Department of Veterans Affairs VA HANDBOOK 5005/161

Washington, DC 20420 Transmittal Sheet

January 29, 2024

STAFFING

1. REASON FOR ISSUE: To issue Department of Veterans Affairs (VA) procedures

regarding staffing and recruitment.

2. SUMMARY OF CONTENTS/MAJOR CHANGES: This handbook contains

mandatory VA procedures on appointment and advancement of full title 38

occupations. The pages in this issuance replace the corresponding page numbers in

VA Handbook 5005, Staffing. Revised text is contained in [brackets]. This change

will be incorporated into the electronic version of VA Handbook 5005, Staffing, that is

maintained on the Office of the Chief Human Capital Officer website and VA

Publications website. Significant changes include:

a. Elimination of Professional Standards Boards for title 38 occupations.

b. Changes in approval coordination for facility chief of staff nominations.

c. Updated position titles for Nurses and Advanced Practice Registered Nurses.

d. Clarification of the maximum number of hours part-time and intermittent

employees can work during a calendar year.

e. Updated procedures for conducting mid-probationary periodic reviews.

f. Updated procedures for the recruitment, appointment, advancement, change in

assignment, and reassignment of Nurses and Advanced Practice Nurses in

assignments at grades IV and V.

g. Added examples of Advanced Practice Nurse assignments at grades IV and V.

h. Elimination procedures in Appendix II-H7 for appointing physician assistants at

chief grade.

i. Added responsibilities for HR offices and supervisory officials as it relates to

promotions, change in assignments, and internal placement of title 38

employees.

3. RESPONSIBLE OFFICE: Office of Human Resources and Administration/

Operations, Security and Preparedness (HRA/OSP) (006), Office of the Chief

Human Capital Officer (05), Recruitment and Placement Policy Service (059).

4. RELATED DIRECTIVE: VA Directive 5005, Staffing.

5. RESCISSION: None.

Department of Veterans Affairs VA HANDBOOK 5005/161

Washington, DC 20420 Transmittal Sheet

January 29, 2024

CERTIFIED BY:

/s/

Guy T. Kiyokawa

Assistant Secretary for

Enterprise Integration

BY DIRECTION OF THE SECRETARY

OF VETERANS AFFAIRS:

/s/

Cassandra M. Law

Assistant Secretary for

Human Resources and Administration/

Operations, Security, and Preparedness

DISTRIBUTION: Electronic only

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PART II. APPOINTMENTS

CHAPTER 3. TITLE 38 APPOINTMENTS

SECTION A. GENERAL

1. SCOPE.

a. General. This chapter contains administrative requirements and procedures

relating to the appointment of individuals to occupations identified in

38 U.S.C. § 7306, 7401(1), and 7401(3); and employees in those occupations

who are appointed under 38 U.S.C. § 7405. This section also applies to medical

support personnel appointed under authority of 38 U.S.C., chapter 73 or 74.

NOTE: All references throughout this handbook to occupations identified in

38 U.S.C. § 7401(3) includes those occupations not specifically listed in

Section 7401(3) but approved for hybrid status by the Assistant Secretary for

Human Resources and Administration/Operations, Security and Preparedness in

accordance with the provisions of paragraph 2 below. See Part III, appendix III-

O for a complete list of hybrid occupations. [ ]

b. Veterans Health Administration (VHA) Central Office Appointments

(VHACO). Provisions of this section apply to Central Office employees in the

occupations indicated in subparagraph a. who are appointed under

38 U.S.C. §§ 7306, 7401(1), 7401(3) or 7405. The terms “medical center

officials” and “facility director or designee” in Central Office refer to the Under

Secretary for Health or designee.

c. Residents. Medical and dental residents appointed under 38 U.S.C. § 7406 and

podiatry, optometry and chiropractic residents and trainees appointed under

38 U.S.C. § 7405 are included within the scope of this section. The term resident

as used in this chapter includes interns.

d. Exception from the Competitive Service and the Provisions of 5 U.S.C.

