EXAMINATIONS AND OBSERVATION AND

EXAMINATION

§ 17.45 Persons entitled to hospital observation and physical examination. Hospitalization for observation and physical (including mental) examination may be effected when requested by an authorized official, or when found necessary in examination of the following persons:

(a) Claimants or beneficiaries of the Veterans Administration for purposes of disability compensation, pension, medical feasibility for vocational training and Government insurance.

(b) Claimants or beneficiaries referred to a diagnostic center for study to determine the clinical identity of an obscure disorder.

(c) Employees of the Veterans' Administration when necessary to determine their mental or physical fitness to perform official duties.

(d) Claimants or beneficiaries of other Federal agencies:

(1) Department of Justice-plaintiffs in Government insurance suits.

(2) United States Civil Service Commission-annuitants or applicants for retirement annuity, and such examinations of prospective appointees as may be requested.

(3) Bureau of Employees' Compensation to determine identity, severity, or persistence of disability.

(4) Railroad Retirement Board-applicants for annuity under Public No. 162, 75th Congress.

(5) Other Federal agencies.

(e) Pensioners of nations allied with the United States in World War I and World War II, upon authorization from accredited officials of the respective governments.

(Sec. 5, 41 Stat. 616, as amended, 617, as amended, sec. 3, 57 Stat. 43, 60 Stat. 526; 5 U.S.C. 710-714, 38 U.S.C. 488 note, 488a ch. 12A) [13 FR. 7156, Nov. 27, 1948, as amended at 16 F.R. 12091, Nov. 30, 1951; 19 F.R. 6716, Oct. 19, 1954; 32 F.R. 13813, Oct. 4, 1967]

§ 17.45a Examinations on an outpatient basis.

Physical examinations on an outpatient basis may be furnished to applicants having prima facie entitlement to hospital or domiciliary care to determine their need for such care and to the same

categories of persons for whom hospitalization for observation and examination may be authorized under § 17.45. [32 F.R. 13813, Oct. 4, 1967]

HOSPITAL, DOMICILIARY AND NURSING HOME CARE

§ 17.46

Persons entitled to hospital or domiciliary care.

Hospital or domiciliary care may be provided:

(a) Subject to the provisions of §§ 17.46b through 17.48, for persons eligible as veterans or on the basis of service in the uniformed services.

(b) Not subject to the eligibility provisions of §§ 17.46b through 17.48, for:

(1) Persons in the Armed Forces when duly referred with authorization therefor, may be supplied hospital care. Emergency treatment may be rendered such persons upon their own application, when absent from their commands, provided that covering formal authorization be procured as promptly as possible after the emergency treatment is begun.

(2) Hospital care may be provided, upon authorization, for beneficiaries of the Public Health Service, Bureau of Employees' Compensation, and other Federal agencies.

(3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized.

(c) Emergency hospital care may be provided for:

(1) Persons having no prima facie eligibility therefor, as a humanitarian service.

(2) Persons admitted because of presumed discharge or retirement from the Armed Forces, but subsequently found to be ineligible as such.

(3) Employees (not potentially eligible as ex-members of the Armed Forces) and members of their families, when residing on reservations of field stations of the Veterans Administration, and when they cannot feasibly obtain emergency treatment from private facilities.

(d) Hospital care when incidental to, and to the extent necessary for, the use of a specialized Veterans Administration medical resource pursuant to a sharing agreement entered into under § 17.210, may be authorized for any person designated by the other party to the agreement as a patient to be benefited under the agreement.

(e) The authorization of services under any provision of this section, except services for eligible veterans, is subject to charges as required by § 17.62.

[23 F.R. 6498, Aug. 22, 1958, as amended at 24 F.R. 8327, Oct. 14, 1959; 32 FR. 6841, May 4, 1967; 34 F.R. 9340, June 13, 1969]

§ 17.46a § 17.46b

[Reserved]

Hospital care for certain retirees with chronic disability (Executive Orders 10122 and 10400). Hospital care may be furnished when beds are available to members or former members of the uniformed services (Army, Navy, Air Force, Marine Corps, Coast Guard, Coast and Geodetic Survey, and Public Health Service) temporarily or permanently retired for physical disability or receiving disability retirement pay who require hospital care for chronic diseases and who have no eligibility for hospital care under laws governing the Veterans Administration, or who having eligibility do not elect hospitalization as Veterans Administration beneficiaries. Care under this section is subject to the following conditions:

(a) Persons defined in this section who are members or former members of the active military, naval, or air service must agree to pay the subsistence rate set by the Administrator of Veterans Affairs, except that no subsistence charge will be made for those persons who are members or former members of the Public Health Service, Coast Guard, Coast and Geodetic Survey, and enlisted personnel of the Army, Navy, Marine Corps, and Air Force.

