**§17.47 Considerations applicable in determining eligibility for
hospital, nursing home 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.
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 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, will
govern the facility Director's disapproval or approval of admission,
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 hospitalization, 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
circumstances, is authorized to approve admission of the applicant for
hospital care, 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 §3.800 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 §3.800 of this title is not being paid
because of the provision of §3.800(a)(2) except to the extent continuing
eligibility for such treatment is provided for in the judgment for
settlement described in §3.800(a)(2) 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
any condition which does not require hospital care for an acute or
chronic condition but requires domiciliary care. Domiciliary care, as
the term implies, is the provision of a 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 or
nursing home care under §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 or nursing
home care under §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 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. 1111(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 §§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)

\(5\) Notwithstanding the attributable income of a veteran, VA may
determine that such veteran is not eligible under paragraph (d)(1) and
(2) of this section if the corpus of the estate of the veteran is such
that under all the circumstances it is reasonable that some part of the
corpus of the estate of the veteran be consumed for the veteran's
maintenance. The corpus of the estate of a veteran shall be determined
in the same manner as determinations are made with respect to the
determinations of eligibility for pension under §3.275 of this chapter.
The term *corpus of the estate of the veteran* includes the corpus of
the estates of the veteran's spouse and dependent children, if any.
(Authority: 38 U.S.C. 1722; sec. 19011, Pub. L. 99-272)

\(6\) 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 or nursing home care under 38
U.S.C. 1710(a)(2) or outpatient care under 38 U.S.C. 1712(a)(4) by
virtue of the veteran's eligibility for hospital care 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 who have no service-connected
disabilities pursuant to §17.47, and/or persons receiving outpatient
medical services pursuant to paragraphs (e), (f), (i), (j), and/or (k)
of §17.60 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 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 for the treatment of nonservice-connected
disabilities pursuant to §17.47, or persons receiving outpatient medical
services pursuant to paragraph (e), (f), (h), (i), (j), or (k) of
§17.60, 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
>
> \(v\) 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, cytemegalovirus,
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)

\[32 FR 13813, Oct. 4, 1967, as amended at 64 FR 54218, Oct. 6, 1999; 73
FR 20532, Apr. 16, 2008\]

**Editorial Note**: For earlier *Federal Register* citations affecting
§17.47, see the List of CFR Sections Affected in the Finding Aids
section of this volume.

**Supplement *Highlights* references**: 37(1), 40(1).