## Section A. Eligibility for Hospital, Nursing Home, Domiciliary, and Medical Care

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  1            Determining Eligibility for Medical Care       7-A-2

  2            Requests Requiring Claims Folder Review Only   7-A-5

  3            Requests Requiring Action by the Authorization 7-A-7
               Activity                                       

  4            Requests Requiring Action by the Rating        7-A-8
               Activity                                       

  5            Requests for Outpatient Medical Benefits       7-A-10

  6            Eligibility for Medical Treatment Tentatively  7-A-11
               Approved on Prima Facie Evidence               

  7            Requests for Medical Benefits for Veterans     7-A-13
               Discharged Under Other Than Honorable          
               Conditions                                     

  8            Requests for Aid and Attendance (A&A) and      7-A-15
               Housebound Medical Benefits                    

  9            Eligibility for Outpatient Medications for A&A 7-A-16
               Cases in Which Income Is Excessive             

  10           Medical Treatment for Veterans Showing a       7-A-19
               Positive Tuberculin Reaction                   

  11           Eligibility Requirements for Veterans Treated  7-A-21
               with Nasopharyngeal Radium Irradiation (NRI)   

  12           Eligibility Requests for Polish and            7-A-24
               Czechoslovakian Armed Forces                   
  ------------ ---------------------------------------------- ------------

#### 1. Determining Eligibility for Medical Care

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on determining        |
| troduction | > eligibility for medical care. It includes information |
|            | > on                                                    |
|            |                                                         |
|            | -   methods of information exchange between the         |
|            |     Veterans Benefits Administration (VBA) and the      |
|            |     Veterans Health Administration (VHA)                |
|            |                                                         |
|            | -   determination of eligibility for medical treatment  |
|            |                                                         |
|            | -   regulations governing eligibility for medical       |
|            |     treatment                                           |
|            |                                                         |
|            | -   providing information to medical facilities, and    |
|            |                                                         |
|            | -   types of requests sent on *VA Form 10-7131,         |
|            |     Exchange of Beneficiary Information and Request for |
|            |     Administrative and Adjudicative Action*.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. M | > Most requests and reports exchanged between the       |
| ethods of  | > Veterans Benefits Administration (VBA) and the        |
| Informatio | > Veterans Health Administration (VHA) are now provided |
| n Exchange | > through the Automated Medical Information Exchange    |
|  Between V | > (AMIE)/Compensation and Pension Records Interchange   |
| BA and VHA | > (CAPRI) system.                                       |
|            | >                                                       |
|            | > However, *VA Form 10-7131, Exchange of Beneficiary    |
|            | > Information and Request for Administrative and        |
|            | > Adjudicative Action*, is still used when              |
|            |                                                         |
|            | -   the veteran is not entered into the AMIE/CAPRI      |
|            |     system as a patient, or                             |
|            |                                                         |
|            | -   the medical facility and the regional office (RO)   |
|            |     are not linked electronically.                      |
|            |                                                         |
|            | > The sections of this chapter dealing with *VA Form    |
|            | > 10-7131, Exchange of Beneficiary Information and      |
|            | > Request for Administrative and Adjudicative Act* are  |
|            | > for application when AMIE or CAPRI is not used for    |
|            | > exchange of information.                              |
|            | >                                                       |
|            | > ***References***: For information on                  |
|            |                                                         |
|            | -   AMIE, see                                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   M21-1MR, Part III, Subpart v, 6.G.30, and           |
|            |                                                         |
|            | -   the *AMIE II User Guide*, and                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   CAPRI, see                                          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   M21-1, Part III, Subpart v, 6.G.32, and             |
|            |                                                         |
|            | -   the *CAPRI User Guide*.                             |
+------------+---------------------------------------------------------+

Continued on next page

1\. Determining Eligibility for Medical Care, Continued

+------------+---------------------------------------------------------+
| ##### b.   | > Generally, when a veteran applies for treatment, the  |
|  Determina | > medical facility determines the veteran's eligibility |
| tion of El | > and enrollment category for hospital, nursing home,   |
| igibility  | > domiciliary, medical, and dental care.                |
| for Medica |                                                         |
| l Treatmen |                                                         |
| t {#b.-det |                                                         |
| ermination |                                                         |
| -of-eligib |                                                         |
| ility-for- |                                                         |
| medical-tr |                                                         |
| eatment .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > The following table lists regulations governing a     |
|  Regulatio | > veteran's eligibility for hospital, nursing home,     |
| ns Governi | > domiciliary, medical, and dental care.                |
| ng Eligibi |                                                         |
| lity for M |                                                         |
| edical Tre |                                                         |
| atment {#c |                                                         |
| .-regulati |                                                         |
| ons-govern |                                                         |
| ing-eligib |                                                         |
| ility-for- |                                                         |
| medical-tr |                                                         |
| eatment .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

  ----------------------------------- --------------------------------------------------------------------------
  Type of Care                        Governing Regulation(s)

  Hospital, nursing home or           [38 CFR
  domiciliary care                    17.46](http://www.warms.vba.va.gov/Regs/38CFR/BookI/Part17/s17_46.doc)

  Outpatient treatment                [38 CFR
                                      17.93](http://www.warms.vba.va.gov/Regs/38CFR/BookI/Part17/s17_93.doc)

  Outpatient dental treatment         [38 CFR
                                      17.161](http://www.warms.vba.va.gov/Regs/38CFR/BookI/Part17/s17_161.doc)
  ----------------------------------- --------------------------------------------------------------------------

+------------+---------------------------------------------------------+
| ####       | > From time to time, a medical facility may require     |
| # d. Provi | > certain information or basic determinations from the  |
| ding Infor | > Veterans Service Center (VSC).                        |
| mation to  |                                                         |
| Medical Fa | > When information for eligibility is required, and is  |
| cilities { | > not available through the VA Medical Center's (VAMC)  |
| #d.-provid | > electronic inquiry of VBA records, the appropriate    |
| ing-inform | > medical authority initiates an inquiry to the VSC via |
| ation-to-m |                                                         |
| edical-fac | -   telephone                                           |
| ilities .u |                                                         |
| nnumbered} | -   the AMIE/CAPRI system, or                           |
|            |                                                         |
|            | -   *VA Form 10-7131, Exchange of Beneficiary           |
|            |     Information and Request for Administrative and      |
|            |     Adjudicative Action*.                               |
|            |                                                         |
|            |     > When a *VA Form 10-7131, Exchange of Beneficiary  |
|            |     > Information and Request for Administrative and    |
|            |     > Adjudicative Action,* or other written            |
|            |     > communication is received, take appropriate       |
|            |     > action as described in M21-1MR, Part III, Subpart |
|            |     > v, 7.A.1.e.                                       |
+------------+---------------------------------------------------------+

