Reports of Hospitalization and Other Information Exchanges Between Department of Veterans Affairs (VA) Regional Offices (ROs) and Medical Facilities

Overview

In This Section

This section contains the following topics:

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1. Methods of Information Exchange

Introduction

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

• definition of hospitalization
• methods of exchanging information
• use of VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action
• use of VA Form 10-7132, Status Change
• automated reporting of admissions and discharges
• protection of information accessed through the Compensation and Pension Record Interchange (CAPRI), and
• administration of CAPRI user accounts.

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 elig ibility 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:

• VA Forms
• 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action, and
• 10-7132, Status Change
• the Compensation and Pension Record Interchange (CAPRI), and
• centralized, automated reporting informed by Veterans Health Administration (VHA) clinical data.

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

• CAPRI, see the CAPRI User Manual
• JLV, see the JLV User Guide, and
• procedures for obtaining VA medical records, see M21-1, Part III, Subpart ii, 1.A.2.

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

• pension adjustments under 38 CFR 3.551 and 3.556, see M21-1, Part X, Subpart iii, 1.D
• adjusting awards involving an A&A allowance, see M21-1, Part X, Subpart iii, 1.C, and
• adjusting compensation when a Veteran is hospitalized in excess of 21 days or undergoes hospital treatment warranting convalescence, see M21-1, Part X, Subpart iii, 1.B.

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

• the Privacy Act, 5 U.S.C. 552(a), and
• confidentiality statutes 38 U.S.C. 5701 and 38 U.S.C. 7332.

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

• determining whether an award adjustment is necessary
• claims processor actions to take upon receipt of VA report of hospitalization, and
• requesting documents/reports under the 7131 REQUEST tab in CAPRI.

Change Date

March 13, 2026

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.

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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 Veterans 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.
• When automation identifies that an SC condition is associated with the hospitalization, it will
• change the EP 330 to an EP 320, and
• route the claim to the rating activity to review in accordance with Step 7 in the table below.

Follow the steps in the table below upon receipt of EP 330 with a claim label indicative of a hospital admission and/or discharge.

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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

• scope of
• hospitalization ratings under 38 CFR 4.29, see M21-1, Part VIII, Subpart iv, 8.B, and
• convalescence ratings under 38 CFR 4.30, see M21-1, Part VIII, Subpart iv, 8.C
• hospitalization benefits when admission is for an NSC disability, see M21-1, Part VIII, Subpart iv, 8.B
• proper EP control for hospitalization reports, see M21-4, Appendix B, and
• proper EP claim labels for hospitalization reports, see M21-4, Appendix C.

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.

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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

• CAPRI, see the CAPRI User Manual, and
• procedures for obtaining VA medical records, see M21-1, Part III, Subpart ii, 1.A.2.

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

Introduction

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

• unsolicited reports that ROs might receive from VA medical facilities
• general information about the MFH program
• eligibility requirements for referral to an MFH
• VA medical center (VAMC) responsibilities, and
• RO responsibilities.

Change Date

March 13, 2026

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.

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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

• 38 CFR 17.73, and
• 38 CFR 3.278.

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/21WEB.
• 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 any of the circumstances apply as discussed in M21-1, Part III, Subpart i, 2.B.1.c.