M21-1 Manual / Part X, Subpart iii, Chapter 1, Section B
Adjusting Compensation When a Veteran Is Hospitalized in Excess of 21 Days or Receives Care Consistent With 38 CFR 4.30
M21-1, Part X, Subpart iii, Chapter 1, Section B
Overview
In This Section | | This section contains the following topics: | Topic | Topic Name |
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| 1 | Reports Involving Department of Veterans Affairs (VA) Hospitalization | | 2 | Adjusting Compensation Awards for Hospitalizations in Excess of 21 Days | | 3 | When VA Is Notified of the Discharge, Termination of Treatment, or Authorized Absence of a Veteran From a Hospital |
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1. Reports Involving VA Hospitalization
Change Date | | November 2, 2020 |
X.iii.1.B.1.a. Automated Reports of Hospitalization and Discharge Reports | | As discussed in M21-1, Part X, Subpart iii, 1.A, Compensation and Pension Record Interchange (CAPRI) data will centrally automate the creation of reports and end product (EP) controls disclosing Department of Veterans Affairs (VA) facility hospitalizations - in excess of 21 days for adjustment of benefits under 38 CFR 4.29, or
- potentially warranting adjustment of benefits for convalescence under 38 CFR 4.30.
Screen and process those automated reports by following procedural guidance found in M21-1, Part X, Subpart iii, 1.A. |
2. Adjusting Compensation Awards for Hospitalizations in Excess of 21 Days
Introduction | | This topic contains information on adjusting compensation awards for hospitalizations in excess of 21 days, including- determining commencing date of awards, and
- preparing open-ended awards for hospitalization.
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Change Date | | August 3, 2020 |
X.iii.1.B.2.a. Determining Commencing Date of Awards | | Use the table below to determine when to commence payment of an award adjustment when a Veteran is hospitalized for a service-connected (SC) disability in excess of 21 days.| If an award adjustment is made by reason of hospitalization for an SC disability in excess of 21 days, and the period of hospitalization ... | Then ... |
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- starts in one calendar month, and
- continues into the next calendar month
| - commence payment of the total rate effective the first day of the month following the date of admission, per 38 CFR 3.31(a) and 38 CFR 3.401(h)(1), and
- reduce the award to the appropriate rate, as determined by rating decision, effective the earlier of the first day of the month following the month
- hospitalization ended, or
- treatment for the SC disability ended, per 38 CFR 3.501(m).
| - is entirely within one calendar month, and
- a convalescent period is not required
| - commence payment effective the first day of the month of admission per 38 CFR 3.31(c)(5), and
- reduce the award to the appropriate rate, as determined by rating decision, effective the first day of the following month, per 38 CFR 3.501(m).
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X.iii.1.B.2.b. Preparing Open-Ended Awards for Hospitalization | | Before preparing an open-ended award of benefits under 38 CFR 4.29, review CAPRI to determine if the Veteran remains hospitalized. If the Veteran has been discharged, ensure that the rating decision awarding entitlement to temporary total disability benefits only does so for the finite period of hospitalization portrayed by the evidence of record. If, however, the Veteran does remain hospitalized,- prepare an open-ended award of benefits
- annotate the award document, indicating “Open-ended Paragraph 29 award”
- clear at authorization the EP 320 selected in connection with procedures found in M21-1, Part X, Subpart iii, 1.A, and
- rely on centrally automated discharge reporting to identify the case at such time as the Veteran is released from hospitalization.
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3. When VA Is Notified of the Discharge, Termination of Treatment, or Authorized Absence of a Veteran From a Hospital
Introduction | | This topic contains information on action to take when VA receives notification of the discharge, termination of treatment, or authorized absence of a Veteran from a hospital, including- acting on notice of discharge from hospitalization
- processing reductions in pre-hospitalization evaluations
- termination of treatment for an SC disability
- consideration of authorized absences
- action upon release to non-bed care status
- definition of
- unauthorized absence, and
- irregular discharge, and
- actions to take when notified of unauthorized absence, irregular discharge, or transfer to nursing home care.