Continued on next page

1\. Determining Eligibility for Medical Care, Continued

+------------+---------------------------------------------------------+
| ##         | > Refer to the following table for information on       |
| ### e. Typ |                                                         |
| es of Requ | -   the types of requests that may be sent on *VA Form  |
| ests Sent  |     10-7131, Exchange of Beneficiary Information and    |
| on *VA For |     Request for Administrative and Adjudicative         |
| m 10-7131* |     Action*, and                                        |
|  {#e.-type |                                                         |
| s-of-reque | -   where to find more information on the particular    |
| sts-sent-o |     type of request.                                    |
| n-va-form- |                                                         |
| 10-7131 .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| Upon receipt of *VA Form         | See the following location for    |
| 10-7131* which involves a        | more information: \...            |
| request that \...                |                                   |
+----------------------------------+-----------------------------------+
| requires claims folder review    | M21-1MR, Part III, Subpart v,     |
| only                             | 7.A.2.                            |
+----------------------------------+-----------------------------------+
| requires action by the           | M21-1MR, Part III, Subpart v,     |
| authorization activity           | 7.A.3.                            |
+----------------------------------+-----------------------------------+
| requires action by the rating    | M21-1MR, Part III, Subpart v,     |
| activity                         | 7.A.4.                            |
+----------------------------------+-----------------------------------+
| pertains to eligibility for      | -   M21-1MR, Part III, Subpart v, |
| medical benefits under [38       |     7.A.5, and                    |
| U.S.C.                           |                                   |
| 1710](http://assembler.law.co    | -   M21-1MR, Part III, Subpart v, |
| rnell.edu/uscode/html/uscode38/u |     7.A.6.                        |
| sc_sec_38_00001710----000-.html) |                                   |
+----------------------------------+-----------------------------------+
| pertains to eligibility for      | M21-1MR, Part III, Subpart v,     |
| health care benefits for         | 7.A.7.                            |
| veterans with discharges under   |                                   |
| other than honorable discharges  |                                   |
| under [38 CFR                    |                                   |
| 3.360                            |                                   |
| ](http://www.warms.vba.va.gov/re |                                   |
| gs/38CFR/BOOKB/PART3/S3_359.DOC) |                                   |
+----------------------------------+-----------------------------------+
| pertains to requests for Aid and | M21-1MR, Part III, Subpart v,     |
| Attendance (A&A) and Housebound  | 7.A.8                             |
| medical benefits provided under  |                                   |
| [38 U.S.C.                       |                                   |
| 1712(d)](http://assembler.law.co |                                   |
| rnell.edu/uscode/html/uscode38/u |                                   |
| sc_sec_38_00001712----000-.html) |                                   |
+----------------------------------+-----------------------------------+
| pertains to medications for Aid  | M21-1MR, Part III, Subpart v,     |
| and Attendance cases in which    | 7.A.9.                            |
| income is excessive under [38    |                                   |
| U.S.C.                           |                                   |
| 1712(d)](http://assembler.law.co |                                   |
| rnell.edu/uscode/html/uscode38/u |                                   |
| sc_sec_38_00001712----000-.html) |                                   |
+----------------------------------+-----------------------------------+
| pertains to treatment for a      | M21-1MR, Part III, Subpart v,     |
| positive tuberculin reaction     | 7.A.10.                           |
+----------------------------------+-----------------------------------+
| pertains to veterans treated     | M21-1MR, Part III, subpart v,     |
| with nasopharyngeal radium       | 7.A.11.                           |
| irradiation (NRI) under [38      |                                   |
| U.S.C.                           |                                   |
| 1720E](http://assembler.law.co   |                                   |
| rnell.edu/uscode/html/uscode38/u |                                   |
| sc_sec_38_00001720---E000-.html) |                                   |
+----------------------------------+-----------------------------------+
| requires a determination of      | M21-1MR, Part III, Subpart v,     |
| service connection for purposes  | 7.A.12.                           |
| of [38 U.S.C.                    |                                   |
| 109(c)](http://assembler.law.co  |                                   |
| rnell.edu/uscode/html/uscode38/u |                                   |
| sc_sec_38_00000109----000-.html) |                                   |
| for the Polish and               |                                   |
| Czechoslovakian Armed Forces     |                                   |
+----------------------------------+-----------------------------------+
| requires a net worth             | M21-1MR, Part III, Subpart v,     |
| determination (means test)       | 6.A.3.a.                          |
+----------------------------------+-----------------------------------+

#### 2. Requests Requiring Claims Folder Review Only

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on handling requests  |
| troduction | > for information received from medical facilities that |
|            | > require claims folder review only. It includes        |
|            | > information on                                        |
|            |                                                         |
|            | -   receipt of *VA Form 10-7131, Exchange of            |
|            |     Beneficiary Information and Request for             |
|            |     Administrative and Adjudicative Action*, indicating |
|            |     the information required, and                       |
|            |                                                         |
|            | -   handling requests requiring claims folder review    |
|            |     only.                                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > *VA Form 10-7131, Exchange of Beneficiary Information |
| ### a. Rec | > and Request for Administrative and Adjudicative       |
| eipt of VA | > Action* should be received in duplicate. The          |
|  Form 10-7 | > hospital, nursing home, domiciliary, or outpatient    |
| 131 Indica | > clinic checks the specific boxes in Part I of *VA     |
| ting the I | > Form 10-7131*, indicating the information required.   |
| nformation |                                                         |
|  Required  |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > Follow the steps in the table below when a *VA Form   |
|  Handling  | > 10-7131, Exchange of Beneficiary Information and      |
| a Request  | > Request for Administrative and Adjudicative Action*   |
| for a Clai | > is received, requesting a claims folder review only.  |
| ms Folder  |                                                         |
| Review {#b |                                                         |
| .-handling |                                                         |
| -a-request |                                                         |
| -for-a-cla |                                                         |
| ims-folder |                                                         |
| -review .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | For each item requested in Part I, enter the information in  |
|       | Part II of *VA Form 10-7131, Exchange of Beneficiary         |
|       | Information and Request for Administrative and Adjudicative  |
|       | Action*.                                                     |
|       |                                                              |
|       | ***Note***: All information may be legibly handwritten.      |
+-------+--------------------------------------------------------------+
| 2     | Mark any non-applicable items, "*NA*."                       |
+-------+--------------------------------------------------------------+
| 3     | If                                                           |
|       |                                                              |
|       | -   information about monetary benefits is requested, and    |
|       |                                                              |
|       | -   the veteran receives military retirement pay,            |
|       |                                                              |
|       |     then complete Part II, Items 5 and 5A (Retirement Pay-By |
|       |     Whom Paid) to show                                       |
|       |                                                              |
|       | -   the amount of military retirement pay, and               |
|       |                                                              |
|       | -   the source responsible for payment of retirement pay.    |
|       |                                                              |
|       |     > ***Example***: "*\$121--Army*"                         |
+-------+--------------------------------------------------------------+

Continued on next page

2\. Requests Requiring Claims Folder Review Only, Continued

  -----------------------------------------------------------------------
  b\. Handling a Request for a Claims Folder Review (continued)

