M21-1 Manual / Part XIII, Subpart i, Chapter 3, Section B

Healthcare Eligibility Determinations for Former Service Members Discharged Under Other-Than-Honorable (OTH) Conditions

M21-1, Part XIII, Subpart i, Chapter 3, Section B

Overview

In This Section

This section contains the topic, "Veterans Health Administration Requests (VHA) Requests for Eligibility Determinations for Former Service Members Discharged Under OTH Conditions.”

1. VHA Requests for Eligibility Determinations for Former Service Members Discharged Under OTH Conditions

Introduction

This topic contains information on VHA requests for eligibility determinations for former service members discharged under OTH conditions, including

requirements for eligibility for health care
initiation of VA Form 20-0986 by a VHA facility
end product (EP) control over eligibility determination requests, and
actions
- to take upon receipt of an eligibility determination request, and
- specific to special eligibility determination requests involving access to emergency mental health care.

Change Date

April 6, 2026

XIII.i.3.B.1.a. Requirements for Eligibility for Health Care

Health care benefits are generally extended to Veterans who meet the minimum active duty service requirements and were discharged or released under conditions other than dishonorable. Medical facilities may request information from regional offices (ROs) when a character-of-discharge (COD) determination is required for the purpose of determining eligibility for health care.

XIII.i.3.B.1.b. Initiation of VA Form 20-0986 by a VHA Facility

Upon receipt of an application for treatment from a former service member with an other-than-honorable (OTH) discharge, the Veterans Health Administration (VHA) facility initiates a VA Form 20-0986, Eligibility Determination for Character of Discharge (COD) Request Form, advising the RO that an eligibility determination is needed.

XIII.i.3.B.1.c. EP Control Over Eligibility Determination Requests

Use an end product (EP) 290 – Character of Discharge to control any incoming VHA request for an eligibility determination regarding COD. Important: If Box 16 of VA Form 20-0986 is checked or if remarks in Box 17 clearly indicate that emergency (as opposed to routine) mental health care is requested,

ensure that the Emergency Care corporate flash has been appended to the former service member’s record, and
follow the procedural instructions found in M21-1, Part XIII, Subpart i, 3.B.1.e.

Notes:

If an application for disability compensation is received after an EP 290 has been established to control such a request,
- separately establish the appropriate rating EP, using the date of receipt of the claim for disability compensation as the date of claim
- add character of discharge as a contention, and
- add the COD AQ95 special issue indicator to the contention.
- If a VHA request is received while a rating EP is pending, and no COD determination has been made,
  - separately establish an EP 290 – Character of Discharge, and
  - add
    - character of discharge as a contention to the rating EP
    - the COD AQ95 special issue indicator to the contention, and
    - any tracked items for the COD determination, previously controlled solely under the rating EP, to the newly established EP 290.

XIII.i.3.B.1.d. Actions to Take Upon Receipt of an Eligibility Determination Request

When a VHA facility initiates a request for an eligibility determination regarding COD, follow the steps in the table below. Exception: If the eligibility determination request pertains to a former service member’s potential access to emergency mental health care, follow processing instructions in M21-1, Part XIII, Subpart i, 3.B.1.e.
Step Action
1 Does review of the claims folder indicate an RO has previously prepared a COD determination or a decision on eligibility for benefits under 38 U.S.C. Chapter 17?
If yes, go to Step 4.
If no, go to the next step.
2 Accomplish any and all development necessary to render an administrative decision in the matter of COD, including all available service department records (service treatment records, personnel records, and records of proceedings pertaining to the discharge).Reference: For more information on collecting information on the facts and circumstances surrounding discharge, see M21-1, Part X, Subpart iv, 1.A.1.
3 Refer the case for preparation of an administrative decision.
4 Based on the outcome of the administrative decision,
complete system updates, as discussed in the Entering Character of Discharge (COD) Decision Job Aid on the Character of Discharge (COD) Information Page, and
complete Part IV of VA Form 20-0986.
Note: The electronic copy of VA Form 20-0986 must be edited to show Part IV has been completed. Upload the annotated document to the electronic claims folder (eFolder) with the attributes displayed in the table below.
In the document field … Enter/select …
SUBJECT Part IV completed and referred to VHA.
CATEGORY – TYPE Checklist: VA Form 20-0986 Eligibility Determination for Character of Discharge (COD) Request Form.
SOURCE Veteran.
DATE OF RECEIPT date action was taken.
5 Return a copy of the completed VA Form 20-0986 to the originating VHA facility, attaching a copy of the administrative decision.Notes:
Add a permanent claim level note stating that the form was returned.
Document the eFolder to reflect if an e-mail is sent to VHA.
6
Create a decision notice communicating the outcome of the administrative decision (unless such notification was previously provided) in accordance with M21-1, Part X, Subpart iv, 1.A.1.
Send the notice to the former service member.
7 Prepare a record-purpose award to clear the EP 290 – Character of Discharge established to control the eligibility determination request.
8 Is a rating EP based on a claim for compensation benefits concurrently pending?
If yes, go to the next step.
If no,take no further action.
9 Use the table below to determine the next action.
If the COD determination indicates ... Then ...
the former member’s service is under conditions other than dishonorable
accomplish any and all normal development necessary to ready the case for rating disposition
refer the case for preparation of a rating decision addressing service connection (SC) for specifed conditions, and
go to the next step.
the former service member’s service is not under conditions other than dishonorable, but
the former service member is eligible for health care benefits under 38 U.S.C. Chapter 17
accomplish any and all development (to include requesting any medical opinions warranted) necessary to ready the case for rating disposition
refer the case for preparation of a rating decision addressing SC for treatment purposes for specified conditions, and
go to the next step.
a statutory bar to VA benefits exists under an offense specified in 38 CFR 3.12(c), or
the former service member is eligible for neither disability compensation nor health care benefits under 38 U.S.C. Chapter 17
clear the rating EP, and
disregard the remaining step in this table.
10 Process the rating decision rendered in response to Step 9 by
preparing a corresponding decision notice for the claimant
completing Part V of the VA Form 20-0986
returning a copy of the completed VA Form 20-0986 to the originating VHA facility
adding a permanent claim-level note indicating that the form was returned, and
documenting the eFolder if an e-mail is sent to VHA.
Important: The electronic copy of VA Form 20-0986 must be edited to show that Part V has been completed. Upload the document to the eFolder with the attributes displayed in the table below.
In the document field … Enter/select …
SUBJECT Part V completed and referred to VHA.
CATEGORY – TYPE Checklist: VA Form 20-0986 Eligibility Determination for Character of Discharge (COD) Request Form.
SOURCE Veteran.
DATE OF RECEIPT date action was taken.
References: For more information on
ratings for SC for treatment purposes, see M21-1, Part XIII, Subpart i, 3.A.4
referring cases to the authorization activity for eligibility determinations, see M21-1, Part XIII, Subpart i, 3.A.3
COD determinations, see M21-1, Part X, Subpart iv, 1.A and B, and
EPs, see M21-4, Appendix B.

