Part X, Subpart iii, Chapter 1, Section BAdjusting Compensation When a Veteran Is Hospitalized in Excess of 21 Days or Receives Care Consistent With 38 CFR 4.30

Revised 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.

2Adjusting 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.

Revised 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 ...

• 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).

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.

3When VA Is Notified of the Discharge, Termination of Treatment, or Authorized Absence of a Veteran From a Hospital

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.

Revised 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.

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.

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.

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.

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.

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

• If yes , follow procedures found in M21-1, Part X, Subpart ii, 6.F.6, to the extent applicable.
• If no , take no further action.

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.