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

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 4     | Make an appropriate entry in the "Remarks" section to advise |
|       | the VA health care facility of *any* of the following        |
|       | conditions which affect eligibility for hospitalization or   |
|       | treatment:                                                   |
|       |                                                              |
|       | -   the veteran has no period of honorable service           |
|       |                                                              |
|       | -   the veteran has forfeited rights to benefits, or         |
|       |                                                              |
|       | -   the veteran's only service was in the Commonwealth Army  |
|       |     of the Philippines, Special Philippine Scouts, or        |
|       |     recognized Guerrilla Service.                            |
|       |                                                              |
|       | ***Note***: If the veteran's only service was in the         |
|       | Commonwealth Army of the Philippines, Special Philippine     |
|       | Scouts, or recognized guerrilla service, then                |
|       |                                                              |
|       | -   medical care is restricted to care provided by the       |
|       |     Philippine government, or                                |
|       |                                                              |
|       | -   VA may furnish hospital and nursing home care and        |
|       |     medical services for treatment of service-connected (SC) |
|       |     disabilities *only* if the veteran resides in the United |
|       |     States.                                                  |
+-------+--------------------------------------------------------------+
| 5     | Upon completion of the requested claims folder review        |
|       |                                                              |
|       | -   return the original form to the medical facility         |
|       |                                                              |
|       | -   file the duplicate form in the claims folder, and        |
|       |                                                              |
|       | -   clear an EP 290 for any formal authorization or rating   |
|       |     determination of eligibility for medical treatment.      |
+-------+--------------------------------------------------------------+

#### 3. Requests Requiring Action by the Authorization Activity

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on requests that      |
| troduction | > require action by the authorization activity. It      |
|            | > includes information on                               |
|            |                                                         |
|            | -   requests that require an authorization decision or  |
|            |     determination, and                                  |
|            |                                                         |
|            | -   handling a requests requiring authorization action. |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a    | > Requests involving authorization action               |
| . Requests |                                                         |
|  Requiring | -   generally require a decision on an other than       |
|  Authoriza |     honorable discharge, and                            |
| tion Decis |                                                         |
| ion or Det | -   occasionally require a line of duty determination   |
| ermination |     for a condition where service connection is         |
|            |     claimed.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Follow the steps in the table below when you receive  |
| b. Handlin | > a request that requires authorization action.         |
| g a Reques |                                                         |
| t Requirin |                                                         |
| g Authoriz |                                                         |
| ation Acti |                                                         |
| on {#b.-ha |                                                         |
| ndling-a-r |                                                         |
| equest-req |                                                         |
| uiring-aut |                                                         |
| horization |                                                         |
| -action .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Accomplish any development indicated on the form.            |
+-------+--------------------------------------------------------------+
| 2     | Prepare a formal determination for the folder to establish   |
|       |                                                              |
|       | -   character of discharge according to M21-1MR, Part III,   |
|       |     Subpart v, 1.B.5, or                                     |
|       |                                                              |
|       | -   line of duty according to M21-1MR, Part III, Subpart v,  |
|       |     1.D.15.                                                  |
+-------+--------------------------------------------------------------+
| 3     | Complete Part II of *VA Form 10-7131, Exchange of            |
|       | Beneficiary Information and Request for Administrative and   |
|       | Adjudicative Action* with the requested information.         |
+-------+--------------------------------------------------------------+
| 4     | -   Return the original form to the originating clinic or    |
|       |     facility, and                                            |
|       |                                                              |
|       | -   file a copy of the form in the claims folder.            |
+-------+--------------------------------------------------------------+

#### 4. Requests Requiring Action by the Rating Activity

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on requests that      |
| troduction | > require action by the rating activity. It includes    |
|            | > information on                                        |
|            |                                                         |
|            | -   request for a determination of service connection,  |
|            |     and                                                 |
|            |                                                         |
|            | -   handling a request for rating activity action.      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > A request for determination of service connection for |
| a. Request | > a particular condition is specified by the requesting |
|  for a Det | > medical facility with the entry of the specific       |
| ermination | > condition in the "Remarks" section of Part I of *VA   |
|  of Servic | > Form 10-7131, Exchange of Beneficiary Information and |
| e Connecti | > Request for Administrative and Adjudicative Action*.  |
| on {#a.-re |                                                         |
| quest-for- | > A copy of *VA Form 10-10m, Medical Certificate*,      |
| a-determin | > along with any other medical evidence available,      |
| ation-of-s | > should be attached to *VA Form 10-7131, Exchange of   |
| ervice-con | > Beneficiary Information and Request for               |
| nection .u | > Administrative and Adjudicative Action*.              |
| nnumbered} |                                                         |
|            | > ***Note***: Occasionally, a request for adjudication  |
|            | > of service connection is a request for determination  |
|            | > of service connection for active psychosis under [38  |
|            | > U.S.C.                                                |
|            | > 1702](http://assembler.law.cornell.edu/               |
|            | uscode/html/uscode38/usc_sec_38_00001702----000-.html). |
|            |                                                         |
|            | > ***Reference***: For more information on service      |
|            | > connection for psychosis under [38 U.S.C.             |
|            | > 1702](http://assembler.law.cornell.edu/               |
|            | uscode/html/uscode38/usc_sec_38_00001702----000-.html), |
|            | > see M21-1MR, Part IX, Subpart ii, 2.5.                |
+------------+---------------------------------------------------------+

Continued on next page

4\. Requests Requiring Action by the Rating Activity, Continued

+------------+---------------------------------------------------------+
| ##### b.   | > Follow the steps in the table below when you receive  |
|  Handling  | > a request requiring rating activity action.           |
| a Request  |                                                         |
| for Rating |                                                         |
|  Activity  |                                                         |
| Action {#b |                                                         |
| .-handling |                                                         |
| -a-request |                                                         |
| -for-ratin |                                                         |
| g-activity |                                                         |
| -action .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Is a rating decision for the condition already of record?    |
|       |                                                              |
|       | -   If *yes*, handle the request as a request requiring      |
|       |     claims folder review only as outlined in M21-1MR, Part   |
|       |     III, Subpart v, 7.A.2.                                   |
|       |                                                              |
|       | -   If *no*, go to Step 2.                                   |
+-------+--------------------------------------------------------------+
| 2     | If the condition has not been rated, perform the necessary   |
|       | development.                                                 |
|       |                                                              |
|       | ***Reference***: For information on reviewing evidence for   |
|       | bars to entitlement, see M21-1MR, Part III, Subpart ii,      |
|       | 7.1.a.                                                       |
+-------+--------------------------------------------------------------+
| 3     | Refer the case to the rating activity.                       |
+-------+--------------------------------------------------------------+
| 4     | When the rating is completed                                 |
|       |                                                              |
|       | -   complete Part II of *VA Form 10-7131, Exchange of        |
|       |     Beneficiary Information and Request for Administrative   |
|       |     and Adjudicative Action*, or                             |
|       |                                                              |
|       | -   prepare an extra copy of the eligibility rating and      |
|       |     attach it to *VA Form 10-7131, Exchange of Beneficiary   |
|       |     Information and Request for Administrative and           |
|       |     Adjudicative Action.*                                    |
+-------+--------------------------------------------------------------+
| 5     | Return *VA Form 10-7131, Exchange of Beneficiary Information |
|       | and Request for Administrative and Adjudicative Action* to   |
|       | the originator.                                              |
|       |                                                              |
|       | ***Important***: Do *not* furnish notice of the decision     |
|       | directly to the veteran. The medical activity provides       |
|       | notice of the determination.                                 |
+-------+--------------------------------------------------------------+