Chapter 51. The appointments of persons under 38 U.S.C. §§ 7306, 7401(1),

7405, and 7406 are excepted from the competitive service and from

5 U.S.C. chapter 51. VA has the authority to exempt persons appointed under

38 U.S.C. § 7401(3) from 5 U.S.C., chapter 51 in specific instances.

2. AUTHORITY AND RESPONSIBILITY.

a. Designation of Hybrid Title 38 Status for Health Care Occupations

(1) The Assistant Secretary for Human Resources and

Administration/Operations, Security and Preparedness, subject to the

concurrence of the Under Secretary for Health, is delegated the authority to

approve health care occupations for conversion to hybrid title 38 status

under 38 U.S.C. § 7401(3) provided such health care occupations:

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(a) Are not occupations relating to administrative, clerical or physical

plant maintenance and protective services;

(b) Would otherwise receive basic pay in accordance with the General

Schedule under section 5332 of title 5;

patient care services; and

(d) Would not otherwise be available to provide medical care or

treatment for Veterans.

(2) Not later than 45 days before the effective date of an appointment or

conversion to a hybrid occupation established under subparagraph (1)

above, the Secretary must submit notice of the new hybrid occupation to

Congress under the provisions of 38 U.S.C. § 7401(3)(B). The Recruitment

and Placement Policy Service (059) is responsible for preparing this notice

for approval of the Secretary.

(3) Prior to submitting notice under subparagraph (2) above, comments shall

be solicited from applicable labor organizations and such comments will be

included in the notice.

b. Effecting Appointments. Appointments will be effected only by appointing

officers (responsible Human Resources Officer). These appointing officers will

effect appointments after the approval of the qualifications and the selection for

appointment has been made by the approving official designated below.

c. Approval of Qualification and Selection for Appointment. [ ] The approving

officials for appointment to positions in VHA under 38 U.S.C., chapter 73 or 74,

will be as follows:

(1) The Secretary.

(a) On advice of the Under Secretary for Health, the approval of the

qualifications and selection of all persons to be appointed under the

authority of section 7306.

(b) The approval of all network and facility directors appointed under the

authority of 38 U.S.C. § 7401(1).

(for network directors appointed in the Senior Executive Service, see

5 U.S.C. § 3393 and VA Handbook 5027, Senior Executive Service).

(d) The approval of Veterans Integrated Service Network (VISN) Chief

Medical Officers appointed under the authority of 38 U.S.C.§ 7401(1).

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(2) Under Secretary for Health or Designee in Central Office. Except as

limited by subparagraph (1) above, the Under Secretary for Health or

designee is the approving official for the appointment of all individuals who

are appointed in Central Office under 38 U.S.C., chapter 74, irrespective of

the type of appointment, title or grade.

(3) Network Directors. Network directors have the authority to appoint facility

chiefs of staff. Facility officials will forward chief of staff nominations to the

[VISN Chief Human Resources Officer]. The [VISN Chief Human

Resources Officer] will provide a technical review of the nomination [ ] and

forward the completed nomination to the network director for approval.

[Notification of a nomination will be forwarded to VHA Executive Resources

and Staffing].

(4) Facility Directors. Except as limited by subparagraphs (2) and (3) above,

the facility director is the approval authority for the following appointment

and assignments.

(a) Physicians. The approval of the qualifications and selection of

physicians appointed under the authority of 38 U.S.C. §§ 7401(1) and

7405, including associate chiefs of staff and physicians in service

chief or comparable positions. See appendices II-G2 and II-H1 for

procedures for qualifying and appointing physicians to service chief

and comparable positions.

(b) Dentists. The approval of the qualifications and selection of dentists

appointed under the authority of 38 U.S.C. §§ 7401(1) and 7405,

including chiefs of dental service or comparable positions and staff

dentists. See appendices II-G3 and II-H2 for procedures for qualifying

and appointing dentists.

Practitioners, Clinical Nurse Specialists and Certified Nurse

Midwives)]. The approval of the qualifications and selection of RNs

and APNs appointed under the authority of 38 U.S.C. §§ 7401(1) and

7405. See appendices II-G6 and II-H5 for procedures on qualifying

and appointing RNs and APNs. In addition, the facility director may

delegate authority to the nurse executive to approve the appointment

of RNs and APNs up to and including Nurse III.

