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Department of Veterans Affairs

Veterans Health Administration

Washington, DC 20420

VHA DIRECTIVE 1601B.04

Transmittal Sheet

December 1, 2017

DECEDENT AFFAIRS

1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive updates

Department of Veterans Affairs (VA) policy pertaining to patients who expire while

receiving VA authorized hospital care, nursing home, or domiciliary care.

2. SUMMARY OF MAJOR CHANGES: Major changes include:

contents of this VHA directive. Questions may be addressed to

.

5. RESCISSIONS: VHA Handbook 1601B.04, dated February 8, 2013, is rescinded.

6. RECERTIFICATION: This VHA directive is scheduled for recertification on or before

the last working day of December 2022. This VHA directive will continue to serve as

national VHA policy until it is recertified or rescinded.

Carolyn M. Clancy, M.D.

Executive in Charge

DISTRIBUTION: Emailed to the VHA Publication Distribution List

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CONTENTS

4. RESPONSIBILITIES ................................................................................................... 2

5. DEATHS DURING AUTHORIZED ADMISSION ......................................................... 2

6. UNCLAIMED REMAINS .............................................................................................. 3

7. DEATHS WHEN ADMISSION HAD NOT BEEN AUTHORIZED ................................. 4

8. AUTOPSIES (POST MORTEM EXAMINATIONS) ...................................................... 4

9. DEATH CERTIFICATES ............................................................................................. 5

10. DISINTERMENTS ..................................................................................................... 6

11. REFERENCES .......................................................................................................... 6

DECEDENT AFFAIRS

pertaining to patients who expire while receiving Department of Veterans Affairs (VA)-

authorized hospital, nursing home, or domiciliary care. AUTHORITY: Title 38 United

(CFR) 3.1700-3.1713; and 38 CFR 17.170.

2. DEFINITIONS

is authorized and documented in Computerized Patient Record System (CPRS) while

the Veteran is in the Emergency Department (ED), but the Veteran expires before

actually being moved to an inpatient ward, the Veteran is considered constructively

hospitalized by VA.

d. Next of Kin. A close relative of the Veteran eighteen years of age or older. The

next of kin (NOK) of a deceased individual will be considered a personal representative

of the deceased person for the purposes of this directive. When there is more than one

surviving NOK, the personal representative will be determined based on the following

hierarchy: spouse, adult child, parent, adult sibling, grandparent, adult grandchild, close

friend. NOTE: Any questions regarding discrepancies with NOK should be addressed

g. VA Health Care Facility. An authorized admission to a VA health care facility

means:

(1) Over which the Secretary of Veterans Affairs has direct jurisdiction;

(2) For which the Secretary contracts; and

for patients receiving care under 38 U.S.C. 1710.

h. Unclaimed Veterans. Veterans who expire in a VA health care facility or a non-

VA health care facility under authorized admission at VA expense with no next of kin to

claim their remains and insufficient funds to cover burial expenses.

3. POLICY

It is VHA policy that the remains of patients who expire while receiving VA

authorized hospital care, nursing home, or domiciliary care be handled in a

dignified manner.

Deputy Under Secretary for Health for Operations and Management is responsible for:

(3) Providing oversight of VISNs to assure compliance with this directive, relevant

standards, and applicable regulations.

c. VA Medical Facility Director. The VA medical facility Director, or designee is

responsible for:

(1) Ensuring procedures regarding autopsies, death certificates, and unclaimed

remains, are followed and documented appropriately.

(2) Ensuring administrative procedures for inpatient deaths and deaths of persons

presumed to have been, but not constructively admitted to a VA health care facility are

initiated and followed.

5. DEATHS DURING AUTHORIZED ADMISSION

b. Notifying the medical examiner of a patient’s death according to state or local laws

or when the death occurs:

(1) Within 24 hours of admission;

(2) On arrival;

c. Assisting the next-of-kin and/or relatives in arranging a dignified funeral and burial.

NOTE: For a description of various funeral and burial benefits offered by VA see 38

CFR Part 3.1700-3.1709.

6. UNCLAIMED REMAINS

a. If a Veteran expires at a VA facility under authorized admission or at a non-VA

facility under authorized admission at VA expense, and the Veteran’s remains are

unclaimed, the facility Director will request funeral and burial services to be procured

as increased from time to time by VA under 38 U.S.C. 2303(c). The burial services may

include the following:

(1) Preparation of the body, to include embalming;

(2) Clothing;

(3) Securing all necessary permits; and

(4) Ensuring that a U.S. flag accompanies the casket to the place of burial.

NOTE: The funeral home may request reimbursement directly from the National

subdivision of a state, VA may pay an amount up to $700, as increased from time to

time by VA under 38 U.S.C. 2303(c), for the cost of the plot. If a Veteran is eligible for

burial in a national cemetery under 38 U.S.C. 2402, but is buried instead in a private

any part of the plot or interment costs of such a burial, VA may pay only the amount of

the plot cost exceeding the total of such paid or assumed amounts.

NOTE: If the cost of the burial exceeds the statutory amount, VA will pay the

additional minimum amount necessary for the burial.

c. If the Veteran expires in a state, VA will pay for the actual cost of transporting the

body to the place of burial in a state, as provided in 38 U.S.C. 2303(a)(1)(B) and 38

CFR 3.1605(b). The cost of transporting the remains is in addition to the burial services

allowance and the plot allowance. The transportation allowance covers:

(1) The transportation cost of the shipment of the body by common carrier or by

hearse from the place of death to the funeral home and to the place of burial;

(2) Any charges for an outside shipping box; and

NOTE: If a Veteran expires in a VA facility under authorized admission or in a non-VA

7. DEATHS WHEN ADMISSION HAD NOT BEEN AUTHORIZED

a. Dead on Arrival. When a death occurs prior to arrival in an ED, the next-of-kin

and coroner or equivalent must be notified immediately. Disposition of the remains

must be made in accordance with the wishes of the next-of-kin, unless stipulated by the

coroner. Burial benefits may not be authorized under these circumstances.

b. Death in the Emergency Department (ED). When a death occurs in an ED and

an admission has not been authorized in writing, the Veteran is not to be admitted to the

VA health care facility. Appropriate clinic disposition and death procedures for Veterans

receiving care on an outpatient basis are to be utilized in such cases.

8. AUTOPSIES (POST MORTEM EXAMINATIONS)

immediate care of a VA health care facility (such as during an outpatient or emergency

care visit, or during an ambulatory care procedure), the Director of that VA health care

facility may order an autopsy on a decedent if the Director determines that an autopsy is

required for VA purposes for the following reasons:

(a) Completion of official records; or

(b) Advancement of medical knowledge.

(2) VA must request consent from the spouse or next-of-kin to perform an autopsy.

The laws of the State where the autopsy will be performed are to be used to identify the

person who is authorized to give VA permission to perform the autopsy. NOTE: The

Director of a VA health care facility may need to consult with Regional Counsel as to

whom under State law, according to 38 CFR 17.170(d), can consent to the autopsy.

the body.

records and/or by an interview with the NOK, nearest relative, or friend. The medical

of death and to identify the deceased. Local, city, or State laws and regulations must be

followed with regards to the completion of documents required by those jurisdictions at

time of death, unless such laws and regulations conflict with VA policy or Federal law.