Application for Extended Care Services, VA Form 10-10EC

Title 38 U.S.C. Chapter 17 authorizes VA to provide hospital care, medical services, domiciliary care, and nursing home care to eligible Veterans. Title 38 U.S.C. § 1705 requires VA to design, establish, and operate a system of annual patient enrollment in accordance with a series of stipulated priorities. A consequence of this is that many groups of Veterans who are in a lower priority group (WWI Veterans, Veterans with disabilities rated as 0% service-connected seeking treatment for other than their service-connected conditions, Veterans exposed to a toxic substance, radiation, or environmental hazard and nonservice-connected Veterans) may request that they be allowed to be income tested in order to gain a higher priority. Title 38 U.S.C. § 1722 establishes eligibility assessment procedures for cost-free VA medical care, based on income levels, which will determine whether nonservice-connected and 0% service-connected non-compensable Veterans are able to defray the necessary expenses of care for nonservice-connected conditions. Title 38 U.S.C. § 1722A establishes the eligibility assessment procedures, based on income levels, for determining Veterans’ eligibility for cost-free medications. Title 38 U.S.C. § 1710B defines the procedures for establishing eligibility for cost-free Extended Care benefits. Title 38 U.S.C § 1729 authorizes VA to recover from Veterans’ health insurance carriers the cost of care furnished for their nonservice-connected conditions. VA Form 10-10EC, Application for Extended Care Services, is used to collect financial information necessary to determine a Veteran’s copayment obligation for extended care services, also known as long term care (LTC). The 10-10EC design and formatting have been revised to clarify the instructions and make it easier to understand and complete the form. However, there are no changes to the anticipated annual number of responses or burden hours for this information collection.

The latest form for Application for Extended Care Services, VA Form 10-10EC expires 2028-05-31 and can be found here.