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Change Date | | September 16, 2025 |
X.iii.1.B.3.a. Acting on Notice of Discharge From Hospitalization | | Use the table below in response to report or notice of a Veteran’s discharge when the hospitalization in question is- the basis of a current, open-ended award of benefits under 38 CFR 4.29, as discussed in M21-1, Part X, Subpart iii, 1.B.2.b, or
- potentially associated with the need for convalescence for an SC disability under 38 CFR 4.30.
Note: Initial awards of benefits under 38 CFR 4.29 will be processed by following the instructions in M21-1, Part X, Subpart iii, 1.A.| If the disability treated during hospitalization ... | Then ... |
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| is the subject of a current, open-ended award of benefits under 38 CFR 4.29 | - upload to the claims folder all CAPRI documentation relevant to the period of hospitalization in question, including
- hospital and/or discharge summaries, and
- reports and records of treatment administered during the course of hospitalization and, if applicable, following discharge
- replace the standard contention with the name of the SC disability for which hospital care was received
- change the pending EP 330 to an EP 320, and
- forward the case to the rating activity for review and action.
| - is SC and evaluated at a level of disability less than 100 percent, and
- required surgery or immobilization of one or more major joint(s) by cast
| - establish EP 320 – Review Due to Hospitalization
- add a contention identifying the SC disability for which hospital care was received
- upload to the claims folder all CAPRI documentation relevant to the period of hospitalization in question, including
- hospital and/or discharge summaries, and
- reports and records of treatment administered during the course of hospitalization and, if applicable, following discharge, and
- forward the case to the rating activity for review and action.
| - is not SC, or
- although SC, did not require surgery or major joint immobilization
| - enter a Veterans Benefits Management System (VBMS) note indicating, No action necessary – Paragraph 29/30 entitlement not shown, and
- clear an EP 330.
| | has been continuously assigned a 100-percent permanent and total schedular evaluation since on or before the date of hospital admission | - enter a VBMS note indicating, No action necessary – Paragraph 29/30 entitlement not shown, and
- clear an EP 330.
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X.iii.1.B.3.b. Processing Reductions in Pre-Hospitalization Evaluations | | The provisions of 38 CFR 3.105(e) do not apply to restoration of the pre-hospitalization evaluation, irrespective of whether a convalescent rating is or is not being assigned. However, due process notification is required for a reduction below the pre-hospitalization evaluation if it results in a reduced rate of compensation. The table below describes the stages involved in reducing the pre-hospitalization evaluation.| Stage | Who Is Responsible | Description |
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| 1 | rating activity | Prepares a rating decision- restoring the evaluation in effect prior to hospitalization effective immediately thereafter, and
- proposing, in accordance with 38 CFR 3.105(e), further reduction to the lower rate supported by the evidence.
| | 2 | authorization activity | - Processes the rating decision prepared in Stage 1
- sends the Veteran a notice of proposed adverse action, and
- after the 60-day due process period ends, returns the case to the rating activity.
| | 3 | rating activity | Prepares a rating decision that reduces the pre-hospitalization evaluation to the lower rate supported by the evidence in accordance with 38 CFR 3.105(e). | | 4 | authorization activity | - Processes the rating decision prepared in Stage 3, and
- provides the Veteran a corresponding decision notice.
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References: For more information on- temporary total disability benefits authorized for a period of convalescence, see 38 CFR 4.30
- preparation of convalescent rating decisions, see M21-1, Part VIII, Subpart iv, 8.C
- requirements for notices of proposed adverse action, see M21-1, Part X, Subpart ii, 3.A.2, and
- effective dates of reduced evaluations, see 38 CFR 3.501.
