17.1002, payment or 
reimbursement under 38 U.S.C. 1725 for ambulance services, including air 
ambulance services, may be made for transporting a veteran to a facility 
only if the following conditions are met:
    (a) 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:
    (1) 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
    (2) Death had not occurred before emergency treatment could be 
provided;
    (b) The veteran is financially liable to the provider of the 
emergency transportation;
    (c) The veteran does not have coverage under a health-plan contract 
that would fully extinguish the medical liability for the emergency 
transportation (this condition is not met if the veteran has coverage 
under a health-plan contract but payment is barred because of a failure 
by the veteran or the provider to comply with the provisions of that 
health-plan contract);
    (d) If the condition for which the emergency transportation was 
furnished was caused by an accident or work-related injury, the claimant 
has exhausted without success all claims and remedies reasonably 
available to the veteran or provider against a third party for payment 
of such transportation; and the veteran 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
    (e) If the veteran is not eligible for reimbursement for any 
emergency treatment expenses under 38 U.S.C. 1728.

(Authority: 38 U.S.C. 1725)

[66 FR 36470, July 12, 2001, as amended at 83 FR 979, Jan. 9, 2018]



Sec.  17.1004  Filing claims.

    (a) A claimant for payment or reimbursement under 38 U.S.C. 1725 
must be the entity that furnished the treatment, the veteran who paid 
for the treatment, or the person or organization that paid for such 
treatment on behalf of the veteran.
    (b) To obtain payment or reimbursement for emergency treatment under 
38 U.S.C. 1725, a claimant must submit to the VA medical facility of 
jurisdiction a completed standard billing form (such as a UB92 or a CMS 
1500). Where the form used does not contain a false claims notice, the 
completed form must also be accompanied by a signed, written statement 
declaring that ``I hereby certify that this claim meets all of the 
conditions for payment by VA for emergency medical services

[[Page 888]]

under 38 CFR 17.1002 (except for paragraph (e)) and 17.1003. I am aware 
that 38 U.S.C. 6102(b) provides that one who obtains payment without 
being entitled to it and with intent to defraud the United States shall 
be fined in accordance with title 18, United States Code, or imprisoned 
not more than one year, or both.''

    Note to Sec.  17.1004(b): These regulations regarding payment or 
reimbursement for emergency services for nonservice-connected conditions 
in non-VA facilities also can be found on the internet at http://
www.va.gov/health/elig.

    (c) Notwithstanding the provisions of paragraph (b) of this section, 
no specific form is required for a claimant (or duly authorized 
representative) to claim payment or reimbursement for emergency 
transportation charges under 38 U.S.C. 1725. The claimant need only 
submit a signed and dated request for such payment or reimbursement to 
the VA medical facility of jurisdiction, together with a bill showing 
the services provided and charges for which the veteran is personally 
liable and a signed statement explaining who requested such 
transportation services and why they were necessary.
    (d) To receive payment or reimbursement for emergency services, a 
claimant must file a claim within 90 days after the latest of the 
following:
    (1) The date that the veteran was discharged from the facility that 
furnished the emergency treatment;
    (2) The date of death, but only if the death occurred during 
transportation to a facility for emergency treatment or if the death 
occurred during the stay in the facility that included the provision of 
the emergency treatment; or
    (3) The date the veteran finally exhausted, without success, action 
to obtain payment or reimbursement for the treatment from a third party.
    (e) If after reviewing a claim the decisionmaker determines that 
additional information is needed to make a determination regarding the 
claim, such official will contact the claimant in writing and request 
additional information. The additional information must be submitted to 
the decisionmaker within 30 days of receipt of the request or the claim 
will be treated as abandoned, except that if the claimant within the 30-
day period requests in writing additional time, the time period for 
submission of the information may be extended as reasonably necessary 
for the requested information to be obtained.
    (f) Notwithstanding paragraph (d) of this section, VA will provide 
retroactive payment or reimbursement for emergency treatment received by 
the veteran on or after July 19, 2001, but more than 90 days before May 
21, 2012, if the claimant files a claim for reimbursement no later than 
1 year after May 21, 2012.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0620.)

[66 FR 36470, July 12, 2001, as amended at 68 FR 3404, Jan. 24, 2003; 77 
FR 23617, Apr. 20, 2012; 84 FR 26307, June 5, 2019]



Sec.  17.1005  Payment limitations.

    (a) Payment or reimbursement for emergency treatment (including 
emergency transportation) under 38 U.S.C. 1725 will be calculated as 
follows:
    (1) If an eligible veteran has personal liability to a provider of 
emergency treatment and no contractual or legal recourse against a third 
party, including under a health-plan contract, VA will pay the lesser of 
the amount for which the veteran is personally liable or 70 percent of 
the applicable Medicare fee schedule amount for such treatment.
    (2) If an eligible veteran has personal liability to a provider of 
emergency treatment after payment by a third party, including under a 
health-plan contract, VA will pay:
    (i) The difference between the amount VA would have paid under 
paragraph (a)(1) of this section for the cost of the emergency treatment 
and the amount paid (or payable) by the third party, if that amount 
would be greater than zero, or;
    (ii) If applying paragraph (a)(2)(i) of this section would result in 
no payment by VA, the lesser of the veteran's remaining personal 
liability after such third-party payment or 70 percent of the applicable 
Medicare fee schedule amount for such treatment.

[[Page 889]]

    (3) In the absence of a Medicare fee schedule rate for the emergency 
treatment, VA payment will be the lesser of the amount for which the 
veteran is personally liable or the amount calculated by the VA Fee 
Schedule in Sec.  17.56 (a)(2)(i)(B).
    (4) Unless rejected and refunded by the provider within 30 days from 
the date of receipt, the provider will consider VA's payment made under 
paragraphs (a)(1), (a)(2), or (a)(3) of this section as payment in full 
and extinguish the veteran's liability to the provider. (Neither the 
absence of a contract or agreement between the Secretary and the 
provider nor any provision of a contract, agreement, or assignment to 
the contrary shall operate to modify, limit, or negate the requirement 
in the preceding sentence.)
    (5) VA will not reimburse a veteran under this section for any 
copayment, deductible, coinsurance, or similar payment that the veteran 
owes the third party or is obligated to pay under a health-plan 
contract.
    (b) Except as provided in paragraph (c) of this section, VA will not 
approve claims for payment or reimbursement of the costs of emergency 
treatment not previously authorized for any period beyond the date on 
which the medical emergency ended. For this purpose, VA considers that 
an emergency ends when the designated VA clinician at the VA facility 
has determined that, based on sound medical judgment, a veteran who 
received emergency treatment:
    (1) Could have been transferred from the non-VA facility to a VA 
medical center (or other Federal facility that VA has an agreement with 
to furnish health care services for veterans) for continuation of 
treatment, or
    (2) Could have reported to a VA medical center (or other Federal 
facility that VA has an agreement with to furnish health care services 
for veterans) for continuation of treatment.
    (c) Claims for payment or reimbursement of the costs of emergency 
treatment not previously authorized may be approved for continued, non-
emergency treatment, only if:
    (1) The non-VA facility notified VA at the time the veteran could be 
safely transferred to a VA facility (or other Federal facility that VA 
has an agreement with to furnish health care services for veterans) and 
the transfer of the veteran was not accepted, and
    (2) The non-VA facility made and documented reasonable attempts to 
request transfer of the veteran to VA (or to another Federal facility 
that VA has an agreement with to furnish health care services for 
veterans), which means the non-VA facility contacted either the VA 
Transfer Coordinator, Administrative Officer of the Day, or designated 
staff responsible for accepting transfer of patients at a local VA (or 
other Federal facility) and documented such contact in the veteran's 
progress/physicians' notes, discharge summary, or other applicable 
medical record.
    (d) If a stabilized veteran who requires continued non-emergency 
treatment refuses to be transferred to an available VA facility (or 
other Federal facility that VA has an agreement with to furnish health 
care services for veterans), VA will make payment or reimbursement only 
for the expenses related to the initial evaluation and the emergency 
treatment furnished to the veteran up to the point of refusal of 
transfer by the veteran.

(Authority: 38 U.S.C. 1725)

[66 FR 36470, July 12, 2001, as amended at 68 FR 3404, Jan. 24, 2003; 76 
FR 79071, Dec. 21, 2011; 77 FR 23618, Apr. 20, 2012; 78 FR 36093, June 
17, 2013; 83 FR 979, Jan. 9, 2018]



Sec.  17.1006  Decisionmakers.

    The Chief of the Health Administration Service or an equivalent 
official at the VA medical facility of jurisdiction will make all 
determinations regarding payment or reimbursement under 38 U.S.C. 1725, 
except that the designated VA clinician at the VA medical facility of 
jurisdiction will make determinations regarding Sec.  17.1002(b), (c), 
and (d). Any decision denying a benefit must be in writing and inform 
the claimant of VA reconsideration and appeal rights.

(Authority: 38 U.S.C. 1725)

[66 FR 36470, July 12, 2001, as amended at 76 FR 79072, Dec. 21, 2011]

[[Page 890]]



Sec.  17.1007  Independent right of recovery.

    (a) VA has the right to recover its payment under this section when, 
and to the extent that, a third party makes payment for all or part of 
the same emergency treatment for which VA reimbursed or made payment 
under this section.
    (1) Under 38 U.S.C. 1725(d)(4), the veteran (or the veteran's 
personal representative, successor, dependents, or survivors) or 
claimant shall ensure that the Secretary is promptly notified of any 
payment received from any third party for emergency treatment furnished 
to the veteran. The veteran (or the veteran's personal representative, 
successor, dependents, or survivors) or claimant shall immediately 
forward all documents relating to such payment, cooperate with the 
Secretary in the investigation of such payment and assist the Secretary 
in enforcing the United States' right to recover any payment made and 
accepted under this section. The required notification and submission of 
documentation must be provided by the veteran or claimant to the VA 
medical facility of jurisdiction within three working days of receipt of 
notice of the duplicate payment.
    (2) If the Chief Financial Officer or equivalent official at the VA 
medical facility of jurisdiction concludes that payment from a third 
party was made for all or part of the same emergency treatment for which 
VA reimbursed or made payment under this section, such VA official 
shall, except as provided in paragraph (c) of this section, initiate 
action to collect or recover the amount of the duplicate payment in the 
same manner as for any other debt owed the United States.
    (b)(1) Any amount paid by the United States to the veteran (or the 
veteran's personal representative, successor, dependents, or survivors) 
or to any other person or organization paying for such treatment shall 
constitute a lien in favor of the United States against any recovery the 
payee subsequently receives from a third party for the same treatment.
    (2) Any amount paid by the United States, and accepted by the 
provider that furnished the veteran's emergency treatment, shall 
constitute a lien against any subsequent amount the provider receives 
from a third party for the same emergency treatment for which the United 
States made payment.
    (c) If it is determined that a duplicate payment was made, the Chief 
Financial Officer or equivalent official at the VA medical facility of 
jurisdiction may waive recovery of a VA payment made under this section 
to a veteran upon determining that the veteran has substantially 
complied with the provisions of paragraph (a)(1) of this section and 
that actions to recover the payment would not be cost-effective or would 
conflict with other litigative interests of the United States.

(Authority: 38 U.S.C. 1725)



Sec.  17.1008  Balance billing prohibited.

    Payment by VA under 38 U.S.C. 1725 on behalf of a veteran to a 
provider of emergency treatment and any non-emergency treatment that is 
authorized under Sec.  17.1005(c) of this part shall, unless rejected 
and refunded by the provider within 30 days of receipt, extinguish all 
liability on the part of the veteran for that emergency treatment and 
any non-emergency treatment that is authorized under Sec.  17.1005(c) of 
this part. Neither the absence of a contract or agreement between VA and 
the provider nor any provision of a contract, agreement, or assignment 
to the contrary shall operate to modify, limit, or negate this 
requirement.

(Authority: 38 U.S.C. 1725)

[66 FR 36470, July 12, 2001, as amended at 76 FR 79072, Dec. 21, 2011]

   Expanded Access to Non-VA Care Through the Veterans Choice Program

    Source: Sections 17.1500 through 17.1540 appear at 79 FR 65585, Nov. 
5, 2014, unless otherwise noted.



Sec.  17.1500  Purpose and scope.

    (a) Purpose. Sections 17.1500 through 17.1540 implement the Veterans 
Choice Program, authorized by section 101 of the Veterans Access, 
Choice, and Accountability Act of 2014.
    (b) Scope. The Veterans Choice Program authorizes VA to furnish 
hospital

[[Page 891]]

care and medical services to eligible veterans, as defined in Sec.  
17.1510, through agreements with eligible entities or providers, as 
defined in Sec.  17.1530.

(Authority: Sec. 101, Pub. L. 113-146, 128 Stat. 1754)



Sec.  17.1505  Definitions.

    For purposes of the Veterans Choice Program under Sec. Sec.  17.1500 
through 17.1540:
    Appointment means an authorized and scheduled encounter with a 
health care provider for the delivery of hospital care or medical 
services. A visit to an emergency room or an unscheduled visit to a 
clinic is not an appointment.
    Attempt to schedule means contact with a VA scheduler or VA health 
care provider in which a stated request by the veteran for an 
appointment is made.
    Episode of care means a necessary course of treatment, including 
follow-up appointments and ancillary and specialty services, which lasts 
no longer than 1 calendar year from the date of the first appointment 
with a non-VA health care provider.
    Full-time primary care physician means a single VA physician whose 
workload, or multiple VA physicians whose combined workload, equates to 
0.9 full time equivalent employee working at least 36 clinical hours a 
week at the VA medical facility and who provides primary care as defined 
by their privileges or scope of practice and licensure.
    Health-care plan means an insurance policy or contract, medical or 
hospital service agreement, membership or subscription contract, or 
similar arrangement not administered by the Secretary of Veterans 
Affairs, under which health services for individuals are provided or the 
expenses of such services are paid; and does not include any such 
policy, contract, agreement, or similar arrangement pursuant to title 
XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq.) or 
chapter 55 of title 10, United States Code.
    Residence means a legal residence or personal domicile, even if such 
residence is seasonal. A person may maintain more than one residence but 
may only have one residence at a time. If a veteran lives in more than 
one location during a year, the veteran's residence is the residence or 
domicile where the person is staying at the time the veteran wants to 
receive hospital care or medical services through the Program. A post 
office box or other non-residential point of delivery does not 
constitute a residence.
    Schedule means identifying and confirming a date, time, location, 
and entity or health care provider for an appointment.
    VA medical facility means a VA hospital, a VA community-based 
outpatient clinic, or a VA health care center, any of which must have at 
least one full-time primary care physician. A Vet Center, or 
Readjustment Counseling Service Center, is not a VA medical facility.
    Wait-time goals of the Veterans Health Administration means, unless 
changed by further notice in the Federal Register, a date not more than 
30 days from either:
    (1) The date that an appointment is deemed clinically appropriate by 
a VA health care provider. In the event a VA health care provider 
identifies a time range when care must be provided (e.g., within the 
next 2 months), VA will use the last clinically appropriate date for 
determining whether or not such care is timely.
    (2) Or, if no such clinical determination has been made, the date 
that a veteran prefers to be seen for hospital care or medical services.

(Authority: Sec. 101, Pub. L. 113-146, 128 Stat. 1754; Sec. 4005, Pub. 
L. 114-41, 129 Stat. 443)

[79 FR 65585, Nov. 5, 2014, as amended at 80 FR 74995, Dec. 1, 2015]



Sec.  17.1510  Eligible veterans.

    A veteran must meet the eligibility criteria under both paragraphs 
(a) and (b) of this section to be eligible for care through the Veterans 
Choice Program. A veteran must also provide the information required by 
paragraphs (c) and (d) of this section.
    (a) A veteran must be enrolled in the VA health care system under 
Sec.  17.36.
    (b) A veteran must also meet at least one of the following criteria:
    (1) The veteran attempts, or has attempted, to schedule an 
appointment with a VA health care provider, but VA is unable to schedule 
an appointment for the veteran within:

[[Page 892]]

    (i) The wait-time goals of the Veterans Health Administration; or
    (ii) With respect to such care or services that are clinically 
necessary, the period VA determines necessary for such care or services 
if such period is shorter than the wait-time goals of the Veterans 
Health Administration.
    (2) The veteran's residence is more than 40 miles from the VA 
medical facility that is closest to the veteran's residence.
    (3) The veteran's residence is both:
    (i) In a state without a VA medical facility that provides hospital 
care, emergency medical services, and surgical care having a surgical 
complexity of standard (VA maintains a Web site with a list of the 
facilities that have been designated with at least a surgical complexity 
of standard. That Web site can be accessed here: www.va.gov/health/
surgery); and
    (ii) More than 20 miles from a medical facility described in 
paragraph (b)(3)(i) of this section.
    (4) The veteran's residence is in a location, other than one in 
Guam, American Samoa, or the Republic of the Philippines, which is 40 
miles or less from a VA medical facility and the veteran:
    (i) Must travel by air, boat, or ferry to reach such a VA medical 
facility; or
    (ii) Faces an unusual or excessive burden in traveling to such a VA 
medical facility based on geographical challenges, such as the presence 
of a body of water (including moving water and still water) or a 
geologic formation that cannot be crossed by road; environmental 
factors, such as roads that are not accessible to the general public, 
traffic, or hazardous weather; a medical condition that affects the 
ability to travel; or other factors, as determined by VA, including but 
not limited to:
    (A) The nature or simplicity of the hospital care or medical 
services the veteran requires;
    (B) The frequency that such hospital care or medical services need 
to be furnished to the veteran; and
    (C) The need for an attendant, which is defined as a person who 
provides required aid and/or physical assistance to the veteran, for a 
veteran to travel to a VA medical facility for hospital care or medical 
services.
    (c) If the veteran changes his or her residence, the veteran must 
update VA about the change within 60 days.
    (d) A veteran must provide to VA information on any health-care plan 
under which the veteran is covered prior to obtaining authorization for 
care under the Veterans Choice Program. If the veteran changes health-
care plans, the veteran must update VA about the change within 60 days.
    (e) For purposes of calculating the distance between a veteran's 
residence and the nearest VA medical facility under this section, VA 
will use the driving distance between the nearest VA medical facility 
and a veteran's residence. VA will calculate a veteran's driving 
distance using geographic information system software.

(Authority: Sec. 101, Pub. L. 113-146, 128 Stat. 1754; Section 3(a)(2) 
of Pub. L. 114-19, 129 Stat. 215)

    (The information collection requirements have been submitted to the 
Office of Management and Budget and are pending OMB approval.)

[79 FR 65585, Nov. 5, 2014, as amended at 80 FR 22909, Apr. 24, 2015; 80 
FR 74996, Dec. 1, 2015]



Sec.  17.1515  Authorizing non-VA care.

    (a) Electing non-VA care. A veteran eligible for the Veterans Choice 
Program under Sec.  17.1510 may choose to schedule an appointment with a 
VA health care provider, be placed on an electronic waiting list for VA 
care, or have VA authorize the veteran to receive an episode of care for 
hospital care or medical services under 38 CFR 17.38 from an eligible 
entity or provider.
    (b) Selecting a non-VA provider. An eligible veteran may specify a 
particular non-VA entity or health care provider, if that entity or 
health care provider meets the requirements of Sec.  17.1530. If an 
eligible veteran does not specify a particular eligible entity or 
provider, VA will refer the veteran to a specific eligible entity or 
provider.

(Authority: Sec. 101, Pub. L. 113-146, 128 Stat. 1754)

    (The information collection requirements have been submitted to the 
Office of Management and Budget and are pending OMB approval.)

[[Page 893]]



Sec.  17.1520  Effect on other provisions.

    (a) General. In general, eligibility under the Veterans Choice 
Program does not affect a veteran's eligibility for hospital care or 
medical services under the medical benefits package, as defined in Sec.  
17.38, or other benefits addressed in this part. Notwithstanding any 
other provision of this part, VA will pay for and fill prescriptions 
written by eligible providers under Sec.  17.1530 for eligible veterans 
under Sec.  17.1510, including prescriptions for drugs, including over-
the-counter drugs and medical and surgical supplies available under the 
VA national formulary system.
    (b) Copayments. VA will be liable for any deductibles, cost-shares, 
or copayments required by an eligible veteran's health-care plan for 
hospital care and medical services furnished under this Program, to the 
extent that such reimbursement does not result in expenditures by VA for 
the furnished care or services in excess of the rate established under 
Sec.  17.1535. Veterans are also liable for a VA copayment for care 
furnished under this Program, as required by Sec. Sec.  17.108(b)(4), 
17.108(c)(4), 17.110(b)(4), and 17.111(b)(3).
    (c) Beneficiary travel. For veterans who are eligible for 
beneficiary travel benefits under part 70 of this chapter, VA will 
provide beneficiary travel benefits for travel to and from the location 
of the eligible entity or provider who furnishes hospital care or 
medical services for an authorized appointment under the Veterans Choice 
Program without regard to the limitations in Sec.  70.30(b)(2) of this 
chapter.

(Authority: 38 U.S.C. 111; Sec. 101, Pub. L. 113-146, 128 Stat. 1754)



Sec.  17.1525  [Reserved]



Sec.  17.1530  Eligible entities and providers.

    (a) General. An entity or provider is eligible to deliver care under 
the Veterans Choice Program if, in accordance with paragraph (c) of this 
section, it is accessible to the veteran and is an entity or provider 
identified in section 101(a)(1)(B)(i)-(iv) of the Veterans Access, 
Choice, and Accountability Act of 2014 or is an entity identified in 
paragraph (e) of this section, and is either:
    (1) Not a part of, or an employee of, VA; or
    (2) If the provider is an employee of VA, is not acting within the 
scope of such employment while providing hospital care or medical 
services through the Veterans Choice Program.
    (b) Agreement. An entity or provider must enter into an agreement 
with VA to provide non-VA hospital care or medical services to eligible 
veterans through one of the following types of agreements: contracts, 
intergovernmental agreements, or provider agreements. Each form of 
agreement must be executed by a duly authorized Department official.
    (c) Accessibility. An entity or provider may only furnish hospital 
care or medical services to an eligible veteran if the entity or 
provider is accessible to the eligible veteran. VA will determine 
accessibility by considering the following factors:
    (1) The length of time the eligible veteran would have to wait to 
receive hospital care or medical services from the entity or provider;
    (2) The qualifications of the entity or provider to furnish the 
hospital care or medical services to the eligible veteran; and
    (3) The distance between the eligible veteran's residence and the 
entity or provider.
    (d) Requirements for health care providers. (1) To be eligible to 
furnish care or services under the Veterans Choice Program, a health 
care provider must:
    (i) Maintain at least the same or similar credentials and licenses 
as those required of VA's health care providers, as determined by the 
Secretary. The agreement reached under paragraph (b) of this section 
will clarify these requirements. Eligible health care providers must 
submit verification of such licenses and credentials maintained by the 
provider to VA at least once per 12-month period.
    (ii) Not be excluded from participation in a Federal health care 
program (as defined in section 1128B(f) of the Social Security Act (42 
U.S.C. 1320a-7b(f)) under section 1128 or 1128A of such Act (42 U.S.C. 
1320a-7 and 1320a-7a)), not be identified as an excluded source on the 
list maintained in the System for Award Management or any successor

[[Page 894]]

system, and not be identified on the List of Excluded Individuals and 
Entities that is maintained by the Office of the Inspector General of 
the U.S. Department of Health and Human Services.
    (2) Any entities that are eligible to provide care through the 
Program must ensure that any of their providers furnishing care and 
services through the Program meet the standards identified in paragraph 
(d)(1) of this section. An eligible entity may submit this information 
on behalf of its providers.
    (e) Other eligible entities and providers. In accordance with 
sections 101(a)(1)(B)(v) and 101(d)(5) of the Veterans Access, Choice, 
and Accountability Act of 2014 (as amended), the following entities or 
providers are eligible to deliver care under the Veterans Choice 
Program, subject to the additional criteria established in this section.
    (1) A health care provider that is participating in a State Medicaid 
plan under title XIX of the Social Security Act (42 U.S.C. 1396 et 
seq.), including any physician furnishing services under such program, 
if the health care provider has an agreement under a State plan under 
title XIX of such Act (42 U.S.C. 1396 et seq.) or a waiver of such a 
plan;
    (2) An Aging and Disability Resource Center, an area agency on 
aging, or a State agency (as defined in section 102 of the Older 
Americans Act of 1965 (42 U.S.C. 3002)), or a center for independent 
living (as defined in section 702 of the Rehabilitation Act of 1973 (29 
U.S.C. 796a)).
    (3) A health care provider that is not identified in paragraph 
(e)(1) or (2) of this section, if that provider meets all requirements 
under paragraph (d) of this section.

(Authority: Sec. 101, Pub. L. 113-146, 128 Stat. 1754; Sec. 4005, Pub. 
L. 114-41, 129 Stat. 443)
    (The information collection requirements have been submitted to the 
Office of Management and Budget and are pending OMB approval.)

[79 FR 65585, Nov. 5, 2014, as amended at 80 FR 74996, Dec. 1, 2015; 81 
FR 24027, Apr. 25, 2016]



Sec.  17.1535  Payment rates and methodologies.

