Sorry for the mess!

The site is undergoing a massive update. All the content on the site still works but things just might look a little messy and disorganized. Most of the upgrades will probably be don by the end of the month. Thank you for your understanding!

Updated Feb 14, 2025

In This Section
This section contains the following topics:
Topic
Topic Name
1
2
3

1.  Methods of Information Exchange

Introduction
This topic contains information on the methods ROs and VA medical facilities use to exchange information, including

Change Date
February 14, 2025

X.iii.1.A.1.a. Definition: Hospitalization
Hospitalization, as it is used in this section and throughout this chapter, generally refers to inpatient care or treatment that a Veteran receives in a
  • Department of Veterans Affairs (VA) hospital or medical facility
  • VA domiciliary
  • VA nursing home, or
  • private facility under VA contract.
Notes:
  • This contextual usage of the term hospitalization does not automatically or inherently imply that the nature of the medical care/treatment administered is consistent with or supports eligibility to a temporary 100-percent evaluation under 38 CFR 4.29 or 4.30.  That determination is contingent on consideration of the individual evidentiary record and procedural principles found in M21-1, Part VIII, Subpart iv, 8.B and C.
  • Where specifically stated elsewhere in this chapter, hospital care may be excluded from the term “hospitalization” for adjustment of benefits for Veterans receiving Veteran’s pension after January 31, 1990.

X.iii.1.A.1.b.  Methods of Exchanging Information
VA medical facilities and regional offices (ROs) use the following methods to exchange information:
Important:  ROs must not rely on e-mailed or faxed transmission of a VA Form 10-7131 in order to obtain relevant VA medical records that are not electronically accessible through CAPRI or the Joint Longitudinal Viewer (JLV).  Instead, claims processors must request the records using the electronic VA Form 10-7131 functionality available in CAPRI.
References:  For more information on

X.iii.1.A.1.c.  Use of VA Form 10-7131
Historically, VA medical facilities and ROs have used VA Form 10-7131 to exchange information or request administrative and adjudicative action relating to a Veteran’s status when they are applying for or receiving VA medical care.
The deployments of CAPRI and centralized, automated reporting have substantially reduced the need to use forms for communication between ROs and VA medical facilities.  However, VA Form 10-7131 is still used in some situations because VA medical facilities cannot initiate electronic requests to ROs.

X.iii.1.A.1.d.  Use of VA Form 10-7132
Historically, VA medical facilities have used VA Form 10-7132 to notify ROs of changes in a patient’s status.  Although the deployment of CAPRI has substantially reduced the need for use of this form, personnel at VA medical facilities still occasionally use it for purposes such as notifying ROs of changes in the statuses of Veterans residing in contract nursing homes.

X.iii.1.A.1.e.  Automated Reporting of Admissions and Discharges
The Veterans Benefits Administration (VBA) currently audits VHA clinical data to centrally automate timely creation and National Work Queue distribution of reports disclosing
  • admissions and discharges of service-connected (SC) Veterans hospitalized in excess of 21 days
  • hospital treatment potentially warranting convalescence benefits
  • hospital admissions, discharges, and re-admissions of beneficiaries in receipt of aid and attendance (A&A) or pension, and
  • contract nursing home reports of admissions/discharges.
Note:  ROs will be instructed to manually generate reports when necessary.  To access these reports, log into CAPRI, but do not attempt to locate a specific Veteran.  Instead, select
  • File from the tool bar in the top, left-hand corner of the screen, and
  • Reports from the drop-down box.
References:  For more information on

X.iii.1.A.1.f. Protection of Information Accessed Through CAPRI
Records accessed through CAPRI contain individually identifiable, highly sensitive health information that is protected by Federal statutes, including
VBA personnel may only access the records on a need-to-know basis and disclose health information for relevant business purposes, as authorized by these statutes.

X.iii.1.A.1.g. Administration of CAPRI User Accounts
The Office of Information and Technology administers CAPRI user accounts for RO employees.  ROs may request access to CAPRI for their employees by submitting VA Form 20-8824-CAPRI, User Request for CAPRI Access, through their local Information Security Officer (ISO).
Before gaining access, each employee must
  • complete VBA and VHA security/privacy training, and
  • acknowledge receipt of and adherence to the CAPRI Rules of Behavior.
Notes:
  • Misuse of CAPRI, such as accessing medical records for purposes other than VA business, may result in disciplinary action and criminal prosecution.
  • Contact the local ISO for more information on CAPRI security/privacy requirements and prevention of unauthorized disclosure of VHA records.