(b) Under this section, the term "chronic diseases" shall include chronic arthritis, malignancy, psychiatric disorders, poliomyelitis with residuals, neurological disabilities, diseases of the nervous system, severe injuries to the nervous system, including quadriplegia, hemiplegia and paraplegia, tuberculosis, blindness and deafness requiring definitive rehabilitation, disability from major amputation, and other diseases as may be agreed upon from time to time by the Chief Medical Director and designated officials of the Department of Defense and Department of Health, Education, and Welfare. For the purpose of this section, blindness is defined as corrected visual acuity of 20/200 or less in the better eye, or corrected central visual acuity of more than 20/200 if there is a field defect in which the peripheral field

has contracted to such an extent that its widest diameter subtends the widest diameter of the field of the better eye at an angle no greater than 20°.

(c) In the case of persons who are former members of the Coast and Geodetic Survey, care may be furnished under this section even though their retirement for disability was from the Environmental Science Services Administration, provided any such person was transferred to that organization from the Coast and Geodetic Survey pursuant to Reorganization Plan No. 2 of 1965 (30 F.R. 8819; 3 CFR 1965 Supp.).

[34 F.R. 9340, June 13, 1969]

§ 17.47 Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service.

Within the limits of Veterans' Administration facilities, hospital, domiciliary, or nursing home care may be furnished the following applicants.

(a) Hospital care for veterans in need of such care for an adjudicated serviceconnected disability or for a nonservice-connected condition which is associated with and held to be aggravating such disability. (See § 17.33 with respect to presumption relating to psychosis 38 U.S.C. 602.)

(b) Hospital care for:

(1) Veterans discharged or released for disability incurred or aggravated in line of duty when in need of hospital care for the disability for which discharged or released, or for a non-serviceconnected condition which is associated with and held to be aggravating such disability.

(2) Persons defined in § 17.46b who require hospitalization for chronic diseases incurred in line of duty.

(c) Hospital or domiciliary care. (1) Hospital care for veterans discharged or released for disability incurred or aggravated in line of duty, or persons in receipt of or but for the receipt of retirement pay would be entitled to disability compensation for a service connected disability, when suffering from non-service connected disabilities requiring hospital care.

(2) Hospital care for persons defined in § 17.46b who require hospital care for chronic diseases not incurred in line of duty.

(3) Domiciliary care for veterans discharged or released for disability incurred or aggravated in line of duty, or

persons in receipt of compensation for service connected disability, when suffering from a permanent disability or tuberculous or neuropsychiatric ailment and who are incapacitated from earning a living and who have no adequate means of support. An additional requirement for eligibility for domiciliary care is the ability of the veteran to perform all the following:

(i) Perform without assistance daily ablutions, such as brushing teeth; bathing; combing hair; body eliminations.

(ii) Dress himself, with a minimum of assistance.

(iii) Proceed to and return from the dining hall without aid.

(iv) Feed himself.

(v) Secure medical attention on an ambulatory basis or by use of personally propelled wheelchair.

(vi) Have voluntary control over body eliminations or control by use of an appropriate prosthesis.

(vii) Share, by his personal efforts, in some measure, however slight, in the maintenance and operation of the station.

(viii) Make rational and competent decisions as to his desires to remain or leave the station.

(d) Hospital or domiciliary care for veterans of any war, or of service after January 31, 1955, or any veteran awarded the Medal of Honor, who swear they unable to defray the expense of hospital or domiciliary care (including the expense of transportation to and from a Veterans Administration facility); and who are suffering from a disability, disease, or defect which, being susceptible to cure or decided improvment, indicates need for hospital care, or which, being essentially chronic in type, is producing disablement of such degree and of such probable persistency as will incapacitate from earning a living for a prospective period, and thereby indicates need for domiciliary care. additional requirement for eligibility for domiciliary care is the ability of the veteran to perform all of the following:

An

(1) Perform without assistance daily ablutions, such as brushing teeth; bathing; combing hair; body eliminations.

