38 USC 1710: Eligibility, Priority Groups, and PACT Act

VA healthcare eligibility comes down to three things: whether you served on qualifying active duty, whether your discharge was anything other than dishonorable, and where you fall on a set of factors — disability rating, income, toxic exposure, and combat service — that decide your priority group and what you’ll pay. Under 38 U.S.C. § 1710, the VA is required to provide hospital care and medical services to veterans with service-connected disabilities and may extend care to others depending on income, military honors, and toxic exposures.¹ The PACT Act of 2022 pulled millions of previously ineligible veterans into the mandatory-care category, so if you last checked your eligibility before 2022, check again.

Who Qualifies Based on Service and Discharge

You need qualifying military service and a discharge that wasn’t dishonorable. Qualifying service generally means active duty in any branch — Army, Navy, Air Force, Marine Corps, Coast Guard, or Space Force. Guard and Reserve members qualify if they were called to active duty by federal order and completed the full period of that call-up.²

If you enlisted after September 7, 1980, or entered active duty after October 16, 1981, you generally need at least 24 continuous months of service or completion of the full period for which you were called to active duty.² Exceptions apply if you were discharged early for a service-connected disability, hardship, or certain other qualifying reasons.

Discharge Status

Honorable and general (under honorable conditions) discharges typically qualify. Other-than-honorable, bad conduct, and dishonorable discharges create problems but don’t necessarily disqualify you. The VA makes its own character-of-discharge determination for benefits purposes, separate from whatever the military placed on your DD-214.³

A regulation that took effect in June 2024 expanded access for some veterans with other-than-honorable discharges. It eliminated the old regulatory bar related to “homosexual acts,” created a “compelling circumstances” exception, and allowed previously denied veterans to reapply.³ A discharge upgrade through the Discharge Review Board or Board for Correction of Military Records can also restore full eligibility.

The PACT Act Expansion

The PACT Act, signed in August 2022, added toxic-exposed veterans as a category the VA is required to serve under 38 U.S.C. § 1710(a)(2)(F).¹ Starting March 5, 2024, the VA accelerated enrollment for these veterans years ahead of the original schedule.⁴

You can enroll now, without first applying for disability benefits, if you meet the basic service and discharge requirements and any of the following apply:

You served in Vietnam, the Gulf War, Iraq, Afghanistan, or any other combat zone after 9/11.
You deployed in support of the Global War on Terror (including Operations Enduring Freedom, Iraqi Freedom, New Dawn, Inherent Resolve, Freedom’s Sentinel, or Resolute Support Mission).
You were exposed to toxins or hazards during military service at home or abroad.

Vietnam-era veterans who served in locations with herbicide exposure are covered too, including the Republic of Vietnam (January 1962 to May 1975), Thailand at U.S. or Royal Thai bases (January 1962 to June 1976), Laos (December 1965 to September 1969), and certain other sites.⁴

Presumptive Conditions

The PACT Act added a long list of conditions now presumed to be service-connected for veterans exposed to burn pits and other airborne hazards. Cancers on the list include brain cancer, glioblastoma, any type of gastrointestinal cancer, kidney cancer, any type of lymphoma, melanoma, pancreatic cancer, reproductive cancers, respiratory cancers, and head or neck cancers. The new presumptive illnesses include COPD, chronic bronchitis, emphysema, pulmonary fibrosis, interstitial lung disease, constrictive bronchiolitis, sarcoidosis, chronic sinusitis, chronic rhinitis, and asthma diagnosed after service.⁴

Presumptions matter because they eliminate the hardest part of many VA claims: proving the link between your military service and your condition. If you have a presumptive condition and qualifying service, the VA cannot require you to prove that your service caused or worsened it.⁵

Vietnam-era Agent Orange presumptives predate the PACT Act and remain in force. They include ischemic heart disease, Parkinson’s disease, Type 2 diabetes, hypertension, hypothyroidism, and several cancers, with more than two dozen conditions on the current list.⁵

All enrolled veterans are entitled to a toxic exposure screening, a five-to-ten-minute review of any potential exposures during service. The VA recommends every enrolled veteran receive this screening at least once every five years, and you can request one at any upcoming appointment or by contacting your facility’s Toxic Exposure Screening Navigator.