#### 5. Requests for Outpatient Medical Benefits

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on requests for       |
| troduction | > outpatient medical benefits. It includes information  |
|            | > on                                                    |
|            |                                                         |
|            | -   eligibility for outpatient medical services         |
|            |                                                         |
|            | -   eligibility based on the level of disability        |
|            |                                                         |
|            | -   providing notification of eligibility to the        |
|            |     veteran, and                                        |
|            |                                                         |
|            | -   processing eligibility requests.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Veterans who are enrolled in the VA healthcare system |
| ## a. Elig | > are eligible for outpatient medical services as       |
| ibility fo | > defined in [38 CFR                                    |
| r Outpatie | > 17.38](http://ww                                      |
| nt Medical | w.warms.vba.va.gov/Regs/38CFR/BookI/Part17/s17_38.doc). |
|  Services  | >                                                       |
|            | > Veterans are assigned to one of eight enrollment      |
|            | > priority groups at the time of enrollment. The        |
|            | > priority group designation determines whether a       |
|            | > co-payment will be required for outpatient services.  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > Veterans with a single service-related disability, or |
|  Eligibili | > a combination of disabilities that render him/her 50  |
| ty Based o | > percent or higher disabled, are assigned to Priority  |
| n Level of | > Group 1 and are eligible for outpatient treatment for |
|  Disabilit | > all disabilities with no co-payment requirement.      |
| y {#b.-eli |                                                         |
| gibility-b | > ***Note***: This includes entitlement to a 50 percent |
| ased-on-le | > or 100 percent rate on the basis of [38 CFR           |
| vel-of-dis | > 4.28](http://                                         |
| ability .u | www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_28.DOC). |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Following the initial processing of a rating          |
| #### c. Pr | > establishing the veteran's level of disability, send  |
| oviding No | > the veteran                                           |
| tification |                                                         |
|  of Eligib | -   a notice of eligibility, and                        |
| ility to t |                                                         |
| he Veteran | -   instructions for applying for treatment.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d. P | > When *VA Form 10-7131, Exchange of Beneficiary        |
| rocessing  | > Information and Request for Administrative and        |
| Eligibilit | > Adjudicative Action* requesting information for       |
| y Requests | > eligibility of a veteran under [38 U.S.C.             |
|  {#d.-proc | > 1710](http://assembler.law.cornell.edu                |
| essing-eli | /uscode/html/uscode38/usc_sec_38_00001710----000-.html) |
| gibility-r | > is received, complete the "Remarks" section of Part   |
| equests .u | > II by listing any and all SC and nonservice-connected |
| nnumbered} | > (NSC) disabilities and their assigned evaluations.    |
+------------+---------------------------------------------------------+

#### 6. Eligibility for Medical Treatment Tentatively Approved on Prima Facie Evidence

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on making a tentative |
| troduction | > determination of eligibility for medical treatment    |
|            | > based on prima facie evidence. It includes            |
|            | > information on                                        |
|            |                                                         |
|            | -   requirements for determining prima facie            |
|            |     eligibility, and                                    |
|            |                                                         |
|            | -   notifying the VSC of the initial determination of   |
|            |     prima facie eligibility, and                        |
|            |                                                         |
|            | -   processing *VA Form 10-7131, Exchange of            |
|            |     Beneficiary Information and Request for             |
|            |     Administrative and Adjudicative Action*.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Clinic directors of RO outpatient clinics and         |
| ### a. Req | > directors of medical centers and independent          |
| uirements  | > outpatient clinics or their designees are authorized  |
| for Determ | > to determine prima facie eligibility upon which       |
| ining Prim | > treatment may be initially authorized if the          |
| a Facie El | > conditions listed below are met.                      |
| igibility  |                                                         |
| {#a.-requi | -   The veteran was discharged or released with an      |
| rements-fo |     honorable or general discharge after active service |
| r-determin |     of                                                  |
| ing-prima- |                                                         |
| facie-elig | ```{=html}                                              |
| ibility .u | <!-- -->                                                |
| nnumbered} | ```                                                     |
|            | -   six or more months, if the enlistment date was      |
|            |     prior to September 8, 1980, or                      |
|            |                                                         |
|            | -   24 or more months, if the enlistment date was       |
|            |     September 8, 1980, or later.                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Application is made within six months from the date |
|            |     of discharge or release.                            |
|            |                                                         |
|            | -   The application of sound medical judgment warrants  |
|            |     a tentative conclusion that the condition           |
|            |     originated in, or was aggravated during, service.   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > If treatment based on prima facie eligibility is      |
| ### b. Not | > initially authorized by VHA, VHA                      |
| ifying the |                                                         |
|  VSC of an | -   prepares *VA Form 10-7131, Exchange of Beneficiary  |
|  Initial D |     Information and Request for Administrative and      |
| eterminati |     Adjudicative Action* and annotates it with          |
| on of Prim |     "*Medical care being authorized for (condition) on  |
| a Facie El |     prima facie evidence of eligibility*," and          |
| igibility  |                                                         |
| {#b.-notif | -   promptly forwards the completed form along with a   |
| ying-the-v |     copy of the VA examination, hospital report, or     |
| sc-of-an-i |     outpatient treatment report, as applicable, to the  |
| nitial-det |     VSC of the office with claims folder jurisdiction.  |
| ermination |                                                         |
| -of-prima- |                                                         |
| facie-elig |                                                         |
| ibility .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

6\. Eligibility for Medical Treatment Tentatively Approved on Prima
Facie Evidence, Continued

+------------+---------------------------------------------------------+
| ##### c.   | > Follow the steps in the table below upon receipt of   |
| Processing | > *VA Form 10-7131, Exchange of Beneficiary Information |
|  VA Form 1 | > and Request for Administrative and Adjudicative       |
| 0-7131, *E | > Action*.                                              |
| xchange of |                                                         |
|  Beneficia |                                                         |
| ry Informa |                                                         |
| tion and R |                                                         |
| equest for |                                                         |
|  Administr |                                                         |
| ative and  |                                                         |
| Adjudicati |                                                         |
| ve Action* |                                                         |
+------------+---------------------------------------------------------+

  -------- --------------------------------------------------------------
  Step     Action

  1        Perform necessary development for service medical records.

  2        Refer the case to the rating activity for determination of
           service connection for the condition at issue.