(d) [APN (Certified Nurse Anesthetists (CNAs)). The approval of the

qualifications and selection of CNAs, including Chiefs of Nurse

Anesthesiology under the authority of 38 U.S.C. §§ 7401(1) and

7405. Refer to appendices II-G6d and II-H6 for procedures for

qualifying and making appointments to Chief, Nurse Anesthesiology

positions.]

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(e) Podiatrists. The approval of the qualifications and selection of all

podiatrists appointed under authority of 38 U.S.C. §§ 7401(1) and

7405. Refer to appendices II-G4 and II-H3 for procedures for

qualifying and appointing podiatrists.

(f) Optometrists. The approval of the qualifications and selection of all

optometrists appointed under authority of 38 U.S.C. §§ 7401(1) and

7405. Refer to appendices II-G5 and II-H4 for procedures for

qualifying and appointing optometrists.

(g) Physician Assistants (PA) The approval of the qualifications and

selection of all PAs, [ ] under authority of 38 U.S.C. §§ 7401(1) and

7405. Refer to appendices II-G8 [ ] for procedures for qualifying and

making appointments of PAs. [In addition, the facility director may

delegate authority to the facility chief of staff or PA (facility lead or

equivalent, at PA IV or V) to appoint PAs up to and including PA III.]

(h) Expanded-Function Dental Auxiliary (EFDA). The approval of the

qualifications and selection of all EFDAs appointed under the

authority of 38 U.S.C. §§ 7401(1) or 7405. Refer to appendices II-G9

and II-H2 for procedures for qualifying and appointing EFDAs. The

[facility] director may delegate approval authority for appointments of

EFDAs to the facility chief of staff.

(i) Pharmacists. The approval of the qualifications and selection of all

pharmacists, including Chiefs of Pharmacy Service (all grades),

clinical pharmacists/pharmacy specialists and program specialists [ ]

appointed under the authority of 38 U.S.C. §§ 7401(3) and 7405.

Refer to appendix II-G15 [ ] for qualifications. In addition, the [facility]

director may delegate authority to the facility chief of staff or to the

Chief, Pharmacy Service, to approve the appointment of pharmacists

at GS-12 and below and of Assistant Chiefs, Pharmacy Service at

GS-13.

(j) Physical Therapist (PTs) and Occupational Therapist (OTs). The

approval of the qualifications and selection of PTs and OTs for

section chief positions and positions at GS-12 appointed under the

authority of 38 U.S.C. §§ 7401(3) and 7405. The [facility] director may

delegate approval authority for appointments of other PTs and OTs to

the facility chief of staff. Refer to appendices II-G12, II-G14, and II-H9

for procedures for qualifying and making appointments to section

chief positions.

(k) Respiratory Therapists (RTs). The approval of the qualifications

and selection of all RTs. The [facility] director may delegate approval

authority for appointments of RTs to the facility chief of staff

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appointed under the authority of 38 U.S.C. §§ 7401(3) and 7405.

Refer to appendix II-G11 for qualifying RTs.

(l) Licensed Practice Nurse/Licensed Vocational Nurse

(LPNs/LVNs). The approval of the qualifications and selection of all

LPNs/LVNs appointed under the authority of 38 U.S.C. §§ 7401(3) or

7405. The [facility] director may delegate approval authority for

appointments of LPNs[/LVNs] to nurse executive. Refer to appendix

II-G13 for qualifications.

(m) Chiropractors. The approval of the qualifications and selection of all

chiropractors appointed under authority of 38 U.S.C. §§ 7401(1) and

7405. The [facility] director may delegate approval authority for

appointments of chiropractors to the facility chief of staff. Refer to

appendices II-G16 and II-H10 for procedures for qualifying and

appointing chiropractors.