    (a) Payment rates. Payment rates will be negotiated and set forth in 
an agreement between the Secretary and an eligible entity or provider.
    (1) Except as otherwise provided in this section, payment rates may 
not exceed the rates paid by the United States to a provider of services 
(as defined in section 1861(u) of the Social Security Act (42 U.S.C. 
1395x(u)) or a supplier (as defined in section 1861(d) of such Act (42 
U.S.C. 1395x(d)) under the Medicare program under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.) for the same care or 
services. These rates are known as the ``Medicare Fee Schedule'' for VA 
purposes.
    (2) For eligible entities or providers in highly rural areas, the 
Secretary may enter into an agreement that includes a rate greater than 
the rate defined paragraph (a)(1) of this section for hospital care or 
medical services, so long as such rate is still determined by VA to be 
fair and reasonable. The term ``highly rural area'' means an area 
located in a county that has fewer than seven individuals residing in 
that county per square mile.
    (3) For eligible entities or providers in Alaska, the Secretary may 
enter into agreements at rates established under Sec. Sec.  17.55(j) and 
17.56(b).
    (4) For eligible entities or providers in a State with an All-Payer 
Model Agreement under the Social Security Act that became effective on 
January 1, 2014, payment rates will be calculated based on the payment 
rates under such agreement.
    (5) When there are no available rates as described in paragraph 
(a)(1) of this section, the Secretary shall, to the extent consistent 
with the Veterans Access, Choice, and Accountability Act of 2014, follow 
the process and methodology outlined in Sec. Sec.  17.55 and 17.56 and 
pay the resulting rate.
    (b) Payment responsibilities. Responsibility for payments will be as 
follows.
    (1) For a nonservice-connected disability, as that term is defined 
at Sec.  3.1(l) of this chapter, a health-care plan of an eligible 
veteran is primarily responsible, to the extent such care or services is 
covered by the health-care plan, for paying the eligible entity or

[[Page 895]]

provider for such hospital care or medical services as are authorized 
under Sec. Sec.  17.1500 through 17.1540 and furnished to an eligible 
veteran. VA shall be responsible for promptly paying only for costs of 
the VA-authorized service not covered by such health-care plan, 
including a payment made by the veteran, except that such payment may 
not exceed the rate determined for such care or services pursuant to 
paragraph (a) of this section.
    (2) For hospital care or medical services furnished for a service-
connected disability, as that term is defined at Sec.  3.1(k) of this 
chapter, or pursuant to 38 U.S.C. 1710(e), 1720D, or 1720E, VA is solely 
responsible for paying the eligible entity or provider for such hospital 
care or medical services as are authorized under Sec. Sec.  17.1500 
through 17.1540 and furnished to an eligible veteran.
    (c) Authorized care. VA will only pay for an episode of care for 
hospital care or medical services authorized by VA. The eligible entity 
or provider must contact VA to receive authorization prior to providing 
any hospital care or medical services the eligible non-VA entity or 
provider believes are necessary that are not identified in the 
authorization VA submits to the eligible entity or provider. VA will 
only pay for the hospital care or medical services that are furnished by 
an eligible entity or provider. There must be an actual encounter with a 
health care provider, who is either an employee of an entity in an 
agreement with VA or who is furnishing care through an agreement the 
health care provider has entered into with VA, and such encounter must 
occur after an election is made by an eligible veteran.

(Authority: Secs. 101, 105, Pub. L. 113-146, 128 Stat. 1754)

[79 FR 65585, Nov. 5, 2014, as amended at 80 FR 66428, Oct. 29, 2015]



Sec.  17.1540  Claims processing system.

    (a) There is established within the Chief Business Office of the 
Veterans Health Administration a nationwide claims processing system for 
processing and paying bills or claims for authorized hospital care and 
medical services furnished to eligible veterans under Sec. Sec.  17.1500 
through 17.1540.
    (b) The Chief Business Office is responsible for overseeing the 
implementation and maintenance of such system.
    (c) The claims processing system will receive requests for payment 
from eligible entities and providers for hospital care or medical 
services furnished to eligible veterans. The claims processing system 
will provide accurate, timely payments for claims received in accordance 
with Sec. Sec.  17.1500 through 17.1540.

(Authority: Secs. 101, 105, Pub. L. 113-146, 128 Stat. 1754)

                               Vet Centers



Sec.  17.2000  Vet Center services.

    (a) Eligibility for readjustment counseling. Upon request, VA will 
provide readjustment counseling to any individual who:
    (1) Is a veteran or member of the Armed Forces, including a member 
of a reserve component of the Armed Forces, who:
    (i) Served on active duty in a theater of combat operations or an 
area of hostilities (i.e., an area at a time during which hostilities 
occurred in that area); or
    (ii) Provided direct emergency medical or mental health care, or 
mortuary services, to the causalities of combat operations or 
hostilities, but who at the time was located outside the theater of 
combat operations or area of hostilities; or
    (iii) Engaged in combat with an enemy of the United States or 
against an opposing military force in a theater of combat operations or 
an area at a time during which hostilities occurred in that area by 
remotely controlling an unmanned aerial vehicle operations, 
notwithstanding whether the physical location of such veteran or member 
during such combat was within such theater of combat operations or area. 
Individuals who remotely control unmanned aerial vehicles includes, but 
is not limited to, individuals who pilot the unmanned aerial vehicle as 
well as individuals who are crew members of the unmanned aerial vehicle 
and participate in combat related missions. The crew members include, 
but are not limited to, intelligence analysts or

[[Page 896]]

weapons specialists who control the cameras, engage the weapon systems, 
as well as those individuals who are directly responsible for the 
mission of the unmanned aerial vehicle.
    (2) Received counseling under this section before January 2, 2013.
    (3) Is a family member of a veteran or member of the Armed Forces, 
including a member of a reserve component of the Armed Forces, who is 
eligible for readjustment counseling under paragraphs (a)(1) or (a)(2) 
of this section. For purposes of this section, family member includes, 
but is not limited to, the spouse, parent, child, step-family member, 
extended family member, and any individual who lives with the veteran or 
member of the Armed Forces, including a member of a reserve component of 
the Armed Forces, but is not a member of the veteran's or member's 
family.
    (b) Proof of eligibility. With the veteran's or member's of the 
Armed Forces, including a member of a reserve component of the Armed 
Forces, consent, VA will assist in obtaining proof of eligibility. For 
the purposes of this section, proof of service in a theater of combat 
operations or in an area during a period of hostilities in that area 
will be established by:
    (1) A DD Form 214 (Certificate of Release or Discharge from Active 
Duty) containing notations of service in a designated theater of combat 
operations; or
    (2) Receipt of one of the following medals: The Armed Forces 
Expeditionary Medal, Service Specific Expeditionary Medal (e.g., Navy 
Expeditionary Medal), Combat Era Specific Expeditionary Medal (e.g., the 
Global War on Terrorism Expeditionary Medal), Campaign Specific Medal 
(e.g., Vietnam Service Medal or Iraq Campaign Medal), or other combat 
theater awards established by public law or executive order; or
    (3) Proof of receipt of Hostile Fire or Imminent Danger Pay 
(commonly referred to as ``combat pay'') or combat tax exemption after 
November 11, 1998.
    (c) Referral and advice. Upon request, VA will provide an individual 
who does not meet the eligibility requirements of paragraph (a) of this 
section, solely because the individual was discharged under dishonorable 
conditions from active military, naval, or air service, the following:
    (1) Referral services to assist such individual, to the maximum 
extent practicable, in obtaining mental health care and services from 
sources outside VA; and
    (2) If pertinent, advice to such individual concerning such 
individual's rights to apply to:
    (i) The appropriate military, naval or air service for review of 
such individual's discharge or release from such service; and
    (ii) VA for a VA benefits eligibility determination under 38 CFR 
3.12.
    (d) Readjustment counseling defined. For the purposes of this 
section, readjustment counseling includes, but is not limited to: 
Psychosocial assessment, individual counseling, group counseling, 
marital and family counseling for military-related readjustment issues, 
substance abuse assessments, medical referrals, referral for additional 
VA benefits, employment assessment and referral, military sexual trauma 
counseling and referral, bereavement counseling, and outreach. A 
``psychosocial assessment'' under this paragraph means the holistic 
assessing of an individual's psychological, social, and functional 
capacities as it relates to their readjustment from combat theaters. 
Readjustment counseling is provided to:
    (1) Veterans and members of the Armed Forces, including a member of 
a reserve component of the Armed Forces, for the purpose of readjusting 
to civilian life or readjustment to continued military service following 
participation in or in support of operations in a combat theater or area 
of hostility.
    (2) A family member of a member of the Armed Forces, including a 
member of a reserve component of the Armed Forces, for the purpose of 
coping with such member's deployment.
    (3) A family member of a veteran or member of the Armed Forces, 
including a member of a reserve component of the Armed Forces, to aid in 
a veteran's or member's readjustment to civilian or continued military 
service following participation in or in support of operations in a 
combat theater or

[[Page 897]]

area of hostility, only as it relates to the veteran's or member's 
military experience.
    (e) Confidentiality. Benefits under this section are furnished 
solely by VA Vet Centers, which maintain confidential records 
independent from any other VA or Department of Defense medical records 
and which will not disclose such records without either the veteran's or 
member's of the Armed Forces, including a member of a reserve component 
of the Armed Forces, voluntary, signed authorization, or a specific 
exception permitting their release. For more information, see 5 U.S.C. 
552a, 38 U.S.C. 5701 and 7332, 45 CFR parts 160 and 164, and VA's System 
of Records 64VA15, ``Readjustment Counseling Service Vet Center 
Program.'' The term Vet Center means a facility that is operated by VA 
for the provision of services under this section and that is situated 
apart from a VA general health care facility.

(Authority: 38 U.S.C. 501, 1712A, 1782, and 1783)

[78 FR 57073, Sept. 17, 2013, as amended at 80 FR 46200, Aug. 4, 2015]

       Home Improvements and Structural Alterations (HISA) Program

    Source: Sections 17.3100 through 17.3130 appear at 79 FR 71660, Dec. 
3, 2014, unless otherwise noted.



Sec.  17.3100  Purpose and scope.

    (a) Purpose. The purpose of Sec. Sec.  17.3100 through 17.3130 is to 
implement the Home Improvements and Structural Alterations (HISA) 
program. The purpose of the HISA benefits program is to provide eligible 
beneficiaries monetary benefits for improvements and structural 
alterations to their homes when such improvements and structural 
alterations:
    (1) Are necessary for the continuation of the provision of home 
health treatment of the beneficiary's disability; or
    (2) Provide the beneficiary with access to the home or to essential 
lavatory and sanitary facilities.
    (b) Scope. 38 CFR 17.3100 through 17.3130 apply only to the 
administration of the HISA benefits program, unless specifically 
provided otherwise.

(Authority: 38 U.S.C. 501, 1717(a)(2))



Sec.  17.3101  Definitions.

    For the purposes of the HISA benefits program (Sec. Sec.  17.3100 
through 17.3130):
    Access to essential lavatory and sanitary facilities means having 
normal use of the standard structural components of those facilities.
    Access to the home means the ability of the beneficiary to enter and 
exit the home and to maneuver within the home to at least one bedroom 
and essential lavatory and sanitary facilities.
    Beneficiary means a veteran or servicemember who is awarded or who 
is eligible to receive HISA benefits.
    Essential lavatory and sanitary facilities means one bathroom 
equipped with a toilet and a shower or bath, one kitchen, and one 
laundry facility.
    HISA benefits means a monetary payment by VA to be used for 
improvements and structural alterations to the home of a beneficiary in 
accordance with Sec. Sec.  17.3100 through 17.3130.
    Home means the primary place where the beneficiary resides or, in 
the case of a servicemember, where the beneficiary intends to reside 
after discharge from service.
    Improvement or structural alteration means a modification to a home 
or to an existing feature or fixture of a home, including repairs to or 
replacement of previously improved or altered features or fixtures.
    Undergoing medical discharge means that a servicemember has been 
found unfit for duty due to a medical condition by their Service's 
Physical Evaluation Board, and a date of medical discharge has been 
issued.

(Authority: 38 U.S.C. 501, 1717)



Sec.  17.3102  Eligibility.

    The following individuals are eligible for HISA benefits:
    (a) A veteran who is eligible for medical services under 38 U.S.C. 
1710(a).
    (b) A servicemember who is undergoing medical discharge from the 
Armed Forces for a permanent disability that was incurred or aggravated

[[Page 898]]

in the line of duty in the active military, naval, or air service. A 
servicemember would be eligible for HISA benefits while hospitalized or 
receiving outpatient medical care, services, or treatment for such 
permanent disability.

(Authority: 38 U.S.C. 501, 1717)



Sec. Sec.  17.3103-17.3104  [Reserved]



Sec.  17.3105  HISA benefit lifetime limits.

    (a) General. Except as provided in paragraph (e) of this section, a 
beneficiary's HISA benefit is limited to the lifetime amount established 
in paragraph (b), (c), or (d) of this section, as applicable. A 
beneficiary may use HISA benefits to pay for more than one home 
alteration, until the beneficiary exhausts his or her lifetime benefit. 
HISA benefits approved by VA for use in a particular home alteration but 
unused by the beneficiary will remain available for future use.
    (b) HISA benefits for a service-connected disability, a disability 
treated ``as if'' it were service connected, or for veterans with a 
service-connected disability rated 50 percent or more. (1) If a veteran:
    (i) Applies for HISA benefits to address a service-connected 
disability;
    (ii) Applies for HISA benefits to address a compensable disability 
treated ``as if'' it is a service-connected disability and for which the 
veteran is entitled to medical services under 38 U.S.C. 1710(a)(2)(C) 
(e.g., a disability acquired through treatment or vocational 
rehabilitation provided by VA); or
    (iii) Applies for HISA benefits to address a nonservice-connected 
disability, if the beneficiary has a service-connected disability rated 
at least 50 percent disabling; and
    (2) The veteran first applies for HISA benefits:
    (i) Before May 5, 2010, then the veteran's lifetime HISA benefit 
limit is $4,100.
    (ii) On or after May 5, 2010, then the veteran's lifetime HISA 
benefit limit is $6,800.
    (c) HISA benefits for any other disabilities. If a veteran who is 
eligible for medical services under 38 U.S.C. 1710(a) applies for HISA 
benefits to address a disability that is not covered under paragraph (b) 
of this section, and the veteran first applies for HISA benefits:
    (1) Before May 5, 2010, then the veteran's lifetime HISA benefit 
limit is $1,200; or
    (2) On or after May 5, 2010, then the veteran's lifetime HISA 
benefit limit is $2,000.
    (d) Servicemembers. If a servicemember is eligible for HISA benefits 
under Sec.  17.3102(b), and the servicemember first applies:
    (1) Before May 5, 2010, then the servicemember's HISA benefit 
lifetime limit is $4,100; or
    (2) On or after May 5, 2010, then the servicemember's HISA benefit 
lifetime limit is $6,800.
    (e) Increases to HISA benefit lifetime limit. (1) A veteran who 
received HISA benefits under paragraph (c) of this section, and who 
subsequently qualifies for HISA benefits under paragraph (b)(1) of this 
section on or after May 5, 2010, due to a new award of disability 
compensation based on service connection or an increased disability 
rating, may apply for the increased lifetime benefit amount under 
paragraph (b)(2)(ii) of this section. The increased amount that will be 
available is $6,800 minus the amount of HISA benefits previously used by 
the beneficiary.
    (2) A veteran who previously received HISA benefits as a 
servicemember is not eligible for a new lifetime HISA benefit amount 
based on his or her attaining veteran status, but the veteran may file a 
HISA claim for any HISA benefit amounts not used prior to discharge. The 
veteran's subsequent HISA award cannot exceed the applicable award 
amount under paragraphs (b), (c), or (e)(1) of this section, as 
applicable, minus the amount of HISA benefits awarded to the veteran 
while the veteran was a servicemember.

(Authority: 38 U.S.C. 501, 1717)



Sec. Sec.  17.3106-17.3119  [Reserved]



Sec.  17.3120  Application for HISA benefits.

    (a) Application package. To apply for HISA benefits, the beneficiary 
must submit to VA a complete HISA benefits application package. A 
complete HISA benefits application package includes all of the 
following:

[[Page 899]]

    (1) A prescription, which VA may obtain on the beneficiary's behalf, 
written or approved by a VA physician that includes all of the 
following:
    (i) The beneficiary's name, address, and telephone number.
    (ii) Identification of the prescribed improvement or structural 
alteration.
    (iii) The diagnosis and medical justification for the prescribed 
improvement or structural alteration.
    (2) A completed and signed VA Form 10-0103, Veterans Application for 
Assistance in Acquiring Home Improvement and Structural Alterations, 
including, if desired, a request for advance payment of HISA benefits.
    (3) A signed statement from the owner of the property authorizing 
the improvement or structural alteration to the property. The statement 
must be notarized if the beneficiary submitting the HISA benefits 
application is not the owner of the property.
    (4) A written itemized estimate of costs for labor, materials, 
permits, and inspections for the home improvement or structural 
alteration.
    (5) A color photograph of the unimproved area.
    (b) Pre-award inspection of site. The beneficiary must allow VA to 
inspect the site of the proposed improvement or structural alteration. 
VA will not approve a HISA application unless VA has either conducted a 
pre-award inspection or has determined that no such inspection is 
needed. No later than 30 days after receiving a complete HISA benefits 
application, VA will conduct the inspection or determine that no 
inspection is required.
    (c) Incomplete applications. If VA receives an incomplete HISA 
benefits application, VA will notify the applicant of the missing 
documentation. If the missing documentation is not received by VA within 
30 days after such notification, VA will close the application and 
notify the applicant that the application has been closed. The closure 
notice will indicate that the application may be re-opened by submitting 
the requested documentation and updating any outdated information from 
the original application.

(Authority: 38 U.S.C. 501, 1717)

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-0188.)



Sec. Sec.  17.3121-17.3124  [Reserved]



Sec.  17.3125  Approving HISA benefits applications.

    (a) Approval of application. VA will approve the HISA benefits 
application if:
    (1) The application is consistent with Sec. Sec.  17.3100 through 
17.3130, and
    (2) VA determines that the proposed improvement or structural 
alteration is reasonably designed to address the needs of the 
beneficiary and is appropriate for the beneficiary's home, based on 
documentation provided and/or through a pre-award inspection of the 
home.
    (b) Notification of approval. No later than 30 days after a 
beneficiary submits a complete application, VA will notify the 
beneficiary whether an application is approved. The notification will:
    (1) State the total benefit amount authorized for the improvement or 
structural alteration.
    (2) State the amount of any advance payment, if requested by the 
beneficiary, and state that the advance payment must be used for the 
improvements or structural alterations detailed in the application. The 
notification will also remind beneficiaries receiving advance payment of 
the obligation to submit the request for final payment upon completion 
of the construction.
    (3) Provide the beneficiary with the notice of the right to appeal 
if they do not agree with VA's decision regarding the award.

(Authority: 38 U.S.C. 501, 1717, 7104)



Sec.  17.3126  Disapproving HISA benefits applications.

    VA will disapprove a HISA benefits application if the complete HISA 
benefits application does not meet all of the criteria outlined in Sec.  
17.3125(a). Notification of the decision provided to the beneficiary 
will include the basis for

[[Page 900]]

the disapproval and notice to the beneficiary of his or her right to 
appeal.

(Authority: 38 U.S.C. 501, 7104)



Sec. Sec.  17.3127-17.3129  [Reserved]



Sec.  17.3130  HISA benefits payment procedures.

    (a) Advance payment. If the beneficiary has requested advance 
payment of HISA benefits in VA Form 10-0103, as provided in Sec.  
17.3120(a)(2), VA will make an advance payment to the beneficiary equal 
to 50 percent of the total benefit authorized for the improvement or 
structural alteration. VA will make the advance payment no later than 30 
days after the HISA benefits application is approved. The beneficiary 
may receive only one advance payment for each approved HISA benefits 
application. A beneficiary must use the advance payment only for the 
improvement or structural alteration described in the application and 
must submit a final payment request, as defined in paragraph (b) of this 
section, to document such use after the construction is finished.
    (b) Final payment request. No later than 60 days after the 
application is approved or, if VA approved an advance payment, no later 
than 60 days after the advance payment was made, the beneficiary must 
submit a complete final payment request to VA for payment. The complete 
final payment request must include:
    (1) A statement by the beneficiary that the improvement or 
structural alteration, as indicated in the application, was completed;
    (2) A color photograph of the completed work; and
    (3) Documentation of the itemized actual costs for material, labor, 
permits, and inspections.
    (c) VA action on final payment request. (1) Prior to approving and 
remitting the final payment, VA may inspect (within 30 days after 
receiving the final payment request) the beneficiary's home to determine 
that the improvement or structural alteration was completed as indicated 
in the application. No payment will be made if the improvement or 
structural alteration has not been completed.
    (2) No later than 30 days after receipt of a complete final payment 
request, or, if VA conducts an inspection of the home under paragraph 
(c)(1) of this section, no later than 30 days after the inspection, VA 
will make a determination on the final payment request. If approved, VA 
will remit a final payment to the beneficiary equal to the lesser of:
    (i) The approved HISA benefit amount, less the amount of any advance 
payment, or
    (ii) The total actual cost of the improvement or structural 
alteration, less the amount of any advance payment.
    (3) If the total actual cost of the improvement or structural 
alteration is less than the amount paid to the beneficiary as an advance 
payment, the beneficiary will reimburse VA for the difference between 
the advance payment and the total actual costs.
    (4) After final payment is made on a HISA benefits application, the 
application file will be closed and no future HISA benefits will be 
furnished to the beneficiary for that application. If the total actual 
cost of the improvement or structural alteration is less than the 
approved HISA benefit, the balance of the approved amount will be 
credited to the beneficiary's remaining HISA benefits lifetime balance.
    (d) Failure to submit a final payment request. (1) If an advance 
payment was made to the beneficiary, but the beneficiary fails to submit 
a final payment request in accordance with paragraph (b) of this section 
within 60 days of the date of the advance payment, VA will send a notice 
to remind the beneficiary of the obligation to submit the final payment 
request. If the beneficiary fails to submit the final payment request or 
to provide a suitable update and explanation of delay within 30 days of 
this notice, VA may take appropriate action to collect the amount of the 
advance payment from the beneficiary.
    (2) If an advance payment was not made to the beneficiary and the 
beneficiary does not submit a final payment request in accordance with 
paragraph (b) of this section within 60 days of the date the application 
was approved, the application will be closed and no future

[[Page 901]]

HISA benefits will be furnished to the beneficiary for that application. 
Before closing the application, VA will send a notice to the beneficiary 
of the intent to close the file. If the beneficiary does not respond 
with a suitable update and explanation for the delay within 30 days, VA 
will close the file and provide a final notice of closure. The notice 
will include information about the right to appeal the decision.
    (e) Failure to make approved improvements or structural alterations. 
If an inspection conducted pursuant to paragraph (c)(1) of this section 
reveals that the improvement or structural alteration has not been 
completed as indicated in the final payment request, VA may take 
appropriate action to collect the amount of the advance payment from the 
beneficiary. VA will not seek to collect the amount of the advance 
payment from the beneficiary if the beneficiary provides documentation 
indicating that the project was not completed due to the fault of the 
contractor, including bankruptcy or misconduct of the contractor.

(Authority: 38 U.S.C. 501, 1717)

(The Office of Management and Budget has approved the information 
collection requirement in this section under control number 2900-0188.)

            Prosthetic and Rehabilitative Items and Services

    Source: Sections 17.3200 through 17.3250, appear at 85 FR 84259, 
Dec. 28, 2020 unless otherwise noted.



Sec.  17.3200  Purpose and scope.

    (a) Purpose. The purpose of this section and Sec. Sec.  17.3210 
through 17.3250 is to establish eligibility and other criteria for the 
provision to veterans of the prosthetic and rehabilitative items and 
services, listed in Sec.  17.3230, authorized as medical services under 
38 U.S.C. 1701(6)(F) and 38 U.S.C. 1710(a).
    (b) Scope. This section and Sec. Sec.  17.3210 through 17.3250 apply 
only to items and services listed in Sec.  17.3230(a) and authorized to 
be provided as medical services under 38 U.S.C. 1701(6)(F) and 38 U.S.C. 
1710(a). The provision of the items or services and payments in table 1 
to this paragraph (b) are authorized in whole or in part by separate 
statutes and controlled by other implementing regulations:

                        Table 1 to Paragraph (b)
------------------------------------------------------------------------
       Item or service               Statute            Regulation(s)
------------------------------------------------------------------------
Clothing allowance..........  38 U.S.C. 1162......  38 CFR 3.810
Service and guide dog         38 U.S.C. 1714(b) &   38 CFR 17.148
 benefits.                     (c).
Sensori-neural aids.........  38 U.S.C. 1707(b)...  38 CFR 17.149
Patient lifts and other       38 U.S.C. 1717(b)...  38 CFR 17.151
 rehabilitative devices.
Devices for deaf veterans...  38 U.S.C. 1717(c)...  38 CFR 17.152
Equipment for blind veterans  38 U.S.C. 1714(b)...  38 CFR 17.154
Automobile adaptive           38 U.S.C. 3901 et     38 CFR 17.155
 equipment.                    seq..                 through 17.159
Home improvements and         38 U.S.C. 1717(a)(2)  38 CFR 17.3100
 structural alterations.                             through 17.3130
------------------------------------------------------------------------



Sec.  17.3210  Definitions.