Service-Connected Disability Ratings

Your service-connected disability rating is the single biggest factor in both your eligibility level and what you’ll pay. The VA rates disabilities in 10 percent increments, from 0 percent to 100 percent. The VA is required to furnish care to any veteran with a service-connected disability for treatment of that disability, and must provide comprehensive care for all conditions when the rating is 50 percent or higher.¹ Veterans rated at 50 percent or above pay no copayments for any type of care, testing, or medication.⁶

Veterans with ratings below 50 percent still receive mandatory care for their service-connected conditions. They may also receive care for non-service-connected conditions but could face copayments depending on their priority group. Even a 0 percent (non-compensable) rating establishes service connection and can open the door to treatment for that specific condition.

Income-Based Eligibility

Veterans without service-connected disabilities or other qualifying status can still access VA healthcare based on financial need. The statute authorizes care for any veteran “unable to defray the expenses of necessary care” under 38 U.S.C. § 1722(a).¹ The VA evaluates your household income through a means test when you apply.

Income thresholds vary by where you live. The VA adjusts them by zip code to reflect local cost of living, and the limits change annually. Veterans whose income falls below the threshold may receive free or reduced-cost care. If you already receive VA pension benefits or qualify for Medicaid, you generally meet the financial criteria automatically.⁷ The VA also recognizes catastrophic disability status for veterans with severe, permanent impairments, granting them access regardless of income.

Priority Groups

Once enrolled, the VA assigns you to one of eight priority groups. Your group determines what you’ll pay for care and, in periods of constrained funding, whether you can enroll at all. Group 1 receives the most generous benefits; Group 8 the least.⁷

Group 1: Veterans with service-connected disabilities rated 50 percent or higher, those the VA has determined are unemployable due to service-connected conditions, and Medal of Honor recipients. No copayments for any care.⁷
Group 2: Veterans with service-connected disabilities rated 30 or 40 percent.
Group 3: Veterans with service-connected disabilities rated 10 or 20 percent, former prisoners of war, and Purple Heart recipients.⁷
Group 4: Veterans receiving VA Aid and Attendance or Housebound benefits, and those the VA has determined to be catastrophically disabled.⁸
Group 5: Veterans without a compensable service-connected disability whose income falls below the VA’s adjusted geographic limits, those receiving VA pension benefits, and veterans eligible for Medicaid.⁷
Group 6: Veterans with conditions related to certain exposures (Agent Orange, ionizing radiation, Camp Lejeune water contamination) and combat veterans discharged on or after October 1, 2013, who served in a theater of combat operations after November 11, 1998.⁷
Group 7: Veterans with income above the VA’s geographic limits but below a higher threshold, who agree to pay copayments.
Group 8: Veterans with income above both thresholds and no other qualifying status, who agree to pay copayments.

Group 8 has a unique history. In January 2003, the VA suspended new enrollments for veterans in this lowest-priority category due to funding constraints. Veterans already enrolled before January 17, 2003 kept their enrollment, but new Group 8 applicants were turned away unless they qualified for a higher group.⁹ The PACT Act has since restored eligibility for many of these veterans by creating new qualifying categories based on toxic exposure and combat service, effectively moving them into higher priority groups.

Combat Veterans After Separation

If you’re a combat veteran who recently separated from service, you receive 10 years of enhanced eligibility. During that window you can get free care for any condition related to your combat service without needing a formal service-connected disability rating, and the VA places you in a higher priority group. Once the 10 years expire, your priority group is reassessed based on your disability ratings and financial status at that time.²

What You’ll Pay

Cost depends entirely on your priority group and whether the treatment is for a service-connected condition. Group 1 pays nothing. Groups 2 through 6 generally pay no copayments for service-connected care but may owe copayments for non-service-connected treatment. Groups 7 and 8 pay copayments for most care.

Current outpatient copays are $15 per primary care visit and $50 per specialty care visit or specialty test such as an MRI or CT scan. For inpatient care, Group 7 and 8 veterans pay either a reduced rate or full rate depending on income. The full inpatient copay is $1,736 for the first 90 days plus $10 per day; the reduced rate is $347.20 for the first 90 days plus $2 per day.¹⁰

Prescription medications follow a tiered system. Preferred generics cost $5 for a 30-day supply, non-preferred generics cost $8, and brand-name drugs cost $11. Once your medication copayments reach $700 in a calendar year, you won’t owe any more for the rest of that year.¹⁰

Hardship Waivers

If you lose your job or experience a sudden drop in income, you can request relief from copayments. The VA offers three options: a debt waiver forgiving all or part of the balance, a compromise offer for a reduced one-time payment, or a monthly repayment plan that typically must be completed within three years. Each requires submitting a Financial Status Report (VA Form 5655) or Repayment Plan Agreement (VA Form 10-323) to your nearest VA medical center’s business office.¹¹