(n) Other occupations appointed under the authority of 38 U.S.C §

7401(3) or 7405. The approval of the qualifications and selection of

all individuals appointed in occupations listed in 38 U.S.C. § 7401(3)

or approved for 38 U.S.C. § 7401(3) hybrid status by the Assistant

Secretary for Human Resources and Administration[/Operations,

Security and Preparedness] in accordance with the provisions in

paragraph 2a of this section. The facility director may delegate

approval authority for appointment of employees in the hybrid

occupations. (See chapter 3, section A, this part.)

[ ]

(5) Human Resources Officer Responsibilities. The Human Resources

Officer will be responsible for:

(a) Adhering to administrative and regulatory requirements;

(b) Reviewing each case for completeness before forwarding to VHA

Central Office;

requirements pertaining to appointments, advancements and

probationary reviews;

(d) Notifying prospective appointees of their selection.

3. APPOINTMENT REQUIREMENTS AND DETERMINATIONS.

a. Preference to Veterans.

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(1) The primary consideration in making appointments of physicians, dentists,

podiatrists, optometrists, chiropractors, [registered nurses, advanced

practice nurses], PAs and EFDAs under 38 U.S.C., chapter 73 or 74, will

be the professional needs of VHA. Consistent with this policy however,

Veterans will be given preference when qualifications of candidates are

approximately equal. This includes qualified disabled Veterans and

preference eligible as defined in 5 U.S.C. § 2108.

(2) When candidates for positions identified in 38 U.S.C. § 7401(3), are

determined to be approximately equally qualified for a particular opening,

hiring preference will be given to Veterans and preference eligibles as

defined in 5 U.S.C. § 2108. Selections from candidates determined to be

approximately equal will be made in the following order:

(a) Disabled Veterans who have a service-connected disability of 10

percent or more.

(b) Preference eligible under 5 U.S.C. § 2108(3)(C) through (H) other

than those above (e.g., disabled Veteran; unmarried widow or

widower of a Veteran who served on active duty in wartime or other

designated service period; spouse of a service-connected disabled

Veteran not qualified for civil service employment; mother of a

Veteran who lost his/her life in wartime or other designated service

period; mother of a service-connected permanently and totally

disabled Veteran.)

Veterans who served on active duty in wartime or other designated

service period.)

(d) All other candidates.

(3) When qualified Veterans apply for appropriate vacancies, it is important

that VA health care facilities establish and maintain documentation within

Human Resources (HR) files to demonstrate that qualified preference

eligible and other Veteran applicants received appropriate consideration for

positions being filled, and to address the relative qualifications of

preference eligible and other Veteran applicants. At a minimum, facilities

must be able to demonstrate from the written record why the qualifications

of non-selected preference eligible and other Veterans are not

approximately equal to those of selected candidates who either lack

preference or are non-Veterans, respectively.

NOTE: The VA is required to follow title 5 Veterans’ preference rules when

hiring individuals for hybrid title 38 positions (Graves v. VA 117 M.S.P.R.

697 (2012). See VA Handbook 5005 Part I, Chapter 4.)

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b. Dual Employment and Dual Compensation Restrictions.

(1) Except as provided in the subparagraphs below, no full-time employee

appointed under authority of 38 U.S.C., chapter 73 or 74, will concurrently

hold any other type of paid appointment in VA.