    For the purposes of Sec. Sec.  17.3200 through 17.3250:
    Activities of daily living (ADL) means specific personal care 
activities that are required for basic daily maintenance and sustenance, 
to include eating, toileting, bathing, grooming, dressing and 
undressing, and mobility.
    Adaptive household item means a durable household item that has been 
adapted to compensate for, or that by design compensates for, loss of 
physical, sensory, or cognitive function and is necessary to complete 
one or more ADLs in the home or other residential setting. Adaptive 
household items include but are not limited to adaptive eating utensils, 
shower stools or chairs, hooks to assist in buttoning clothing, or shoe 
horns. This definition does not include household furniture or

[[Page 902]]

furnishings, improvements or structural alterations, or household 
appliances, unless a household appliance is necessary to complete an ADL 
in the home or other residential setting. VA will not furnish such items 
or services in such a manner as to relieve any other person or entity of 
a contractual obligation to furnish these items or services to the 
veteran.
    Adaptive recreation equipment means an item that is designed to 
compensate for, or that by design compensates for, loss of physical, 
sensory, or cognitive function and is necessary for the veteran to 
actively and regularly participate in a sport, recreation, or leisure 
activity to achieve the veteran's rehabilitation goals as documented in 
the veteran's medical record.
    Cognitive device means an item that compensates for a cognitive 
impairment and that is used to maintain or improve a veteran's 
functional capabilities, including but not limited to technological 
equipment such as tablets and smart phones, and associated technological 
equipment, applications or software that can assist veterans in 
maintaining daily scheduling of important tasks or navigating their 
surroundings (e.g., global positioning system, or GPS).
    Communication device means an item that compensates for a 
communication deficiency and allows participation in daily communication 
activities, including but not limited to picture or symbol communication 
boards and an electro larynx.
    Durable means capable of, and intended for, repeat use.
    Home exercise equipment means an item used in a home or residential 
setting that compensates for a loss of physical, sensory, or cognitive 
function and that is necessary for the veteran to actively and regularly 
participate in aerobic, fitness, strength, or flexibility activities to 
achieve the veteran's rehabilitation goals as documented in the 
veteran's medical record, when there is no other means for the veteran 
to exercise to achieve the veteran's rehabilitation goals. Such 
equipment includes but is not limited to an upper body ergometer and a 
functional electrical stimulation cycle.
    Home medical equipment means an item that is a movable and durable 
medical device that is used in a home or residential setting to treat or 
support treatment of specific medical conditions. Such equipment 
includes but is not limited to hospital beds, portable patient lifts, 
portable ramps, ventilators, home dialysis equipment, and infusion, 
feeding, or wound therapy pumps. This definition does not include 
household furniture or furnishings, improvements or structural 
alterations, or household appliances. VA will not furnish home medical 
equipment in such a manner as to relieve any other person or entity of a 
contractual obligation to furnish these items or services to the 
veteran.
    Home respiratory equipment means an item used to provide oxygen 
therapy or to support or enhance respiratory function, including but not 
limited to compressed oxygen, oxygen concentrators, and continuous 
positive airway pressure machines.
    Household appliance means an item used in the home for performance 
of domestic chores or other domestic tasks, including but not limited to 
a refrigerator, stove, washing machine, and vacuum cleaner.
    Household furniture or furnishing means an item commonly used to 
make a home habitable or otherwise used to ornament a home, including 
but not limited to tables, chairs, desks, lamps, cabinets, non-hospital 
beds, curtains, and carpet(s).
    Implant means any biological or non-biological material that:
    (1) Is manufactured or processed to be placed into a surgically or 
naturally formed cavity on the human body;
    (2) Is covered with tissue, has the potential to be covered with 
tissue, or is permanently embedded in tissue;
    (3) Does not dissolve or dissipate within the body; and
    (4) Is not a living organ, embryonic tissue, blood, or blood 
product.
    Improvements or structural alterations means a modification to a 
home or to an existing feature or fixture of a home, including repairs 
to or replacement of previously improved or altered features or 
fixtures.
    Mobility aid means an item that compensates for a mobility 
impairment

[[Page 903]]

and that is used to maintain or improve a veteran's functional 
capabilities to be mobile. Mobility aids include but are not limited to 
manual and motorized wheelchairs, canes, walkers, and equipment to 
assist a veteran to reach for or grasp items. This definition does not 
include a service or guide dog.
    Orthotic device means an item fitted externally to the body that is 
used to support, align, prevent, or correct deformities or to improve 
the function of movable parts of the body. Orthotic devices include but 
are not limited to leg braces, upper extremity splints and braces, and 
functional stimulation devices.
    Primary residence means the personal domicile or residential setting 
in which the veteran resides the majority of the year.
    Prosthetic device means an item that replaces a missing or defective 
body part. Prosthetic devices include but are not limited to artificial 
limbs and artificial eyes.
    Replacement item means an item that is similar or identical to an 
item provided under Sec.  17.3230(a), and that takes the place of such 
an item.
    VA-authorized vendor means a vendor that has been authorized by VA 
to provide items and services under Sec.  17.3230.



Sec.  17.3220  Eligibility.

    A veteran is eligible to receive items and services described in 
Sec.  17.3230 if:
    (a) The veteran is enrolled under Sec.  17.36 or exempt from 
enrollment under Sec.  17.37(a) through (c); and
    (b) The veteran is otherwise receiving care or services under 
chapter 17 of title 38 U.S.C. If a VA provider or an eligible entity or 
provider as defined in Sec.  17.4005 prescribes an item or service for 
the veteran, the veteran is considered to otherwise be receiving care or 
services under chapter 17 of title 38 U.S.C.



Sec.  17.3230  Authorized items and services.

    (a)(1) VA will provide veterans eligible under Sec.  17.3220 with 
the following items and services if VA determines that such items and 
services are needed under Sec.  17.38(b), serve as a direct and active 
component of the veteran's medical treatment and rehabilitation, and do 
not solely support the comfort or convenience of the veteran:
    (i) Adaptive household items.
    (ii) Adaptive recreation equipment.
    (iii) Cognitive devices.
    (iv) Communication devices.
    (v) Home exercise equipment, where such equipment will only be 
provided for one location, the veteran's primary residence, unless it is 
clinically determined that the equipment should be provided at the 
veteran's non-primary residence instead of the veteran's primary 
residence. Prior to any installation of home exercise equipment, the 
owner of the residence must agree to the installation. Such equipment 
will only be provided to achieve the veteran's rehabilitation goals as 
documented in the veteran's medical record.
    (vi) Home medical equipment, and if required, installation that does 
not amount to an improvement or structural alteration to a veteran's 
residence. Such equipment will only be provided for one location, the 
veteran's primary residence, unless it is clinically determined that the 
equipment should be provided at the veteran's non-primary residence 
instead of the veteran's primary residence. Prior to any installation of 
home medical equipment, the owner of the residence must agree to the 
installation.
    (vii) Home respiratory equipment.
    (viii) Implants.
    (ix) Mobility aids.
    (x) Orthotic devices.
    (xi) Prosthetic devices.
    (xii) Repairs to items provided under paragraph (a) of this section, 
even if the item was not initially prescribed by VA, unless VA 
determines to replace the item for cost or clinical reasons.
    (xiii) Replacement items, if items provided under this section have 
been damaged, destroyed, lost, or stolen, or if replacement is 
clinically indicated, subject to the following: Items that are 
serviceable, and that still meet the veteran's need, will not be 
replaced for the sole purpose of obtaining a newer model of the same or 
similar item.
    (xiv) Specialized clothing made necessary by the wearing of a 
prosthetic device.

[[Page 904]]

    (xv) Training with and fitting of prescribed items.
    (2) Paragraph (a)(1) of this section supplements the requirement in 
Sec.  17.38(b) for a determination of need but only with respect to the 
provision of items and services listed in paragraph (a)(1) of this 
section. The exclusions under Sec.  17.38(c) will apply to the items and 
services provided under this section. While VA will generally provide 
only one item under this section, the provision of spare items may be 
authorized based on a clinical determination of need using the criteria 
set forth in this section.
    (b) Unless an item provided under Sec.  17.3230(a) is loaned to the 
veteran based on a clinical determination that a loan is more beneficial 
for the veteran, such items become the property of the veteran once the 
veteran takes possession of those items. If the determination is that 
the item will be loaned to a veteran, the veteran must agree to the 
terms of the loan in order to receive the item.



Sec.  17.3240  Furnishing authorized items and services.

    (a)(1) VA providers, or eligible entities and providers as defined 
in Sec.  17.4005, will prescribe items and services in accordance with 
Sec.  17.3230(a) and will do so in consultation with the veteran.
    (2) Once the item or service is prescribed under paragraph (a)(1) of 
this section, VA will either fill such prescriptions directly or will 
pay for such prescriptions to be furnished through a VA-authorized 
vendor.
    (3) The determination under paragraph (a)(2) of this section of 
whether a prescription will be filled by VA directly or will be 
furnished by a VA-authorized vendor will be based on, but not limited 
to, such factors as the veteran's clinical needs, VA capacity and 
availability, geographic availability, and cost.
    (b) Except for emergency care under Sec. Sec.  17.120 through 
17.132, Sec. Sec.  17.1000 through 17.1008, or Sec.  17.4020(c), or 
urgent care under Sec.  17.4600, prior authorization of items and 
services under Sec.  17.3230 is required for VA to reimburse VA-
authorized vendors for furnishing such items or services to veterans.



Sec.  17.3250  Veteran responsibilities.

    (a) Veterans must use items provided under Sec. Sec.  17.3230 and 
17.3240 as they are prescribed, and consistent with the manufacturer's 
instructions and any training provided. Failure to do so may result in 
the item not being replaced under Sec.  17.3230(a)(13).
    (b) Except for emergency care under Sec. Sec.  17.120 through 
17.132, Sec. Sec.  17.1000 through 17.1008, or Sec.  17.4020(c), or 
urgent care under Sec.  17.4600, veterans obtaining items and services 
provided under Sec.  17.3230 must obtain prior authorization from VA in 
order to obtain VA reimbursement for such items and services obtained 
from a VA-authorized vendor. VA will not be responsible for the cost of 
items and services provided that are not preauthorized by VA or not 
covered as emergency care under Sec. Sec.  17.120 through 17.132, 
Sec. Sec.  17.1000 through 17.1008, or Sec.  17.4020(c), or urgent care 
under Sec.  17.4600.

                      Clinical Laboratory Standards



Sec.  17.3500  VA application of 42 CFR part 493 standards for clinical
laboratory operations.

    Laboratory testing within VA performed for the diagnosis, 
prevention, or treatment of any disease or impairment of, or health 
assessment of, human beings must meet, at a minimum, requirements 
established under the following subparts of 42 CFR part 493 as 
implemented by VA. Except as noted below, functions and responsibilities 
assigned to the Centers for Medicare & Medicaid Services (CMS) in 42 CFR 
part 493 are implemented by VA at VA laboratories and outreach clinics, 
as well as with contracted laboratory services performed on site at VA 
laboratories or other testing sites. Provisions that are specific to 
oversight by state licensure programs are not applicable. VA administers 
the application of the relevant provisions of 42 CFR part 493 to VA 
laboratories as follows:
    (a) General provisions. All provisions in subpart A of 42 CFR part 
493 apply to VA with the following exceptions:
    (1) Functions assigned to HHS in this subpart are performed by VA.
    (2) While 42 CFR part 493 requires laboratories that perform waived, 
moderate and high complexity tests to

[[Page 905]]

meet the regulations, VA requires VA laboratories meet or exceed the 
requirements of 42 CFR part 493.
    (b) Certificate of waiver. All provisions in subpart B of 42 CFR 
part 493 apply to VA, except that:
    (1) Certificates issued by HHS under this subpart are instead issued 
by VA pursuant to an agreement between CMS and VA.
    (2) CMS does not require remittance of a fee from laboratories for 
any certificate issued by the VA under this subpart.
    (c) Registration certificate, certificate for provider-performed 
microscopy procedures, and certificate of compliance. All provisions in 
subpart C of 42 CFR part 493 apply to VA, except that:
    (1) Certificates issued by HHS under this subpart are instead issued 
by VA pursuant to an agreement between CMS and VA.
    (2) CMS does not require remittance of a fee from laboratories for 
any certificate issued by VA under this subpart.
    (d) Certificates of accreditation. All provisions in subpart D of 42 
CFR part 493 apply to VA, except that:
    (1) Certificates issued by HHS under this subpart are instead issued 
by VA pursuant to an agreement between CMS and VA.
    (2) CMS does not require remittance of a fee from laboratories for 
any certificate issued by VA under this subpart.
    (e) Accreditation by a private, nonprofit accreditation organization 
or exemption under an approved state laboratory program. All provisions 
in subpart E of 42 CFR part 493 apply to VA, to the extent that this 
subpart addresses accreditation by a private, nonprofit accreditation 
organization. VA applies this subpart as follows:
    (1) VA relies on CMS to grant deeming authority for accreditation 
organizations. VA uses only an accreditation agency with deeming 
authority to determine whether a laboratory is in compliance with 
standards established by the accreditation organization. VA determines 
whether the laboratory is in compliance with any additional standard 
established by VA which is:
    (i) More stringent than that required for accreditation purposes, or
    (ii) Not addressed by accreditation standards or 42 CFR part 493.
    (2) VA uses only CMS-approved proficiency testing providers.
    (3) Proficiency testing providers release proficiency testing 
results directly to VA.
    (4) VA, rather than CMS, performs inspections of VA laboratories.
    (5) Oversight and enforcement functions under this subpart are 
performed by VA.
    (f) General administration. Subpart F of 42 CFR part 493 sets forth 
the methodology for determining the amount of the fees for issuing the 
appropriate certificate, and for determining compliance with the 
applicable standards of the Public Health Service Act and the Federal 
validation of accredited laboratories and of CLIA-exempt laboratories. 
This subpart is inapplicable to VA, as CMS does not collect fees for 
certification of VA laboratories.
    (g) Participation in proficiency testing for laboratories performing 
nonwaived testing. All provisions in subpart H of 42 CFR part 493 apply 
to VA, except that all enforcement and oversight functions related to 
proficiency testing which are assigned to HHS in this subpart are 
performed by VA.
    (h) Proficiency testing programs for nonwaived testing. All 
provisions in subpart I of 42 CFR part 493 apply to VA, and VA employs 
scoring criteria under this subpart. VA uses only CMS approved 
proficiency testing providers. Enforcement and oversight functions 
related to proficiency testing which are assigned to HHS in this subpart 
are performed by VA.
    (i) Facility administration for nonwaived testing. VA applies 
standards established in Subpart J of 42 CFR part 493.
    (j) Quality system for nonwaived testing. VA applies standards 
established in Subpart K of 42 CFR part 493.
    (k) Personnel for nonwaived testing. VA applies standards 
established in subpart M of 42 CFR part 493, except that requirements 
regarding maintaining a license in the state where the laboratory is 
located are not applicable.
    (l) Inspection. VA applies standards established in subpart Q of 42 
CFR part 493, except that all enforcement and oversight functions, which 
are assigned

[[Page 906]]

to HHS in this subpart are performed by VA.
    (m) Enforcement procedures. VA applies standards established in 
subpart R of 42 CFR part 493, except:
    (1) Enforcement and oversight functions which are assigned to HHS in 
this subpart are performed by VA.
    (2) Due process protections afforded by CMS to CMS certified 
laboratories facing sanctions are not applicable to laboratories 
operating under this section.
    (3) Suspension of the right to Medicare or Medicaid payments as an 
available sanction is not applicable. VA does not participate in these 
programs.
    (4) State onsite monitoring and monetary penalties imposed by CMS as 
an alternate sanction under 42 CFR 493.1806(c) are not applicable.
    (5) VA may cease laboratory testing immediately at any site subject 
to this section upon notification of immediate jeopardy to patients.
    (6) VA does not participate in laboratory registry under 42 CFR 
493.1850. VA may disclose laboratory information useful in evaluating 
the performance of laboratories under 5 U.S.C. 552.
    (n) Consultations. Subpart T of 42 CFR part 493 requires HHS to 
establish a Clinical Laboratory Improvement Advisory Committee (CLIAC) 
to advise and make recommendations on technical and scientific aspects 
of the provisions of part 493. This subpart does not apply to VA.

[86 FR 24498, May 7, 2021]

                     Veterans Community Care Program

    Source: Sections 17.4000 through 17.4040, appear as 84 FR 26307, 
June 5, 2019, unless otherwise noted.



Sec.  17.4000  Purpose and scope.

    (a) Purpose. Sections 17.4000 through 17.4040 implement the Veterans 
Community Care Program, authorized by 38 U.S.C. 1703.
    (b) Scope. The Veterans Community Care Program establishes when a 
covered veteran may elect to have VA authorize an episode of care for 
hospital care, medical services, or extended care services from an 
eligible entity or provider. Sections 17.4000 through 17.4040 do not 
affect eligibility for non-VA care under sections 1724, 1725, 1725A, or 
1728 of title 38, United States Code.



Sec.  17.4005  Definitions.

    For purposes of the Veterans Community Care Program under Sec. Sec.  
17.4000 through 17.4040:
    Appointment means an authorized and scheduled encounter, including 
telehealth and same-day encounters, with a health care provider for the 
delivery of hospital care, medical services, or extended care services.
    Covered veteran means a veteran enrolled under the system of patient 
enrollment in Sec.  17.36, or a veteran who otherwise meets the criteria 
to receive care and services notwithstanding his or her failure to 
enroll in Sec.  17.37(a) through (c).
    Eligible entity or provider means a health care entity or provider 
that meets the requirements of Sec.  17.4030.
    Episode of care means a necessary course of treatment, including 
follow-up appointments and ancillary and specialty services, which lasts 
no longer than 1 calendar year.
    Extended care services include the same services as described in 38 
U.S.C. 1710B(a).
    Full-service VA medical facility means a VA medical facility that 
provides hospital care, emergency medical services, and surgical care 
and having a surgical complexity designation of at least ``standard.''
    Note 1 to the definition of ``full-service VA medical facility'': VA 
maintains a website with a list of the facilities that have been 
designated with at least a surgical complexity of ``standard,'' which 
can be accessed on VA's website.
    Hospital care has the same meaning as defined in 38 U.S.C. 1701(5).
    Medical services have the same meaning as defined in 38 U.S.C. 
1701(6).
    Other health-care plan contract means an insurance policy or 
contract, medical or hospital service agreement, membership or 
subscription contract, or similar arrangement not administered by the 
Secretary of Veterans Affairs, under which health services for 
individuals are provided or the expenses of such services are paid; and 
does not include any such policy, contract, agreement, or similar 
arrangement pursuant to title XVIII or XIX of

[[Page 907]]

the Social Security Act (42 U.S.C. 1395 et seq.) or chapter 55 of title 
10, United States Code.
    Residence means a legal residence or personal domicile, even if such 
residence is seasonal. A covered veteran may maintain more than one 
residence but may only have one residence at a time. If a covered 
veteran lives in more than one location during a year, the covered 
veteran's residence is the residence or domicile where they are staying 
at the time they want to receive hospital care, medical services, or 
extended care services through the Veterans Community Care Program. A 
post office box or other non-residential point of delivery does not 
constitute a residence.
    Schedule means identifying and confirming a date, time, location, 
and entity or health care provider for an appointment in advance of such 
appointment.
    Note 1 to the definition of ``schedule'': A VA telehealth encounter 
and a same-day care encounter are considered to be scheduled even if 
such an encounter is conducted on an ad hoc basis.
    VA facility means a VA facility that offers hospital care, medical 
services, or extended care services.
    VA medical service line means a specific medical service or set of 
services delivered in a VA facility.



Sec.  17.4010  Veteran eligibility.

    Section 1703(d) of title 38, U.S.C., establishes the conditions 
under which, at the election of the veteran and subject to the 
availability of appropriations, VA must furnish care in the community 
through eligible entities and providers. VA has regulated these 
conditions under paragraphs (a)(1) through (5) of this section. If VA 
determines that a covered veteran meets at least one or more of the 
conditions in paragraph (a) of this section and has provided information 
required by paragraphs (b) and (c) of this section, the covered veteran 
may elect to receive authorized non-VA care under Sec.  17.4020.
    (a) The covered veteran requires hospital care, medical services, or 
extended care services and:
    (1) No VA facility offers the hospital care, medical services, or 
extended care services the veteran requires.
    (2) VA does not operate a full-service VA medical facility in the 
State in which the veteran resides.
    (3) The veteran was eligible to receive care and services from an 
eligible entity or provider under section 101(b)(2)(B) of the Veterans 
Access, Choice, and Accountability Act of 2014 (Pub. L. 113-146, sec. 
101, as amended; 38 U.S.C. 1701 note) as of June 5, 2018, and continues 
to reside in a location that would qualify the veteran under that 
provision, and:
    (i) Resides in Alaska, Montana, North Dakota, South Dakota, or 
Wyoming; or
    (ii) Does not reside in one of the States described in paragraph 
(a)(3)(i) of this section, but received care or services under title 38 
U.S.C. between June 6, 2017, and June 6, 2018, and is seeking care 
before June 6, 2020.
    (4) Has contacted an authorized VA official to request the care or 
services the veteran requires, but VA has determined it is not able to 
furnish such care or services in a manner that complies with designated 
access standards established in Sec.  17.4040.
    (5) The veteran and the veteran's referring clinician determine it 
is in the best medical interest of the veteran, for the purpose of 
achieving improved clinical outcomes, to access the care or services the 
veteran requires from an eligible entity or provider, based on one or 
more of the following factors, as applicable:
    (i) The distance between the veteran and the facility or facilities 
that could provide the required care or services;
    (ii) The nature of the care or services required by the veteran;
    (iii) The frequency the veteran requires the care or services;
    (iv) The timeliness of available appointments for the required care 
or services;
    (v) The potential for improved continuity of care;
    (vi) The quality of the care provided; or
    (vii) Whether the veteran faces an unusual or excessive burden in 
accessing a VA facility based on consideration of the following:

[[Page 908]]

    (A) Excessive driving distance; geographical challenges, such as the 
presence of a body of water (including moving water and still water) or 
a geologic formation that cannot be crossed by road; or environmental 
factors, such as roads that are not accessible to the general public, 
traffic, or hazardous weather.
    (B) Whether care and services are available from a VA facility that 
is reasonably accessible.
    (C) Whether a medical condition of the veteran affects the ability 
to travel.
    (D) Whether there is a compelling reason the veteran needs to 
receive care and services from a non-VA facility.
    (E) The need for an attendant, which is defined as a person who 
provides required aid and/or physical assistance to the veteran, for a 
veteran to travel to a VA medical facility for hospital care or medical 
services.
    (6) In accordance with Sec.  17.4015, VA has determined that a VA 
medical service line that would furnish the care or services the veteran 
requires is not providing such care or services in a manner that 
complies with VA's standards for quality.
    (b) If the covered veteran changes his or her residence, the covered 
veteran must update VA about the change within 60 days.
    (c) A covered veteran must provide to VA information on any other 
health-care plan contract under which the veteran is covered prior to 
obtaining authorization for care and services the veteran requires. If 
the veteran changes such other health-care plan contract, the veteran 
must update VA about the change within 60 days.
    (d) Review of veteran eligibility determinations. The review of any 
decisions under paragraph (a) of this section are subject to VA's 
clinical appeals process, and such decisions may not be appealed to the 
Board of Veterans' Appeals.

(The information collection is pending Office of Management and Budget 
approval.)



Sec.  17.4015  Designated VA medical service lines.

    (a) VA may identify VA medical service lines that are 
underperforming based on the timeliness of care when compared with the 
same medical service line at other VA facilities and based on data 
related to two or more distinct and appropriate quality measures of VA's 
standards for quality when compared with non-VA medical service lines.
    (b) VA will make determinations regarding VA medical service lines 
under this section using data described in paragraph (a) of this 
section, VA standards for quality, and based on factors identified in 
paragraph (e) of this section.
    (c) VA will announce annually any VA medical service lines 
identified under paragraph (a) of this section by publishing a document 
in the Federal Register. Such document will identify and describe the 
standards for quality VA used to inform the determination under 
paragraph (a), as well as how the data described in paragraph (a) and 
factors identified in paragraph (e) of this section were used to make 
the determinations. Such document will also identify limitations, if 
any, concerning when and where covered veterans can receive qualifying 
care and services at their election in the community based on this 
section. Such limitations may include a defined timeframe, a defined 
geographic area, and a defined scope of services. VA will also take 
reasonable steps to provide direct notice to covered veterans affected 
under this section.
    (d) VA will identify no more than 3 VA medical services lines in a 
single VA facility under this section, and no more than 36 VA medical 
service lines nationally under this section.
    (e) In determining whether a VA medical service line should be 
identified under paragraph (a) of this section, and to comply with 
paragraph (c) of this section, VA will consider:
    (1) Whether the differences between performance of individual VA 
medical service lines, and between performance of VA medical service 
lines and non-VA medical service lines, is clinically significant.
    (2) Likelihood and ease of remediation of the VA medical service 
line within a short timeframe.

[[Page 909]]

    (3) Recent trends concerning the VA medical service line or non-VA 
medical service line.
    (4) The number of covered veterans served by the medical service 
line or that could be affected by the designation.
    (5) The potential impact on patient outcomes.
    (6) The effect that designating one VA medical service line would 
have on other VA medical service lines.



Sec.  17.4020  Authorized non-VA care.

    (a) Electing non-VA care. Except as provided for in paragraph (d) of 
this section, a covered veteran eligible for the Veterans Community Care 
Program under Sec.  17.4010 may choose to schedule an appointment with a 
VA health care provider, or have VA authorize the veteran to receive an 
episode of care for hospital care, medical services, or extended care 
services from an eligible entity or provider when VA determines such 
care or services are clinically necessary.
    (b) Selecting an eligible entity or provider. A covered veteran may 
specify a particular eligible entity or provider. If a covered veteran 
does not specify a particular eligible entity or provider, VA will refer 
the veteran to a specific eligible entity or provider.
    (c) Authorizing emergency treatment. This paragraph (c) applies only 
to emergency treatment furnished to a covered veteran by an eligible 
entity or provider when such treatment was not the subject of an 
election by a veteran under paragraph (a) of this section. This 
paragraph (c) does not affect eligibility for, or create any new rules 
or conditions affecting, reimbursement for emergency treatment under 
section 1725 or 1728 of title 38, United States Code.
    (1) Under the conditions set forth in this paragraph (c), VA may 
authorize emergency treatment after it has been furnished to a covered 
veteran. For purposes of this paragraph (c), ``emergency treatment'' has 
the meaning defined in section 1725(f)(1) of title 38, United States 
Code.
    (2) VA may only authorize emergency treatment under this paragraph 
(c) if the covered veteran, someone acting on the covered veteran's 
behalf, or the eligible entity or provider notifies VA within 72-hours 
of such care or services being furnished and VA approves the furnishing 
of such care or services under paragraph (c)(3) of this section.
    (3) VA may approve emergency treatment of a covered veteran under 
this paragraph (c) only if:
    (i) The veteran is receiving emergency treatment from an eligible 
entity or provider.
    (ii) The notice to VA complies with the provisions of paragraph 
(c)(4) of this section and is submitted within 72 hours of the beginning 
of such treatment.
    (iii) The emergency treatment only includes services covered by VA's 
medical benefits package in Sec.  17.38.
    (4) Notice to VA must:
    (i) Be made to the appropriate VA official at the nearest VA 
facility;
    (ii) Identify the covered veteran; and
    (iii) Identify the eligible entity or provider.
    (d) Organ and bone marrow transplant care. (1) In the case of a 
covered veteran described in paragraph (d)(3) of this section, the 
Secretary will determine whether to authorize an organ or bone marrow 
transplant for the covered veteran through an eligible entity or 
provider.
    (2) The Secretary will make determinations under paragraph (d)(1) of 
this section, and the primary care provider of the veteran will make 
determinations concerning whether there is a medically compelling reason 
to travel outside the region of the Organ Procurement and 
Transplantation Network in which the veteran resides to receive a 
transplant, in consideration of, but not limited to, the following 
factors:
    (i) Specific patient factors.
    (ii) Which facilities meet VA's standards for quality, including 
quality metrics and outcomes, for the required transplant.
    (iii) The travel burden on covered veterans based upon their medical 
conditions and the geographic location of eligible transplant centers.
    (iv) The timeliness of transplant center evaluations and management.
    (3) This paragraph (d) applies to covered veterans who meet one or 
more

[[Page 910]]

conditions of eligibility under Sec.  17.4010(a) and:
    (i) Require an organ or bone marrow transplant as determined by VA 
based upon generally-accepted medical criteria; and
    (ii) Have, in the opinion of the primary care provider of the 
veteran, a medically compelling reason, as determined in consideration 
of the factors described in paragraph (d)(2) of this section, to travel 
outside the region of the Organ Procurement and Transplantation Network 
in which the veteran resides, to receive such transplant.