  3        Return the properly completed *VA Form 10-7131, Exchange of
           Beneficiary Information and Request for Administrative and
           Adjudicative Action* to give prompt notice of either favorable
           or unfavorable rating action to the medical facility
           originating the request.
  -------- --------------------------------------------------------------

#### 7. Requests for Medical Benefits for Veterans Discharged Under Other Than Honorable Conditions

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on requests for       |
| troduction | > medical benefits for veterans discharged under "other |
|            | > than honorable" conditions. It includes information   |
|            | > on                                                    |
|            |                                                         |
|            | -   requirements for eligibility for health care        |
|            |                                                         |
|            | -   initiation of *VA Form 10-7131, Exchange of         |
|            |     Beneficiary Information and Request for             |
|            |     Administrative and Adjudicative Action* by a        |
|            |     medical facility                                    |
|            |                                                         |
|            | -   action to take when a favorable discharge or        |
|            |     eligibility decision exists                         |
|            |                                                         |
|            | -   action to take when there is no character of        |
|            |     discharge or eligibility decision, and              |
|            |                                                         |
|            | -   completing the "Remarks" section of *VA Form        |
|            |     10-7131, Exchange of Beneficiary Information and    |
|            |     Request for Administrative and Adjudicative         |
|            |     Action*.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a    | > Effective October 8, 1977, any serviceperson          |
| . Requirem | > discharged under "other than honorable" conditions is |
| ents for E | > eligible for the health care and related benefits     |
| ligibility | > authorized under [38 U.S.C.                           |
|  for Healt | > 1710](http://assembler.law.cornell.edu/               |
| h Care  {# | uscode/html/uscode38/usc_sec_38_00001710----000-.html), |
| a.-require | > if he/she meets the following requirements:           |
| ments-for- |                                                         |
| eligibilit | -   the disability was incurred or aggravated in the    |
| y-for-heal |     line of duty during active service, and             |
| th-care .u |                                                         |
| nnumbered} | -   the serviceperson was not discharged by reason of a |
|            |     "bad conduct" discharge, or under one of the        |
|            |     statutory bars of [38 CFR                           |
|            |     3.12](http://                                       |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_12.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b. I | > On receipt of an application for treatment from a     |
| nitiation  | > veteran with an "other than honorable" discharge, the |
| of VA Form | > medical activity initiates a *VA Form 10-7131,        |
|  10-7131 b | > Exchange of Beneficiary Information and Request for   |
| y a Medica | > Administrative and Adjudicative Action*, advising VA  |
| l Facility | > as to what information is required.                   |
|  {#b.-init |                                                         |
| iation-of- |                                                         |
| va-form-10 |                                                         |
| -7131-by-a |                                                         |
| -medical-f |                                                         |
| acility .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

7\. Requests for Medical Benefits for Veterans Discharged Under Other
Than Honorable Conditions, Continued

+------------+---------------------------------------------------------+
| ##         | > Search for a formal rating decision or a memorandum   |
| ### c. Act | > rating entitled *For Medical Care Eligibility Under   |
| ion to Tak | > Chapter 17, Title 38, U.S. Code (PL 95-126),* which   |
| e When a F | > covers the condition in question when                 |
| avorable D |                                                         |
| ischarge o | -   a favorable character of discharge determination is |
| r Eligibil |     of record, or                                       |
| ity Decisi |                                                         |
| on Exists  | -   a decision on eligibility for [38 U.S.C.            |
| {#c.-actio |     1710](http://assembler.law.cornell.edu              |
| n-to-take- | /uscode/html/uscode38/usc_sec_38_00001710----000-.html) |
| when-a-fav |     benefits has already been made.                     |
| orable-dis |                                                         |
| charge-or- |     > If there is no rating for the condition in        |
| eligibilit |     > question, complete any needed development and     |
| y-decision |     > refer the case to the rating activity for         |
| -exists .u |     > preparation of the memorandum rating.             |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > If no character of discharge determination has been   |
| # d. Actio | > made, or a statement of eligibility to [38 U.S.C.     |
| n to Take  | > 1710](http://assembler.law.cornell.edu                |
| When There | /uscode/html/uscode38/usc_sec_38_00001710----000-.html) |
|  Is No Cha | > benefits has not been annotated on an existing        |
| racter of  | > determination                                         |
| Discharge  |                                                         |
| or Eligibi | -   accomplish any necessary development, and           |
| lity Decis |                                                         |
| ion {#d.-a | -   refer the claims folder to the authorization        |
| ction-to-t |     activity for an eligibility determination.          |
| ake-when-t |                                                         |
| here-is-no |     > ***Note***: If the resulting character discharge  |
| -character |     > is favorable, or if eligibility for [38 U.S.C.    |
| -of-discha |     > 1710](http://assembler.law.cornell.edu            |
| rge-or-eli | /uscode/html/uscode38/usc_sec_38_00001710----000-.html) |
| gibility-d |     > benefits is found to exist, refer the case to the |
| ecision .u |     > rating activity for preparation of the memorandum |
| nnumbered} |     > rating.                                           |
|            |                                                         |
|            |     > ***Reference***: For more information on medical  |
|            |     > care eligibility, see M21-1MR, Part IX, Subpart   |
|            |     > ii, 2.4.                                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e.   | > Upon review of the memorandum rating from the rating  |
|  Completin | > activity, complete the "Remarks" section of Part II   |
| g the "Rem | > of *VA Form 10-7131, Exchange of Beneficiary          |
| arks" Sect | > Information and Request for Administrative and        |
| ion of VA  | > Adjudicative Action* to show the following:           |
| Form 10-71 |                                                         |
| 31 {#e.-co | > "*The individual (is) (is not) entitled to health     |
| mpleting-t | > care under Section 1710 of Title 38, U.S. Code for    |
| he-remarks | > any disabilities determined to be service connected.  |
| -section-o | > (List the SC disabilities) is/are service             |
| f-va-form- | > connected*."                                          |
| 10-7131 .u |                                                         |
| nnumbered} | > ***Reference***: For information on character of      |
|            | > discharge determinations**, s**ee M21-1MR, Part III,  |
|            | > Subpart v, 1.B.7.                                     |
+------------+---------------------------------------------------------+

#### 8. Requests for Aid and Attendance (A&A) and Housebound Medical Benefits

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on requests for A&A   |
| troduction | > and Housebound medical benefits. It includes          |
|            | > information on                                        |
|            |                                                         |
|            | -   eligibility for benefits under 38 U.S.C. 1712(d)    |
|            |                                                         |
|            | -   providing notification of eligibility to veterans,  |
|            |     and                                                 |
|            |                                                         |
|            | -   processing eligibility requests.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Under [38 U.S.C.                                      |
| # a. Eligi | > 1712(d)](http://assembler.law.cornell.edu/            |
| bility for | uscode/html/uscode38/usc_sec_38_00001712----000-.html), |
|  Medical S | > veterans receiving additional compensation or         |
| ervices Un | > increased pension for A&A or Housebound benefits are  |
| der 38 U.S | > entitled to medical services, including               |
| .C. 1712 { |                                                         |
| #a.-eligib | -   outpatient treatment                                |
| ility-for- |                                                         |
| medical-se | -   drugs, and                                          |
| rvices-und |                                                         |
| er-38-u.s. | -   medicines.                                          |
| c.-1712 .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > Notify a veteran of medical care eligibility and      |
|  Providing | > application information when A&A or Housebound        |
|  Notificat | > benefits are granted. The information is provided on  |
| ion of Eli | > *VA Form 21-8764, Disability Compensation Award       |
| gibility t | > Attachment* or *VA From 21-8768, Disability Pension   |
| o Veterans | > Award Attachment*.                                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c. P | > Follow the steps in the table below when an           |
| rocessing  | > eligibility request is received for medical benefits  |
| Eligibilit | > under [38 U.S.C.                                      |
| y Requests | > 1712(d)](http://assembler.law.cornell.edu/            |
|  {#c.-proc | uscode/html/uscode38/usc_sec_38_00001712----000-.html). |
| essing-eli |                                                         |
| gibility-r |                                                         |
| equests .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Complete VA Form 10-7131, *Exchange of Beneficiary           |
|       | Information and Request for Administrative and Adjudicative  |
|       | Action,* to show entitlement.                                |
|       |                                                              |
|       | ***Note***: A future examination control has no effect on    |
|       | entitlement.                                                 |
+-------+--------------------------------------------------------------+
| 2     | Complete the "Remarks" section of Part II of *VA Form        |
|       | 10-7131* to show the following, as appropriate:              |
|       |                                                              |
|       | > "*Veteran receiving (additional compensation) (increased   |
|       | > pension) by reason of being (in need of regular A&A)       |
|       | > (permanently Housebound)*."                                |
+-------+--------------------------------------------------------------+