(2) The following personnel may hold more than one appointment provided it is

not contrary to 5 U.S.C. § 5533 and VA Directive and Handbook 5007,

Appendix F, Paragraph 3, Pay Administration: full-time personnel

appointed under 38 U.S.C. § 7401(3), personnel in occupations listed in 38

U.S.C. § 7401(3) who are appointed on a full-time or part-time basis under

38 U.S.C. § 7405(a)(1)(B) and medical support personnel appointed on a

full-time or part-time basis under 38 U.S.C. § 7405(a)(1)(D). A medical

resident may serve as an admitting physician on a fee-basis in accordance

with the criteria in VA Handbook 5007, Pay Administration. Paid trainees in

medical support programs funded through the Office of the Chief Academic

Affiliations may simultaneously hold part-time, intermittent or fee-basis

appointments provided there is no violation of dual compensation

restrictions, the trainee is determined to be the best qualified applicant and

the utilization as a trainee is consistent with the provisions of VHA Manual

M-8, Academic Affairs. All other personnel appointed under authority of 38

U.S.C., chapter 73 or 74 are covered by the provisions of subparagraph b

(2) through b (4). Pharmacy residents appointed under

38 U.S.C. § 7405(a)(1)(D) may be appointed to another position under

38 U.S.C. § 7405 without regard to the restrictions in 5 U.S.C. § 5533.

(3) Facility directors may appoint, on a lump-sum fee-basis, full-time

employees from other VA facilities employed in occupations listed under 38

U.S.C. § 7401(1), provided the criteria in paragraph b (4) are met and such

an appointment would not be contrary to Department conflict of interest

regulations (38 C.F.R., part 0). Such appointments permit the use of full-

time employees on a fee-basis at a second VA facility, provided

management officials at both facilities agree that the arrangement permits

them to meet staffing needs; fees are paid on other than a time basis; and

the arrangement results in an employer-employee relationship. (5 C.F.R.,

part 304.) Facilities wishing to use this authority should identify the task

they need accomplished and compensate the employee on a fee-basis for

the completion of that task. Appointment of full-time employees covered by

38 U.S.C. § 7401(1) on a fee-basis at the same VA facility is not permitted.

No consultant, attending, fee-basis, part-time or intermittent employee will

simultaneously hold more than one compensable appointment in VHA

unless the outlined criteria are met. The restriction in the preceding

sentence applies to appointment at the same facility or at more than one

facility.

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(4) For individuals identified in subparagraph b (2), dual appointments may be

approved by the facility director, subject to the following conditions and

restrictions:

(a) Services are essential to the health care needs of patients.

(b) No other equally qualified individual in the specific specialty is

available in the locality.

(5) For individuals identified in subparagraph b (2), the following dual

appointments will be approved by the facility director only in exceptional

circumstances and if requirements in subparagraph b (4) are met. Officials

will ensure that these appointments will not present or lead to a conflict of

interest or the appearance thereof. Questions concerning conflict of

interest matters may be directed to the Regional Counsel.

(a) Utilization as a consultant or attending in combination with

employment on a part- time or intermittent basis at the same facility.

(b) On-facility fee-basis appointment under the schedule of fees in

combination with utilization as a consultant or attending at the same

facility. (NOTE: This subparagraph does not apply to outpatient

services of off-facility fee-basis personnel in a private office or private

clinic, even though consultant or attending services may be

performed on the same day.)

consultants and attendings, in combination with an on-facility fee-

basis appointment to perform an operation, give treatment or perform

special duty nursing.

(6) Recommendations to approving officials should include sufficient

information to indicate that dual employment is justified.

c. Equal Opportunity for Employment. Employment actions will be taken on the

basis of merit and without discrimination for such reasons as age, race, color,

religion, national origin, sex, lawful partisan political affiliation, marital status,

physical, or mental disability (when the individual is qualified to do the work) or

membership or non- membership in a labor organization.

d. Member of Family Restrictions. Employment actions will conform to the

restrictions governing the employment of family members as provided in 5

C.F.R., part 310. (For further guidance, refer to chapter 2, this part).

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e. Restrictions Regarding Political Activity. Employees appointed under

authority of 38 U.S.C., chapter 73 or 74, are subject to the political activity

restrictions in 5 U.S.C., chapter 73 and VA Handbook 5025, Legal.

f. Qualification Standards.

(1) General. The basic qualification requirements for individuals appointed

under 38 U.S.C., chapters 73 and 74, in occupations identified in under

38 U.S.C. §§ 7401(1) and 7401(3), are contained in VA Qualification

Standards approved, under the delegated authority, by the Assistant

Secretary for Human Resources and Administration/Operations, Security

and Preparedness upon recommendations of the Under Secretary for

Health. These standards apply to all appointments in these occupations

under authority of 38 U.S.C., chapter 73 or 74, regardless of the nature or

tenure of the appointment.

(2) Qualification Standards for Occupations. The qualification standards for

individual occupations are contained in appendix II-G of this chapter.

