Mileage exception for “geographically challenged” veterans in NH, Alaska & Hawaii

When I first read about the 40-mile distance from place of residence as the standard for the Veterans Choice Act, I assumed, as did many, that meant 40-miles from a VA hospital.  Wrong!

…Veterans may qualify based on their place of residence if they live more than 40 miles from the closest VA medical facility; if they reside in a state without a VA medical facility that provides hospital care, emergency medical services, and surgical care rated by the Secretary as having a surgical complexity of standard, and they reside more than 20 miles from a medical facility that offers these services in another state; 

The words “VA medical facility” defined: 

A “VA medical facility” is defined as a VA hospital, a VA community-based outpatient clinic (CBOC), or a VA health care center.

For example, if a veteran needs cardiac care and lives 10 miles from a VA community-based outpatient clinic (CBOC) that only offers primary care and mental health care, but 50 miles from a VA medical facility that offers cardiac care, the veteran would not be eligible based on his or her proximity to the CBOC.


hi ho, hi ho, it’s off the VAMC we go….. Image: Wikipedia Commons

It’s a sore point with New Hampshire veterans that the state doesn’t have a real full-service* VA hospital.  They must travel to Boston, White River Junction (VT) or use a contracted private NH hospital for complicated medical services.  In winter, it’s safer to snow shoe, ski, or dog sled than risk driving on roads coated with black ice in and around the White Mountains, notches, valleys, ranges, and forests of NH’s varied geography.

But at last, a wee 20-mile break for eligible NH vets thanks to its Senators Ayotte and Shaheen who both serve on the Senate Committe on Armed Forces.  These vets, if they live more than 20 miles from a real VA medical facility, get a choice card. I find the VA’s discussion confusing but here it is:

Under § 17.1510(b)(3), a veteran is eligible if the veteran’s residence is in a state without a full-service (*meaning that it provides, on its own and not through a joint venture, hospital care, emergency medical services, and surgical care having a surgical complexity of standard) VA medical facility and the veteran lives more than 20 miles from such a facility. As of the publication of this rule, veterans in three states would qualify under this standard: Alaska, Hawaii, and New Hampshire. No veteran residing in Alaska or Hawaii lives within 20 miles of a full-service VA medical facility in another state, but some veterans residing in New Hampshire do live within 20 miles of a full-service VA medical facility that is located in a bordering state.

Now the VA uses this provision to illustrate a nasty and absurd loophole that it blames on Congress.

We note that this specific, special eligibility for veterans in states without full-service VA medical facilities further supports our view that the Act requires VA to find veterans ineligible who live within 40 miles of a VA medical facility, even if such facility cannot provide the specific care required...When read as a whole, the Act specifically addresses the ability  of a facility to provide care only in section 101(b)(2)(C).

Source for most quotes: Federal Register: Expanded Access to Non-VA Care Through the Veterans Choice Program (published Nov. 5, 2014)

The 40/20 mile rules (straight-line trespassing or fantasy travel, not by actual public roadways) to any VA medical facility is just another kick in the head to veterans.  When the folly and meanness of this particular rule is understood by stakeholders, I hope Miller and Bernie and his replacement get earfuls. Live too close to a VA medical clinic? Be fanatical about those wait-times!  I’m happy for the vets in NH, AK and HI but their access problems are far from unique.  This new rule severely limits veterans ability to opt into local non-VA healthcare.


Ed. note: I have the new Tacoma Narrows Bridge ($6.00 trip) between me and VAMC American Lake. My actual distance to the VAMC is 31.2 miles. At the current remuneration rate of .41 per mile, one would think VA might equate that to 14.6 more miles worth of “distance” traveled. Consider also that they deduct six dollars for each foray under the aegis of some obscure claw back until you make four or more trips to the VA facility, you are financially in the hole under any scenario. I suspect the panacea is to report an hour or two early for your cardio appt. at the nearest CBOC and ask them to transport you to the VAMC. I’d wager that might get you some unwanted attention from VA’s vaunted jack-booted thugs. A warm thank you, also,  to Kiedove for unraveling this VA medical mystery.


Kiedove response to Editor–There will be more bitter illogical VA interpretative rules to discover as they roll out.  If you need a cardio apt., they have to make one for you somewhere within whatever wait-times they deem clinically necessary.  But guidance about wait-times for specialty care is hard to find.  And the “geographically challenged” definitions the VA will apply, in my sane view, should include transportation.  Again, demanding telehealth technologies to be installed for certain conditions, may help.  One ASKNOD member wrote that he was in the program and it was helpful.

mt washington

Mine did–in summer.

