The short answer
Mental health Community Care denials are appealed through VA's clinical appeals process, not the Board of Veterans' Appeals. First, get the decision and reason in writing. Then send a written appeal with supporting records to your facility's Patient Advocate. The facility's chief medical officer decides, and you can appeal to your VISN.
How do I appeal a mental health Community Care denial?
Through VA's clinical appeals process. Under 38 CFR 17.4010(d), Community Care eligibility decisions are reviewed through VA's clinical appeals process and can't be appealed to the Board of Veterans' Appeals. VA's eligibility page confirms that denied Community Care requests can be appealed through clinical appeals.
This applies to mental health denials based on:
- the 20-day or 30-minute access standards;
- best medical interest, like continuity or frequency of care;
- telehealth being offered instead of in-person care; or
- an authorization or extension VA wouldn't approve.
Step 1: Get the decision in writing
Many denials are only said on the phone. Before you appeal, send a Secure Message asking VA to confirm its decision and reason in writing. Sometimes that resolves it. If not, you'll have the written decision your appeal needs. See What to Do If Your Referral Is Delayed or Stuck.
Step 2: Write your appeal
VA's clinical appeals page says to include:
- the decision you disagree with;
- why you disagree; and
- any medical evidence that supports you, like records from your provider or published studies.
For mental health access, make it concrete:
- The date you asked for care, and the earliest VA appointment offered.
- Whether you agreed to a later date. If not, say so.
- Your average drive time to the VA clinic that offers the care.
- For best medical interest: how often you need care, how long you've been with your current provider, how symptoms affect travel or video sessions.
- A letter from your current or prospective therapist, if you have one.
A plain sentence can anchor it: "I'm appealing the denial of Community Care for outpatient mental health care. Under 38 CFR 17.4040(a)(1), VA must schedule mental health care within 20 days of my request and within a 30-minute average drive. I asked on [date], and the earliest VA appointment offered was [date]. I did not agree to a later date."
Step 3: Send it to the Patient Advocate
Send the written appeal to your VA facility's Patient Advocate as soon as you can. You'll get a notice that it was received. The Patient Advocate works with the facility's chief medical officer. If you included new medical evidence, they may first ask your care team to reconsider.
Step 4: The decision
The facility's chief medical officer, or someone they choose, reviews your appeal and records and sends you a final letter.
If you disagree, you can appeal in writing 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.
What if my mental health gets worse while I wait?
Don't wait on the appeal. Ask your VA team for same-day mental health care. If you're in crisis, call 988 and press 1, text 838255, or go to the nearest emergency room. VA covers emergency suicide crisis care at no cost. See Free Emergency Suicide Crisis Care.
What we see in practice
Most mental health referral refusals we hear about happen on the phone, often with the claim that the 20-day standard only applies to new patients. Before starting a formal appeal, get VA's position in writing: a short Secure Message that points to 38 CFR 17.4040(a) and asks VA to confirm its answer. In our experience, that resolves it most of the time. If it doesn't, the written reply is exactly what your appeal needs. Steps and a ready-to-send message: What to do if your Community Care referral is delayed or stuck.