The short answer
Under 38 CFR 17.109, Veterans of World War II, Korea, Vietnam, or the Gulf War who developed psychosis within 2 years after leaving service, and before their era's cutoff date, are presumed eligible for VA care for it. Gulf War Veterans with another mental illness in that window get the same. This care has no VA copays.
What is the psychosis and mental illness presumption?
A rule that makes certain Veterans eligible for VA treatment of psychosis or other mental illness without proving it's service connected. It's in 38 CFR 17.109.
This is a health care rule. It covers treatment, not disability compensation. A disability rating is a separate claim.
Who qualifies for the psychosis presumption?
Veterans of these periods who developed psychosis:
- within two years after leaving active service; and
- before the cutoff date for their period:
| Period | Psychosis must have developed before |
|---|---|
| World War II | July 26, 1949 |
| Korean conflict | February 1, 1957 |
| Vietnam era | May 8, 1977 |
| Persian Gulf War | The end of the two-year period starting on the last day of the Persian Gulf War |
The care covers treatment of an active psychosis.
Who qualifies for the other mental illness presumption?
Only Persian Gulf War Veterans. If you developed a mental illness other than psychosis, like depression or PTSD, within two years after leaving active service and before the end of the two-year period starting on the last day of the Persian Gulf War, you're presumed eligible for treatment of that active mental illness.
The Persian Gulf War hasn't officially ended. Its end date is set by law or presidential proclamation, so this window hasn't closed for Gulf War Veterans.
Does length of service matter?
No. Under 38 CFR 17.109(c), eligibility for this care, and the copay exemption, doesn't depend on how long you served on active duty.
Are there copays?
No. 38 CFR 17.109 exempts this care from VA copays for outpatient care, medications, and inpatient care, under 17.108, 17.110, and 17.111. 38 CFR 17.108 also lists these Veterans among those not subject to outpatient copays for this care.
How does this connect to Community Care?
This rule decides whether VA will treat the condition. Community Care decides where. If you qualify under 17.109 and VA can't provide mental health care within its 20-day and 30-minute standards, or Community Care is in your best medical interest, VA can refer you to a community provider.
Routine Community Care usually requires enrollment in VA health care, so if you aren't enrolled, ask about enrolling. See Who Is a Covered Veteran?
How do I use this rule?
- Gather your records. Your DD-214 showing your service period and discharge date, and any medical records showing when symptoms started.
- Contact VA's enrollment office or call 877-222-8387 and say you may qualify for care under 38 CFR 17.109.
- Ask VA to note the presumption in your record so the copay exemption applies.
- Ask for mental health care, and if VA can't meet the access standards, ask about Community Care.
Timing can be hard to show years later. Records from the first two years after discharge, like treatment notes or statements from people who knew you then, can help.