What Is Community Care
Community care is VA-authorized treatment from private healthcare providers when the VA cannot deliver care within established wait time standards or when you live more than 40 miles from a VA medical facility. Under the MISSION Act of 2018, eligible veterans can access these services through the VA Community Care Network without losing VA benefits or coverage.
Eligibility and the 40-Mile Rule
You qualify for community care in two primary scenarios. First, if you live more than 40 miles from the nearest VA medical facility, you're automatically eligible for community care referrals. Second, if the VA cannot schedule you within the VA's established access standards, you become eligible to seek treatment elsewhere. The VA must authorize and pay for this care directly to the private provider, preventing you from paying out-of-pocket.
This matters for disability claims because treatment records from community care providers count as evidence when you file or appeal a VA rating claim. Your C&P examiner may request medical records from your private doctor, and those documents carry the same evidentiary weight as VA medical records.
Community Care and Your Disability Claim
Community care directly affects your disability rating in several ways. If you've been receiving ongoing treatment for a service-connected condition at a private hospital or clinic, that medical evidence strengthens your nexus argument. When you submit a disability claim or appeal, include community care records showing continuous treatment, frequency of visits, medications prescribed, and functional limitations documented by your private provider.
During a Compensation and Pension (C&P) exam, the VA examiner may reference your community care records. If you've been treated privately, bring a copy of those records to your C&P exam appointment. If your private provider conducted diagnostic tests, imaging, or lab work, request those results in writing before your exam.
VA Payment and Authorization
The VA pays community care providers directly after authorization. You should never receive a bill for authorized services. If you're referred to community care, the VA should issue an authorization number before you receive treatment. Keep this authorization number and share it with the private provider's billing department to ensure the VA is billed.
If you received private treatment without prior VA authorization, you may still be covered if the VA determines the care was medically necessary and appropriate. Document why you sought private care, such as VA wait times or facility distance, and submit this explanation with your community care claim.
Coordinating with VSO Representation
A Veterans Service Officer (VSO) can help you navigate community care authorization and ensure your private treatment records are included in your disability file. When working with a VSO on a claim or appeal, inform them of all community care providers you've used. They can request these records through the VA's system and organize them chronologically for maximum impact during rating decisions.
If you're appealing a disability rating and believe community care records were overlooked, your VSO can file a Board of Veterans' Appeals (BVA) appeal or Higher-Level Review citing those records as new evidence of your service-connected condition's severity.
Common Questions
- Do I have to use community care if the VA offers it? No. You can choose VA care even if community care is available. However, if the VA cannot meet access standards or you live farther than 40 miles from a facility, community care may be your faster option for treatment you need now.
- Will using community care affect my VA disability rating? Not negatively. Community care records are official VA-authorized medical evidence. They support your claim by showing continuous, documented treatment of your service-connected condition.
- What if my private provider refuses to accept the VA authorization? Contact the VA's community care coordinator at 1-866-606-8198 or your local VA medical center. The VA can work directly with the provider to resolve billing disputes and ensure authorization is honored.