Sec.  17.4025  Effect on other provisions.

    (a) General. No provision in this section may be construed to alter 
or modify any other provision of law establishing specific eligibility 
criteria for certain hospital care, medical services, or extended care 
services.
    (b) Prescriptions. Notwithstanding any other provision of this part, 
VA will:
    (1) Pay for prescriptions no longer than 14 days written by eligible 
entities or providers for covered veterans, including over-the-counter 
drugs and medical and surgical supplies, available under the VA national 
formulary system to cover a course of treatment for an urgent or 
emergent condition.
    (2) Fill prescriptions written by eligible entities or providers for 
covered veterans, including over-the-counter drugs and medical and 
surgical supplies, available under the VA national formulary system.
    (3) Pay for prescriptions written by eligible entities or providers 
for covered veterans that have an immediate need for durable medical 
equipment and medical devices that are required for urgent or emergent 
conditions (e.g., splints, crutches, manual wheelchairs).
    (4) Fill prescriptions written by eligible entities or providers for 
covered veterans for durable medical equipment and medical devices that 
are not required for urgent or emergent conditions.
    (c) Copayments. Covered veterans are liable for a VA copayment for 
care or services furnished under the Veterans Community Care Program, if 
required by Sec.  17.108(b)(4) or (c)(4), Sec.  17.110(b)(4), or Sec.  
17.111(b)(3).



Sec.  17.4030  Eligible entities and providers.

    To be eligible to furnish care and services under the Veterans 
Community Care Program, entities or providers:
    (a) Must enter into a contract, agreement, or other arrangement to 
furnish care and services under the Veterans Community Care Program 
under Sec. Sec.  17.4000 through 17.4040.
    (b) Must either:
    (1) Not be a part of, or an employee of, VA; or
    (2) If the provider is an employee of VA, not be acting within the 
scope of such employment while providing hospital care, medical 
services, or extended care services through the Veterans Community Care 
Program under Sec. Sec.  17.4000 through 17.4040.
    (c) Must be accessible to the covered veteran. VA will determine 
accessibility by considering the following factors:
    (1) The length of time the covered veteran would have to wait to 
receive hospital care, medical services, or extended care services from 
the entity or provider;
    (2) The qualifications of the entity or provider to furnish the 
hospital care, medical services, or extended care services from the 
entity or provider; and
    (3) The distance between the covered veteran's residence and the 
entity or provider.



Sec.  17.4035  Payment rates.

    The rates paid by VA for hospital care, medical services, or 
extended care services (hereafter referred to as ``services'') furnished 
pursuant to a procurement contract or an agreement authorized by 
Sec. Sec.  17.4100 through 17.4135 will be the rates set forth in the 
terms of such contract or agreement. Such payment rates will comply with 
the following parameters:
    (a) Except as otherwise provided in this section, payment rates will 
not exceed the applicable Medicare fee schedule (including but not 
limited to allowable rates under 42 U.S.C. 1395m) or prospective payment 
system amount (hereafter ``Medicare rate''), if any, for the period in 
which the service was provided (without any changes based

[[Page 911]]

on the subsequent development of information under Medicare 
authorities).
    (b) With respect to services furnished in a State with an All-Payer 
Model Agreement under section 1814(b)(3) of the Social Security Act (42 
U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, 
the Medicare payment rates under paragraph (a) of this section will be 
calculated based on the payment rates under such agreement.
    (c) Payment rates for services furnished in a highly rural area may 
exceed the limitations set forth in paragraphs (a) and (b) of this 
section. The term ``highly rural area'' means an area located in a 
county that has fewer than seven individuals residing in that county per 
square mile.
    (d) Payment rates may deviate from the parameters set forth in 
paragraphs (a) through (c) of this section when VA determines, based on 
patient needs, market analyses, health care provider qualifications, or 
other factors, that it is not practicable to limit payment for services 
to the rates available under paragraphs (a) through (c).
    (e) Payment rates for services furnished in Alaska are not subject 
to paragraphs (a) through (d) of this section and will be set forth in 
the terms of the procurement contract or agreement authorized by 
Sec. Sec.  17.4100 through 17.4135, pursuant to which such services are 
furnished. If no payment rate is set forth in the terms of such a 
contract or agreement pursuant to which such services are furnished, 
payment rates for services furnished in Alaska will follow the Alaska 
Fee Schedule of the Department of Veterans Affairs.



Sec.  17.4040  Designated access standards.

    (a) The following access standards have been designated to apply for 
purposes of eligibility determinations to access care in the community 
through the Veterans Community Care Program under Sec.  17.4010(a)(4).
    (1) Primary care, mental health care, and non-institutional extended 
care services. VA cannot schedule an appointment for the covered veteran 
with a VA health care provider for the required care or service:
    (i) Within 30 minutes average driving time of the veteran's 
residence; and
    (ii) Within 20 days of the date of request unless a later date has 
been agreed to by the veteran in consultation with the VA health care 
provider.
    (2) Specialty care. VA cannot schedule an appointment for the 
covered veteran with a VA health care provider for the required care or 
service:
    (i) Within 60 minutes average driving time of the veteran's 
residence; and
    (ii) Within 28 days of the date of request unless a later date has 
been agreed to by the veteran in consultation with the VA health care 
provider.
    (b) For purposes of calculating average driving time from the 
veteran's residence in paragraph (a) of this section, VA will use 
geographic information system software.

                        Veterans Care Agreements

    Source: Sections 17.4100 through 17.4135 appear at 84 FR 21678, May 
14, 2019, unless otherwise noted.



Sec.  17.4100  Definitions.

    For the purposes of Sec. Sec.  17.4100 through 17.4135, the 
following definitions apply:
    Contract is any of the following: Federal procurement agreements 
regulated by the Federal Acquisition Regulation; common law contracts; 
other transactions; or any other instrument. Veterans Care Agreements 
are excluded from this definition.
    Covered individual is an individual who is eligible to receive 
hospital care, medical services, or extended care services from a non-VA 
provider under title 38 U.S.C. and title 38 CFR.
    Extended care services are the services described in 38 U.S.C. 
1710B(a).
    Hospital care is defined in 38 U.S.C. 1701(5).
    Medical services is defined in 38 U.S.C. 1701(6).
    Sharing agreement is an agreement, under statutory authority other 
than 38 U.S.C. 1703A, by which VA can obtain hospital care, medical 
services, or extended care services for a covered individual.
    VA facility is a point of VA care where covered individuals can 
receive hospital care, medical services, or extended care services, to 
include a VA medical center, a VA community-based outpatient clinic, a 
VA health care center, a VA community living center,

[[Page 912]]

a VA independent outpatient clinic, and other VA outpatient services 
sites.
    Veterans Care Agreement is an agreement authorized under 38 U.S.C. 
1703A for the furnishing of hospital care, medical services, or extended 
care services to covered individuals.



Sec.  17.4105  Purpose and Scope.

    (a) Purpose. Sections 17.4100 through 17.4135 implement 38 U.S.C. 
1703A, as required under section 1703A(j). Section 1703A authorizes VA 
to enter into and utilize Veterans Care Agreements to furnish hospital 
care, medical services, and extended care services to a covered 
individual when such individual is eligible for and requires such care 
or services that are not feasibly available to the covered individual 
through a VA facility, a contract, or a sharing agreement.
    (b) Scope. Sections 17.4100 through 17.4135 contain procedures, 
requirements, obligations, and limitations for: The process of 
certifying entities or providers under 38 U.S.C. 1703A; entering into, 
administering, furnishing care or services pursuant to, and 
discontinuing Veterans Care Agreements; and all disputes arising under 
or related to Veterans Care Agreements. Sections 17.4100 through 17.4135 
apply to all entities and providers, where applicable, that are parties 
to a Veterans Care Agreement, participate in the certification process, 
or furnish hospital care, medical services, or extended care services 
pursuant to a Veterans Care Agreement.



Sec.  17.4110  Entity or provider certification.

    (a) General. To be eligible to enter into a Veterans Care Agreement, 
an entity or provider must be certified by VA in accordance with the 
process and criteria established in paragraph (b) of this section. 
Additionally, an entity or provider must be actively certified while 
furnishing hospital care, medical services, or extended care services 
pursuant to a Veterans Care Agreement that the entity or provider has 
entered into with VA.
    (b) Process and criteria--(1) Application for certification. An 
entity or provider must apply for certification by submitting the 
following information and documentation to VA:
    (i) Documentation of applicable medical licenses; and
    (ii) All other information and documentation required by VA. This 
information and documentation may include, but is not limited to, 
provider first and last names, legal business names, National Provider 
Identifier (NPI), NPI type, provider identifier type (e.g., individual 
or group practice), tax identification number, specialty (taxonomy 
code), business address, billing address, phone number, and care site 
address.
    (2) Approval or denial of certification. (i) VA will review all 
information obtained by VA, including through applicable federal and 
state records systems and as submitted by the applicant, and will 
determine eligibility for certification.
    (ii) An applicant must submit all information required under 
paragraph (b)(1) of this section.
    (iii) VA will deny an application for certification if VA determines 
that the entity or provider is excluded from participation in a Federal 
health care program (as defined in section 1128B(f) of the Social 
Security Act (42 U.S.C. 1320a-7b(f)) under section 1128 or 1128A of such 
Act (42 U.S.C. 1320a-7 and 1320a-7a) or is identified as an excluded 
source on the System for Award Management Exclusions list described in 
part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 
of such Code, or successor regulations.
    (iv) VA will deny an application for certification if VA determines 
that the applicant is already barred from furnishing hospital care, 
medical services, and extended care services under chapter 17 of title 
38, U.S.C., because VA has previously determined the applicant submitted 
to VA a fraudulent claim, as that term is defined in 38 U.S.C. 
1703D(i)(4), for payment for hospital care, medical services, or 
extended care services.
    (v) VA may deny an application for certification if VA determines 
that based on programmatic considerations, VA is unlikely to seek to 
enter into a Veterans Care Agreement with the applicant.

[[Page 913]]

    (vi) VA will issue a decision approving or denying an application 
for certification within 120 calendar days of receipt of such 
application, if practicable. Notices of approval will set forth the 
effective date and duration of the certification. Notices of denial will 
set forth the specific grounds for denial and supporting evidence. A 
denial constitutes VA's final decision on the application.
    (3) Duration of certification and application for recertification. 
(i) An entity or provider's certification under this section lasts for a 
three-year period, unless VA revokes certification during that three-
year period pursuant to paragraph (b)(4) of this section.
    (ii) A certified entity or provider must maintain its eligibility 
throughout the period in which it is certified and must inform VA of any 
changes or events that would affect its eligibility within 30 calendar 
days of the change or event.
    (iii) A certified entity or provider seeking certification after the 
end of its current three-year certification must apply for 
recertification at least 60 calendar days prior to the expiration of its 
current certification; otherwise, the procedures set forth in paragraph 
(b)(3)(iv) of this section will apply. Upon application for 
recertification by the entity or provider, including submitting any new 
or updated information within the scope of paragraph (b)(1) of this 
section that VA requests in conjunction with such application for 
recertification, VA will reassess the entity or provider under the 
criteria in paragraph (b)(2) of this section. VA will issue a decision 
approving or denying the application for recertification within 60 
calendar days of receiving the application, if practicable. Notice of 
the decision will be furnished to the applicant in writing. Notices of 
recertification will set forth the effective date and duration of the 
certification. Notices of denial will set forth the specific grounds for 
denial and supporting evidence. A denial constitutes VA's final decision 
on the application for recertification.
    (iv) If a certified entity or provider applies for recertification 
after the deadline in paragraph (b)(3)(iii) of this section, such 
application will constitute a new application for certification and will 
be processed in accordance with paragraphs (b)(1) and (2) of this 
section.
    (4) Revocation of certification--(i) Standard for revocation. VA may 
revoke an entity's or provider's certification in accordance with 
paragraphs (b)(2)(ii) through (v) of this section.
    (ii) Notice of proposed revocation. When VA determines revocation is 
appropriate, VA will notify the entity or provider in writing of the 
proposed revocation. The notice of proposed revocation will set forth 
the specific grounds for the action and will notify the entity or 
provider that it has 30 calendar days from the date of issuance to 
submit a written response addressing either of the following:
    (A) Documenting compliance and proving any grounds false, or
    (B) Providing information and documentation that demonstrates the 
entity or provider has, subsequent to the notice of proposed revocation, 
achieved compliance with all criteria for certification set forth in 
paragraph (b)(2) of this section.
    (iii) Decision to revoke. Following the 30-day response period, VA 
will consider any information and documentation submitted by the entity 
or provider and will, within 30 calendar days, determine whether 
revocation is warranted. If VA determines that revocation is not 
warranted, VA will notify the entity or provider of that determination 
in writing. If VA determines that revocation is warranted, the entity or 
provider will immediately lose certified status, and VA will issue a 
notice of revocation to the entity or provider. Notices of revocation 
will set forth the specific facts and grounds for, and the effective 
date of, such revocation. A notice of revocation constitutes VA's final 
decision.
    (iv) Effect of revocation. Revocation of certification results in 
such status being rendered void, and the provider or entity may not 
furnish services or care to a covered individual under a Veterans Care 
Agreement prior to applying for and obtaining certified VCA status.


[[Page 914]]



(The information collection requirements have been submitted to the 
Office of Management and Budget (OMB) and are pending OMB approval.)



Sec.  17.4115  VA use of Veterans Care Agreements.

    (a) Criteria for using. VA may furnish hospital care, medical 
services, or extended care services through a Veterans Care Agreement 
only if:
    (1) Such care or services are furnished to a covered individual who 
is eligible for such care or services under 38 U.S.C. chapter 17 and 
requires such care or services; and
    (2) Such care or services are not feasibly available to that covered 
individual through a VA facility, contract, or sharing agreement. For 
purposes of this subparagraph, hospital care, medical services, or 
extended care services are not feasibly available through a VA facility, 
contract, or sharing agreement when VA determines that the medical 
condition of the covered individual, the travel involved, the nature of 
the care or services, or a combination of these factors make the use of 
a VA facility, contract, or sharing agreement impracticable or 
inadvisable.
    (b) Standards of conduct and improper business practices--(1) 
General. (i) Government business shall be conducted in a manner above 
reproach and, except as authorized by statute or regulation, with 
complete impartiality and with preferential treatment for none. 
Transactions relating to the expenditure of public funds require the 
highest degree of public trust and an impeccable standard of conduct. 
The general rule is to avoid strictly any conflict of interest or even 
the appearance of a conflict of interest in Government-contractor 
relationships. The conduct of Government personnel must be such that 
they would have no reluctance to make a full public disclosure of their 
actions.
    (ii) VA officials and employees are reminded that there are other 
statutes and regulations that deal with prohibited conduct, including:
    (A) The offer or acceptance of a bribe or gratuity is prohibited by 
18 U.S.C. 201. The acceptance of a gift, under certain circumstances, is 
prohibited by 5 U.S.C. 7353, and 5 CFR part 2635;
    (B)(1) Certain financial conflicts of interest are prohibited by 18 
U.S.C. 208 and regulations at 5 CFR part 2635.
    (2) Contacts with an entity or provider that is seeking or receives 
certification under section 17.4110 of this part or is seeking, enters 
into, and/or furnishes services or care under a Veterans Care Agreement 
may constitute ``seeking employment,'' (see Subpart F of 5 CFR part 
2635). Government officers and employees (employees) are prohibited by 
18 U.S.C. 208 and 5 CFR part 2635 from participating personally and 
substantially in any particular matter that would affect the financial 
interests of any person from whom the employee is seeking employment. An 
employee who engages in negotiations or is otherwise seeking employment 
with an offeror or who has an arrangement concerning future employment 
with an offeror must comply with the applicable disqualification 
requirements of 5 CFR 2635.604 and 2635.606. The statutory prohibition 
in 18 U.S.C. 208 also may require an employee's disqualification from 
participation in matters pertaining to the certification of an entity or 
provider or a entering into and administering a Veterans Care Agreement 
with an entity or provider even if the employee's duties may not be 
considered ``participating personally and substantially'';
    (C) Post-employment restrictions are covered by 18 U.S.C. 207 and 5 
CFR part 2641, that prohibit certain activities by former Government 
employees, including representation of an entity or provider before the 
Government in relation to any particular matter involving specific 
parties on which the former employee participated personally and 
substantially while employed by the Government. Additional restrictions 
apply to certain senior Government employees and for particular matters 
under an employee's official responsibility; and
    (D) Using nonpublic information to further an employee's private 
interest or that of another and engaging in a financial transaction 
using nonpublic information are prohibited by 5 CFR 2635.703.
    (2) Standards and requirements for entities or providers that enter 
into Veterans Care Agreements. An entity or provider

[[Page 915]]

that enters into a Veterans Care Agreement must comply with the 
following standards and requirements throughout the term of the Veterans 
Care Agreement:
    (i) Must have a satisfactory performance record.
    (ii) Must have a satisfactory record of integrity and business 
ethics.
    (iii) Must notify VA within 30 calendar days of the existence of an 
indictment, charge, conviction, or civil judgment, or Federal tax 
delinquency in an amount that exceeds $3,500.
    (iv) Must not engage in any of the following:
    (A) Commission of fraud or a criminal offense in connection with--
    (1) Obtaining;
    (2) Attempting to obtain; or
    (3) Performing a public contract or subcontract, or a Veterans Care 
Agreement;
    (B) Violation of Federal or State antitrust statutes relating to the 
submission of offers;
    (C) Commission of embezzlement, theft, forgery, bribery, 
falsification or destruction of records, making false statements, tax 
evasion, violating Federal criminal tax laws, or receiving stolen 
property;
    (D) Delinquent Federal taxes in an amount that exceeds $3,500. 
Federal taxes are considered delinquent for purposes of this provision 
if both of the following criteria apply:
    (1) The tax liability is finally determined. The liability is 
finally determined if it has been assessed and all available 
administrative remedies and rights to judicial review have been 
exhausted or have lapsed.
    (2) The taxpayer is delinquent in making payment. A taxpayer is 
delinquent if the taxpayer has failed to pay the tax liability when full 
payment was due and required. A taxpayer is not delinquent in cases 
where enforced collection action is precluded.
    (E) Knowing failure by a principal, until 3 years after final 
payment on any Government contract awarded to the contractor (or any 
Veterans Care Agreement entered into with the entity or provider), to 
timely disclose to the Government, in connection with the award or 
agreement, performance, or closeout of the contract or agreement or a 
subcontract thereunder, credible evidence of--
    (1) Violation of Federal criminal law involving fraud, conflict of 
interest, bribery, or gratuity violations found in Title 18 of the 
United States Code;
    (2) Violation of the civil False Claims Act (31 U.S.C. 3729-3733); 
or
    (3) Significant overpayment(s) on the contract or Veterans Care 
Agreement, other than overpayments resulting from contract financing 
payments. Contract financing payments means an authorized Government 
disbursement of monies to a contractor prior to acceptance of supplies 
or services by the Government; or
    (F) Commission of any other offense indicating a lack of business 
integrity or business honesty that seriously and directly affects the 
present responsibility of an entity or provider.
    (v) Must not submit to VA a fraudulent claim, as that term is 
defined in 38 U.S.C. 1703D(i)(4), for payment for hospital care, medical 
services, or extended care services.



Sec.  17.4120  Payment rates.

    The rates paid by VA for hospital care, medical services, and 
extended care services (hereafter in this section referred to as 
``services'') furnished pursuant to a Veterans Care Agreement will be 
the rates set forth in the price terms of the Veterans Care Agreement. 
Each Veterans Care Agreement will contain price terms for all services 
within its scope. Such payment rates will comply with the following 
parameters:
    (a) Except as otherwise provided in this section, payment rates will 
not exceed the applicable Medicare fee schedule or prospective payment 
system amount (hereafter in this section referred to as ``Medicare 
rate''), if any, for the period in which the service was provided 
(without any changes based on the subsequent development of information 
under Medicare authorities).
    (b) With respect to services furnished in a State with an All-Payer 
Model Agreement under section 1814(b)(3) of the Social Security Act (42 
U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, 
the Medicare rate under paragraph (a) will be calculated

[[Page 916]]

based on the payment rates under such agreement.
    (c) Payment rates for services furnished in a highly rural area may 
exceed the limitations set forth in paragraphs (a) and (b) of this 
section. The term ``highly rural area'' means an area located in a 
county that has fewer than seven individuals residing in that county per 
square mile.
    (d) Payment rates may deviate from the parameters set forth in 
paragraphs (a) through (c) of this section when VA determines, based on 
patient needs, market analyses, health care provider qualifications, or 
other factors, that it is not practicable to limit payment for services 
to the rates available under paragraphs (a) through (c).
    (e) Payment rates for services furnished in Alaska are not subject 
to paragraphs (a) through (d) of this section.



Sec.  17.4125  Review of Veterans Care Agreements.

    VA will periodically review each Veterans Care Agreement that 
exceeds $5,000,000 annually, to determine if it is feasible and 
advisable to furnish the hospital care, medical services, and extended 
care services that VA has furnished or anticipates furnishing under such 
Veterans Care Agreements through a VA facility, contract, or sharing 
agreement instead. If VA determines it is feasible and advisable to 
provide any such hospital care, medical services, or extended care 
services in a VA facility or by contract or sharing agreement, it will 
take action to do so.



Sec.  17.4130  Discontinuation of Veterans Care Agreements.

    (a) Discontinuation of the agreement by the entity or provider 
requires a written notice of request to discontinue, in accordance with 
the terms of the Veterans Care Agreement and the following notice 
requirements:
    (1) Written notice must be received by VA at least 45 calendar days 
before the discontinuation date and must specify the discontinuation 
date; and
    (2) Such notice must be delivered to the designated VA official to 
which such notice must be submitted under the terms of the Veterans Care 
Agreement, and the notice and delivery must comply with all terms of the 
Veterans Care Agreement.
    (b)(1) Discontinuation of the agreement by VA requires a written 
notice of discontinuation to the entity or provider in accordance with 
the terms of the Veterans Care Agreement and the following notice 
standards:
    (i) Written notice of discontinuation will be issued at least 45 
calendar days before the discontinuation date, except as provided in 
subparagraph (ii).
    (ii) Notice may be issued fewer than 45 calendar days before the 
discontinuation date, including notice that is effective immediately 
upon issuance, when VA determines such abbreviated or immediate notice 
is necessary to protect the health of covered individuals or when such 
abbreviated or immediate notice is permitted under the terms of the 
Veterans Care Agreement.
    (2) Notice will be delivered to the entity or provider in accordance 
with the terms of the Veterans Care Agreement.
    (3) VA may discontinue a Veterans Care Agreement for the following 
reasons:
    (i) If VA determines the entity or provider failed to comply 
substantially with the provisions of 38 U.S.C. 1703A or 38 CFR 17.4100-
17.4135
    (ii) If VA determines the entity or provider failed to comply 
substantially with the provisions, terms, or conditions of the Veterans 
Care Agreement;
    (iii) If VA determines the entity or provider is excluded from 
participation in a Federal health care program (as defined in section 
1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)) under 
section 1128 or 1128A of such Act (42 U.S.C. 1320a-7 and 1320a-7a), or 
is identified as an excluded source on the System for Award Management 
Exclusions list described in part 9 of title 48, Code of Federal 
Regulations, and part 180 of title 2 of such Code, or successor 
regulations;
    (iv) If VA ascertains that the entity or provider has been convicted 
of a felony or other serious offense under federal or state law and 
determines that discontinuation of the Veterans Care Agreement would be 
in the best interest of a covered individual or VA; or
    (v) If VA determines it is reasonable to discontinue the Veterans 
Care

[[Page 917]]

Agreement based on the health care needs of a covered individual.


(The information collection requirements have been submitted to the 
Office of Management and Budget (OMB) and are pending OMB approval.)



Sec.  17.4135  Disputes.

