The short answer
First, find out which step is stuck: eligibility, the referral, the authorization, or scheduling. Ask your facility's Community Care office and write down the answers. If you were told no on the phone, ask VA through Secure Messaging to confirm its position in writing. If it's still stuck, contact the Patient Advocate.
Where is my referral stuck?
Start by finding the exact step. A Community Care request moves through several stages, and "it's stuck" can mean any of them:
| Stage | What's happening | Who to ask |
|---|---|---|
| Request | Your VA team hasn't entered or acted on your request | Your VA care team |
| Eligibility | VA hasn't decided, or said no, on whether you qualify | Your VA care team |
| Referral | VA approved it but hasn't finished preparing the referral | Community Care office |
| Authorization | The referral is done but the provider hasn't received it | Community Care office and the provider |
| Scheduling | The provider has it but hasn't booked you | The provider, then Community Care office |
| More care | Your authorization ran out and a Request for Service is pending | Your community provider, then Community Care office |
VA says preparing a referral can take up to 14 days. If it's been longer, or you're stuck at a different stage, it's time to follow up.
What should I ask the Community Care office?
Your VA medical center has a Community Care office. You can usually reach it through the facility's main number (choose the Community Care option), through Secure Messaging, or in person. Ask:
- Has my referral been entered, and on what date?
- Is it approved? Under which eligibility rule?
- What's the authorization number?
- Which provider was it sent to, and when?
- If something is missing, what is it, and who's handling it?
Write down the date, the name of the person, and what they said.
What if I was told no on the phone?
Get the answer in writing. A phone "no" isn't a decision you can act on or appeal. A short, polite Secure Message that restates your request, points to the regulation, and asks VA to confirm its position in writing often resolves it.
The access standards are in 38 CFR 17.4040: 20 days and a 30-minute average drive for primary care, mental health, and non-institutional extended care; 28 days and 60 minutes for specialty care. The days count from the date you asked for the care. See Wait-Time and Drive-Time Standards and, for mental health, Mental Health Access Rules.
The section below, from our experience, includes a message you can copy.
What should I keep track of?
A simple record makes every next step easier:
- the date you first asked for the care;
- every call: date, name, what was said;
- copies of every Secure Message you send and receive;
- any earliest VA appointment date you were offered, and whether you agreed to a later date; and
- referral and authorization numbers.
The date you asked for care matters most. It's when the access-standard clock starts.
When should I contact the Patient Advocate?
When talking to your care team and the Community Care office hasn't fixed it. VA's Patient Advocate page suggests this order:
- Your treatment team.
- Your provider's supervisor or the service chief.
- The Patient Advocate.
Every VA medical center has one. You can find yours on your facility's website. Patient Advocates work with staff and managers to resolve problems and can help you file an appeal when one is appropriate. Bring your written record.
When is it time for a formal appeal?
When VA has decided, in writing, that you don't qualify for Community Care, and you disagree. Eligibility decisions are reviewed through VA's clinical appeals process, not the Board of Veterans' Appeals, under 38 CFR 17.4010(d). You send a written appeal to the Patient Advocate, and the facility's chief medical officer decides. If you disagree with that, you can appeal to your regional network (VISN) office.
See Appealing a Community Care Eligibility Denial and, for mental health, Appealing a Mental Health Community Care Denial.
A few cautions
- Don't book a routine appointment before the referral is approved. VA generally won't pay for it.
- Don't agree to a later VA date unless it's medically fine for you. An agreed later date changes how the wait time is measured.
- If your health gets worse while you wait, don't wait on paperwork. Use same-day care at VA, urgent care, or the emergency room. If you're in crisis, call 988 and press 1.
What we see in practice
This is one of the most common problems people bring to us. A Veteran asks for a Community Care referral, and the person on the phone says no. Sometimes they act like the 20-day rule doesn't exist. Other times they say it doesn't apply to your situation. Recently, a Veteran who had been in mental health care at VA took a break and then asked to start again. They were told the 20-day standard only applies to new patients. The regulation doesn't say that.
What works, in our experience, is not arguing on the phone. Put it in writing instead:
- Log in to VA.gov and open Secure Messaging.
- Send a short, polite message to your care team. Say what you were told, say you understand, and point them to the exact regulation.
- Ask them to confirm their position in writing.
- Save a copy of what you sent and what they send back.
About 9 times out of 10, the team writes back quickly and puts in the Community Care referral. If they confirm the refusal in writing instead, you now have exactly what you need for a clinical appeal or a talk with the Patient Advocate.
A message you can copy and paste
Hello,
On [date], I spoke with someone about a referral to Community Care for [type of care]. I was told that your office does not follow this policy.
I understand and accept that this is your position, and I'm not trying to argue.
I just want to make sure you are aware of the VA regulation on Community Care access standards, 38 CFR 17.4040(a). It says VA has to be able to get a Veteran in for mental health care within 20 days and within 30 minutes of their home. If VA can't do both, the Veteran is supposed to be allowed to use VA Community Care.*
I asked for this care on [date]. The earliest VA appointment I was offered is [date, or: I was not offered one]. I have not agreed to a later date.
If your office's position is that this standard doesn't apply to my request, please reply in writing and tell me why, so we're all on the same page. If it does apply, please submit the Community Care referral.
Thank you
* Which care this covers
- Mental health care, primary care, and non-institutional extended care (care you get at home or in the community, like a home health aide or adult day care): VA has to get you in within 20 days and within 30 minutes of your home.
- Specialty care (like a cardiologist, orthopedic doctor, or dermatologist): VA has to get you in within 28 days and within 60 minutes of your home. If you're asking for specialty care, change "mental health care" to the care you need, "20 days" to "28 days," and "30 minutes" to "60 minutes" before you send the message.
- If VA can't meet both limits, you should be able to use Community Care. An appointment 3 hours away doesn't count just because it's soon, and an appointment down the street doesn't count if it's 2 months out.
- The days are counted from the date you asked for the care.