#### 9. Eligibility for Outpatient Medications for A&A Cases in Which Income Is Excessive

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on eligibility for    |
| troduction | > drugs and medicines in A&A cases in which income      |
|            | > exceeds pension limits. It includes information on    |
|            |                                                         |
|            | -   the income limitation for eligibility for           |
|            |     medications                                         |
|            |                                                         |
|            | -   cases involving the termination of pension awards   |
|            |                                                         |
|            | -   processing message code 652                         |
|            |                                                         |
|            | -   establishing continued entitlement to medications   |
|            |                                                         |
|            | -   requesting income information from the veteran, and |
|            |                                                         |
|            | -   completing the "Remarks" section of *VA Form        |
|            |     10-7131, Exchange of Beneficiary Information and    |
|            |     Request for Administrative and Adjudicative         |
|            |     Action*.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Per [38 U.S.C.                                        |
|  Income Li | > 1712(d)](http://assembler.law.cornell.edu/            |
| mitation f | uscode/html/uscode38/usc_sec_38_00001712----000-.html), |
| or Eligibi | > VA continues to furnish outpatient medications to     |
| lity for O | > veterans entitled to A&A, including those reduced     |
| utpatient  | > under [38 CFR                                         |
| Medication | > 3.552(b)(1)](http://w                                 |
| s {#a.-inc | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_552.DOC), |
| ome-limita | > whose income exceeds the applicable limitation by no  |
| tion-for-e | > more than \$1,000.                                    |
| ligibility |                                                         |
| -for-outpa |                                                         |
| tient-medi |                                                         |
| cations .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > If a pension award to a veteran entitled to A&A (code |
| # b. Cases | > 1 or 2) is terminated because of excess income,       |
|  Involving | > message code 652*, A&A Term---\[Year\] Income Over    |
|  Terminati | > Limit by \$\_\_\_\_\_*, is issued for routing to the  |
| on of Pens | > pension maintenance center (PMC).                     |
| ion Awards |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Follow the steps in the table below when you receive  |
| ### c. Pro | > a message code 652.                                   |
| cessing Me |                                                         |
| ssage Code |                                                         |
|  652 {#c.- |                                                         |
| processing |                                                         |
| -message-c |                                                         |
| ode-652 .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Review the claims/electronic folder to                       |
|       |                                                              |
|       | -   verify that the veteran is entitled to A&A, and          |
|       |                                                              |
|       | -   determine the amount by which income exceeded the        |
|       |     maximum annual limitation.                               |
+-------+--------------------------------------------------------------+
| 2     | Annotate *VA Form 20-6560*, *Notice of Benefit Payment*      |
|       | *Transaction*, with entry of the amount over the income      |
|       | limit in the message legend space "\$\_\_\_\_\_\_".          |
+-------+--------------------------------------------------------------+
| 3     | Date and sign the form.                                      |
+-------+--------------------------------------------------------------+

Continued on next page

9\. Eligibility for Outpatient Medications for A&A Cases in Which Income
Is Excessive, Continued

  -----------------------------------------------------------------------
  c\. Processing Message Code 652 (continued)

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

  -------- --------------------------------------------------------------
  Step     Action

  4        Send the form to the requesting medical center.

  5        Annotate the claims/electronic folder to show the income
           information furnished to the outpatient clinic.
  -------- --------------------------------------------------------------

+------------+---------------------------------------------------------+
| ##### d.   | > Establish continued entitlement to outpatient         |
|  Establish | > medications annually in those pension cases in which  |
| ing Contin | > the current year income did *not* exceed the          |
| ued Entitl | > limitation by more than \$1,000.                      |
| ement to O |                                                         |
| utpatient  | > Individual requests from the medical facility for     |
| Medication | > income information for the next calendar year are     |
| s {#d.-est | > received on *VA Form 10-7131, Exchange of Beneficiary |
| ablishing- | > Information and Request for Administrative and        |
| continued- | > Adjudicative Action* during the last three months of  |
| entitlemen | > the current year.                                     |
| t-to-outpa |                                                         |
| tient-medi |                                                         |
| cations .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e. R | > Check the claims/electronic folder to determine if    |
| equesting  | > there is current data sufficient to permit furnishing |
| Income Inf | > income information for the next year.                 |
| ormation F |                                                         |
| rom the Ve | > If the claims/electronic folder does not already      |
| teran {#e. | > contain sufficient income data for the next year      |
| -requestin |                                                         |
| g-income-i | -   request that the veteran complete the appropriate   |
| nformation |     Eligibility Verification Report (EVR) form, and     |
| -from-the- |                                                         |
| veteran .u | -   in the transmittal letter, indicate the reason for  |
| nnumbered} |     the request and state that the completed form       |
|            |     should be returned within 60 days.                  |
+------------+---------------------------------------------------------+

Continued on next page

9\. Eligibility for Outpatient Medications for A&A Cases in Which Income
Is Excessive, Continued