2.  Receipt of Notice of a Veteran’s Hospitalization at VA Expense

Introduction
This topic contains information on the initial actions to take upon receipt of notice from a VA medical facility of a Veteran’s hospitalization at VA expense, including

Change Date
February 14, 2025

X.iii.1.A.2.a. Determining Whether an Award Adjustment Is Necessary
The table below
  • describes situations under which an award adjustment may be necessary based on receipt of notice from a VA medical facility of a Veteran’s hospitalization, outpatient treatment, or nursing home admission at VA expense, and
  • provides hyperlinks to references with instructions for addressing each situation.
If the Veteran is …
Then see …
receiving additional benefits for A&A
  • receiving pension, and
  • has no dependents
still hospitalized for treatment of an SC disability that is currently evaluated at less than 100 percent or received medical or surgical treatment necessitating convalescence
Notes:
  • “Notice,” for the purpose of this topic, includes both centrally automated and manual CAPRI reports generated to identify Veterans whose awards might require adjustment because of hospitalization at VA expense.
  • Upon receipt of notice, first review the CURRENT AND HISTORICAL AWARD INFORMATION page in the Veteran’s Benefits Management System (VBMS) to determine whether an adjustment of the Veteran’s award is necessary.  Review the claims folder only if information required to determine whether an award adjustment is necessary cannot be obtained through VBMS.
Reference:  For more information on VBMS, see the VBMS Core User Guide.

X.iii.1.A.2.b.  Claims Processor Actions to Take Upon Receipt of VA Report of Hospitalization
As noted in M21-1, Part II, Subpart iii, 2.D.1, the VA will review a report of hospitalization in a VA hospital occurring on or after March 24, 2015, to determine whether entitlement to benefits under 38 CFR 4.29 or 38 CFR 4.30 exists.
Automated reporting will generate the hospitalization report controlled by end product (EP) 330.  For hospitalizations
  • in excess of 21 days associated with consideration under 38 CFR 4.29, EP 330 will be accompanied by the Admission Report for SC Veteran claim label and a standard contention labeled hospitalization review, or
  • potentially necessitating convalescence associated with consideration under 38 CFR 4.30, EP 330 will be accompanied by the Convalescence Report claim label and a standard contention labeled hospitalization review.
Follow the steps in the table below upon receipt of EP 330 with a claim label, as included in M21-4, Appendix C.1, indicative of a hospital admission and/or discharge.
Step
Action
1
Does review of the VA hospitalization report show that an SC disability was treated during the hospitalization?
  • If yes, go to Step 2.
  • If no,
    • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown due to treatment for NSC disability for admission dated [date of admission] in the VBMS NOTES screen and take no further action, and
    • clear EP 330.
2
Review the hospitalization report to determine if additional review by the rating activity is required.  Does the evidence suggest that hospitalization
  • was in excess of 21 days for an SC disability, as described in 38 CFR 4.29, or
  • included surgical treatment or resulted in immobilization by cast of one major joint or more for an SC disability?
If yes, go to Step 3.
If no,
  • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown on the report of hospitalization and take no further action
  • change EP 320 to EP 330 (if EP 320 is pending), and
  • clear EP 330.
3
  • Establish EP 320, if not already established, or
  • change EP 330 to 320.
4
Obtain all relevant records associated with the report of hospitalization.  Use CAPRI, as directed at M21-1, Part III, Subpart ii, 1.A.2.
5
Edit the VBMS contentions screen as follows:
  • Replace the hospitalization review contention with the name of the SC disability for which treatment occurred, ensuring that the diagnosis is exactly as it appears on the most recent rating decision Codesheet.
  • Add additional contentions if more than one SC disability was treated.
6
Forward to the rating activity for review and action.
7
The rating activity reviews the report of hospitalization to determine whether entitlement to benefits is warranted under
8
If entitlement to benefits under 38 CFR 4.29 or 38 CFR 4.30 is
  • warranted, then proceed with rating and authorization action under EP 320, or
  • not warranted, then
    • change the controlling EP 320 to an EP 330
    • clear the EP 330, and
    • annotate No Action Necessary – Paragraph 29 and/or 30 entitlement not shown on the report of hospitalization in the claims folder.
Note:  The proper EP to clear for action based on receipt of a hospital report is contingent on the ending action.  When benefit entitlement
  • is warranted, clear EP 320.
  • is not warranted, clear EP 330.
References:  For more information on

X.iii.1.A.2.c. Requesting Documents/Reports Under the 7131 REQUEST Tab in CAPRI
Generally and in most instances, the medical information required to process a claim or adjust a Veteran’s award based on hospitalization at VA expense is available and instantaneously retrievable under the CLINICAL DOCUMENTS tab in CAPRI.
When such medical information is unavailable in CAPRI, users must request it under the 7131 REQUEST tab.
The table below lists reports/documents available under the 7131 REQUEST tab and the circumstances under which users might request them.
If …
Then request …
a VA medical facility notifies an RO that a Veteran was hospitalized, and
  • the admission diagnosis is a(n)
    • SC disability, or
    • disability that an SC disability may have caused
  • the admission diagnosis is unclear and the Veteran has an SC disability
  • a claim for compensation or pension is pending, or
  • the Veteran has a service-connected disability that is subject to improvement (a diary for a future examination exists)
Note:  A hospital summary is also necessary, according to M21-1, Part X, Subpart iii, 1.C.3.a, if VA awards additional benefits for A&A based on a Veteran’s nursing home status.
Hospital Summary.
a hospital report covering certain disabilities is needed immediately
Note:  Enter the specific disabilities at issue in the ADDITIONAL REMARKS or COMMENTS section.
Other/Exam.
a hospital report is required after a specific number of days.  (This generally occurs when a Veteran is totally disabled or when permanency for pension purposes has not been established and a hospital report is needed in 90 or 180 days.)
Note:  Other situations may arise that require a request for a Special Report. These include situations in which an RO must retrieve
  • an autopsy report, or
  • medical evidence or information in connection with a Board of Veteran’s Appeals remand.
Special Report.
a Veteran’s competency is at issue and the evidence of record indicates treatment for a disability other than a mental condition
Note:  Information about a Veteran’s competency is normally included in hospital reports when treatment is for a mental condition.
Competency Report.
Important:  As is noted in M21-1, Part X, Subpart iii, 1.A.1.b, ROs must not rely on e-mailed or faxed transmission of VA Form 10-7131 in order to obtain relevant VA medical records that are not electronically accessible.
References:  For more information on

