The short answer
Community Care eligibility decisions are appealed through VA's clinical appeals process, not the Board of Veterans' Appeals. Get the decision in writing, then send a written appeal with your evidence to your facility's Patient Advocate. The facility chief medical officer decides, and you can appeal to your regional VISN office.
How do I appeal a Community Care eligibility denial?
Through VA's clinical appeals process. 38 CFR 17.4010(d) says eligibility decisions under the Community Care rules are reviewed through VA's clinical appeals process and can't be appealed to the Board of Veterans' Appeals. VA's eligibility page says the same: if VA denies your request, you can appeal through Clinical Appeals, and the facility's chief medical officer or a designee reviews it.
What can I appeal?
A decision that you don't qualify under any of the six eligibility rules, such as:
- VA says it can meet the wait-time or drive-time standards;
- your VA clinician won't agree Community Care is in your best medical interest;
- VA says the service is available at a VA facility; or
- VA says the care isn't clinically necessary.
Step 1: Get the decision in writing
A phone "no" is hard to appeal. Ask VA through Secure Messaging to confirm its decision and the reason in writing.
Step 2: Gather your evidence
VA's clinical appeals page says to include the decision, why you disagree, and any medical evidence, like records from your provider or published studies. Helpful evidence for Community Care:
- Dates: when you asked for the care, and the earliest VA appointment offered.
- Whether you agreed to a later date. If not, say so.
- Drive time: your average drive to the VA facility that actually offers the care.
- Medical records showing the care you need and why.
- A provider letter explaining continuity, frequency, or why VA's option doesn't work for you.
- Travel burden details: your condition, the route, weather, or needing someone to drive you.
- Copies of Secure Messages and notes from calls.
Step 3: Write and send the appeal
Keep it short and specific. Name the decision, the rule you believe applies, and the facts that support it. Send it to your facility's Patient Advocate as soon as you can. Their contact is on your facility's website.
You'll get a Notice of Receipt of Clinical Appeal.
Step 4: The facility decision
The Patient Advocate works with the facility chief medical officer. If you sent new medical evidence, they may first ask your care team to reconsider. If the appeal goes forward, the chief medical officer or a designee reviews it, can consult other experts, and sends you a final letter.
Step 5: Appeal to the VISN if needed
If you disagree with the facility decision, send a written appeal to your Veterans Integrated Service Network (VISN), VA's regional office. A VISN Patient Advocate handles it, and the VISN chief medical officer decides.
You can withdraw an appeal at any time.
Is this the same as a benefits decision review?
No. Clinical appeals cover Community Care eligibility and treatment decisions. Other VA health benefit decisions, like VA health care enrollment, travel pay, or reimbursement claims, use VA's decision review options instead. See Provider Claim Disputes vs. Veteran Appeals.
For mental health denials, see Appealing a Mental Health Community Care Denial.
What we see in practice
Before you file a clinical appeal, make sure you have VA's decision in writing. Many of the denials people bring to us were only said out loud on a phone call. A polite Secure Message that points to the regulation and asks VA to confirm its position in writing usually gets the referral approved. If it doesn't, you'll have a written denial to appeal. Steps and a ready-to-send message: What to do if your Community Care referral is delayed or stuck.