    (a) General. (1) This section establishes the administrative 
procedures and requirements for asserting and resolving disputes arising 
under or related to a Veterans Care Agreement. For purposes of this 
section, a dispute means a disagreement, between VA and the entity or 
provider that entered into the subject Veterans Care Agreement with VA, 
that meets the following criteria:
    (i) Pertains to one of the subject matters set forth in paragraph 
(b) of this section;
    (ii) Is not resolved informally by mutual agreement of the parties; 
and
    (iii) Culminates in one of the parties demanding or asserting, as a 
matter of right, the payment of money in a sum certain under the 
Veterans Care Agreement, the interpretation of the terms of the Veterans 
Care Agreement or a specific authorization thereunder, or other relief 
arising under or relating to the Veterans Care Agreement. However, a 
dispute does not encompass any demand or assertion, as a matter of 
right, for penalties or forfeitures prescribed by a statute or 
regulation that another federal agency is specifically authorized to 
administer, settle, or determine.
    (2) The procedures established in this section should only be used 
when the parties to a Veterans Care Agreement have failed to resolve an 
issue in controversy by mutual agreement.
    (3) The procedures established in this section constitute an 
entity's or provider's exclusive administrative remedy for disputes 
under this section.
    (4) Disputes under this section are not considered claims for the 
purposes of laws that would otherwise require the application of 
sections 7101 through 7109 of title 41 U.S.C.
    (5) An entity or provider must first exhaust the procedures 
established in this section before seeking judicial review under section 
1346 of title 28 U.S.C.
    (b) Subject matter of disputes. Disputes under this section must 
pertain to:
    (1) The scope of one or more specific authorizations under the 
applicable Veterans Care Agreement; or
    (2) Claims for payment under the applicable Veterans Care Agreement.
    (c) Procedures--(1) Initiation of dispute. Disputes under this 
section must be initiated in accordance with the following procedures 
and requirements:
    (i) Disputes must be initiated by submitting a notice of dispute, in 
writing, to the designated VA official to which notice must be submitted 
under the terms of the Veterans Care Agreement. The notice of dispute 
must comply with, and be submitted in accordance with, applicable terms 
of the Veterans Care Agreement.
    (ii) The notice of dispute must contain all specific assertions or 
demands, all facts pertinent to the dispute, any specific resolutions or 
relief sought, and all information and documentation necessary to review 
and adjudicate the dispute.
    (iii) The notice of dispute must be received by the designated VA 
official to which such notice must be submitted, in accordance with the 
terms of the Veterans Care Agreement, within 90 calendar days after the 
accrual of the dispute. For purposes of this paragraph, the accrual of 
the dispute is the date when all events, that fix the alleged liability 
of either VA or the entity or provider and permit the applicable 
demand(s) and assertion(s), were known or should have been known. The 
term ``accrual of the dispute,'' as defined, has the following meanings 
in each of the two specific circumstances that follow:
    (A) When a dispute consists of an entity or provider asserting that 
VA has made payment in an incorrect amount, under circumstances where VA 
has issued a corresponding payment notice and the entity or provider has 
received such notice, the accrual of the dispute is the date such notice 
was received by the entity or provider.
    (B) When a dispute consists of an entity or provider asserting that 
VA has improperly denied payment to which it is entitled, under 
circumstances where VA has issued a corresponding denial of

[[Page 918]]

payment notice and the entity or provider has received such notice, the 
accrual of the dispute is the date such notice was received by the 
entity or provider.
    (2) VA authority to decide and resolve disputes arising under or 
relating to Veterans Care Agreements. (i) A VA official acting within 
the scope of authority delegated by the Secretary of Veterans Affairs 
(hereafter referred to in this section as the ``responsible VA 
official'') will decide and resolve disputes under this section.
    (ii) The authority to decide or resolve disputes under this section 
does not extend to the settlement, compromise, payment, or adjustment of 
any claim for payment that involves fraud or misrepresentation of fact. 
For purposes of this paragraph, ``misrepresentation of fact'' means a 
false statement of substantive fact, or any conduct which leads to the 
belief of a substantive fact material to proper understanding of the 
matter in hand, made with intent to deceive or mislead. If the 
responsible VA official encounters evidence of misrepresentation of fact 
or fraud on the part of the entity or provider, the responsible VA 
official shall refer the matter to the agency official responsible for 
investigating fraud and may refer the matter to other federal entities 
as necessary.
    (3) Review of dispute and written decision. (i) Upon receipt of a 
notice of dispute, the responsible VA official will review the dispute 
and all facts pertinent to the dispute.
    (ii) If the responsible VA official determines additional 
information or documentation is required for review and adjudication of 
the dispute, the official will, within 90 calendar days of VA's receipt 
of the notice of dispute, provide written notice to both parties, in 
accordance with the notice provisions of the Veterans Care Agreement, 
that additional information or documentation is required for review and 
adjudication of the dispute. Such notice will identify and request the 
additional information and documentation deemed necessary to review and 
adjudicate the dispute.
    (iii) Upon VA receipt of a notice of dispute that conforms to the 
requirements of paragraph (c)(1) of this section (including containing 
all information and documentation necessary to review and adjudicate the 
dispute), the responsible VA official will take one of the following 
actions within 90 calendar days:
    (A) Issue a written decision, in accordance with the notice 
provisions of the Veterans Care Agreement, to both parties. The written 
decision will include:
    (1) A description of the dispute;
    (2) A reference to the pertinent terms of the Veterans Care 
Agreement and any relevant authorizations;
    (3) A statement of the factual areas of agreement and disagreement;
    (4) A statement of the responsible official's decision, with 
supporting rationale; and
    (5) A statement that the decision constitutes the final agency 
decision on the matter in dispute.
    (B) Upon a determination that additional time is reasonably required 
to issue a decision, the responsible VA official will provide written 
notice to both parties, in accordance with the notice provisions of the 
Veterans Care Agreement, of such determination and the time within which 
a decision will be issued. The time within which a decision will be 
issued must be reasonable, taking into account the complexity of the 
dispute and any other relevant factors, and must not exceed 150 calendar 
days after receipt of a notice of dispute that conforms to the 
requirements of paragraph (c)(1) of this section and all information and 
documentation necessary to review and adjudicate the dispute. The 
responsible VA official will subsequently issue a written decision in 
accordance with paragraph (c)(3)(iii)(A) of this section.
    (4) Issuance of decision. VA will furnish the decision to the entity 
or provider by any method that provides evidence of receipt.
    (5) Effect of decision. A written decision issued by the responsible 
VA official constitutes the agency's final decision on the dispute.


(The information collection requirements have been submitted to the 
Office of Management and Budget (OMB) and are pending OMB approval.)

[[Page 919]]



Sec.  17.4600  Urgent care.

    (a) Purpose. The purpose of this section is to establish procedures 
for accessing urgent care. Eligible veterans may obtain urgent care, in 
accordance with the requirements and processes set forth in this 
section, from qualifying non-VA entities or providers in VA's network 
that are identified by VA in accordance with paragraph (c)(2) of this 
section.
    (b) Definitions. The following definitions apply to this section.
    (1) Eligible veteran means a veteran described in 38 U.S.C. 
1725A(b).
    (2) Episodic care means care or services provided in a single visit 
to an eligible veteran for a particular health condition, or a limited 
set of particular health conditions, without an ongoing relationship 
being established between the eligible veteran and qualifying non-VA 
entities or providers.
    (3) Longitudinal management of conditions means outpatient care that 
addresses important disease prevention and treatment goals and is 
dependent upon bidirectional communications that are ongoing over an 
extended period of time. For purposes of this section, the term 
``longitudinal management of conditions'' and ``longitudinal care'' are 
synonymous.
    (4) Qualifying non-VA entity or provider means a non-VA entity or 
provider, including Federally-qualified health centers as defined in 42 
U.S.C. 1396d(l)(2)(B), that has entered into a contract, agreement, or 
other arrangement with the Secretary to furnish urgent care under this 
section, or has entered into an agreement with a third-party 
administrator with whom VA has a contract to furnish such care.
    (5) Urgent care means services provided by a qualifying non-VA 
entity or provider, and as further defined in paragraphs (b)(5)(i) 
through (iv) of this section.
    (i) Urgent care includes service available from entities or 
providers submitting claims for payment as a walk-in retail health 
clinic (Centers for Medicare and Medicaid Services (CMS) Place of 
Service code 17) or urgent care facility (CMS Place of Service code 20);
    (ii)(A) Except as provided in paragraph (b)(5)(ii)(B) or (b)(5)(iv) 
of this section, urgent care does not include preventive health 
services, as defined in section 1701(9) of title 38, United States Code, 
dental care, or chronic disease management.
    (B) Urgent care includes immunization against influenza (flu shots), 
as well as therapeutic vaccines that are necessary in the course of 
treatment of an otherwise included service and screenings related to the 
treatment of symptoms associated with an immediate illness or exposure.
    (iii) Urgent care may only be furnished as episodic care for 
eligible veterans needing immediate non-emergent medical attention, and 
it does not include longitudinal care. Veterans requiring follow-up care 
as a result of an urgent care visit under this section must contact VA 
or their VA-authorized primary care provider to arrange such care.
    (iv) If VA determines that the provision of additional services is 
in the interest of eligible veterans, based upon identified health 
needs, VA may offer such additional services under this section as VA 
determines appropriate. Such services may be limited in duration and 
location. VA will inform the public through a Federal Register document, 
published as soon as practicable, and other communications, as 
appropriate.
    (c) Procedures. (1)(i)(A) Eligible veterans may receive urgent care 
under this section without prior approval from VA.
    (B) Eligible veterans must declare at each episode of care if they 
are using this benefit prior to receiving urgent care under this 
section.
    (2) VA will publish a website providing information on urgent care, 
including the names, locations, and contact information for qualifying 
non-VA entities or providers from which urgent care is available under 
this section.
    (3) In general, eligibility under this section does not affect 
eligibility for hospital care or medical services under the medical 
benefits package, as defined in Sec.  17.38, or other benefits addressed 
in this title. Nothing in this section waives the eligibility 
requirements established in other statutes or regulations.
    (4) Urgent care furnished under this section must meet VA's 
standards for

[[Page 920]]

quality established under 38 U.S.C. 1703C, as applicable.
    (d) Copayment. (1) Except as provided in paragraphs (d)(2) and (3) 
of this section, an eligible veteran, as a condition for receiving 
urgent care provided by VA under this section, must agree to pay VA (and 
is obligated to pay VA) a copayment of $30:
    (i) After three visits in a calendar year if such eligible veteran 
is enrolled under Sec.  17.36(b)(1) through (6), except those veterans 
described in Sec.  17.36(d)(3)(iii) for all matters not covered by 
priority category 6.
    (ii) If such eligible veteran is enrolled under Sec.  17.36(b)(7) or 
(8), including veterans described in Sec.  17.36(d)(3)(iii).
    (2) An eligible veteran who receives urgent care under paragraph 
(b)(5)(iv) of this section or urgent care consisting solely of an 
immunization against influenza (flu shot) is not subject to a copayment 
under paragraph (d)(1) of this section and such a visit shall not count 
as a visit for purposes of paragraph (d)(1)(i) of this section.
    (3) If an eligible veteran would be required to pay more than one 
copayment under this section, or a copayment under this section and a 
copayment under Sec.  17.108 or Sec.  17.111, on the same day, the 
eligible veteran will only be charged the higher copayment.
    (e) Prescriptions. Notwithstanding any other provision of this part, 
VA will:
    (1) Pay for prescriptions written by qualifying non-VA entities or 
providers for eligible veterans, including over-the-counter drugs and 
medical and surgical supplies, available under the VA national formulary 
system to cover a course of treatment for urgent care no longer than 14 
days.
    (2) Fill prescriptions for urgent care written by qualifying non-VA 
entities or providers for eligible veterans, including over-the-counter 
drugs and medical and surgical supplies, available under the VA national 
formulary system.
    (3) Pay for prescriptions written by qualifying non-VA entities or 
providers for eligible veterans that have an immediate need for durable 
medical equipment and medical devices that are required for urgent 
conditions (e.g., splints, crutches, manual wheelchairs).
    (f) Payments. Payments made for urgent care constitute payment in 
full and shall extinguish the veteran's liability to the qualifying non-
VA entity or provider. The qualifying non-VA entity or provider may not 
impose any additional charge on a veteran or his or her health care 
insurer for any urgent care service for which payment is made by VA. 
This section does not abrogate VA's right, under 38 U.S.C. 1729, to 
recover or collect from a third party the reasonable charges of the care 
or services provided under this section.

[84 FR 26018, June 5, 2019]

[[Page 921]]



                              FINDING AIDS




  --------------------------------------------------------------------

  A list of current CFR titles, subtitles, chapters, subchapters and 
parts and an alphabetical list of agencies publishing in the CFR are 
included in the CFR Index and Finding Aids volume to the Code of Federal 
Regulations which is published separately and revised annually.

  Table of CFR Titles and Chapters
  Alphabetical List of Agencies Appearing in the CFR
  List of CFR Sections Affected

[[Page 923]]



                    Table of CFR Titles and Chapters




                      (Revised as of July 1, 2021)

                      Title 1--General Provisions

         I  Administrative Committee of the Federal Register 
                (Parts 1--49)
        II  Office of the Federal Register (Parts 50--299)
       III  Administrative Conference of the United States (Parts 
                300--399)
        IV  Miscellaneous Agencies (Parts 400--599)
        VI  National Capital Planning Commission (Parts 600--699)

                    Title 2--Grants and Agreements

            Subtitle A--Office of Management and Budget Guidance 
                for Grants and Agreements
         I  Office of Management and Budget Governmentwide 
                Guidance for Grants and Agreements (Parts 2--199)
        II  Office of Management and Budget Guidance (Parts 200--
                299)
            Subtitle B--Federal Agency Regulations for Grants and 
                Agreements
       III  Department of Health and Human Services (Parts 300--
                399)
        IV  Department of Agriculture (Parts 400--499)
        VI  Department of State (Parts 600--699)
       VII  Agency for International Development (Parts 700--799)
      VIII  Department of Veterans Affairs (Parts 800--899)
        IX  Department of Energy (Parts 900--999)
         X  Department of the Treasury (Parts 1000--1099)
        XI  Department of Defense (Parts 1100--1199)
       XII  Department of Transportation (Parts 1200--1299)
      XIII  Department of Commerce (Parts 1300--1399)
       XIV  Department of the Interior (Parts 1400--1499)
        XV  Environmental Protection Agency (Parts 1500--1599)
     XVIII  National Aeronautics and Space Administration (Parts 
                1800--1899)
        XX  United States Nuclear Regulatory Commission (Parts 
                2000--2099)
      XXII  Corporation for National and Community Service (Parts 
                2200--2299)
     XXIII  Social Security Administration (Parts 2300--2399)
      XXIV  Department of Housing and Urban Development (Parts 
                2400--2499)
       XXV  National Science Foundation (Parts 2500--2599)
      XXVI  National Archives and Records Administration (Parts 
                2600--2699)

[[Page 924]]

     XXVII  Small Business Administration (Parts 2700--2799)
    XXVIII  Department of Justice (Parts 2800--2899)
      XXIX  Department of Labor (Parts 2900--2999)
       XXX  Department of Homeland Security (Parts 3000--3099)
      XXXI  Institute of Museum and Library Services (Parts 3100--
                3199)
     XXXII  National Endowment for the Arts (Parts 3200--3299)
    XXXIII  National Endowment for the Humanities (Parts 3300--
                3399)
     XXXIV  Department of Education (Parts 3400--3499)
      XXXV  Export-Import Bank of the United States (Parts 3500--
                3599)
     XXXVI  Office of National Drug Control Policy, Executive 
                Office of the President (Parts 3600--3699)
    XXXVII  Peace Corps (Parts 3700--3799)
     LVIII  Election Assistance Commission (Parts 5800--5899)
       LIX  Gulf Coast Ecosystem Restoration Council (Parts 5900--
                5999)

                        Title 3--The President

         I  Executive Office of the President (Parts 100--199)

                           Title 4--Accounts

         I  Government Accountability Office (Parts 1--199)

                   Title 5--Administrative Personnel

         I  Office of Personnel Management (Parts 1--1199)
        II  Merit Systems Protection Board (Parts 1200--1299)
       III  Office of Management and Budget (Parts 1300--1399)
        IV  Office of Personnel Management and Office of the 
                Director of National Intelligence (Parts 1400--
                1499)
         V  The International Organizations Employees Loyalty 
                Board (Parts 1500--1599)
        VI  Federal Retirement Thrift Investment Board (Parts 
                1600--1699)
      VIII  Office of Special Counsel (Parts 1800--1899)
        IX  Appalachian Regional Commission (Parts 1900--1999)
        XI  Armed Forces Retirement Home (Parts 2100--2199)
       XIV  Federal Labor Relations Authority, General Counsel of 
                the Federal Labor Relations Authority and Federal 
                Service Impasses Panel (Parts 2400--2499)
       XVI  Office of Government Ethics (Parts 2600--2699)
       XXI  Department of the Treasury (Parts 3100--3199)
      XXII  Federal Deposit Insurance Corporation (Parts 3200--
                3299)
     XXIII  Department of Energy (Parts 3300--3399)
      XXIV  Federal Energy Regulatory Commission (Parts 3400--
                3499)
       XXV  Department of the Interior (Parts 3500--3599)
      XXVI  Department of Defense (Parts 3600--3699)

[[Page 925]]

    XXVIII  Department of Justice (Parts 3800--3899)
      XXIX  Federal Communications Commission (Parts 3900--3999)
       XXX  Farm Credit System Insurance Corporation (Parts 4000--
                4099)
      XXXI  Farm Credit Administration (Parts 4100--4199)
    XXXIII  U.S. International Development Finance Corporation 
                (Parts 4300--4399)
     XXXIV  Securities and Exchange Commission (Parts 4400--4499)
      XXXV  Office of Personnel Management (Parts 4500--4599)
     XXXVI  Department of Homeland Security (Parts 4600--4699)
    XXXVII  Federal Election Commission (Parts 4700--4799)
        XL  Interstate Commerce Commission (Parts 5000--5099)
       XLI  Commodity Futures Trading Commission (Parts 5100--
                5199)
      XLII  Department of Labor (Parts 5200--5299)
     XLIII  National Science Foundation (Parts 5300--5399)
       XLV  Department of Health and Human Services (Parts 5500--
                5599)
      XLVI  Postal Rate Commission (Parts 5600--5699)
     XLVII  Federal Trade Commission (Parts 5700--5799)
    XLVIII  Nuclear Regulatory Commission (Parts 5800--5899)
      XLIX  Federal Labor Relations Authority (Parts 5900--5999)
         L  Department of Transportation (Parts 6000--6099)
       LII  Export-Import Bank of the United States (Parts 6200--
                6299)
      LIII  Department of Education (Parts 6300--6399)
       LIV  Environmental Protection Agency (Parts 6400--6499)
        LV  National Endowment for the Arts (Parts 6500--6599)
       LVI  National Endowment for the Humanities (Parts 6600--
                6699)
      LVII  General Services Administration (Parts 6700--6799)
     LVIII  Board of Governors of the Federal Reserve System 
                (Parts 6800--6899)
       LIX  National Aeronautics and Space Administration (Parts 
                6900--6999)
        LX  United States Postal Service (Parts 7000--7099)
       LXI  National Labor Relations Board (Parts 7100--7199)
      LXII  Equal Employment Opportunity Commission (Parts 7200--
                7299)
     LXIII  Inter-American Foundation (Parts 7300--7399)
      LXIV  Merit Systems Protection Board (Parts 7400--7499)
       LXV  Department of Housing and Urban Development (Parts 
                7500--7599)
      LXVI  National Archives and Records Administration (Parts 
                7600--7699)
     LXVII  Institute of Museum and Library Services (Parts 7700--
                7799)
    LXVIII  Commission on Civil Rights (Parts 7800--7899)
      LXIX  Tennessee Valley Authority (Parts 7900--7999)
       LXX  Court Services and Offender Supervision Agency for the 
                District of Columbia (Parts 8000--8099)
      LXXI  Consumer Product Safety Commission (Parts 8100--8199)
    LXXIII  Department of Agriculture (Parts 8300--8399)

[[Page 926]]

     LXXIV  Federal Mine Safety and Health Review Commission 
                (Parts 8400--8499)
     LXXVI  Federal Retirement Thrift Investment Board (Parts 
                8600--8699)
    LXXVII  Office of Management and Budget (Parts 8700--8799)
      LXXX  Federal Housing Finance Agency (Parts 9000--9099)
   LXXXIII  Special Inspector General for Afghanistan 
                Reconstruction (Parts 9300--9399)
    LXXXIV  Bureau of Consumer Financial Protection (Parts 9400--
                9499)
    LXXXVI  National Credit Union Administration (Parts 9600--
                9699)
     XCVII  Department of Homeland Security Human Resources 
                Management System (Department of Homeland 
                Security--Office of Personnel Management) (Parts 
                9700--9799)
    XCVIII  Council of the Inspectors General on Integrity and 
                Efficiency (Parts 9800--9899)
      XCIX  Military Compensation and Retirement Modernization 
                Commission (Parts 9900--9999)
         C  National Council on Disability (Parts 10000--10049)
        CI  National Mediation Board (Parts 10100--10199)
       CII  U.S. Office of Special Counsel (Parts 10200--10299)

                      Title 6--Domestic Security

         I  Department of Homeland Security, Office of the 
                Secretary (Parts 1--199)
         X  Privacy and Civil Liberties Oversight Board (Parts 
                1000--1099)

                         Title 7--Agriculture

            Subtitle A--Office of the Secretary of Agriculture 
                (Parts 0--26)
            Subtitle B--Regulations of the Department of 
                Agriculture
         I  Agricultural Marketing Service (Standards, 
                Inspections, Marketing Practices), Department of 
                Agriculture (Parts 27--209)
        II  Food and Nutrition Service, Department of Agriculture 
                (Parts 210--299)
       III  Animal and Plant Health Inspection Service, Department 
                of Agriculture (Parts 300--399)
        IV  Federal Crop Insurance Corporation, Department of 
                Agriculture (Parts 400--499)
         V  Agricultural Research Service, Department of 
                Agriculture (Parts 500--599)
        VI  Natural Resources Conservation Service, Department of 
                Agriculture (Parts 600--699)
       VII  Farm Service Agency, Department of Agriculture (Parts 
                700--799)
      VIII  Agricultural Marketing Service (Federal Grain 
                Inspection Service, Fair Trade Practices Program), 
                Department of Agriculture (Parts 800--899)

[[Page 927]]

        IX  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Fruits, Vegetables, Nuts), Department 
                of Agriculture (Parts 900--999)
         X  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Milk), Department of Agriculture 
                (Parts 1000--1199)
        XI  Agricultural Marketing Service (Marketing Agreements 
                and Orders; Miscellaneous Commodities), Department 
                of Agriculture (Parts 1200--1299)
       XIV  Commodity Credit Corporation, Department of 
                Agriculture (Parts 1400--1499)
        XV  Foreign Agricultural Service, Department of 
                Agriculture (Parts 1500--1599)
       XVI  (Parts 1600--1699) [Reserved]
      XVII  Rural Utilities Service, Department of Agriculture 
                (Parts 1700--1799)
     XVIII  Rural Housing Service, Rural Business-Cooperative 
                Service, Rural Utilities Service, and Farm Service 
                Agency, Department of Agriculture (Parts 1800--
                2099)
        XX  (Parts 2200--2299) [Reserved]
       XXV  Office of Advocacy and Outreach, Department of 
                Agriculture (Parts 2500--2599)
      XXVI  Office of Inspector General, Department of Agriculture 
                (Parts 2600--2699)
     XXVII  Office of Information Resources Management, Department 
                of Agriculture (Parts 2700--2799)
    XXVIII  Office of Operations, Department of Agriculture (Parts 
                2800--2899)
      XXIX  Office of Energy Policy and New Uses, Department of 
                Agriculture (Parts 2900--2999)
       XXX  Office of the Chief Financial Officer, Department of 
                Agriculture (Parts 3000--3099)
      XXXI  Office of Environmental Quality, Department of 
                Agriculture (Parts 3100--3199)
     XXXII  Office of Procurement and Property Management, 
                Department of Agriculture (Parts 3200--3299)
    XXXIII  Office of Transportation, Department of Agriculture 
                (Parts 3300--3399)
     XXXIV  National Institute of Food and Agriculture (Parts 
                3400--3499)
      XXXV  Rural Housing Service, Department of Agriculture 
                (Parts 3500--3599)
     XXXVI  National Agricultural Statistics Service, Department 
                of Agriculture (Parts 3600--3699)
    XXXVII  Economic Research Service, Department of Agriculture 
                (Parts 3700--3799)
   XXXVIII  World Agricultural Outlook Board, Department of 
                Agriculture (Parts 3800--3899)
       XLI  [Reserved]
      XLII  Rural Business-Cooperative Service and Rural Utilities 
                Service, Department of Agriculture (Parts 4200--
                4299)

[[Page 928]]

         L  Rural Business-Cooperative Service, and Rural 
                Utilities Service, Department of Agriculture 
                (Parts 5000--5099)

                    Title 8--Aliens and Nationality

         I  Department of Homeland Security (Parts 1--499)
         V  Executive Office for Immigration Review, Department of 
                Justice (Parts 1000--1399)

                 Title 9--Animals and Animal Products

         I  Animal and Plant Health Inspection Service, Department 
                of Agriculture (Parts 1--199)
        II  Agricultural Marketing Service (Fair Trade Practices 
                Program), Department of Agriculture (Parts 200--
                299)
       III  Food Safety and Inspection Service, Department of 
                Agriculture (Parts 300--599)

                           Title 10--Energy

         I  Nuclear Regulatory Commission (Parts 0--199)
        II  Department of Energy (Parts 200--699)
       III  Department of Energy (Parts 700--999)
         X  Department of Energy (General Provisions) (Parts 
                1000--1099)
      XIII  Nuclear Waste Technical Review Board (Parts 1300--
                1399)
      XVII  Defense Nuclear Facilities Safety Board (Parts 1700--
                1799)
     XVIII  Northeast Interstate Low-Level Radioactive Waste 
                Commission (Parts 1800--1899)

                      Title 11--Federal Elections

         I  Federal Election Commission (Parts 1--9099)
        II  Election Assistance Commission (Parts 9400--9499)

                      Title 12--Banks and Banking

         I  Comptroller of the Currency, Department of the 
                Treasury (Parts 1--199)
        II  Federal Reserve System (Parts 200--299)
       III  Federal Deposit Insurance Corporation (Parts 300--399)
        IV  Export-Import Bank of the United States (Parts 400--
                499)
         V  (Parts 500--599) [Reserved]
        VI  Farm Credit Administration (Parts 600--699)
       VII  National Credit Union Administration (Parts 700--799)
      VIII  Federal Financing Bank (Parts 800--899)
        IX  (Parts 900--999) [Reserved]
         X  Bureau of Consumer Financial Protection (Parts 1000--
                1099)

[[Page 929]]

        XI  Federal Financial Institutions Examination Council 
                (Parts 1100--1199)
       XII  Federal Housing Finance Agency (Parts 1200--1299)
      XIII  Financial Stability Oversight Council (Parts 1300--
                1399)
       XIV  Farm Credit System Insurance Corporation (Parts 1400--
                1499)
        XV  Department of the Treasury (Parts 1500--1599)
       XVI  Office of Financial Research, Department of the 
                Treasury (Parts 1600--1699)
      XVII  Office of Federal Housing Enterprise Oversight, 
                Department of Housing and Urban Development (Parts 
                1700--1799)
     XVIII  Community Development Financial Institutions Fund, 
                Department of the Treasury (Parts 1800--1899)

               Title 13--Business Credit and Assistance

         I  Small Business Administration (Parts 1--199)
       III  Economic Development Administration, Department of 
                Commerce (Parts 300--399)
        IV  Emergency Steel Guarantee Loan Board (Parts 400--499)
         V  Emergency Oil and Gas Guaranteed Loan Board (Parts 
                500--599)

