The short answer
If VA can't schedule primary care, mental health care, or non-institutional extended care within 20 days of your request and within a 30-minute average drive of your home, you qualify for Community Care. For specialty care, it's 28 days and 60 minutes. The clock starts when you ask, unless you agree to a later date.
What are the access standards?
They're VA's limits on how long you should wait and how far you should drive. If VA can't meet them, you can choose Community Care under 38 CFR 17.4010(a)(4). The standards themselves are in 38 CFR 17.4040.
| Type of care | Wait-time limit | Drive-time limit |
|---|---|---|
| Primary care | 20 days | 30-minute average drive |
| Mental health care | 20 days | 30-minute average drive |
| Non-institutional extended care (like home health or adult day care) | 20 days | 30-minute average drive |
| Specialty care (like cardiology, orthopedics, dermatology) | 28 days | 60-minute average drive |
You only need to miss one. If VA can see you in 10 days but the clinic is a 45-minute average drive for mental health care, you qualify.
When does the 20- or 28-day clock start?
On the date you request the care. The regulation counts from the date of request, not from when VA gets around to scheduling, and not from when a consult is entered.
There's one exception: a later date you agree to with your VA provider. If your provider says you should come back in three months and you agree, the clock is measured against that date. If you didn't agree to a later date, VA can't count it against you.
The standard doesn't make an exception for existing patients. A Veteran returning to therapy after a break, or asking for a new kind of care, is measured from the date of that request.
How is drive time measured?
By average driving time, not miles. VA calculates it with geographic information system (GIS) software from your residence to the VA facility. A few details matter:
- It's average drive time, so a bad-traffic day doesn't change it by itself.
- It's measured to a VA facility that can provide the care you need. A closer VA clinic that doesn't offer the service doesn't count.
- It's from your residence, meaning your legal or seasonal home, not a PO box. See Moving With VA Health Care.
If your actual trip is much harder than the average suggests, because of a medical condition, weather, or terrain, that falls under best medical interest instead.
What about follow-up specialty care?
The same 28-day standard applies when you need follow-up specialty care VA can't schedule in time, unless you agreed to a later date. If you're already seeing a community provider, follow-ups are usually covered under your existing authorization. When that runs out, your provider asks for more through a Request for Service.
Does a telehealth appointment count?
Under VA's rules, yes, it can. 38 CFR 17.4005 defines an appointment to include telehealth and same-day visits. So VA may say it can meet the standard by offering video care. Whether that's appropriate for you is a separate question. See Do Telehealth or Same-Day Appointments Count?
How do I use the access standards?
- Ask for the care and note the date. Use Secure Messaging so the date is in writing.
- Ask for the earliest VA appointment date. Don't agree to a later date unless it's medically fine for you.
- If it's past 20 or 28 days, say you'd like Community Care. You can also name a provider you want.
- If you're told no, ask for the decision in writing with the reason.
VA says preparing a referral can take up to 14 days. That's paperwork time after you're approved. It doesn't change the access standards.
For mental health specifically, see Community Care Access Rules for Mental Health.
What we see in practice
The 20-day standard is the one we see questioned most. People are told it doesn't exist, that it doesn't apply to their kind of care, or that it only counts for new patients. The regulation doesn't carve out existing patients; it counts from the date you request the care. The approach that works best for us is a polite Secure Message that points to the exact regulation and asks VA to confirm its position in writing. Full steps and a copy-and-paste message: What to do if your Community Care referral is delayed or stuck.