For ongoing hardship, you can request a hardship determination using VA Form 10-10HS. If approved, you’re moved to a higher priority group and exempted from copayments for the rest of the calendar year. This exemption does not cover pharmacy copayments. Take action within 30 days of receiving your bill to avoid late charges and interest.¹¹

How to Apply

You apply using VA Form 10-10EZ (Application for Health Benefits). There are four ways to submit it:¹²

Online through VA.gov, which is the fastest method.
By phone at 877-222-8387 (Monday through Friday, 8:00 a.m. to 8:00 p.m. ET).
By mail: send the completed, signed paper form to the Health Eligibility Center at PO Box 5207, Janesville, WI 53547-5207.
In person at your nearest VA medical center or clinic, or with help from a Veterans Service Organization, accredited claims agent, or attorney.

For mail and in-person submissions, the form must be signed and dated by you or someone with your power of attorney. If someone else signs on your behalf under a power of attorney, include a copy of that document. If you sign with an “X,” two witnesses must also sign and print their names.

VA Coverage and Medicare: Watch the Part B Trap

The VA will ask for your private insurance information when you enroll. For non-service-connected care, the VA bills your private insurer and uses whatever it collects to offset your copayment. You won’t be stuck with any unpaid balance your insurer declines to cover beyond your normal VA copay.¹³

The VA does not bill Medicare or Medicaid, though it may bill Medicare supplemental insurance for covered services.¹³ Here’s the part that trips people up. VA healthcare enrollment is not considered creditable coverage for Medicare Part B. If you turn 65 and decide to skip Part B because you have VA coverage, you’ll face a permanent late enrollment penalty when you eventually sign up. The penalty raises your Part B premiums by 10 percent for every full 12-month period you could have been enrolled but weren’t. Veterans who might ever need care outside the VA system, such as at a non-VA hospital, should enroll in Medicare Part B during their initial eligibility window.

If the VA Denies Your Enrollment

When the VA denies your healthcare enrollment or a specific benefit, it must provide written notice explaining the reasons and your appeal options. Denials typically stem from discharge status, insufficient evidence of service connection, income above the means test threshold, or enrollment restrictions for lower-priority groups.

The Veterans Appeals Improvement and Modernization Act of 2017 gives you three review options.¹⁴ A Supplemental Claim lets you submit new and relevant evidence that wasn’t part of the original record.¹⁵ A Higher-Level Review sends the same evidence to a more senior VA adjudicator for a fresh look, with an optional informal conference to point out factual or legal errors.¹⁶ A Board Appeal puts your case before a Veterans Law Judge at the Board of Veterans’ Appeals; you file a Notice of Disagreement (VA Form 10182) within one year of the decision you’re contesting.¹⁷

If you exhaust your options at the Board and still disagree, you can appeal to the U.S. Court of Appeals for Veterans Claims within 120 days of the date on your Board decision letter.¹⁸ That deadline is strict. Missing it means losing the right to judicial review entirely. Veterans Service Organizations provide free representation at every stage, and the VA maintains a searchable database of accredited representatives.

1
Office of the Law Revision Counsel. 38 USC 1710 – Eligibility for Hospital, Nursing Home, and Domiciliary Care
2
Department of Veterans Affairs. Eligibility For VA Health Care
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Department of Veterans Affairs. Applying for Benefits and Your Character of Discharge
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Department of Veterans Affairs. The PACT Act And Your VA Benefits
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Department of Veterans Affairs. Agent Orange Exposure and Disability Compensation
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Department of Veterans Affairs. Your Health Care Costs
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U.S. Department of Veterans Affairs. VA Priority Groups
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Department of Veterans Affairs. 2025 Health Care Benefits Overview
9
Federal Register. Enrollment-Provision of Hospital and Outpatient Care to Veterans
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U.S. Department of Veterans Affairs. VA Health Care Copay Rates
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Department of Veterans Affairs. Request VA Financial Hardship Assistance
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Department of Veterans Affairs. How To Apply For VA Health Care
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Department of Veterans Affairs. VA Health Care And Other Insurance
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Department of Veterans Affairs. Veterans Appeals Improvement and Modernization Act of 2017
15
eCFR. 38 CFR 3.2501 – Supplemental Claims
16
Department of Veterans Affairs. What’s An Informal Conference And How Do I Ask For One
17
U.S. Department of Veterans Affairs. Board Appeals
18
U.S. Department of Veterans Affairs. Contested Claims