                    Title 14--Aeronautics and Space

         I  Federal Aviation Administration, Department of 
                Transportation (Parts 1--199)
        II  Office of the Secretary, Department of Transportation 
                (Aviation Proceedings) (Parts 200--399)
       III  Commercial Space Transportation, Federal Aviation 
                Administration, Department of Transportation 
                (Parts 400--1199)
         V  National Aeronautics and Space Administration (Parts 
                1200--1299)
        VI  Air Transportation System Stabilization (Parts 1300--
                1399)

                 Title 15--Commerce and Foreign Trade

            Subtitle A--Office of the Secretary of Commerce (Parts 
                0--29)
            Subtitle B--Regulations Relating to Commerce and 
                Foreign Trade
         I  Bureau of the Census, Department of Commerce (Parts 
                30--199)
        II  National Institute of Standards and Technology, 
                Department of Commerce (Parts 200--299)
       III  International Trade Administration, Department of 
                Commerce (Parts 300--399)
        IV  Foreign-Trade Zones Board, Department of Commerce 
                (Parts 400--499)
       VII  Bureau of Industry and Security, Department of 
                Commerce (Parts 700--799)

[[Page 930]]

      VIII  Bureau of Economic Analysis, Department of Commerce 
                (Parts 800--899)
        IX  National Oceanic and Atmospheric Administration, 
                Department of Commerce (Parts 900--999)
        XI  National Technical Information Service, Department of 
                Commerce (Parts 1100--1199)
      XIII  East-West Foreign Trade Board (Parts 1300--1399)
       XIV  Minority Business Development Agency (Parts 1400--
                1499)
        XV  Office of the Under-Secretary for Economic Affairs, 
                Department of Commerce (Parts 1500--1599)
            Subtitle C--Regulations Relating to Foreign Trade 
                Agreements
        XX  Office of the United States Trade Representative 
                (Parts 2000--2099)
            Subtitle D--Regulations Relating to Telecommunications 
                and Information
     XXIII  National Telecommunications and Information 
                Administration, Department of Commerce (Parts 
                2300--2399) [Reserved]

                    Title 16--Commercial Practices

         I  Federal Trade Commission (Parts 0--999)
        II  Consumer Product Safety Commission (Parts 1000--1799)

             Title 17--Commodity and Securities Exchanges

         I  Commodity Futures Trading Commission (Parts 1--199)
        II  Securities and Exchange Commission (Parts 200--399)
        IV  Department of the Treasury (Parts 400--499)

          Title 18--Conservation of Power and Water Resources

         I  Federal Energy Regulatory Commission, Department of 
                Energy (Parts 1--399)
       III  Delaware River Basin Commission (Parts 400--499)
        VI  Water Resources Council (Parts 700--799)
      VIII  Susquehanna River Basin Commission (Parts 800--899)
      XIII  Tennessee Valley Authority (Parts 1300--1399)

                       Title 19--Customs Duties

         I  U.S. Customs and Border Protection, Department of 
                Homeland Security; Department of the Treasury 
                (Parts 0--199)
        II  United States International Trade Commission (Parts 
                200--299)
       III  International Trade Administration, Department of 
                Commerce (Parts 300--399)
        IV  U.S. Immigration and Customs Enforcement, Department 
                of Homeland Security (Parts 400--599) [Reserved]

[[Page 931]]

                     Title 20--Employees' Benefits

         I  Office of Workers' Compensation Programs, Department 
                of Labor (Parts 1--199)
        II  Railroad Retirement Board (Parts 200--399)
       III  Social Security Administration (Parts 400--499)
        IV  Employees' Compensation Appeals Board, Department of 
                Labor (Parts 500--599)
         V  Employment and Training Administration, Department of 
                Labor (Parts 600--699)
        VI  Office of Workers' Compensation Programs, Department 
                of Labor (Parts 700--799)
       VII  Benefits Review Board, Department of Labor (Parts 
                800--899)
      VIII  Joint Board for the Enrollment of Actuaries (Parts 
                900--999)
        IX  Office of the Assistant Secretary for Veterans' 
                Employment and Training Service, Department of 
                Labor (Parts 1000--1099)

                       Title 21--Food and Drugs

         I  Food and Drug Administration, Department of Health and 
                Human Services (Parts 1--1299)
        II  Drug Enforcement Administration, Department of Justice 
                (Parts 1300--1399)
       III  Office of National Drug Control Policy (Parts 1400--
                1499)

                      Title 22--Foreign Relations

         I  Department of State (Parts 1--199)
        II  Agency for International Development (Parts 200--299)
       III  Peace Corps (Parts 300--399)
        IV  International Joint Commission, United States and 
                Canada (Parts 400--499)
         V  United States Agency for Global Media (Parts 500--599)
       VII  U.S. International Development Finance Corporation 
                (Parts 700--799)
        IX  Foreign Service Grievance Board (Parts 900--999)
         X  Inter-American Foundation (Parts 1000--1099)
        XI  International Boundary and Water Commission, United 
                States and Mexico, United States Section (Parts 
                1100--1199)
       XII  United States International Development Cooperation 
                Agency (Parts 1200--1299)
      XIII  Millennium Challenge Corporation (Parts 1300--1399)
       XIV  Foreign Service Labor Relations Board; Federal Labor 
                Relations Authority; General Counsel of the 
                Federal Labor Relations Authority; and the Foreign 
                Service Impasse Disputes Panel (Parts 1400--1499)
        XV  African Development Foundation (Parts 1500--1599)
       XVI  Japan-United States Friendship Commission (Parts 
                1600--1699)
      XVII  United States Institute of Peace (Parts 1700--1799)

[[Page 932]]

                          Title 23--Highways

         I  Federal Highway Administration, Department of 
                Transportation (Parts 1--999)
        II  National Highway Traffic Safety Administration and 
                Federal Highway Administration, Department of 
                Transportation (Parts 1200--1299)
       III  National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 1300--1399)

                Title 24--Housing and Urban Development

            Subtitle A--Office of the Secretary, Department of 
                Housing and Urban Development (Parts 0--99)
            Subtitle B--Regulations Relating to Housing and Urban 
                Development
         I  Office of Assistant Secretary for Equal Opportunity, 
                Department of Housing and Urban Development (Parts 
                100--199)
        II  Office of Assistant Secretary for Housing-Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Parts 200--299)
       III  Government National Mortgage Association, Department 
                of Housing and Urban Development (Parts 300--399)
        IV  Office of Housing and Office of Multifamily Housing 
                Assistance Restructuring, Department of Housing 
                and Urban Development (Parts 400--499)
         V  Office of Assistant Secretary for Community Planning 
                and Development, Department of Housing and Urban 
                Development (Parts 500--599)
        VI  Office of Assistant Secretary for Community Planning 
                and Development, Department of Housing and Urban 
                Development (Parts 600--699) [Reserved]
       VII  Office of the Secretary, Department of Housing and 
                Urban Development (Housing Assistance Programs and 
                Public and Indian Housing Programs) (Parts 700--
                799)
      VIII  Office of the Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Section 8 Housing Assistance 
                Programs, Section 202 Direct Loan Program, Section 
                202 Supportive Housing for the Elderly Program and 
                Section 811 Supportive Housing for Persons With 
                Disabilities Program) (Parts 800--899)
        IX  Office of Assistant Secretary for Public and Indian 
                Housing, Department of Housing and Urban 
                Development (Parts 900--1699)
         X  Office of Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Interstate Land Sales 
                Registration Program) (Parts 1700--1799) 
                [Reserved]
       XII  Office of Inspector General, Department of Housing and 
                Urban Development (Parts 2000--2099)
        XV  Emergency Mortgage Insurance and Loan Programs, 
                Department of Housing and Urban Development (Parts 
                2700--2799) [Reserved]

[[Page 933]]

        XX  Office of Assistant Secretary for Housing--Federal 
                Housing Commissioner, Department of Housing and 
                Urban Development (Parts 3200--3899)
      XXIV  Board of Directors of the HOPE for Homeowners Program 
                (Parts 4000--4099) [Reserved]
       XXV  Neighborhood Reinvestment Corporation (Parts 4100--
                4199)

                           Title 25--Indians

         I  Bureau of Indian Affairs, Department of the Interior 
                (Parts 1--299)
        II  Indian Arts and Crafts Board, Department of the 
                Interior (Parts 300--399)
       III  National Indian Gaming Commission, Department of the 
                Interior (Parts 500--599)
        IV  Office of Navajo and Hopi Indian Relocation (Parts 
                700--899)
         V  Bureau of Indian Affairs, Department of the Interior, 
                and Indian Health Service, Department of Health 
                and Human Services (Part 900--999)
        VI  Office of the Assistant Secretary, Indian Affairs, 
                Department of the Interior (Parts 1000--1199)
       VII  Office of the Special Trustee for American Indians, 
                Department of the Interior (Parts 1200--1299)

                      Title 26--Internal Revenue

         I  Internal Revenue Service, Department of the Treasury 
                (Parts 1--End)

           Title 27--Alcohol, Tobacco Products and Firearms

         I  Alcohol and Tobacco Tax and Trade Bureau, Department 
                of the Treasury (Parts 1--399)
        II  Bureau of Alcohol, Tobacco, Firearms, and Explosives, 
                Department of Justice (Parts 400--799)

                   Title 28--Judicial Administration

         I  Department of Justice (Parts 0--299)
       III  Federal Prison Industries, Inc., Department of Justice 
                (Parts 300--399)
         V  Bureau of Prisons, Department of Justice (Parts 500--
                599)
        VI  Offices of Independent Counsel, Department of Justice 
                (Parts 600--699)
       VII  Office of Independent Counsel (Parts 700--799)
      VIII  Court Services and Offender Supervision Agency for the 
                District of Columbia (Parts 800--899)
        IX  National Crime Prevention and Privacy Compact Council 
                (Parts 900--999)

[[Page 934]]

        XI  Department of Justice and Department of State (Parts 
                1100--1199)

                            Title 29--Labor

            Subtitle A--Office of the Secretary of Labor (Parts 
                0--99)
            Subtitle B--Regulations Relating to Labor
         I  National Labor Relations Board (Parts 100--199)
        II  Office of Labor-Management Standards, Department of 
                Labor (Parts 200--299)
       III  National Railroad Adjustment Board (Parts 300--399)
        IV  Office of Labor-Management Standards, Department of 
                Labor (Parts 400--499)
         V  Wage and Hour Division, Department of Labor (Parts 
                500--899)
        IX  Construction Industry Collective Bargaining Commission 
                (Parts 900--999)
         X  National Mediation Board (Parts 1200--1299)
       XII  Federal Mediation and Conciliation Service (Parts 
                1400--1499)
       XIV  Equal Employment Opportunity Commission (Parts 1600--
                1699)
      XVII  Occupational Safety and Health Administration, 
                Department of Labor (Parts 1900--1999)
        XX  Occupational Safety and Health Review Commission 
                (Parts 2200--2499)
       XXV  Employee Benefits Security Administration, Department 
                of Labor (Parts 2500--2599)
     XXVII  Federal Mine Safety and Health Review Commission 
                (Parts 2700--2799)
        XL  Pension Benefit Guaranty Corporation (Parts 4000--
                4999)

                      Title 30--Mineral Resources

         I  Mine Safety and Health Administration, Department of 
                Labor (Parts 1--199)
        II  Bureau of Safety and Environmental Enforcement, 
                Department of the Interior (Parts 200--299)
        IV  Geological Survey, Department of the Interior (Parts 
                400--499)
         V  Bureau of Ocean Energy Management, Department of the 
                Interior (Parts 500--599)
       VII  Office of Surface Mining Reclamation and Enforcement, 
                Department of the Interior (Parts 700--999)
       XII  Office of Natural Resources Revenue, Department of the 
                Interior (Parts 1200--1299)

                 Title 31--Money and Finance: Treasury

            Subtitle A--Office of the Secretary of the Treasury 
                (Parts 0--50)
            Subtitle B--Regulations Relating to Money and Finance

[[Page 935]]

         I  Monetary Offices, Department of the Treasury (Parts 
                51--199)
        II  Fiscal Service, Department of the Treasury (Parts 
                200--399)
        IV  Secret Service, Department of the Treasury (Parts 
                400--499)
         V  Office of Foreign Assets Control, Department of the 
                Treasury (Parts 500--599)
        VI  Bureau of Engraving and Printing, Department of the 
                Treasury (Parts 600--699)
       VII  Federal Law Enforcement Training Center, Department of 
                the Treasury (Parts 700--799)
      VIII  Office of Investment Security, Department of the 
                Treasury (Parts 800--899)
        IX  Federal Claims Collection Standards (Department of the 
                Treasury--Department of Justice) (Parts 900--999)
         X  Financial Crimes Enforcement Network, Department of 
                the Treasury (Parts 1000--1099)

                      Title 32--National Defense

            Subtitle A--Department of Defense
         I  Office of the Secretary of Defense (Parts 1--399)
         V  Department of the Army (Parts 400--699)
        VI  Department of the Navy (Parts 700--799)
       VII  Department of the Air Force (Parts 800--1099)
            Subtitle B--Other Regulations Relating to National 
                Defense
       XII  Department of Defense, Defense Logistics Agency (Parts 
                1200--1299)
       XVI  Selective Service System (Parts 1600--1699)
      XVII  Office of the Director of National Intelligence (Parts 
                1700--1799)
     XVIII  National Counterintelligence Center (Parts 1800--1899)
       XIX  Central Intelligence Agency (Parts 1900--1999)
        XX  Information Security Oversight Office, National 
                Archives and Records Administration (Parts 2000--
                2099)
       XXI  National Security Council (Parts 2100--2199)
      XXIV  Office of Science and Technology Policy (Parts 2400--
                2499)
     XXVII  Office for Micronesian Status Negotiations (Parts 
                2700--2799)
    XXVIII  Office of the Vice President of the United States 
                (Parts 2800--2899)

               Title 33--Navigation and Navigable Waters

         I  Coast Guard, Department of Homeland Security (Parts 
                1--199)
        II  Corps of Engineers, Department of the Army, Department 
                of Defense (Parts 200--399)
        IV  Great Lakes St. Lawrence Seaway Development 
                Corporation, Department of Transportation (Parts 
                400--499)

[[Page 936]]

                          Title 34--Education

            Subtitle A--Office of the Secretary, Department of 
                Education (Parts 1--99)
            Subtitle B--Regulations of the Offices of the 
                Department of Education
         I  Office for Civil Rights, Department of Education 
                (Parts 100--199)
        II  Office of Elementary and Secondary Education, 
                Department of Education (Parts 200--299)
       III  Office of Special Education and Rehabilitative 
                Services, Department of Education (Parts 300--399)
        IV  Office of Career, Technical, and Adult Education, 
                Department of Education (Parts 400--499)
         V  Office of Bilingual Education and Minority Languages 
                Affairs, Department of Education (Parts 500--599) 
                [Reserved]
        VI  Office of Postsecondary Education, Department of 
                Education (Parts 600--699)
       VII  Office of Educational Research and Improvement, 
                Department of Education (Parts 700--799) 
                [Reserved]
            Subtitle C--Regulations Relating to Education
        XI  (Parts 1100--1199) [Reserved]
       XII  National Council on Disability (Parts 1200--1299)

                          Title 35 [Reserved]

             Title 36--Parks, Forests, and Public Property

         I  National Park Service, Department of the Interior 
                (Parts 1--199)
        II  Forest Service, Department of Agriculture (Parts 200--
                299)
       III  Corps of Engineers, Department of the Army (Parts 
                300--399)
        IV  American Battle Monuments Commission (Parts 400--499)
         V  Smithsonian Institution (Parts 500--599)
        VI  [Reserved]
       VII  Library of Congress (Parts 700--799)
      VIII  Advisory Council on Historic Preservation (Parts 800--
                899)
        IX  Pennsylvania Avenue Development Corporation (Parts 
                900--999)
         X  Presidio Trust (Parts 1000--1099)
        XI  Architectural and Transportation Barriers Compliance 
                Board (Parts 1100--1199)
       XII  National Archives and Records Administration (Parts 
                1200--1299)
        XV  Oklahoma City National Memorial Trust (Parts 1500--
                1599)
       XVI  Morris K. Udall Scholarship and Excellence in National 
                Environmental Policy Foundation (Parts 1600--1699)

             Title 37--Patents, Trademarks, and Copyrights

         I  United States Patent and Trademark Office, Department 
                of Commerce (Parts 1--199)
        II  U.S. Copyright Office, Library of Congress (Parts 
                200--299)

[[Page 937]]

       III  Copyright Royalty Board, Library of Congress (Parts 
                300--399)
        IV  National Institute of Standards and Technology, 
                Department of Commerce (Parts 400--599)

           Title 38--Pensions, Bonuses, and Veterans' Relief

         I  Department of Veterans Affairs (Parts 0--199)
        II  Armed Forces Retirement Home (Parts 200--299)

                       Title 39--Postal Service

         I  United States Postal Service (Parts 1--999)
       III  Postal Regulatory Commission (Parts 3000--3099)

                  Title 40--Protection of Environment

         I  Environmental Protection Agency (Parts 1--1099)
        IV  Environmental Protection Agency and Department of 
                Justice (Parts 1400--1499)
         V  Council on Environmental Quality (Parts 1500--1599)
        VI  Chemical Safety and Hazard Investigation Board (Parts 
                1600--1699)
       VII  Environmental Protection Agency and Department of 
                Defense; Uniform National Discharge Standards for 
                Vessels of the Armed Forces (Parts 1700--1799)
      VIII  Gulf Coast Ecosystem Restoration Council (Parts 1800--
                1899)
        IX  Federal Permitting Improvement Steering Council (Part 
                1900)

          Title 41--Public Contracts and Property Management

            Subtitle A--Federal Procurement Regulations System 
                [Note]
            Subtitle B--Other Provisions Relating to Public 
                Contracts
        50  Public Contracts, Department of Labor (Parts 50-1--50-
                999)
        51  Committee for Purchase From People Who Are Blind or 
                Severely Disabled (Parts 51-1--51-99)
        60  Office of Federal Contract Compliance Programs, Equal 
                Employment Opportunity, Department of Labor (Parts 
                60-1--60-999)
        61  Office of the Assistant Secretary for Veterans' 
                Employment and Training Service, Department of 
                Labor (Parts 61-1--61-999)
   62--100  [Reserved]
            Subtitle C--Federal Property Management Regulations 
                System
       101  Federal Property Management Regulations (Parts 101-1--
                101-99)
       102  Federal Management Regulation (Parts 102-1--102-299)
  103--104  [Reserved]
       105  General Services Administration (Parts 105-1--105-999)

[[Page 938]]

       109  Department of Energy Property Management Regulations 
                (Parts 109-1--109-99)
       114  Department of the Interior (Parts 114-1--114-99)
       115  Environmental Protection Agency (Parts 115-1--115-99)
       128  Department of Justice (Parts 128-1--128-99)
  129--200  [Reserved]
            Subtitle D--Other Provisions Relating to Property 
                Management [Reserved]
            Subtitle E--Federal Information Resources Management 
                Regulations System [Reserved]
            Subtitle F--Federal Travel Regulation System
       300  General (Parts 300-1--300-99)
       301  Temporary Duty (TDY) Travel Allowances (Parts 301-1--
                301-99)
       302  Relocation Allowances (Parts 302-1--302-99)
       303  Payment of Expenses Connected with the Death of 
                Certain Employees (Part 303-1--303-99)
       304  Payment of Travel Expenses from a Non-Federal Source 
                (Parts 304-1--304-99)

                        Title 42--Public Health

         I  Public Health Service, Department of Health and Human 
                Services (Parts 1--199)
   II--III  [Reserved]
        IV  Centers for Medicare & Medicaid Services, Department 
                of Health and Human Services (Parts 400--699)
         V  Office of Inspector General-Health Care, Department of 
                Health and Human Services (Parts 1000--1099)

                   Title 43--Public Lands: Interior

            Subtitle A--Office of the Secretary of the Interior 
                (Parts 1--199)
            Subtitle B--Regulations Relating to Public Lands
         I  Bureau of Reclamation, Department of the Interior 
                (Parts 400--999)
        II  Bureau of Land Management, Department of the Interior 
                (Parts 1000--9999)
       III  Utah Reclamation Mitigation and Conservation 
                Commission (Parts 10000--10099)

             Title 44--Emergency Management and Assistance

         I  Federal Emergency Management Agency, Department of 
                Homeland Security (Parts 0--399)
        IV  Department of Commerce and Department of 
                Transportation (Parts 400--499)

[[Page 939]]

                       Title 45--Public Welfare

            Subtitle A--Department of Health and Human Services 
                (Parts 1--199)
            Subtitle B--Regulations Relating to Public Welfare
        II  Office of Family Assistance (Assistance Programs), 
                Administration for Children and Families, 
                Department of Health and Human Services (Parts 
                200--299)
       III  Office of Child Support Enforcement (Child Support 
                Enforcement Program), Administration for Children 
                and Families, Department of Health and Human 
                Services (Parts 300--399)
        IV  Office of Refugee Resettlement, Administration for 
                Children and Families, Department of Health and 
                Human Services (Parts 400--499)
         V  Foreign Claims Settlement Commission of the United 
                States, Department of Justice (Parts 500--599)
        VI  National Science Foundation (Parts 600--699)
       VII  Commission on Civil Rights (Parts 700--799)
      VIII  Office of Personnel Management (Parts 800--899)
        IX  Denali Commission (Parts 900--999)
         X  Office of Community Services, Administration for 
                Children and Families, Department of Health and 
                Human Services (Parts 1000--1099)
        XI  National Foundation on the Arts and the Humanities 
                (Parts 1100--1199)
       XII  Corporation for National and Community Service (Parts 
                1200--1299)
      XIII  Administration for Children and Families, Department 
                of Health and Human Services (Parts 1300--1399)
       XVI  Legal Services Corporation (Parts 1600--1699)
      XVII  National Commission on Libraries and Information 
                Science (Parts 1700--1799)
     XVIII  Harry S. Truman Scholarship Foundation (Parts 1800--
                1899)
       XXI  Commission of Fine Arts (Parts 2100--2199)
     XXIII  Arctic Research Commission (Parts 2300--2399)
      XXIV  James Madison Memorial Fellowship Foundation (Parts 
                2400--2499)
       XXV  Corporation for National and Community Service (Parts 
                2500--2599)

                          Title 46--Shipping

         I  Coast Guard, Department of Homeland Security (Parts 
                1--199)
        II  Maritime Administration, Department of Transportation 
                (Parts 200--399)
       III  Coast Guard (Great Lakes Pilotage), Department of 
                Homeland Security (Parts 400--499)
        IV  Federal Maritime Commission (Parts 500--599)

[[Page 940]]

                      Title 47--Telecommunication

         I  Federal Communications Commission (Parts 0--199)
        II  Office of Science and Technology Policy and National 
                Security Council (Parts 200--299)
       III  National Telecommunications and Information 
                Administration, Department of Commerce (Parts 
                300--399)
        IV  National Telecommunications and Information 
                Administration, Department of Commerce, and 
                National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 400--499)
         V  The First Responder Network Authority (Parts 500--599)

           Title 48--Federal Acquisition Regulations System

         1  Federal Acquisition Regulation (Parts 1--99)
         2  Defense Acquisition Regulations System, Department of 
                Defense (Parts 200--299)
         3  Department of Health and Human Services (Parts 300--
                399)
         4  Department of Agriculture (Parts 400--499)
         5  General Services Administration (Parts 500--599)
         6  Department of State (Parts 600--699)
         7  Agency for International Development (Parts 700--799)
         8  Department of Veterans Affairs (Parts 800--899)
         9  Department of Energy (Parts 900--999)
        10  Department of the Treasury (Parts 1000--1099)
        12  Department of Transportation (Parts 1200--1299)
        13  Department of Commerce (Parts 1300--1399)
        14  Department of the Interior (Parts 1400--1499)
        15  Environmental Protection Agency (Parts 1500--1599)
        16  Office of Personnel Management Federal Employees 
                Health Benefits Acquisition Regulation (Parts 
                1600--1699)
        17  Office of Personnel Management (Parts 1700--1799)
        18  National Aeronautics and Space Administration (Parts 
                1800--1899)
        19  Broadcasting Board of Governors (Parts 1900--1999)
        20  Nuclear Regulatory Commission (Parts 2000--2099)
        21  Office of Personnel Management, Federal Employees 
                Group Life Insurance Federal Acquisition 
                Regulation (Parts 2100--2199)
        23  Social Security Administration (Parts 2300--2399)
        24  Department of Housing and Urban Development (Parts 
                2400--2499)
        25  National Science Foundation (Parts 2500--2599)
        28  Department of Justice (Parts 2800--2899)
        29  Department of Labor (Parts 2900--2999)
        30  Department of Homeland Security, Homeland Security 
                Acquisition Regulation (HSAR) (Parts 3000--3099)
        34  Department of Education Acquisition Regulation (Parts 
                3400--3499)

[[Page 941]]

        51  Department of the Army Acquisition Regulations (Parts 
                5100--5199) [Reserved]
        52  Department of the Navy Acquisition Regulations (Parts 
                5200--5299)
        53  Department of the Air Force Federal Acquisition 
                Regulation Supplement (Parts 5300--5399) 
                [Reserved]
        54  Defense Logistics Agency, Department of Defense (Parts 
                5400--5499)
        57  African Development Foundation (Parts 5700--5799)
        61  Civilian Board of Contract Appeals, General Services 
                Administration (Parts 6100--6199)
        99  Cost Accounting Standards Board, Office of Federal 
                Procurement Policy, Office of Management and 
                Budget (Parts 9900--9999)

                       Title 49--Transportation

            Subtitle A--Office of the Secretary of Transportation 
                (Parts 1--99)
            Subtitle B--Other Regulations Relating to 
                Transportation
         I  Pipeline and Hazardous Materials Safety 
                Administration, Department of Transportation 
                (Parts 100--199)
        II  Federal Railroad Administration, Department of 
                Transportation (Parts 200--299)
       III  Federal Motor Carrier Safety Administration, 
                Department of Transportation (Parts 300--399)
        IV  Coast Guard, Department of Homeland Security (Parts 
                400--499)
         V  National Highway Traffic Safety Administration, 
                Department of Transportation (Parts 500--599)
        VI  Federal Transit Administration, Department of 
                Transportation (Parts 600--699)
       VII  National Railroad Passenger Corporation (AMTRAK) 
                (Parts 700--799)
      VIII  National Transportation Safety Board (Parts 800--999)
         X  Surface Transportation Board (Parts 1000--1399)
        XI  Research and Innovative Technology Administration, 
                Department of Transportation (Parts 1400--1499) 
                [Reserved]
       XII  Transportation Security Administration, Department of 
                Homeland Security (Parts 1500--1699)