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X.iii.1.B.3.c. Termination of Treatment for an SC Disability | | If treatment for, or observation of, an SC disability is terminated and the Veteran remains hospitalized for treatment of a nonservice-connected (NSC) disability, the medical center notifies the regional office of the date on which treatment for this NSC disability began. On receipt of such information, prepare an amended award effective the first day of the month following the month in which treatment for the SC disability terminated. |
X.iii.1.B.3.d. Consideration of Authorized Absences | | An authorized absence of 96 hours or less (14 days or less for a long-term patient) does not interrupt the continuity of hospitalization when the requirements for a 100-percent evaluation under 38 CFR 4.29(a)(1) of the rating schedule are otherwise met. One full period of authorized absence may not be immediately followed by another. Requirements for absences exceeding these limits normally are met by releasing the patient. If consecutive 14-day absences have been granted, a third authorized absence of 14 days is the equivalent of a hospital discharge, per 38 CFR 4.29(a)(2), unless convalescence is required. Use the table below to determine the appropriate award action to take when a Veteran has been released or granted consecutive authorized absences.Note: In all cases, upload relevant CAPRI documents to the claims folder, and forward cases to the rating activity for review and action. | If the Veteran has been ... | Then ... |
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released- with a regular discharge
- with an irregular discharge, or
- to outpatient treatment
| reduce the award effective the first day of the month following the month of release. Reference: For information on release to non-bed care, see M21-1, Part X, Subpart iii, 1.B.3.e. | granted - three consecutive authorized absences of 14 days, or
- an authorized absence in excess of 14 consecutive days
| reduce the award effective the first day of the month following the month in which the third 14-day period (or period in excess of 14 days) begins, per 38 CFR 4.29(a)(2). |
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X.iii.1.B.3.e. Action Upon Release to Non-Bed Care Status | | A release to non-bed care is equivalent to a regular discharge. Apply the procedures found in M21-1, Part X, Subpart iii, 1.B.3.a. |
X.iii.1.B.3.f. Definition: Unauthorized Absence | | An unauthorized absence is- the absence of a committed patient, or a patient considered unable to understand the significance of actions, from medical center or nursing home care without prior authorization, or
- an absence that results from the failure of such a patient to return from an authorized absence
Note: A Veteran is either discharged or placed on non-bed care status after failing to return after 30 days. |
X.iii.1.B.3.g. Definition: Irregular Discharge | | An irregular discharge results when a patient- is discharged
- against medical advice, or
- for disciplinary reasons, or
- fails to return from an authorized or unauthorized absence.
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X.iii.1.B.3.h. Actions to Take When Notified of Unauthorized Absence, Irregular Discharge, or Transfer to Nursing Home Care | | Follow the steps in the table below when notified that a Veteran in receipt of a temporary total disability rating under 38 CFR 4.29 has- incurred an unauthorized absence, as defined in M21-1, Part X, Subpart iii, 1.B.3.f
- received an irregular discharge, as defined in M21-1, Part X, Subpart iii, 1.B.3.g, or
- been transferred to nursing home care.
Note: Veterans transferred to nursing home care are no longer entitled to benefits under 38 CFR 4.29, as they can no longer be considered to require “hospital treatment” or “hospital observation.”| Step | Action |
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| 1 | Refer the case, including all relevant CAPRI documentation of the hospitalization, to the rating activity for review (of both evaluation and competency status, if appropriate) and action. | | 2 | Promulgate the rating decision prepared in response to Step 1, reducing benefits effective the first day of the month following the month in which hospitalization or treatment for the SC disability ended. Note: For nursing home care transfers, treat the date of the transfer as the date of discharge. | | 3 | Is the Veteran rated incompetent and in receipt of an institutional award, as defined in M21-1, Part X, Subpart ii, 6.F.6.a? |
Note: VA must- not assign a convalescent rating under 38 CFR 4.29(e) when termination of hospitalization was due to unauthorized absence or irregular discharge
- treat a Veteran’s return following unauthorized absence or irregular discharge as a new admission, and
- pay 38 CFR 4.29 benefits only after 21 consecutive days of hospitalization following return.
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Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part X, Subpart iii, Chapter 1, Section B (U.S. government work, reproduced for reference). Browse all sections →