Getting care outside VA: Community Care and your claim

Why now

On Oct 31, 2026 VA News published "Keeping care connected: How VA Direct supports Veterans." It explains Direct Secure Messaging, a tool VA and community (non-VA) providers use to send each other clinical information quickly and securely, so care is coordinated without delays or repeat tests. That is good news for your care. But care coordination is not the same as claim evidence, so read the claim section below.

Who can get Community Care

Per VA.gov, you must be enrolled in (or eligible for) VA health care and have approval from your VA health care team before seeing a community provider (except in cases like urgent or emergency care). Then at least one of these must be true:

• You need a service VA doesn't provide at any VA facility.
• You live in a state or territory without a full-service VA facility (VA lists Alaska, Hawaii, New Hampshire, Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands).
• You and your VA provider agree community care is in your best medical interest.
• VA can't provide the service in a way that meets its quality standards.
• You qualified under the old 40-mile rule as of June 6, 2018 and live in Alaska, Montana, North Dakota, South Dakota, Wyoming, or another location that still qualifies.
• VA can't meet its drive-time or wait-time standards (next card).

You can always choose to stay at a VA facility.

The drive-time and wait-time standards

These are set in 38 CFR 17.4040 and on VA.gov:

• Primary care, mental health, and non-institutional extended care: VA can't schedule you within a 30-minute average drive time or within 20 days of the date of request.
• Specialty care: VA can't schedule you within a 60-minute average drive time or within 28 days.

The wait clock runs from the date of request, unless you agreed to a later date with your VA provider. Drive time is calculated with mapping software, not your own estimate. If VA denies your request, you can appeal through VA's Clinical Appeals process (reviewed by your facility's chief medical officer or a designee).

How referrals and approvals work

• Ask your VA provider or care team about community care. Bring up drive time, wait time, or medical reasons that make the trip hard.
• If you qualify, VA approves the care before your visit and arranges it with an in-network community provider.
• Go only to the approved provider for the approved care. If the community provider wants more visits or tests, they ask VA, so check that it's been approved before you go.
• Ask your care team any time you're unsure whether a visit is covered. Getting care first and asking later can leave you with a bill.

Urgent care and emergencies

Urgent care (VA.gov): if you're enrolled and got VA or in-network care in the past 24 months, you can use VA or in-network urgent care and retail walk-in clinics with no referral. Confirm the clinic is in network (VA can't pay out-of-network urgent care), say you want to use your VA urgent care benefit, and don't pay a copay at the visit; if you owe one, VA bills you.

Emergencies: if you think your life or health is in danger, call 911 or go to the nearest ER. VA can pay for community emergency care only under certain conditions, and VA must be notified quickly. See our page on VA's 72-hour emergency notification rule.

The claim angle: community records don't always reach your claims file

Your community provider's notes may go back to VA for care purposes. That doesn't mean they're in your VA claims file, which is what the person rating your claim reads. Don't assume a community diagnosis or test result is already there.

• Ask each community provider for copies of your records: visit notes, test results, imaging reports, diagnoses.
• Upload them with your claim yourself, or
• Sign VA Form 21-4142 and 21-4142a so VA can request them from the provider.
• Keep a list of every community provider, with dates and what they treated.

Step-by-step: getting your private medical records into your claim.

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