                   Title 50--Wildlife and Fisheries

         I  United States Fish and Wildlife Service, Department of 
                the Interior (Parts 1--199)
        II  National Marine Fisheries Service, National Oceanic 
                and Atmospheric Administration, Department of 
                Commerce (Parts 200--299)
       III  International Fishing and Related Activities (Parts 
                300--399)

[[Page 942]]

        IV  Joint Regulations (United States Fish and Wildlife 
                Service, Department of the Interior and National 
                Marine Fisheries Service, National Oceanic and 
                Atmospheric Administration, Department of 
                Commerce); Endangered Species Committee 
                Regulations (Parts 400--499)
         V  Marine Mammal Commission (Parts 500--599)
        VI  Fishery Conservation and Management, National Oceanic 
                and Atmospheric Administration, Department of 
                Commerce (Parts 600--699)

[[Page 943]]





           Alphabetical List of Agencies Appearing in the CFR




                      (Revised as of July 1, 2021)

                                                  CFR Title, Subtitle or 
                     Agency                               Chapter

Administrative Conference of the United States    1, III
Advisory Council on Historic Preservation         36, VIII
Advocacy and Outreach, Office of                  7, XXV
Afghanistan Reconstruction, Special Inspector     5, LXXXIII
     General for
African Development Foundation                    22, XV
  Federal Acquisition Regulation                  48, 57
Agency for International Development              2, VII; 22, II
  Federal Acquisition Regulation                  48, 7
Agricultural Marketing Service                    7, I, VIII, IX, X, XI; 9, 
                                                  II
Agricultural Research Service                     7, V
Agriculture, Department of                        2, IV; 5, LXXIII
  Advocacy and Outreach, Office of                7, XXV
  Agricultural Marketing Service                  7, I, VIII, IX, X, XI; 9, 
                                                  II
  Agricultural Research Service                   7, V
  Animal and Plant Health Inspection Service      7, III; 9, I
  Chief Financial Officer, Office of              7, XXX
  Commodity Credit Corporation                    7, XIV
  Economic Research Service                       7, XXXVII
  Energy Policy and New Uses, Office of           2, IX; 7, XXIX
  Environmental Quality, Office of                7, XXXI
  Farm Service Agency                             7, VII, XVIII
  Federal Acquisition Regulation                  48, 4
  Federal Crop Insurance Corporation              7, IV
  Food and Nutrition Service                      7, II
  Food Safety and Inspection Service              9, III
  Foreign Agricultural Service                    7, XV
  Forest Service                                  36, II
  Information Resources Management, Office of     7, XXVII
  Inspector General, Office of                    7, XXVI
  National Agricultural Library                   7, XLI
  National Agricultural Statistics Service        7, XXXVI
  National Institute of Food and Agriculture      7, XXXIV
  Natural Resources Conservation Service          7, VI
  Operations, Office of                           7, XXVIII
  Procurement and Property Management, Office of  7, XXXII
  Rural Business-Cooperative Service              7, XVIII, XLII
  Rural Development Administration                7, XLII
  Rural Housing Service                           7, XVIII, XXXV
  Rural Utilities Service                         7, XVII, XVIII, XLII
  Secretary of Agriculture, Office of             7, Subtitle A
  Transportation, Office of                       7, XXXIII
  World Agricultural Outlook Board                7, XXXVIII
Air Force, Department of                          32, VII
  Federal Acquisition Regulation Supplement       48, 53
Air Transportation Stabilization Board            14, VI
Alcohol and Tobacco Tax and Trade Bureau          27, I
Alcohol, Tobacco, Firearms, and Explosives,       27, II
     Bureau of
AMTRAK                                            49, VII
American Battle Monuments Commission              36, IV
American Indians, Office of the Special Trustee   25, VII
Animal and Plant Health Inspection Service        7, III; 9, I
Appalachian Regional Commission                   5, IX
Architectural and Transportation Barriers         36, XI
   Compliance Board
[[Page 944]]

Arctic Research Commission                        45, XXIII
Armed Forces Retirement Home                      5, XI; 38, II
Army, Department of                               32, V
  Engineers, Corps of                             33, II; 36, III
  Federal Acquisition Regulation                  48, 51
Benefits Review Board                             20, VII
Bilingual Education and Minority Languages        34, V
     Affairs, Office of
Blind or Severely Disabled, Committee for         41, 51
     Purchase from People Who Are
  Federal Acquisition Regulation                  48, 19
Career, Technical, and Adult Education, Office    34, IV
     of
Census Bureau                                     15, I
Centers for Medicare & Medicaid Services          42, IV
Central Intelligence Agency                       32, XIX
Chemical Safety and Hazard Investigation Board    40, VI
Chief Financial Officer, Office of                7, XXX
Child Support Enforcement, Office of              45, III
Children and Families, Administration for         45, II, III, IV, X, XIII
Civil Rights, Commission on                       5, LXVIII; 45, VII
Civil Rights, Office for                          34, I
Coast Guard                                       33, I; 46, I; 49, IV
Coast Guard (Great Lakes Pilotage)                46, III
Commerce, Department of                           2, XIII; 44, IV; 50, VI
  Census Bureau                                   15, I
  Economic Affairs, Office of the Under-          15, XV
       Secretary for
  Economic Analysis, Bureau of                    15, VIII
  Economic Development Administration             13, III
  Emergency Management and Assistance             44, IV
  Federal Acquisition Regulation                  48, 13
  Foreign-Trade Zones Board                       15, IV
  Industry and Security, Bureau of                15, VII
  International Trade Administration              15, III; 19, III
  National Institute of Standards and Technology  15, II; 37, IV
  National Marine Fisheries Service               50, II, IV
  National Oceanic and Atmospheric                15, IX; 50, II, III, IV, 
       Administration                             VI
  National Technical Information Service          15, XI
  National Telecommunications and Information     15, XXIII; 47, III, IV
       Administration
  National Weather Service                        15, IX
  Patent and Trademark Office, United States      37, I
  Secretary of Commerce, Office of                15, Subtitle A
Commercial Space Transportation                   14, III
Commodity Credit Corporation                      7, XIV
Commodity Futures Trading Commission              5, XLI; 17, I
Community Planning and Development, Office of     24, V, VI
     Assistant Secretary for
Community Services, Office of                     45, X
Comptroller of the Currency                       12, I
Construction Industry Collective Bargaining       29, IX
     Commission
Consumer Financial Protection Bureau              5, LXXXIV; 12, X
Consumer Product Safety Commission                5, LXXI; 16, II
Copyright Royalty Board                           37, III
Corporation for National and Community Service    2, XXII; 45, XII, XXV
Cost Accounting Standards Board                   48, 99
Council on Environmental Quality                  40, V
Council of the Inspectors General on Integrity    5, XCVIII
     and Efficiency
Court Services and Offender Supervision Agency    5, LXX; 28, VIII
     for the District of Columbia
Customs and Border Protection                     19, I
Defense, Department of                            2, XI; 5, XXVI; 32, 
                                                  Subtitle A; 40, VII
  Advanced Research Projects Agency               32, I
  Air Force Department                            32, VII
  Army Department                                 32, V; 33, II; 36, III; 
                                                  48, 51
  Defense Acquisition Regulations System          48, 2
  Defense Intelligence Agency                     32, I

[[Page 945]]

  Defense Logistics Agency                        32, I, XII; 48, 54
  Engineers, Corps of                             33, II; 36, III
  National Imagery and Mapping Agency             32, I
  Navy, Department of                             32, VI; 48, 52
  Secretary of Defense, Office of                 2, XI; 32, I
Defense Contract Audit Agency                     32, I
Defense Intelligence Agency                       32, I
Defense Logistics Agency                          32, XII; 48, 54
Defense Nuclear Facilities Safety Board           10, XVII
Delaware River Basin Commission                   18, III
Denali Commission                                 45, IX
Disability, National Council on                   5, C; 34, XII
District of Columbia, Court Services and          5, LXX; 28, VIII
     Offender Supervision Agency for the
Drug Enforcement Administration                   21, II
East-West Foreign Trade Board                     15, XIII
Economic Affairs, Office of the Under-Secretary   15, XV
     for
Economic Analysis, Bureau of                      15, VIII
Economic Development Administration               13, III
Economic Research Service                         7, XXXVII
Education, Department of                          2, XXXIV; 5, LIII
  Bilingual Education and Minority Languages      34, V
       Affairs, Office of
  Career, Technical, and Adult Education, Office  34, IV
       of
  Civil Rights, Office for                        34, I
  Educational Research and Improvement, Office    34, VII
       of
  Elementary and Secondary Education, Office of   34, II
  Federal Acquisition Regulation                  48, 34
  Postsecondary Education, Office of              34, VI
  Secretary of Education, Office of               34, Subtitle A
  Special Education and Rehabilitative Services,  34, III
       Office of
Educational Research and Improvement, Office of   34, VII
Election Assistance Commission                    2, LVIII; 11, II
Elementary and Secondary Education, Office of     34, II
Emergency Oil and Gas Guaranteed Loan Board       13, V
Emergency Steel Guarantee Loan Board              13, IV
Employee Benefits Security Administration         29, XXV
Employees' Compensation Appeals Board             20, IV
Employees Loyalty Board                           5, V
Employment and Training Administration            20, V
Employment Policy, National Commission for        1, IV
Employment Standards Administration               20, VI
Endangered Species Committee                      50, IV
Energy, Department of                             2, IX; 5, XXIII; 10, II, 
                                                  III, X
  Federal Acquisition Regulation                  48, 9
  Federal Energy Regulatory Commission            5, XXIV; 18, I
  Property Management Regulations                 41, 109
Energy, Office of                                 7, XXIX
Engineers, Corps of                               33, II; 36, III
Engraving and Printing, Bureau of                 31, VI
Environmental Protection Agency                   2, XV; 5, LIV; 40, I, IV, 
                                                  VII
  Federal Acquisition Regulation                  48, 15
  Property Management Regulations                 41, 115
Environmental Quality, Office of                  7, XXXI
Equal Employment Opportunity Commission           5, LXII; 29, XIV
Equal Opportunity, Office of Assistant Secretary  24, I
     for
Executive Office of the President                 3, I
  Environmental Quality, Council on               40, V
  Management and Budget, Office of                2, Subtitle A; 5, III, 
                                                  LXXVII; 14, VI; 48, 99
  National Drug Control Policy, Office of         2, XXXVI; 21, III
  National Security Council                       32, XXI; 47, II
  Presidential Documents                          3
  Science and Technology Policy, Office of        32, XXIV; 47, II
  Trade Representative, Office of the United      15, XX
     States
[[Page 946]]

Export-Import Bank of the United States           2, XXXV; 5, LII; 12, IV
Family Assistance, Office of                      45, II
Farm Credit Administration                        5, XXXI; 12, VI
Farm Credit System Insurance Corporation          5, XXX; 12, XIV
Farm Service Agency                               7, VII, XVIII
Federal Acquisition Regulation                    48, 1
Federal Aviation Administration                   14, I
  Commercial Space Transportation                 14, III
Federal Claims Collection Standards               31, IX
Federal Communications Commission                 5, XXIX; 47, I
Federal Contract Compliance Programs, Office of   41, 60
Federal Crop Insurance Corporation                7, IV
Federal Deposit Insurance Corporation             5, XXII; 12, III
Federal Election Commission                       5, XXXVII; 11, I
Federal Emergency Management Agency               44, I
Federal Employees Group Life Insurance Federal    48, 21
     Acquisition Regulation
Federal Employees Health Benefits Acquisition     48, 16
     Regulation
Federal Energy Regulatory Commission              5, XXIV; 18, I
Federal Financial Institutions Examination        12, XI
     Council
Federal Financing Bank                            12, VIII
Federal Highway Administration                    23, I, II
Federal Home Loan Mortgage Corporation            1, IV
Federal Housing Enterprise Oversight Office       12, XVII
Federal Housing Finance Agency                    5, LXXX; 12, XII
Federal Labor Relations Authority                 5, XIV, XLIX; 22, XIV
Federal Law Enforcement Training Center           31, VII
Federal Management Regulation                     41, 102
Federal Maritime Commission                       46, IV
Federal Mediation and Conciliation Service        29, XII
Federal Mine Safety and Health Review Commission  5, LXXIV; 29, XXVII
Federal Motor Carrier Safety Administration       49, III
Federal Permitting Improvement Steering Council   40, IX
Federal Prison Industries, Inc.                   28, III
Federal Procurement Policy Office                 48, 99
Federal Property Management Regulations           41, 101
Federal Railroad Administration                   49, II
Federal Register, Administrative Committee of     1, I
Federal Register, Office of                       1, II
Federal Reserve System                            12, II
  Board of Governors                              5, LVIII
Federal Retirement Thrift Investment Board        5, VI, LXXVI
Federal Service Impasses Panel                    5, XIV
Federal Trade Commission                          5, XLVII; 16, I
Federal Transit Administration                    49, VI
Federal Travel Regulation System                  41, Subtitle F
Financial Crimes Enforcement Network              31, X
Financial Research Office                         12, XVI
Financial Stability Oversight Council             12, XIII
Fine Arts, Commission of                          45, XXI
Fiscal Service                                    31, II
Fish and Wildlife Service, United States          50, I, IV
Food and Drug Administration                      21, I
Food and Nutrition Service                        7, II
Food Safety and Inspection Service                9, III
Foreign Agricultural Service                      7, XV
Foreign Assets Control, Office of                 31, V
Foreign Claims Settlement Commission of the       45, V
     United States
Foreign Service Grievance Board                   22, IX
Foreign Service Impasse Disputes Panel            22, XIV
Foreign Service Labor Relations Board             22, XIV
Foreign-Trade Zones Board                         15, IV
Forest Service                                    36, II
General Services Administration                   5, LVII; 41, 105
  Contract Appeals, Board of                      48, 61
  Federal Acquisition Regulation                  48, 5
  Federal Management Regulation                   41, 102

[[Page 947]]

  Federal Property Management Regulations         41, 101
  Federal Travel Regulation System                41, Subtitle F
  General                                         41, 300
  Payment From a Non-Federal Source for Travel    41, 304
       Expenses
  Payment of Expenses Connected With the Death    41, 303
       of Certain Employees
  Relocation Allowances                           41, 302
  Temporary Duty (TDY) Travel Allowances          41, 301
Geological Survey                                 30, IV
Government Accountability Office                  4, I
Government Ethics, Office of                      5, XVI
Government National Mortgage Association          24, III
Grain Inspection, Packers and Stockyards          7, VIII; 9, II
     Administration
Great Lakes St. Lawrence Seaway Development       33, IV
     Corporation
Gulf Coast Ecosystem Restoration Council          2, LIX; 40, VIII
Harry S. Truman Scholarship Foundation            45, XVIII
Health and Human Services, Department of          2, III; 5, XLV; 45, 
                                                  Subtitle A
  Centers for Medicare & Medicaid Services        42, IV
  Child Support Enforcement, Office of            45, III
  Children and Families, Administration for       45, II, III, IV, X, XIII
  Community Services, Office of                   45, X
  Family Assistance, Office of                    45, II
  Federal Acquisition Regulation                  48, 3
  Food and Drug Administration                    21, I
  Indian Health Service                           25, V
  Inspector General (Health Care), Office of      42, V
  Public Health Service                           42, I
  Refugee Resettlement, Office of                 45, IV
Homeland Security, Department of                  2, XXX; 5, XXXVI; 6, I; 8, 
                                                  I
  Coast Guard                                     33, I; 46, I; 49, IV
  Coast Guard (Great Lakes Pilotage)              46, III
  Customs and Border Protection                   19, I
  Federal Emergency Management Agency             44, I
  Human Resources Management and Labor Relations  5, XCVII
       Systems
  Immigration and Customs Enforcement Bureau      19, IV
  Transportation Security Administration          49, XII
HOPE for Homeowners Program, Board of Directors   24, XXIV
     of
Housing, Office of, and Multifamily Housing       24, IV
     Assistance Restructuring, Office of
Housing and Urban Development, Department of      2, XXIV; 5, LXV; 24, 
                                                  Subtitle B
  Community Planning and Development, Office of   24, V, VI
       Assistant Secretary for
  Equal Opportunity, Office of Assistant          24, I
       Secretary for
  Federal Acquisition Regulation                  48, 24
  Federal Housing Enterprise Oversight, Office    12, XVII
       of
  Government National Mortgage Association        24, III
  Housing--Federal Housing Commissioner, Office   24, II, VIII, X, XX
       of Assistant Secretary for
  Housing, Office of, and Multifamily Housing     24, IV
       Assistance Restructuring, Office of
  Inspector General, Office of                    24, XII
  Public and Indian Housing, Office of Assistant  24, IX
       Secretary for
  Secretary, Office of                            24, Subtitle A, VII
Housing--Federal Housing Commissioner, Office of  24, II, VIII, X, XX
     Assistant Secretary for
Housing, Office of, and Multifamily Housing       24, IV
     Assistance Restructuring, Office of
Immigration and Customs Enforcement Bureau        19, IV
Immigration Review, Executive Office for          8, V
Independent Counsel, Office of                    28, VII
Independent Counsel, Offices of                   28, VI
Indian Affairs, Bureau of                         25, I, V
Indian Affairs, Office of the Assistant           25, VI
   Secretary
[[Page 948]]

Indian Arts and Crafts Board                      25, II
Indian Health Service                             25, V
Industry and Security, Bureau of                  15, VII
Information Resources Management, Office of       7, XXVII
Information Security Oversight Office, National   32, XX
     Archives and Records Administration
Inspector General
  Agriculture Department                          7, XXVI
  Health and Human Services Department            42, V
  Housing and Urban Development Department        24, XII, XV
Institute of Peace, United States                 22, XVII
Inter-American Foundation                         5, LXIII; 22, X
Interior, Department of                           2, XIV
  American Indians, Office of the Special         25, VII
       Trustee
  Endangered Species Committee                    50, IV
  Federal Acquisition Regulation                  48, 14
  Federal Property Management Regulations System  41, 114
  Fish and Wildlife Service, United States        50, I, IV
  Geological Survey                               30, IV
  Indian Affairs, Bureau of                       25, I, V
  Indian Affairs, Office of the Assistant         25, VI
       Secretary
  Indian Arts and Crafts Board                    25, II
  Land Management, Bureau of                      43, II
  National Indian Gaming Commission               25, III
  National Park Service                           36, I
  Natural Resource Revenue, Office of             30, XII
  Ocean Energy Management, Bureau of              30, V
  Reclamation, Bureau of                          43, I
  Safety and Environmental Enforcement, Bureau    30, II
       of
  Secretary of the Interior, Office of            2, XIV; 43, Subtitle A
  Surface Mining Reclamation and Enforcement,     30, VII
       Office of
Internal Revenue Service                          26, I
International Boundary and Water Commission,      22, XI
     United States and Mexico, United States 
     Section
International Development, United States Agency   22, II
     for
  Federal Acquisition Regulation                  48, 7
International Development Cooperation Agency,     22, XII
     United States
International Development Finance Corporation,    5, XXXIII; 22, VII
     U.S.
International Joint Commission, United States     22, IV
     and Canada
International Organizations Employees Loyalty     5, V
     Board
International Trade Administration                15, III; 19, III
International Trade Commission, United States     19, II
Interstate Commerce Commission                    5, XL
Investment Security, Office of                    31, VIII
James Madison Memorial Fellowship Foundation      45, XXIV
Japan-United States Friendship Commission         22, XVI
Joint Board for the Enrollment of Actuaries       20, VIII
Justice, Department of                            2, XXVIII; 5, XXVIII; 28, 
                                                  I, XI; 40, IV
  Alcohol, Tobacco, Firearms, and Explosives,     27, II
       Bureau of
  Drug Enforcement Administration                 21, II
  Federal Acquisition Regulation                  48, 28
  Federal Claims Collection Standards             31, IX
  Federal Prison Industries, Inc.                 28, III
  Foreign Claims Settlement Commission of the     45, V
       United States
  Immigration Review, Executive Office for        8, V
  Independent Counsel, Offices of                 28, VI
  Prisons, Bureau of                              28, V
  Property Management Regulations                 41, 128
Labor, Department of                              2, XXIX; 5, XLII
  Benefits Review Board                           20, VII
  Employee Benefits Security Administration       29, XXV
  Employees' Compensation Appeals Board           20, IV
  Employment and Training Administration          20, V
  Federal Acquisition Regulation                  48, 29

[[Page 949]]

  Federal Contract Compliance Programs, Office    41, 60
       of
  Federal Procurement Regulations System          41, 50
  Labor-Management Standards, Office of           29, II, IV
  Mine Safety and Health Administration           30, I
  Occupational Safety and Health Administration   29, XVII
  Public Contracts                                41, 50
  Secretary of Labor, Office of                   29, Subtitle A
  Veterans' Employment and Training Service,      41, 61; 20, IX
       Office of the Assistant Secretary for
  Wage and Hour Division                          29, V
  Workers' Compensation Programs, Office of       20, I, VI
Labor-Management Standards, Office of             29, II, IV
Land Management, Bureau of                        43, II
Legal Services Corporation                        45, XVI
Libraries and Information Science, National       45, XVII
     Commission on
Library of Congress                               36, VII
  Copyright Royalty Board                         37, III
  U.S. Copyright Office                           37, II
Management and Budget, Office of                  5, III, LXXVII; 14, VI; 
                                                  48, 99
Marine Mammal Commission                          50, V
Maritime Administration                           46, II
Merit Systems Protection Board                    5, II, LXIV
Micronesian Status Negotiations, Office for       32, XXVII
Military Compensation and Retirement              5, XCIX
     Modernization Commission
Millennium Challenge Corporation                  22, XIII
Mine Safety and Health Administration             30, I
Minority Business Development Agency              15, XIV
Miscellaneous Agencies                            1, IV
Monetary Offices                                  31, I
Morris K. Udall Scholarship and Excellence in     36, XVI
     National Environmental Policy Foundation
Museum and Library Services, Institute of         2, XXXI
National Aeronautics and Space Administration     2, XVIII; 5, LIX; 14, V
  Federal Acquisition Regulation                  48, 18
National Agricultural Library                     7, XLI
National Agricultural Statistics Service          7, XXXVI
National and Community Service, Corporation for   2, XXII; 45, XII, XXV
National Archives and Records Administration      2, XXVI; 5, LXVI; 36, XII
  Information Security Oversight Office           32, XX
National Capital Planning Commission              1, IV, VI
National Counterintelligence Center               32, XVIII
National Credit Union Administration              5, LXXXVI; 12, VII
National Crime Prevention and Privacy Compact     28, IX
     Council
National Drug Control Policy, Office of           2, XXXVI; 21, III
National Endowment for the Arts                   2, XXXII
National Endowment for the Humanities             2, XXXIII
National Foundation on the Arts and the           45, XI
     Humanities
National Geospatial-Intelligence Agency           32, I
National Highway Traffic Safety Administration    23, II, III; 47, VI; 49, V
National Imagery and Mapping Agency               32, I
National Indian Gaming Commission                 25, III
National Institute of Food and Agriculture        7, XXXIV
National Institute of Standards and Technology    15, II; 37, IV
National Intelligence, Office of Director of      5, IV; 32, XVII
National Labor Relations Board                    5, LXI; 29, I
National Marine Fisheries Service                 50, II, IV
National Mediation Board                          5, CI; 29, X
National Oceanic and Atmospheric Administration   15, IX; 50, II, III, IV, 
                                                  VI
National Park Service                             36, I
National Railroad Adjustment Board                29, III
National Railroad Passenger Corporation (AMTRAK)  49, VII
National Science Foundation                       2, XXV; 5, XLIII; 45, VI
  Federal Acquisition Regulation                  48, 25
National Security Council                         32, XXI; 47, II

[[Page 950]]

National Technical Information Service            15, XI
National Telecommunications and Information       15, XXIII; 47, III, IV, V
     Administration
National Transportation Safety Board              49, VIII
Natural Resource Revenue, Office of               30, XII
Natural Resources Conservation Service            7, VI
Navajo and Hopi Indian Relocation, Office of      25, IV
Navy, Department of                               32, VI
  Federal Acquisition Regulation                  48, 52
Neighborhood Reinvestment Corporation             24, XXV
Northeast Interstate Low-Level Radioactive Waste  10, XVIII
     Commission
Nuclear Regulatory Commission                     2, XX; 5, XLVIII; 10, I
  Federal Acquisition Regulation                  48, 20
Occupational Safety and Health Administration     29, XVII
Occupational Safety and Health Review Commission  29, XX
Ocean Energy Management, Bureau of                30, V
Oklahoma City National Memorial Trust             36, XV
Operations Office                                 7, XXVIII
Patent and Trademark Office, United States        37, I
Payment From a Non-Federal Source for Travel      41, 304
     Expenses
Payment of Expenses Connected With the Death of   41, 303
     Certain Employees
Peace Corps                                       2, XXXVII; 22, III
Pennsylvania Avenue Development Corporation       36, IX
Pension Benefit Guaranty Corporation              29, XL
Personnel Management, Office of                   5, I, IV, XXXV; 45, VIII
  Federal Acquisition Regulation                  48, 17
  Federal Employees Group Life Insurance Federal  48, 21
       Acquisition Regulation
  Federal Employees Health Benefits Acquisition   48, 16
       Regulation
  Human Resources Management and Labor Relations  5, XCVII
       Systems, Department of Homeland Security
Pipeline and Hazardous Materials Safety           49, I
     Administration
Postal Regulatory Commission                      5, XLVI; 39, III
Postal Service, United States                     5, LX; 39, I
Postsecondary Education, Office of                34, VI
President's Commission on White House             1, IV
     Fellowships
Presidential Documents                            3
Presidio Trust                                    36, X
Prisons, Bureau of                                28, V
Privacy and Civil Liberties Oversight Board       6, X
Procurement and Property Management, Office of    7, XXXII
Public and Indian Housing, Office of Assistant    24, IX
     Secretary for
Public Contracts, Department of Labor             41, 50
Public Health Service                             42, I
Railroad Retirement Board                         20, II
Reclamation, Bureau of                            43, I
Refugee Resettlement, Office of                   45, IV
Relocation Allowances                             41, 302
Research and Innovative Technology                49, XI
     Administration
Rural Business-Cooperative Service                7, XVIII, XLII
Rural Development Administration                  7, XLII
Rural Housing Service                             7, XVIII, XXXV
Rural Utilities Service                           7, XVII, XVIII, XLII
Safety and Environmental Enforcement, Bureau of   30, II
Science and Technology Policy, Office of, and     32, XXIV; 47, II
     National Security Council
Secret Service                                    31, IV
Securities and Exchange Commission                5, XXXIV; 17, II
Selective Service System                          32, XVI
Small Business Administration                     2, XXVII; 13, I
Smithsonian Institution                           36, V
Social Security Administration                    2, XXIII; 20, III; 48, 23
Soldiers' and Airmen's Home, United States        5, XI
Special Counsel, Office of                        5, VIII
Special Education and Rehabilitative Services,    34, III
   Office of
[[Page 951]]

