VA Form FL-10-431: Letter of Approval for Fee-Based Care – VA Form FL-10-431 is an official Department of Veterans Affairs (VA) letter that historically approved eligible veterans for fee-basis outpatient medical treatment. This legacy form, dated January 1989, notified veterans that they had been approved to receive outpatient care from a private licensed physician (doctor of medicine or osteopathy) of their choice. It came with an enclosed authorization card — VA Form 10-1174 — often referred to as the fee-basis or “yellow card.”
Although the terminology and processes have evolved significantly, the form remains available on VA.gov and provides important historical context for veterans who may still encounter references to fee-basis care or older authorization cards.
What Is VA Form FL-10-431 and What Does It Do?
VA Form FL-10-431 served as formal written approval for fee-basis outpatient medical care. Under the older fee-basis program, the VA authorized veterans to seek treatment from community (non-VA) providers for specific service-connected disabilities or when VA facilities could not provide timely care.
The letter explicitly stated that the veteran had been approved and that the VA Form 10-1174 authorization card was enclosed. This card listed the approved disabilities and served as the veteran’s authority to obtain outpatient treatment from a chosen private doctor within a reasonable distance of their residence.
Key limitations included:
- Outpatient treatment only (no hospitalization, eyeglasses, or other non-approved services without contacting the VA clinic of jurisdiction).
- Care had to be provided by a licensed MD or DO.
- VA’s responsibility was limited to payment of authorized fees for approved services.
Key Details Explained in VA Form FL-10-431
The letter provided clear instructions for using the approval:
- Show the authorization card to your doctor and pharmacist. Include your name, Social Security Number, and the address of the VA clinic of jurisdiction.
- Travel reimbursement: Veterans could request mileage allowance for local round-trip travel. A one-time written request submitted within 30 days of the first visit could be approved retroactively to the first date of service.
- Prescriptions: Most prescriptions were to be brought or mailed to the VA clinic of jurisdiction for filling. For immediate needs, the physician could certify the prescription on the authorization card so the pharmacist could bill the VA directly.
- Reporting changes: Veterans were required to promptly notify the clinic of jurisdiction of any change in address or VA disability rating (increases, decreases, additions, or deletions of disabilities), as these could affect the authorization.
The form emphasized that care came from a private source and that VA’s liability was limited to authorized fees.
Is VA Form FL-10-431 Still Used Today?
The fee-basis program and the specific FL-10-431 letter represent an older VA process. The modern equivalent is the VA Community Care program, significantly expanded by the MISSION Act of 2018.
Today, veterans receive referrals and authorizations for care outside VA through the HealthShare Referral Manager (HSRM) system. Recent updates (2025) allow year-long authorizations for many standardized types of specialty care, reducing the need for frequent reauthorizations.
If you have an old FL-10-431 letter or VA Form 10-1174 card, contact your local VA Medical Center’s Community Care office or your VA care team to determine its current validity and transition to the modern referral process if needed.
How to Download VA Form FL-10-431
You can download the official PDF directly from the VA:
Download VA Form FL-10-431 (PDF) – Official Letter of Approval for Fee-Based Outpatient Medical Treatment
This is the current hosted version on VA.gov. Note that it is a legacy form.
Current Process for Community Care Outpatient Treatment (Modern Equivalent)
Veterans seeking care from community providers today generally follow these steps:
- Talk with your VA health care team about your needs.
- Confirm eligibility for community care (enrolled in VA health care + approval from your VA team for most non-emergency care).
- Receive a referral/authorization through VA systems.
- Schedule with an in-network community provider.
- The provider coordinates with VA for payment.
Eligibility often depends on factors such as VA wait times, drive distance, or clinical need. Many specialties now qualify for 12-month authorizations.
Practical Tips for Veterans
- Keep copies of any old fee-basis letters or cards you receive and note the “clinic of jurisdiction” or VA facility listed.
- For current care, always obtain VA approval before seeing a community provider (except in true emergencies).
- Track your authorization details, including any referral or authorization numbers provided by VA.
- Report changes in your health or contact information promptly to your VA care coordinator.
- If you receive a bill for authorized community care, follow the instructions on the explanation of benefits or contact the VA Community Care office handling your referral.
Need Help Understanding Your VA Approval or Referral?
Veterans with questions about legacy fee-basis approvals, current community care referrals, or how to transition should contact their local VA Medical Center Community Care office or use the resources above. Veterans Service Organizations (VSOs) such as DAV, VFW, or American Legion can also provide free assistance with VA paperwork and benefits navigation.
This guide is based on official VA sources, including the current hosting of VA Form FL-10-431 and publicly available information on the modern Community Care program. Processes and forms can change, so always verify details directly with VA for your specific situation.