Because the program only runs for three years (unless reauthorized) it’s vital that we focus on the Choice Program, pick it apart and make it work. VA studies have shown that the VA saves money per patient on non-VA appointments. So instead of increasing clinic hours, and paying overtime, refer out and co-ordinate care with the vet’s VA PCP. The savings will be a big plus for taxpayers and veterans. Money saved should be used to house homeless vets (not for VA bonuses and parties (conferences).  Back to NH, for a moment.  In New England states, these bumper stickers are often seen.  It’s an awesome and scary experience.  Here are conditions on the summit now.  But severe winter weather is only one geographic challenge that veterans face all across the country.

About Laura

NW Vermont.
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4 Responses to Mileage exception for “geographically challenged” veterans in NH, Alaska & Hawaii

  1. So, once again, the VA “works around” the “benefit of the doubt should favor the Veteran” (even when interpreting regulations) to mean the exact opposite. To the VA the “benefit of the doubt” rule is interpreted as follows: Whenever possible, the VA tries to save money so there is money left over for executive bonuses. If this means 243 Veterans must die to ensure there are funds left for bonuses, they shall publish a report “doubting” that there is any “benefit” to Veterans recieving timely medical care and they “doubt” that substandard VA medical care “caused” any deaths…they died from the disease, not neglect.

  2. Frank says:

    This ever happen to anyone else? I was told to report to VAMC in another state (because my VAMC had a comflict of interest). When I went to collect my mileage “pay,” it was short a couple pf $, so I asked why. The pay clerk said, “We reimbursed you for the toll on the way here but how do we know you’ll use the tollroad on the way back?

    • Kiedove says:

      Conflict of interest–another concept to untangle. Did you ask them to explain what that meant?
      As far as getting stiffed–no benefit of the doubt about tollroads!
      This got me wondering about how many non-service connected veterans who pay copays, and have private insurance that the VA bills for VA Care, actually get reimbursed for those co-pays by the VA if the private insurance pays enough to cover the care and copay.
      During the period my spouse had private insurance, and was over-income for no-co pay care, we never got any information about how much the private insurance paid towards his VA Care either from the insurance company or the VA. (He paid co-pays for doc visits and medication.) Any readers with information about this, please let us know. I suppose we could write to the VISN business office for a report–unless this is another VA secret. Nothing was ever disclosed on the VA co-pay bills he received.

      • Frank says:

        My VAMC actually did have a conflict of interest: for a year, they had continued to diagnose a small mass on my thigh as a harmless fatty cyst, including a 6-month period after the skin over the mass had turned purple. A resident resected the mass by chopping it out in pieces, and didn’t bother trying to get tumor-free margins. Turned out it was a soft-tissue sarcoma, which, given the resident’s botched resection, required a wide resection by a specialist at a civilian medical center & radiation therapy (VA told me to pay for it all myself, and that I wasn’t eligible for VA disability benefits). The specialist, even with his expertise, didn’t go wide enough; there was still a positive margin (pathology report said the tumor had been “highly infiltrative.”) When I finally discovered, very much by accident, that I actually was eligible for benefits, I filed under 1151. The RO said, given the circumstances, the MC had a conflict of interest, and farmed out the C & P exam to a MC in another state. The examiner there upheld my 1151 claims… Fast forward 8 years, to when my senator asked VHA about their “ethical & legal obligation to reveal ‘adverse events’ in a patient’s care,” and “policy” to tell such patients about their remedial options of filing an 1151 claim or a lawsuit. VHA said what you’d expect them to say, “We take such matters very seriously…yada, yada, yada,” and launched a whitewash, er,sorry, I mean, a “clinical investigation.” Who conducted the whitewash? The Acting Director of my VAMC. What did he find? No adverse events, so no remedial options. So far, all the high mucky mucks in OGC who have deigned to reply to my rebuttal letters, just point to the finding that there were no adverse events in my care, and tell me, essentially, to go away. The high mucky muck in VHA told me to re-read the Acting Director’s original letter. (Just what part of “no” can’t you grasp?) As for my complaint to them that the Acting Director of my VAMC had a conflict of interest…studious silence. (However incompetent these folks are in so many ways, at “circling the wagons,” they’re masters.)

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