XIII.i.3.B.1.e. Actions Specific to Special Eligibility Determination Requests Involving Access to Emergency Mental Health Care

When a VHA facility initiates a request for an eligibility determination regarding COD, and the request contains the MHI language referenced in M21-1, XIII, Subpart i, 3.B.1.c, consider it sought in support of affording the former service member access to emergency mental health care, and prioritize action accordingly. Note: Application of the Emergency Care corporate flash mandated in M21-1, Part XIII, Subpart i, 3.B.1.c prompts National Work Queue reassignment to one of several designated processing stations. Eligibility determination requests involving access to emergency mental health care are centrally processed by the Nashville and Winston-Salem ROs. Follow the steps in the table below to respond to an eligibility determination request of this type.
Step Action
1
Review the claims folder for a previously-prepared COD determination or decision on eligibility for benefits under 38 U.S.C. Chapter 17, and
accomplish any and all development necessary to render such a determination, as needed.
Reference: For more information on development required for COD determinations, see M21-1, Part X, Subpart iv, 1.A.1.
2
Prepare an administrative decision as to COD and eligibility for benefits under 38 U.S.C. Chapter 17
complete system updates, as discussed in the Entering Character of Discharge COD Decision Job Aid on the Character of Discharge (COD) Information Page, and
provide notice of the administrative decision’s findings to the
former service member by following the instructions in M21-1, Part X, Subpart iv, 1.A.1, and
originating VHA facility by
completing Part IV of the VA Form 20-0986, and
returning the form by e-mail to the originating VHA facility.
Reference: For more information on providing notice of COD determinations’ outcomes to VA and non-VA entities, see M21-1, Part X, Subpart iv, 1.A.1.
3 Use the table below to determine the next action.
If ... Then ...
the former service member’s COD was deemed under conditions other than dishonorable
prepare a record-purpose award to clear the pending EP 290
remove the Emergency Care corporate flash, and
continue processing the case from Step 8 of the table in M21-1, Part XII, Subpart i, 3.B.1.d.
the former service member’s COD was deemed not under conditions other than dishonorable, and
the former service member was not found eligible for health care benefits under 38 U.S.C. Chapter 17 (for reasons such as a statutory bar identified in 38 CFR 3.12(c))
prepare a record-purpose award to clear the pending EP 290
remove the Emergency Care corporate flash, and
disregard the remaining steps in this table.
the former service member’s COD was deemed not under conditions other than dishonorable (for reasons such as a regulatory bar identified in 38 CFR 3.12(d)), but
the former service member was found eligible for health care benefits under 38 U.S.C. Chapter 17
prepare a record-purpose award, continuing the EP 290 at authorization
add the Emergency Care – CH17 Determination special issue indicator, and
go to the next step.
Important: Unlike other VHA eligibility determination requests, those involving access to emergency mental health care must be construed as free-standing claims for SC for treatment purposes for any mental health condition(s) for which the Veteran is receiving treatment.
4 Because the request from VHA is received on a VA Form 20-0986 and not a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, ensure that Section 5103 notice requirements have been satisfied. Accomplish any and all development necessary to ready the case for a rating decision (the development that would be required for SC under a typical rating EP) concerning the former service member’s entitlement to SC for treatment purposes for a mental health condition.Note: The development referenced above may involve the
acquisition of specified medical treatment records, and/or
ordering of any medical opinions warranted under M21-1, Part IV, Subpart i, 1.A.
5 Prepare a rating decision addressing SC for the specified conditions for treatment purposes as described in M21-1, Part XIII, Subpart i, 3.A.4.c.
6
Process the rating decision prepared in Step 5, and
prepare a corresponding decision notice for the claimant.
7
Notify the originating VHA facility of all disabilities individually deemed SC or NSC for treatment purposes under 38 U.S.C. Chapter 17 by
completing Part V of the VA Form 20-0986, and
returning the form to the originating VHA facility
clear the pending EP 290, and
remove the Emergency Care corporate flash.
Note: If a former service member in need of emergency mental health care submits a completed application claiming disability compensation for the underlying mental condition(s) before the issue of COD is resolved, any decision concerning SC for treatment purposes for the mental condition(s) will be decided under the pending EP 290.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part XIII, Subpart i, Chapter 3, Section B (U.S. government work, reproduced for reference). Browse all sections →