(2) Dress himself with a minimum of assistance.

(3) Proceed to and return from the dining hall without aid.

(4) Feed himself.

(5) Secure medical attention on an ambulatory basis or by use of personally propelled wheelchair.

(6) Have voluntary control over body eliminations or control by use of an appropriate prosthesis.

(7) Share, by his personal efforts, in some measure, however, slight, in the maintenance and operation of the station.

(8) Make rational and competent decisions as to his desires to remain or leave the station.

Except for applicants presenting emergent conditions, consideration in admissions under this paragraph may be given to the length or character of service.

(e) Nursing home care for veterans hospitalized under paragraph (a), (b), (c), or (d) of this section who have attained maximum hospital benefits, or veterans domiciled under paragraph (c) or (d) of this section, when they require a period of nursing home care.

[24 F.R. 8328, Oct. 4, 1959, as amended 27 F.R. 11423, Nov. 20, 1962; 30 F.R. 1787, Feb. 9, 1965; 31 F.R. 4116, Mar. 9, 1966; 32 F.R. 13813, Oct. 4, 1967; 34 F.R. 9340, June 13, 1969] § 17.48 Considerations applicable in determining eligibility for hospital or domiciliary care.

(a) (1) For applicants discharged or released for disability incurred or aggravated in line of duty and who are not in receipt of compensation for service-connected or service-aggravated disability, the official records of the Armed Forces relative to findings of line of duty for its purposes will be accepted in determining eligibility for hospital care. Where the official records of the Armed Forces show a finding of disability not incurred or aggravated in line of duty and evidence is submitted to the Veterans Administration which permits of a different finding, the decision of the Armed Forces will not be binding upon the Veterans Administration, which will be free to make its own determination of line of duty incurrence or aggravation upon evidence so submitted. It will be incumbent upon the applicant to present controverting evidence and, until he so acts and a determination favorable to him is made by the Veterans Administration, the finding of the Armed Forces will control and hospital care will not be authorized. Such controverting evidence, when received from an applicant, will be referred to the adjudicating agency which would have jurisdiction if the applicant was filing

claim for pension or disability compensation, and the determination of such agency as to line of duty, which is promptly to be communicated to the head of the field station receiving the application for hospital care, will govern the station head's disapproval or approval of admission, other eligibility requirements having been met. Where the official records of the Armed Forces show that the disability for which a veteran was discharged or released from the Armed Forces under other than dishonorable conditions was incurred or aggravated in the line of duty, such showing will be accepted for the purpose of determining his eligibility for hospitalization, notwithstanding the fact that the Veterans Administration has made a determination in connection with a claim for monetary benefits that the disability was incurred or aggravated not in line of duty.

(2) In those exceptional cases where the official records of the Armed Forces show discharge or release under other than dishonorable conditions because of expiration of period of enlistment or any other reason except disability, but also show a disability incurred or aggravated in line of duty during the said enlistment; and the disability so recorded is considered in medical judgment to be or to have been of such character, duration, and degree as to have justified a discharge or release for disability had the period of enlistment not expired or other reason for discharge or release been given, the Chief Medical Director, upon consideration of a clear, full statement of circumstances submitted to him, is authorized to approve admission of the applicant for hospital care, provided other eligibility requirements are met. A typical case of this kind will be one where the applicant was under treatment for the said disability recorded during his service at the time discharge or release was given for the reason other than disability.

able for his use because of other obligations such as contributions in whole or in part to the support of a spouse, child, mother, or father. In all such cases of alleged inadequate means of support, the circumstances will be submitted to the Director for decision.

(c) Under paragraph (d) of § 17.47:

(1) "A disability, disease, or defect" will comprehend any acute, subacute, or chronic disease (of a general medical, tuberculous, or neuropsychiatric type) or any acute, subacute, or chronic surgical condition susceptible of cure or decided improvement by hospital care; or any condition which does not require hospital care for an acute or chronic condition but requires domiciliary care. Domiciliary care, as the term implies, is the provision of a home, with such ambulant medical care as is needed. To be entitled to domiciliary care, the applicant must consistently have a disability, disease, or injury which is essentially chronic in type and is producing disablement of such degree and probable persistency as will incapacitate from earning a living for a prospective period. (2) "Unable to defray the expense of hospital or domiciliary care (including the expense of transportation to and from a Veterans Administration facility)" the affidavit of the applicant on VA Form 10-P-10 that he is unable to defray the expenses of hospital or domiciliary care (including transportation to and from a Veterans Administration facility) will constitute sufficient warrant to furnish hospitalization or domiciliary care (including Government transportation to cover transportation to the facility).