3.  Unsolicited Reports from VA Medical Facilities and the MFH Program

Introduction
This topic contains information about unsolicited reports and the MFH program, including

Change Date
November 2, 2020

X.iii.1.A.3.a.  Unsolicited Reports That ROs Might Receive From VA Medical Facilities
The Chief of Medical Administration Specialist (MAS) at a VA medical facility may send unsolicited reports to an RO under the situations described in the table below.
If …
Then the MAS will send the RO of jurisdiction (ROJ) …
staff at the medical facility believe a Veteran might be entitled to additional benefits for A&A or because the Veteran is housebound
Note:  The MAS might send supplemental reports regarding the Veteran’s medical condition to the ROJ.
  • staff at the medical facility believe a Veteran might be incompetent, and
  • the Veteran has a claim for disability benefits pending or is receiving compensation, pension, or retirement pay as a competent Veteran
a report regarding the Veteran’s competency.
staff at the medical facility believe a Veteran rated incompetent for VA purposes might be competent
a report regarding the Veteran’s competency.

X.iii.1.A.3.b.  General Information About the MFH Program
The Medical Foster Home (MFH) Program is a non-institutional alternative to nursing home care for Veterans that are unable to safely live alone due to chronic or terminal illness.
Note:  Eligible Veterans must bear the cost of residing at an MFH.  However, the cost is less than the amount traditional nursing homes charge.
Reference:  For more information on MFHs, see

X.iii.1.A.3.c.  Eligibility Requirements for Referral to an MFH
To be eligible for referral to an MFH, a Veteran must require the level of care that a nursing home provides.  This includes
  • the inability to live independently due to functional, cognitive, and/or psychosocial impairment, and
  • the existence of complex medical conditions that require care from a VA home health care team.

X.iii.1.A.3.d.  VAMC Responsibilities
Each VA medical center (VAMC) that participates in the MFH Program is responsible for designating an MFH Coordinator.  These coordinators are responsible for
  • identifying Veterans that meet the eligibility requirements for referral to an MFH
  • assisting eligible Veterans in completing an application for VA disability benefits (compensation and/or pension)
  • ensuring the VAMC examines eligible Veterans and completes a VA Form 21-2680 for each of them
  • contacting the MFH Coordinator at the ROJ when a Veteran is ready to be admitted to an MFH and asking whether the RO needs any additional information or evidence to process the Veteran’s claim, and
  • faxing the following to the MFH Coordinator of the ROJ for each eligible Veteran:
    • application for VA disability benefits
    • completed VA Form 21-2680, and
    • pertinent medical records.

X.iii.1.A.3.e.  RO Responsibilities
ROs are responsible for designating an MFH Coordinator and alternate coordinator.  Following receipt of a claim that is based on a Veteran’s referral to an MFH, these coordinators are responsible for
  • undertaking development to obtain any documentation (such as forms, applications, or medical evidence) that is necessary to decide the claim
  • monitoring the progress of the claim throughout the claim process and taking any action necessary to prevent unnecessary delays, and
  • notifying the VAMC MFH Coordinator that submitted the claim of the decision the RO ultimately makes on the claim.
Notes:
  • Compensation Service maintains a list of coordinators by RO on their Medical Foster Home Coordinator Listing.  When an RO designates a new coordinator, it must notify Compensation Service of the change by sending an e-mail to VAVBAWAS/CO/212.
  • In order to effectively track claims that are based on a Veteran’s referral to an MFH, RO MFH Coordinators must utilize the Medical Foster Home special issue indicator when placing the claims under end product control.
  • In many cases, claims that an RO MFH Coordinator receives from a VAMC MFH Coordinator will be ready for a decision without further development other than accessing VA treatment records through CAPRI.
  • If a Veteran is otherwise entitled to pension, an RO may administratively (without a rating decision) grant entitlement to special monthly pension based on the Veteran’s referral to an MFH.
  • An RO MFH Coordinator must issue Section 5103 notice to a Veteran and work with the VAMC MFH Coordinator to obtain the associated notice response if