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section). Understanding that some veterans are not eligible for VA travel, and that travel is often noted as a barrier to care, the Disabled American Veterans (DAV) reports that they "then began organizing a national transportation network to find volunteer drivers to drive disabled veterans to their medical appointments because of the medical problems that this lack of access was creating."19 DAV's transportation efforts began in 1987. Since then, DAV has donated 2,519 vehicles, transported more than 13 million veterans almost 500 million miles, and devoted more than 27 million volunteer hours in transporting veterans to VA medical facilities. The DAV Volunteer Transportation Network remains a key component of transportation services to veterans. TRANSPORTATION SERVICES THAT VHA PROVIDES FOR VETERANS The Beneficiary Travel Program Conditions for Eligibility The VA, through its Veterans Health Administration (VHA), provides health care benefits to eligible veterans that include outpatient medical services, hospital care, medicine, and supplies. Transportation costs can be considered part of outpatient and inpatient medical services. VHA's Beneficiary Travel Office can authorize reimbursements to eligible beneficiaries for mileage costs, costs for special transportation modes, or, in certain circumstances, the costs of taxis or hired cars. These payments are specified in United States Code (USC), Payments or Allowances for Beneficiary Travel 38 U.S.C. 111 . (Appendix A, VHA's Frequently Asked Questions concerning its Beneficiary Travel Program, includes other references regarding payment procedures and conditions for eligibility.) Veterans Eligible for Beneficiary Travel Payments Veterans who are eligible for payments under VA's Beneficiary Travel Program include: A veteran who travels to or from a VA facility or VA-authorized health care facility in connection with treatment or care for a Service Connected (SC) disability (regardless of percent of disability). 19 Ibid. 20

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A veteran with a SC disability rated at 30 percent or more who travels to or from a VA facility or VA-authorized health care facility for examination, treatment, or care for any condition. A veteran who travels to a VA facility or VA-authorized health care facility for a scheduled compensation and pension (C&P) examination. A veteran receiving pension under 38 U.S.C. 1521, who travels to or from a VA facility or VA-authorized health care facility for examination, treatment, or care. A veteran whose annual income (as determined under 38 U.S.C. 1503) does not exceed the maximum annual rate of pension that the veteran would receive under 38 U.S.C. 1521as adjusted under 38 U.S.C. 5312) if the veteran was eligible for pension and travels to or from a VA facility or VA authorized health care facility for examination, treatment, or care. In addition, certain veterans are eligible for certain kinds of emergency trips. Non-Veterans Eligible for Beneficiary Travel Non-veterans who are eligible for payments under VA's Beneficiary Travel Program include: Allied Beneficiaries. For Allied Beneficiaries, as defined by 38 U.S.C. 109, travel is subject to a reimbursement agreement by the government concerned. For information on the beneficiary travel eligibility of Allied Beneficiaries, see VHA Handbook 1601D.02. Attendants. Someone other than a VA employee, who is accompanying and assisting a veteran or beneficiary eligible for beneficiary travel payments, when such beneficiary is medically determined to require the presence of the attendant because of a physical or mental condition. Beneficiaries of Other Federal Agencies. Travel for beneficiaries of other federal agencies may be authorized travel incident to medical services rendered upon requests of those agencies, subject to a reimbursement agreement by those agencies. Other Persons. A member of a veteran's immediate family, a veteran's legal guardian, or a person in whose household the veteran certifies an intention to live, if such person is traveling for consultation, professional counseling, training, or mental health services concerning a veteran who is receiving care for a SC disability; or a member of a veteran's immediate family, if the person is traveling for bereavement counseling 21

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relating to the death of the veteran in the active military, naval, or air service in the line of duty and under circumstances not due to the Veteran's own misconduct.20 Special Mode Transportation Veterans qualify for Special Mode Transportation (ambulance, wheelchair van, "and other modes which are specifically designed to transport certain disabled individuals"21) when: 1. VA determines that their medical condition requires an ambulance or a specially equipped van, and 2. They meet one of the eligibility criteria for veterans described above, and 3. The travel is preauthorized (authorization is not required for emergencies if a delay would be hazardous to life or health).22 Veterans must meet all three of these criteria unless they are OIF or OEF veterans, and then they need only meet one of the criteria to be administratively eligible for transport at VA expense. This includes meeting the basic criteria, as well as being "unable to defray the expenses of travel" as defined in 38 CFR 70.10 (c). . . Once administrative eligibility is established, a VA clinician must then determine that a special mode of transportation is medically required to transport the veteran for VA health care. Unless one of the forms of special mode of transportation is required and documented as such, this method of transportation is inappropriate."23 Means of Transportation The VA will, under certain circumstances, reimburse individual veterans for their medical travel under regulations for the Beneficiary Travel program. In addition, travel offices at VAMCs may provide their own transportation services, may contract directly with transportation providers for trips to VAMCs, or may work with volunteer networks to provide transportation for veterans 20 July 21, 2010 VHA HANDBOOK 1601B.05, http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2275 accessed November 9, 2010. 21 Department of Veterans Affairs. (no dates). "Beneficiary Travel Frequently Asked Questions" http://www4.va.gov/healtheligibility/Library/FAQs/BeneTravelFAQ.asp , accessed December 9, 2009. 22Department of Veterans Affairs. (no dates). "VA Health Care Eligibility Enrollment: Special and Limited Benefits" http://www4.va.gov/healtheligibility/coveredservices/SpecialBenefits.asp#Auto , accessed May 5, 2010. 23 Department of Veterans Affairs. (no dates). "Beneficiary Travel Frequently Asked Questions" http://www4.va.gov/healtheligibility/Library/FAQs/BeneTravelFAQ.asp , accessed December 9, 2009. 22

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seeking health care. The ways that VA is involved in assisting a veteran with his or her trips for medical care are as follows: Individual veterans provide their own travel and are reimbursed. o The current rate is 41.5 cents per mile. o The Beneficiary Travel deductible amounts are: $3.00 per one-way trip $6.00 per round trip, or $18.00 per calendar month or six one-way trips (three round trips), whichever occurs first, for travel to all VA facilities. Some trips are exempt from the deductible amount, including trips made by veterans who require a special mode of transportation and travel in relation to a VA compensation and pension examination. Transportation services are provided directly by VA Medical Centers. Transportation services are provided by contractors to VA Medical Centers. Transportation is provided by volunteer organizations working with VA Medical Centers. Title 38 United States Code (U.S.C.) 111 and 38 Code of Federal Regulations (C.F.R.) 70.1 70.50 are the authorities for Beneficiary Travel. Regulations that currently apply to VHA beneficiary travel were published in the Federal Register on July 29, 2008. The Regulations are currently under revision due to several recent legislative and policy changes; these revised are expected to be published in 2011. Trips to access to medical care are the only travel needs supported by VHA Beneficiary Travel funding. (Travel for compensation and pension examinations is considered to be allowable under the Beneficiary Travel program.) Trip purposes such as shopping, recreation, personal business, and other nonmedical or noneducational trips are not supported by VA, even though such trips may have a profound impact on an individual veteran's quality of life. 23