+------------+---------------------------------------------------------+
| ###        | > Upon receipt of the desired information, or at the    |
| ## f. Comp | > end of 60 days, enter the response in the "Remarks,"  |
| leting the | > section, Part II, of *VA Form 10-7131, Exchange of    |
|  "Remarks" | > Beneficiary Information and Request for               |
|  Section o | > Administrative and Adjudicative Action*.              |
| f VA Form  |                                                         |
| 10-7131, * | > The table below indicates what to enter into          |
| Exchange o | > "Remarks" when income information is received or not  |
| f Benefici | > received from the veteran.                            |
| ary Inform |                                                         |
| ation and  |                                                         |
| Request fo |                                                         |
| r Administ |                                                         |
| rative and |                                                         |
|  Adjudicat |                                                         |
| ive Action |                                                         |
| * {#f.-com |                                                         |
| pleting-th |                                                         |
| e-remarks- |                                                         |
| section-of |                                                         |
| -va-form-1 |                                                         |
| 0-7131-exc |                                                         |
| hange-of-b |                                                         |
| eneficiary |                                                         |
| -informati |                                                         |
| on-and-req |                                                         |
| uest-for-a |                                                         |
| dministrat |                                                         |
| ive-and-ad |                                                         |
| judicative |                                                         |
| -action .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+-----------------------------+----------------------------------------+
| If income information is    | Then ...                               |
| ...                         |                                        |
+-----------------------------+----------------------------------------+
| -   received, and           | indicate the amount by which income    |
|                             | for the next year will exceed the      |
| -   the veteran is entitled | applicable maximum income limitation.  |
|     to A&A benefits, except |                                        |
|     as to income            |                                        |
+-----------------------------+----------------------------------------+
| -   received, and           | -   handle the case as a reopened      |
|                             |     claim, and                         |
| -   the veteran is entitled |                                        |
|     to resumption of        | -   annotate *VA Form 10-7131,         |
|     pension, including A&A  |     Exchange of Beneficiary            |
|     allowance               |     Information and Request for        |
|                             |     Administrative and Adjudicative    |
|                             |     Action* to indicate that           |
|                             |     information.                       |
+-----------------------------+----------------------------------------+
| not received                | -   annotate *VA Form 10-7131,         |
|                             |     Exchange of Beneficiary            |
|                             |     Information and Request for        |
|                             |     Administrative and Adjudicative    |
|                             |     Action* to indicate that no reply  |
|                             |     was received from the veteran, and |
|                             |                                        |
|                             | -   do not take follow-up action.      |
+-----------------------------+----------------------------------------+

#### 10. Medical Treatment for Veterans Showing a Positive Tuberculin Reaction

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on medical treatment  |
| troduction | > for veterans showing a positive tuberculin reaction.  |
|            | > It includes information on                            |
|            |                                                         |
|            | -   the chemotherapy program adopted by the service     |
|            |     departments                                         |
|            |                                                         |
|            | -   the policy on chemotherapy treatments               |
|            |                                                         |
|            | -   chemotherapy for discharged personnel, and          |
|            |                                                         |
|            | -   processing *VA Form 10-7131, Exchange of            |
|            |     Beneficiary Information and Request for             |
|            |     Administrative and Adjudicative Action*.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Individuals who receive tuberculin tests sometimes    |
| # a. Chemo | > show a change from negative to positive without any   |
| therapy Pr | > other evidence of a tuberculosis infection.           |
| ogram Adop | >                                                       |
| ted by the | > The military service departments have adopted a       |
|  Service D | > program of chemotherapy for personnel who had a       |
| epartments | > negative tuberculin test on entrance into service,    |
|            | > but who were found to have converted to positive      |
|            | > during service.                                       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Chemotherapy prescribed for personnel testing         |
| ### b. Pol | > positive is to be continued over a 12-month period to |
| icy on Che | > reduce the possibility of subsequently acquiring      |
| motherapy  | > tuberculosis.                                         |
| Treatments | >                                                       |
|            | > ***Important***: A positive tuberculin reaction       |
|            | > without any other evidence of a tuberculosis          |
|            | > infection is *not* a disease or disability, and is    |
|            | > *not* a reason for discharge from service.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > At the request of the military service departments,   |
| c. Chemoth | > VA outpatient clinics and medical centers provide     |
| erapy for  | > continued chemotherapy for the remainder of the       |
| Discharged | > 12-month period to discharged personnel who tested    |
|  Personnel | > positive for tuberculosis during service.             |
|            | >                                                       |
|            | > After treatment, the outpatient clinic or medical     |
|            | > center forwards *VA Form 10-7131, Exchange of         |
|            | > Beneficiary Information and Request for               |
|            | > Administrative and Adjudicative Action* to the        |
|            | > appropriate RO and VSC with the following legend:     |
|            | >                                                       |
|            | > "*Medical care being authorized for positive reaction |
|            | > to tuberculin test on basis of prima facie evidence   |
|            | > of eligibility*."                                     |
+------------+---------------------------------------------------------+

Continued on next page

10\. Medical Treatment for Veterans Showing a Positive Tuberculin
Reaction, Continued

+------------+---------------------------------------------------------+
| ##### d.   | > Follow the steps in the table below when you receive  |
| Processing | > *VA Form 10-7131, Exchange of Beneficiary Information |
|  VA Form 1 | > and Request for Administrative and Adjudicative       |
| 0-7131, *E | > Action* for discharged personnel testing positive for |
| xchange of | > tuberculosis.                                         |
|  Beneficia |                                                         |
| ry Informa |                                                         |
| tion and R |                                                         |
| equest for |                                                         |
|  Administr |                                                         |
| ative and  |                                                         |
| Adjudicati |                                                         |
| ve Action* |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Construe *VA Form 10-7131, Exchange of Beneficiary           |
|       | Information and Request for Administrative and Adjudicative  |
|       | Action* to mean there is no disease or disability present.   |
+-------+--------------------------------------------------------------+
| 2     | File *VA Form 10-7131, Exchange of Beneficiary Information   |
|       | and Request for Administrative and Adjudicative Action* in   |
|       | the claims folder without any control.                       |
|       |                                                              |
|       | ***Notes***:                                                 |
|       |                                                              |
|       | -   A final report of examination is submitted at the end of |
|       |     the 12-month treatment period.                           |
|       |                                                              |
|       | -   When completing any *VA Form 10-7131, Exchange of        |
|       |     Beneficiary Information and Request for Administrative   |
|       |     and Adjudicative Action* subsequently received in which  |
|       |     "*Service-Connected*" is checked in Part I, do not make  |
|       |     any reference to service connection for a positive       |
|       |     tuberculin reaction.                                     |
|       |                                                              |
|       | ***Reference***: For information on compensation claims      |
|       | based on a positive tuberculin reaction, see M21-1MR, Part   |
|       | IV, Subpart ii, 1.H.26.                                      |
+-------+--------------------------------------------------------------+