(d) Persons hospitalized pursuant to paragraph (c) (1) or (d) of § 17.47, who it is believed may be entitled to hospital care or medical or surgical treatment or to reimbursement for all or part of the cost thereof by reason of any one or more of the following:

(1) (i) Membership in a union, fraternal or other organization;

(ii) Rights under a group hospitalization plan, or under any of the prepay medical care or insurance contracts or plans which provide for payment or reimbursement in whole or in part, for the cost of medical or hospital care, and conditions the obligation of the insurer to pay upon payment or incurrence of liability by the person covered;

(iii) "Workmen's Compensation" or "employer's liability" statutes, State or Federal; and

(iv) Right to maintenance and cure in admiralty, or

(2) By reason of statutory or other relationships with third parties, including those liable for damages because of negligence or other legal wrong;

will not be furnished hospital care, medical or surgical treatment, without charge therefor to the extent of the amount for which such parties, referred to in subparagraph (1) or (2) of this paragraph, are, or will become liable. Such patients will be requested to execute an appropriate assignment as prescribed in this paragraph. Patients who, it is believed, may be entitled to care under any one of the plans in subparagraph (1) of this paragraph, will be requested to execute VA Form 10-2381, Power of Attorney and Agreement. Those patients who, it is believed, may be entitled to hospital care under the circumstances prescribed in subparagraph (2) of this paragraph will be requested to complete SF 96A. Notice of this assignment will be mailed promptly to the party or parties believed to be liable. When the amount of charges is ascertained, bill therefor will be mailed such party or parties.

(e) Women veterans will not be entitled to hospital care for pregnancy and parturition unless it is complicated by a pathological condition.

(f) Within the limits of Veterans' Administration facilities, any veteran who is receiving hospital care in a hospital under the direct and exclusive jurisdiction of the Veterans' Administration, or in a Federal hospital under agreement, may be furnished medical services to correct or treat any non-service-connected disability in addition to treatment for the disability for which he is hospitalized: Provided, The veteran is willing, and furnishing the services would (1) be in the veteran's interest, (2) not prolong his hospitalization, and (3) not interfere with the furnishing of medical services under other provisions of Part 17 to other veterans.

[32 FR. 13813, Oct. 4, 1967, as amended at 34 F.R. 9340, June 13, 1969]

ferred to a Veterans Administration hospital in the following order:

(1) Emergency. Applicants presenting a bona fide medical emergency (i.e., delay in immediate admission would result in the loss of life or do irreparable and serious damage to a part of the body) will be admitted immediately without regard to their entitlement under the priority groups set forth in subparagraph (3) of this paragraph. Applicants for hospital care for a psychotic condition will not be accorded emergency priority if, without hazard, they can be transported to another hospital.

(2) Patients on hospital rolls and not occupying a bed. As these patients are carried on the rolls of the hospital for further treatment of the condition for which they were originally hospitalized, readmission will be effected for treatment of this condition when required without regard to their entitlement under the priority groups set forth in subparagraph (3) of this paragraph.

NOTE: Patients included are those who are on authorized pass, leave of absence, CBOC (completion of bed occupancy care,) in elopement status, and trial visit.

(3) Priority groups. (1) Group I includes:

(a) Veterans requiring hospital treatment for service-connected or adjunct disabilities (§ 17.47 (a) or (b)) who are:

(1) Applicants not hospitalized by the Veterans Administration. (Are not in hospitals, or are in non-Veterans Administration hospitals but not under Veterans Administration authorization.)

(2) Patients currently hospitalized by Veterans Administration in Veterans Administration or non-Veterans Administration hospitals whose transfer has been requested for medical reasons.

(b) Armed Forces active duty personnel eligible for hospital treatment under § 17.46 (b) (1) who are transferred in anticipation of retirement or separation from active service.

(c) A veteran who has been found in need of vocational rehabilitation, and for whom an objective has been selected, or who is pursuing a course of vocational rehabilitation training, and such care is medically determined necessary for any of the reasons enumerated in § 17.36 (b). (ii) Group II includes:

(a) Persons whose hospital care under 17.45 for observation and examination