State, Department of                              2, VI; 22, I; 28, XI
  Federal Acquisition Regulation                  48, 6
Surface Mining Reclamation and Enforcement,       30, VII
     Office of
Surface Transportation Board                      49, X
Susquehanna River Basin Commission                18, VIII
Tennessee Valley Authority                        5, LXIX; 18, XIII
Trade Representative, United States, Office of    15, XX
Transportation, Department of                     2, XII; 5, L
  Commercial Space Transportation                 14, III
  Emergency Management and Assistance             44, IV
  Federal Acquisition Regulation                  48, 12
  Federal Aviation Administration                 14, I
  Federal Highway Administration                  23, I, II
  Federal Motor Carrier Safety Administration     49, III
  Federal Railroad Administration                 49, II
  Federal Transit Administration                  49, VI
  Great Lakes St. Lawrence Seaway Development     33, IV
       Corporation
  Maritime Administration                         46, II
  National Highway Traffic Safety Administration  23, II, III; 47, IV; 49, V
  Pipeline and Hazardous Materials Safety         49, I
       Administration
  Secretary of Transportation, Office of          14, II; 49, Subtitle A
  Transportation Statistics Bureau                49, XI
Transportation, Office of                         7, XXXIII
Transportation Security Administration            49, XII
Transportation Statistics Bureau                  49, XI
Travel Allowances, Temporary Duty (TDY)           41, 301
Treasury, Department of the                       2, X; 5, XXI; 12, XV; 17, 
                                                  IV; 31, IX
  Alcohol and Tobacco Tax and Trade Bureau        27, I
  Community Development Financial Institutions    12, XVIII
       Fund
  Comptroller of the Currency                     12, I
  Customs and Border Protection                   19, I
  Engraving and Printing, Bureau of               31, VI
  Federal Acquisition Regulation                  48, 10
  Federal Claims Collection Standards             31, IX
  Federal Law Enforcement Training Center         31, VII
  Financial Crimes Enforcement Network            31, X
  Fiscal Service                                  31, II
  Foreign Assets Control, Office of               31, V
  Internal Revenue Service                        26, I
  Investment Security, Office of                  31, VIII
  Monetary Offices                                31, I
  Secret Service                                  31, IV
  Secretary of the Treasury, Office of            31, Subtitle A
Truman, Harry S. Scholarship Foundation           45, XVIII
United States Agency for Global Media             22, V
United States and Canada, International Joint     22, IV
     Commission
United States and Mexico, International Boundary  22, XI
     and Water Commission, United States Section
U.S. Copyright Office                             37, II
U.S. Office of Special Counsel                    5, CII
Utah Reclamation Mitigation and Conservation      43, III
     Commission
Veterans Affairs, Department of                   2, VIII; 38, I
  Federal Acquisition Regulation                  48, 8
Veterans' Employment and Training Service,        41, 61; 20, IX
     Office of the Assistant Secretary for
Vice President of the United States, Office of    32, XXVIII
Wage and Hour Division                            29, V
Water Resources Council                           18, VI
Workers' Compensation Programs, Office of         20, I, VII
World Agricultural Outlook Board                  7, XXXVIII

[[Page 953]]



List of CFR Sections Affected



All changes in this volume of the Code of Federal Regulations (CFR) that 
were made by documents published in the Federal Register since January 
1, 2016 are enumerated in the following list. Entries indicate the 
nature of the changes effected. Page numbers refer to Federal Register 
pages. The user should consult the entries for chapters, parts and 
subparts as well as sections for revisions.
For changes to this volume of the CFR prior to this listing, consult the 
annual edition of the monthly List of CFR Sections Affected (LSA). The 
LSA is available at www.govinfo.gov. For changes to this volume of the 
CFR prior to 2001, see the ``List of CFR Sections Affected, 1949-1963, 
1964-1972, 1973-1985, and 1986-2000'' published in 11 separate volumes. 
The ``List of CFR Sections Affected 1986-2000'' is available at 
www.govinfo.gov.

                                  2016

38 CFR
                                                                   81 FR
                                                                    Page
Chapter I
3.808 Regulation at 80 FR 10003 confirmed...........................1513
9.1 Regulation at 77 FR 60306 confirmed............................21468
9.5 Regulation at 77 FR 60306 confirmed............................21468
14.629 (c)(3) amended..............................................32649
17 Authority citation revised...............................66820, 90206
17.36 (d)(1) revised; interim......................................13997
17.36 Regulation at 81 FR 13997 confirmed..........................62632
17.96 Introductory text revised....................................46602
17.97 Removed......................................................46602
17.110 (b)(1)(i), (ii), (iii) and (2) amended; interim.............88120
    (a), (b)(1)(i), (ii), (iii), (2) and (3) revised; (b)(1)(iv), 
(4) heading and (5) added..........................................89390
17.400 Revised.....................................................46605
17.415 Undesignated center heading and section added...............90206
17.640 Undesignated center heading and section added...............66820
17.641 Added.......................................................66820
17.642 Added.......................................................66820
17.643 Added (OMB number pending)..................................66820
17.644 Added.......................................................66820
17.645 Added.......................................................66820
17.646 Added.......................................................66820
17.647 Added.......................................................66820
17.900 Amended.....................................................19890
17.902 (a) introductory text amended; OMB number...................19890
17.903 (a)(1) amended; OMB number..................................19890
17.904 OMB number..................................................19891
17.1530 (a)(1) and (2) correctly added.............................24027
17.2000 Regulation at 80 FR 46200 confirmed........................10765

                                  2017

38 CFR
                                                                   82 FR
                                                                    Page
Chapter I
1.460 Amended......................................................14822
1.461 (a)(1)(i) revised............................................14822
3.307 Heading, (a) introductory text and (1) revised; (a)(7) added
                                                                    4184
3.309 (f) added.....................................................4185
3.317 Regulation at 81 FR 71384 confirmed..........................49121
3.321 (b) heading and (1) revised..................................57835
4.104 Amended......................................................50804
4.119 Amended......................................................50804
4.150 Table amended................................................36083
4 Appendix A amended........................................36084, 50806
    Appendix B amended......................................36085, 50807

[[Page 954]]

    Appendix C amended......................................36085, 50807
8a.1 (a), (b), (d), and (e) introductory text amended; (c) 
        revised; authority citation and (f) added..................48631
8a.2 (a), (b)(2) through (8), and (c) amended; (b)(1) and 
        authority citation revised.................................48631
8a.3 (a), (b), (c), (d), and (e) amended; authority citation 
        revised....................................................48631
8a.4 (b) and (c) amended; authority citation revised...............48631
14.627 (r) added....................................................6272
    Regulation at 82 FR 6272 eff. date delayed to 3-21-17..........11151
    (l) through (r), (k) and (g) through (j) redesignated to (o) 
through (u), (m) and (h) through (k); new (g), new (l) and (n) 
added..............................................................26753
14.628 (b) designated as (b)(1); (b)(2) added; OMB number...........6272
    Regulation at 82 FR 6272 eff. date delayed to 3-21-17..........11151
14.629 (a)(2) introductory text and (i) amended.....................6272
    Regulation at 82 FR 6272 eff. date delayed to 3-21-17..........11151
    Introductory text revised; (a)(2)(ii), (b)(1)(i), (ii), 
(2)(ix), (5) and (c)(1) amended....................................26753
14.631 (d) amended.................................................26754
14.633 (e), introductory text and (f) amended......................26754
14.635 Introductory text amended....................................6272
    Regulation at 82 FR 6272 eff. date delayed to 3-21-17..........11151
14.636 (i)(2) amended; (3) revised.................................26754
14.637 (d)(2) amended; (3) revised.................................26754
16 Revised; eff. 1-19-18............................................7272
17 Authority citation revised..................6275, 16288, 21122, 51772
17.38 (c)(2) revised; OMB number; interim...........................6275
17.63 (e)(1)(i), (ii), and (j)(3) through (9) added; (i) revised 
                                                                   34415
    (j)(4)(i)(K) amended...........................................35451
17.110 Regulation at 81 FR 88120 confirmed.........................21118
17.169 Amended.....................................................16288
17.380 Undesignated center heading and section added; interim.......6275
    (b) correctly amended; interim.................................11153
17.410 Undesignated center heading revised; interim.................6276
    Revised........................................................21122
17.412 Added; interim...............................................6276
    (b) correctly amended; interim.................................11153
17.643 Second (c)(2)(ii) correctly redesignated as (c)(2)(iii)......4795
17.644 (a)(4) through (8) correctly redesignated as (a)(3) through 
        (7).........................................................4796
17.655 Undesignated center heading and section added...............51772

                                  2018

38 CFR
                                                                   83 FR
                                                                    Page
Chapter I
3.261 (a) table amended............................................47268
3.262 (l) introductory text amended; (s), (u), (v), (x), (y), (z), 
        and (aa) removed; (t) and (w) redesignated as (s) and (t); 
        new (t) revised; new (u) and new (v) added.................47268
    (u) amended....................................................52323
3.263 (e) through (i) removed; new (e) added.......................47269
3.270 (a) heading, note, and (b) heading amended...................47269
3.271 (i) added....................................................47269
3.272 (g) introductory text amended; (k), (o), (p), (r), (t) 
        through (w) removed; (q), (s), and (x) redesignated as 
        (o), (p), and (q); new (k), new (r), new (s), and new (t) 
        added; new (q) authority citation revised..................47269
3.274 Revised......................................................47269
3.275 Revised......................................................47271
3.276 Revised......................................................47271
3.277 (c)(2) introductory text amended.............................47272
3.278 Added........................................................47272
3.279 Added........................................................47274
3.307 Regulation at 80 FR 35248 confirmed..........................53182
3.350 (j) authority citation and paragraph added...................20736

[[Page 955]]

3.352 (b)(2) through (5) redesignated as (b)(3) through (6); 
        (b)(1)(iii) and new (4) amended; (b) authority citation 
        removed; new (b)(2) and new (b) authority citation added 
                                                                   20737
3.353 (b)(1) and (2) amended.......................................32738
3.401 (d) removed..................................................32738
3.403 Heading and (a)(2) revised...................................32738
3.452 Cross references revised.....................................32738
3.500 (l) and (m) removed..........................................32738
3.501 (j) removed..................................................32738
3.503 (c) added....................................................47275
3.551 (i) revised..................................................47275
3.552 (b)(2) amended; (b) authority citation removed; new (b) 
        authority citation added...................................20737
3.660 (d) amended..................................................47275
3.850--3.857 Undesignated center heading and sections removed......32738
3.1702 (a) revised.................................................39888
4.25 Table amended.................................................17756
4.77 (a) revised...................................................15320
4.78 (a) revised...................................................15321
4.79 Table amended.................................................15321
4.116 Amended......................................................15071
4.117 Undesignated center heading revised..........................54254
    Table amended...........................................54254, 54881
4.118 Introductory text removed; (a) and (b) added; table amended 
                                                                   32597
    Table amended..................................................38663
4 Appendix A amended..........................15072, 15322, 32600, 54257
4 Appendix B amended........................................32600, 54258
4 Appendix C amended........................................32601, 54259
    Appendices B and C amended..............................15073, 15323
8.34 Added.........................................................18422
9.2 (b)(5) added...................................................65528
9.22 Added.........................................................10623
13 Revised.........................................................32738
16.101 (l)(3) and (4) revised.......................................2893
    (l)(1) heading and (5) added; (l)(2), (3), and (4) revised.....28517
17 Authority citation revised.......................................9212
    Authority citation amended..............................21906, 29448
17.30 (b) revised..................................................48382
17.35 Revised; eff. 7-25-18........................................29448
17.47 (c) amended..................................................48382
17.101 (a)(9) added; authority citation revised....................31454
17.125 Revised; eff. 7-25-18.......................................29448
17.140 Removed; eff. 7-25-18.......................................29449
17.141 Removed; eff. 7-25-18.......................................29449
17.142 Undesignated center heading added; eff. 7-25-18.............29449
17.190--17.200 Undesignated center heading removed.................61271
17.190 Removed.....................................................61271
17.191 Removed.....................................................61271
17.192 Removed.....................................................61271
17.193 Removed.....................................................61271
17.194 Removed.....................................................61271
17.196 Removed.....................................................61271
17.197 Removed.....................................................61271
17.198 Removed.....................................................61271
17.199 Removed.....................................................61271
17.200 Removed.....................................................61271
17.350--17.370 Undesignated center heading removed; eff. 7-25-18 
                                                                   29449
17.350 Removed; eff. 7-25-18.......................................29449
17.351 Removed; eff. 7-25-18.......................................29449
17.352 Removed; eff. 7-25-18.......................................29449
17.355 Removed; eff. 7-25-18.......................................29449
17.362 Removed; eff. 7-25-18.......................................29449
17.363 Removed; eff. 7-25-18.......................................29449
17.364 Removed; eff. 7-25-18.......................................29449
17.365 Removed; eff. 7-25-18.......................................29449
17.366 Removed; eff. 7-25-18.......................................29449
17.367 Removed; eff. 7-25-18.......................................29449
17.369 Removed; eff. 7-25-18.......................................29449
17.370 Removed; eff. 7-25-18.......................................29449
17.380 Undesignated center heading revised; interim.................9212
17.390 Added; interim...............................................9212
17.415 Undesignated center heading revised.........................21906
17.417 Added.......................................................21906
17.1002 (f) revised; interim.........................................979
17.1003 (a), (c), and (d) revised; (e) added; interim................979
17.1005 (a) revised; (e) and (f) removed; interim....................979
17.1505 Regulation at 80 FR 74995 confirmed........................21897
17.1510 Regulation at 80 FR 74996 confirmed........................21897
17.1525 Regulation at 80 FR 74996 confirmed........................21897
17.1530 Regulation at 80 FR 74996 confirmed........................21897
    Regulation at 81 FR 24027 confirmed............................21897

[[Page 956]]

                                  2019

38 CFR
                                                                   84 FR
                                                                    Page
Chapter I
0.600--0.603 (Subpart A) Heading revised...........................22710
0.600 Revised......................................................22710
0.603 Added........................................................22710
1.519 (c) revised..................................................12125
1.550 (b) revised..................................................12125
1.551 Amended......................................................12125
1.552 (a) revised..................................................12125
1.554 (a), (b), (c), (d)(2), (4), and (e) revised..................12125
1.556 (c)(1) and (d)(3) revised....................................12126
1.557 (d) redesignated as (e); new (d) added; (a), (c), and (e) 
        revised....................................................12127
1.558 (c)(3) and (e) revised.......................................12127
1.559 (b), (c), and (d) revised....................................12127
1.561 (a), (b)(3), (d)(2), (e), (f), (g) introductory text, (1), 
        (h), (i), (l)(3), (5), and (n)(1) revised; (g)(2) removed; 
        (b)(1) added...............................................12128
    (b)(10) added..................................................14874
1.577 (c) and (e) revised..........................................12130
1.580 Revised......................................................12130
3 Notification......................................................2449
    Technical correction............................................4336
3.1 (p) revised......................................................166
3.31 Amended.........................................................166
3.103 Heading, (b)(1), (c), (d), and (f) revised.....................166
3.104 Heading and (a) revised; (b) heading and (c) added.............167
3.105 (a) and (b) revised; (j) added.................................167
3.110 (b) amended....................................................168
3.114 Amended........................................................168
3.151 (a) revised; (c) and (d) added.................................168
3.155 Introductory text amended; (d)(1) revised......................168
3.156 Heading, (a), and (b) heading revised; Introductory text and 
        (d) added....................................................169
3.158 (a) amended....................................................169
3.159 (a)(3), (b)(3), (c) introductory text, and (4)(iii) revised; 
        (b)(1) and (d) introductory text amended; (b)(4) and 
        (c)(4)(iv) added.............................................169
3.160 (a), (d), and (e) revised; (f) removed.........................170
3.161 Removed........................................................170
3.321 Amended........................................................170
3.326 Amended........................................................170
3.328 (b) amended; (c) revised.......................................170
3.372 Amended........................................................170
3.400 Introductory text, (h)(1), (2), (3), and (z)(2) revised; 
        (z)(3) added.................................................170
3.401 Amended........................................................171
3.402 Amended........................................................171
3.404 Amended........................................................171
3.655 Amended........................................................171
3.814 (e) introductory text amended..................................171
3.815 (i) introductory text amended..................................171
3.2400 Added.........................................................171
    (d) amended.....................................................4336
3.2500 Added.........................................................171
    (b) amended.....................................................4336
    Correction: (c) introductory text amended......................54033
3.2501 Added.........................................................172
3.2502 Added.........................................................172
3.2600 Heading revised; introductory text added; (g) removed.........172
    Heading and (c) revised; introductory text added; (g) removed 
                                                                    4336
3.2601 Added.........................................................173
4.88b Introductory text added; section amended; eff. 8-11-19.......28230
4 Appendix A amended; eff. 8-11-19.................................28233
4 Appendix B and Appendix C amended; eff. 8-11-19..................28234
8 Notification......................................................2449
    Technical correction............................................4336
8.30 Revised.........................................................173
14 Notification.....................................................2449
    Technical correction............................................4336
14.629 Introductory text removed; (b)(5) amended; (d) added..........174
14.631 (c) amended...................................................174
14.632 (c)(6) amended................................................174
14.633 (e)(2)(i), (ii), and (i) amended; (h) revised; (j) added......174
14.636 (c), (e)(8), (f), (i)(3), and (k) revised; (e)(7), (h)(3) 
        introductory text, and (i) amended; (e)(9) added.............175
14.637 (d)(3) and (f) revised........................................176
17 Notification......................................................407
17 Authority citation amended...8257, 26017, 26306, 33696, 57329, 61551, 
                                                                   68048
17.36 (b)(1) and (3) revised........................................7815
17.38 (a)(1)(iv) amended...........................................26306

[[Page 957]]

17.46 (a) introductory text amended; (a) authority citation and 
        (b) authority citation removed.............................26306
17.47 (d)(5) and authority citation removed; (d)(6) redesignated 
        as new (d)(5)..............................................24034
17.52 (a)(1) authority citation, (2) authority citation, (3) 
        authority citation, (4) authority citation, (5) authority 
        citation, (6) authority citaiton, (7) authority citation, 
        (8) authority citation, (9) authority citation, (10) 
        authority citation, and (b) removed; (c) added.............26306
17.54 Removed......................................................26306
17.55 Introductory text revised; authority citation removed........26306
17.56 (e) added; authority citation removed........................26306
17.61 (b) amended; authority citation removed......................33696
17.62 Revised......................................................33697
17.63 (b) added; (k) revised; authority citation removed...........33697
17.65 Authority citation removed...................................33697
17.66 Authority citation removed...................................33697
17.67 Authority citation removed...................................33697
17.68 Authority citation removed...................................33697
17.69 Authority citation removed...................................33697
17.70 Authority citation removed...................................33697
17.71 Authority citation removed...................................33697
17.72 Authority citation removed...................................33697
17.73 Authority citation removed...................................33697
17.74 Authority citation removed...................................33697
17.105 (c) amended; authority citation removed.....................26017
17.108 (d)(13) added................................................7815
    (e) introductory text revised; authority citation removed......26017
17.108 (b)(4) and (c)(4) amended; authority citation removed.......26306
17.110 (c)(11) added................................................7815
    (b)(4) amended; authority citation removed.....................26306
17.111 (f)(10) added................................................7815
    (b)(3) amended; authority citation removed.....................26307
17.380 (b) revised..................................................8257
17.390 (f) removed.................................................68048
17.412 (b) revised..................................................8257
17.450 Undesignated center heading and section added...............57329
17.613--17.618 Undesignated center heading added...................61551
17.613 Added.......................................................61551
17.614 Added.......................................................61551
17.615 Added.......................................................61551
17.616 Added.......................................................61551
17.617 Added.......................................................61551
17.618 Added.......................................................61551
17.1004 (b) introductory text amended; authority citation removed 
                                                                   26307
17.4000--17.4040 Undesignated center heading added.................26307
17.4000 Added......................................................26307
17.4005 Added......................................................26307
17.4010 Added......................................................26307
17.4015 Added......................................................26307
17.4020 Added......................................................26307
17.4025 Added......................................................26307
17.4030 Added......................................................26307
17.4035 Added......................................................26307
17.4040 Added......................................................26307
17.4100 Authority citation added...................................21678
17.4100--17.4135 Undesignated center heading added; interim........21678
17.4600 Added......................................................26018

                                  2020

38 CFR
                                                                   85 FR
                                                                    Page
Chapter I
1 Authority citation revised.......................................64043
1 Authority citation removed.......................................64043
1.460 Amended; authority citation removed..........................64043
1.461 Authority citation removed...................................64043
1.479 Authority citation removed...................................64043
1.481 Added........................................................64043
1.482 Added........................................................64043
1.484 Authority citation removed...................................64043
1.496 Authority citation removed...................................64043
4.71a Amended......................................................76460

[[Page 958]]

4.71a Correction: table amended....................................85523
4.73 Amended.......................................................76464
4 Appendix A Amended...............................................76464
4 Appendix B Amended...............................................76466
4 Appendix C Amended...............................................76467
4 Correction: appendix C amended...................................85523
5 Added............................................................72570
5 Technical correction.............................................75857
9.1 (k)(1) revised.................................................14802
9.2 (f) added; interim.............................................35563
9.2 Regulation at 85 FR 35563 confirmed............................63209
9.2 (g) added......................................................75859
9.24 Added.........................................................75859
17 Authority citation amended..................3170145535, 71845, 84259,
17 Policy statement................................................42724
17.32 Revised; interim.............................................31701
17.38 (a)(1)(viii) revised; (b) introductory text amended..........84259
17.100 Added.......................................................53174
17.101 Heading and (a)(6) revised; (a)(5) amended..................53176
17.106 (f)(2)(viii) added..........................................53176
17.120 Introductory text amended...................................84259
17.122 Removed.....................................................84259
17.148--17.154 Undesignated center heading revised.................84259
17.150 Removed.....................................................84259
17.153 Removed.....................................................84259
17.390 Correction: amended; OMB number.............................31983
17.419 Added; interim..............................................71845
17.525--17.531 Undesignated center heading added...................45535
17.525 Added.......................................................45535
17.526 Added.......................................................45535
17.527 Added.......................................................45535
17.528 Added.......................................................45535
17.529 Added.......................................................45535
17.530 Added.......................................................45535
17.531 Added.......................................................45535
17.603 (b) revised.................................................13053
17.607 (c)(1) revised..............................................13053
17.610 (b)(4) and (5) redesignated as (b)(5) and (6); new (b)(4) 
        added......................................................13053
17.3200--17.3250 Undesignated center heading and sections added....84259

                                  2021

   (Regulations published from January 1, 2021, through July 1, 2021)

38 CFR
                                                                   86 FR
                                                                    Page
Chapter I
3.156 (c)(2) revised...............................................15414
4.71a Correction: amended...........................................8142
4 Correction: appendix A, appendix B, and appendix C amended........8143
5 Authority citation revised.......................................30184
5.0 Revised; eff. 7-7-21...........................................30184
5.15 (a)(1) amended; (a)(2)(viii) and (b)(1) removed; (a)(2)(ix) 
        and (b)(2) through (4) redesignated as new (a)(2)(viii) 
        and (b)(1) through (3); (a)(2) introductory text, (vii), 
        (b) introductory text, new (1), and new (3) revised; eff. 
        7-7-21.....................................................30184
5.20 (c) revised; eff. 7-7-21......................................30184
5.25 Revised; eff. 7-7-21..........................................30184
9.2 (f)(2) revised; interim........................................30543
17 Amended.........................................................16053
17 Authority citation amended......................................24497
17.38 Regulation at 85 FR 84259 eff. date delayed to 2-26-21........7349
17.101 (a)(2), (3), (5), (b)(2) introductory text, (3), (d)(2) 
        introductory text, (e)(3)(i) introductory text, (A), (B), 
        (C), (ii), (4), (f)(4), (g)(3)(i), (i)(2)(i), (iii), 
        (j)(2)(i), (k)(2)(i), (ii), and (l)(5)(ii) amended; 
        (a)(7), (f)(2)(ii), (3) introductory text, (h)(2) 
        introductory text, (i), (ii), (3), (i)(2)(ii), (3) 
        introductory text, (l)(3) introductory text, and (iii) 
        revised....................................................16053
17.106 (c)(4) revised; (f)(2)(ix) added............................16055
17.120 Regulation at 85 FR 84259 eff. date delayed to 2-26-21.......7349
17.122 Regulation at 85 FR 84259 eff. date delayed to 2-26-21.......7349
17.148--17.154 Regulation at 85 FR 84259 eff. date delayed to 2-
        26-21.......................................................7349
17.150 Regulation at 85 FR 84259 eff. date delayed to 2-26-21.......7349
17.151 Regulation at 85 FR 84259 eff. date delayed to 2-26-21.......7349
17.152 Regulation at 85 FR 84259 eff. date delayed to 2-26-21.......7349
17.153 Regulation at 85 FR 84259 eff. date delayed to 2-26-21.......7349

[[Page 959]]

17.3200--17.3250 Regulation at 85 FR 84259 eff. date delayed to 2-
        26-21.......................................................7349
17.3250 Added......................................................24498
17.3500 Undesignated center heading and section added..............24498


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