#### 11. Eligibility Requirements for Veterans Treated with Nasopharyngeal Radium Irradiation (NRI)

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on eligibility        |
| troduction | > requirements for veterans treated with nasopharyngeal |
|            | > radium irradiation (NRI) under 38 U.S.C. 1720E. It    |
|            | > includes                                              |
|            |                                                         |
|            | -   a definition of ***nasopharyngeal radium            |
|            |     irradiation***                                      |
|            |                                                         |
|            | -   background information on its use in the military   |
|            |                                                         |
|            | -   the policy on services provided to veterans, and    |
|            |                                                         |
|            | -   information on the                                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   eligibility requirements for medical care           |
|            |                                                         |
|            | -   types of examinations and care offered              |
|            |                                                         |
|            | -   provision of other services                         |
|            |                                                         |
|            | -   verification of eligibility, and                    |
|            |                                                         |
|            | -   processing the eligibility request.                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > ***Nasopharyngeal Radium Irradiation*** (NRI) is a    |
| # a. Defin | > technique developed in the 1920s that used radium to  |
| ition: Nas | > treat hearing loss caused by repeated ear infections. |
| opharyngea | > This technique was also used for treating other       |
| l Radium I | > conditions including                                  |
| rradiation |                                                         |
|            | -   sinusitis                                           |
|            |                                                         |
|            | -   tonsillitis                                         |
|            |                                                         |
|            | -   asthma                                              |
|            |                                                         |
|            | -   bronchitis, and                                     |
|            |                                                         |
|            | -   repeated viral and bacterial infections.            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > Because NRI was effective in treating otitis media,   |
| ### b. Bac | > military physicians used NRI to treat aerotitis media |
| kground on | > (barotrauma) in submariners, aviators, and divers due |
|  Use in th | > to enlarged tissue in the throat combined with rapid  |
| e Military | > pressure changes.                                     |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > VA is authorized to provide medical examination,      |
|  Policy on | > hospital care, and services for the treatment of head |
|  Services  | > and neck cancers for veterans who were treated with   |
| Provided t | > NRI during active service.                            |
| o Veterans | >                                                       |
|            | > ***Reference***: For the authority for this care see  |
|            | > [38 U.S.C.                                            |
|            | > 1720E](http://assembler.law.cornell.edu/              |
|            | uscode/html/uscode38/usc_sec_38_00001720---E000-.html). |
+------------+---------------------------------------------------------+

Continued on next page

11\. Eligibility Requirements for Veterans Treated with Nasopharyngeal
Radium Irradiation (NRI), Continued

+------------+---------------------------------------------------------+
| ###        | > To be eligible for VA medical care under this         |
| ## d. Elig | > provision of law, the veteran must have               |
| ibility Re |                                                         |
| quirements | -   documentation of NRI treatment in active military,  |
|            |     naval, or air service                               |
|            |                                                         |
|            | -   served as an aviator in the active military, naval, |
|            |     or air service before the end of the Korean         |
|            |     Conflict, or                                        |
|            |                                                         |
|            | -   undergone submarine training during active naval    |
|            |     service before January 1, 1965.                     |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Eligible veterans may receive this care whether or  |
|            |     not they are enrolled for VA healthcare.            |
|            |                                                         |
|            | -   No co-payment is required for medical care          |
|            |     associated with NRI treatment.                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Veterans with head or neck complaints or who are      |
|  e. Types  | > concerned about the possible adverse effects of their |
| of Care/ E | > NRI treatments will be offered the opportunity to     |
| xamination | > receive an Ionizing Radiation Registry (IRR)          |
| s Offered  | > examination.                                          |
|            | >                                                       |
|            | > Examination by an ear, nose, and throat specialist    |
|            | > and additional studies, such as biopsies, will be     |
|            | > performed if clinically indicated.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f    | > Provision of other services to these veterans in      |
| . Provisio | > addition to examinations and treatment of head or     |
| n of Other | > neck cancers is dependent on their other eligibility  |
|  Services  | > for medical treatment, for example, whether or not    |
|            | > they are enrolled for VA care.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > If the VA medical facility cannot verify eligibility  |
| g. Verific | > for treatment on the basis of the information of      |
| ation of E | > record, a request for verification of eligibility     |
| ligibility | > must be sent to the RO via the AMIE /CAPRI systems.   |
+------------+---------------------------------------------------------+

Continued on next page

11\. Eligibility Requirements for Veterans Treated with Nasopharyngeal
Radium Irradiation (NRI), Continued

+------------+---------------------------------------------------------+
| ###        | > When a request for verification for treatment is      |
| ## h. Proc | > received                                              |
| essing the |                                                         |
|  Eligibili | -   review the veteran's records to determine whether   |
| ty Request |     one or more of the eligibility criteria stated in   |
|            |     M21-1MR, Part III, Subpart v, 7.A.11.d have been    |
|            |     met, and                                            |
|            |                                                         |
|            | -   return *VA Form 10-7131, Exchange of Beneficiary    |
|            |     Information and Request for Administrative and      |
|            |     Adjudicative Action* or the 7131 AMIE/CAPRI request |
|            |     with "Remarks" in Part II annotated to state        |
|            |     "*Eligibility to medical treatment under 38 U.S.C.  |
|            |     1720E \[is\] \[is not\] established*."              |
+------------+---------------------------------------------------------+

#### 12. Eligibility Requests for Polish and Czechoslovakian Armed Forces

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on eligibility        |
| troduction | > requests for the Polish and Czechoslovakian armed     |
|            | > forces. It includes information on                    |
|            |                                                         |
|            | -   the regulatory basis for eligibility                |
|            |                                                         |
|            | -   rating jurisdiction                                 |
|            |                                                         |
|            | -   information forwarded when rating action is         |
|            |     required, and                                       |
|            |                                                         |
|            | -   establishing controls.                              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > April 12, 2007                                        |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > [38 U.S.C.                                            |
| ### a. Reg | > 109(c)](http://assembler.law.cornell.edu              |
| ulatory Ba | /uscode/html/uscode38/usc_sec_38_00000109----000-.html) |
| sis for El | > covers eligibility requests for veterans of the       |
| igibility  | > Polish and Czechoslovakian Armed Forces.              |
| {#a.-regul |                                                         |
| atory-basi |                                                         |
| s-for-elig |                                                         |
| ibility .u |                                                         |
| nnumbered} |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b.   | > The Wilmington VSC has sole rating jurisdiction for   |
|  Rating Ju | > veterans of the Polish and Czechoslovakian Armed      |
| risdiction | > Forces.                                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > If rating action is required, the Wilmington Medical  |
| ### c. Inf | > Administration Service (MAS) refers as many of the    |
| ormation F | > following items as are available, identified as a     |
| orwarded W | > *Public Law (PL) 94-491* case, to the Wilmington VSC  |
| hen Rating | > by *OF-41, Routing and Transmittal Slip*:             |
|  Action Is |                                                         |
|  Required  | -   *VA Form 10-7131, Exchange of Beneficiary           |
| {#c.-infor |     Information and Request for Administrative and      |
| mation-for |     Adjudicative Action* indicating the specific        |
| warded-whe |     condition for which service connection is claimed   |
| n-rating-a |                                                         |
| ction-is-r | -   a copy of the certification of service establishing |
| equired .u |     dates of qualifying service during World War I or   |
| nnumbered} |     II                                                  |
|            |                                                         |
|            | -   records of treatment of the disability during       |
|            |     service, and                                        |
|            |                                                         |
|            | -   current medical evidence relating to the            |
|            |     disability.                                         |
|            |                                                         |
|            |     > ***Note***: In these cases, no VA number is       |
|            |     > assigned.                                         |
+------------+---------------------------------------------------------+

Continued on next page

12\. Eligibility Requests for Polish and Czechoslovakian Armed Forces,
Continued

+------------+---------------------------------------------------------+
| ##### d. E | > Maintain temporary control pending completion of      |
| stablishin | > rating action by using an alphabetical holding file   |
| g Controls | > under the claimant's last name.                       |
|            | >                                                       |
|            | > ***Reference***: For more information, see M21-1MR,   |
|            | > Part IX, Subpart ii, 2.11.                            |
+------------+---------------------------------------------------------+