(3) Education.

(a) Approved schools and satisfactory internships or their equivalents for

the purpose of 38 U.S.C. § 7402, will be those designated in the

appropriate qualification standards. The accrediting agency or body

for verifying education of applicants is also identified in the

qualification standards.

(b) Provisions of 38 U.S.C., chapter 73 or 74, require that individuals

have education and licensure, registration or certification as specified

in the appropriate qualification standard in order to qualify for

assignment of patient care responsibility. Unless otherwise indicated

in the qualification standard, an unlicensed candidate may not use

professional education as a substitute for the accredited education

and/or training required by the qualification standards of another

occupation. For example, an unlicensed physician may not be

appointed as a PA by using graduation from medical school as a

substitute for completion of an approved PA training program.

Likewise, an unlicensed dentist may not be appointed as an EFDA by

using graduation from dental school as a substitute for completion of

approved dental assistant or hygienist training.

(4) Grade Level Determinations. The grade to which an applicant is

appointed will be determined by the individual’s qualifications and

assignment. Under the Title 38 “rank-in-person” system, candidates are to

be appointed at the highest grade or level within the grade for which they

are fully qualified up to the full performance level. For positions above the

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full performance (journey level) the complexity of the assignment and

scope of responsibility are considered in determining grades.

g. Citizenship.

(1) To be eligible for appointment in VHA, an applicant must be a citizen of the

United States (U.S.), except as provided in 38 U.S.C. § 7407(a) and

subparagraph (2). The acquisition of “first papers” or the “owing of

allegiance to the United States” does not satisfy the basic requirement of

citizenship. Naturalized citizens must furnish evidence of citizenship.

(2) After a determination is made that it is not possible to recruit qualified

citizens, necessary personnel may be appointed on a temporary basis

under authority of 38 U.S.C. § 7405 without regard to the citizenship

requirements of 38 U.S.C. § 7402 or any other law prohibiting the

employment of or payment of compensation to a person who is not a

citizen of the United States. Candidates must meet all other requirements

for the grade and position concerned.

(3) Requests to petition the U.S. Department of State (DOS) for waiver of the

2-year home residence requirement under 22 C.F.R., part 514 must be

approved VHA Workforce Management and Consulting Office (106A1).

Requests to petition DOS will be submitted in accordance with instructions

contained in appendix II-J of this chapter and VHA Handbook 5005.1,

“Requests to Petition the United States Department of State for a Waiver of

the Two-Year Home Residency Requirement on Behalf of an Exchange

Visitor”. No appointment may be effected or commitment made until the

required approval is received from the U.S. Citizenship and Immigration

Service’s (USCIS), formerly the Immigration and Naturalization Service.

(4) Officials of VHA will not commit positions to noncitizens not legally entitled

to reside in this country.

(5) Consistent with provisions in this paragraph, the appointment of

noncitizens may be approved by the following officials:

(a) The facility director is the approval authority for appointment of:

i All noncitizens as residents.

ii Immigrants (aliens who have been admitted for permanent

residence.) As of September 20, 1994, all immigrants are required

to have an Alien Registration Receipt Card, Form I-551. Form I-

551 has the lawful holder’s photograph, fingerprint and signature

on a white background; it is commonly known as the “green card.”

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NOTE: The Form I-151 and all previous forms are no longer valid

after September 19, 1994.

iii All nonimmigrants (e.g., exchange visitors, alien students, visiting

professors), provided employment is authorized by the USCIS.

This includes authority to sponsor an individual for a nonimmigrant

visa or an extension of such visa. The authorization for

employment may be cited on the nonimmigrant’s visa or the

nonimmigrant may possess an Employment Authorization Form (I-

688B). In cases where the authority to accept compensated or

non-compensated employment by the nonimmigrant is not clearly

evident, a report of contact with USCIS officials verifying the

employment authorization must be made. A copy of the document

used to verify the employment authorization of the nonimmigrant is

to be filed in the appointee’s personnel folder.

(b) The Under Secretary for Health or designee is the approval authority

for the appointment of noncitizens to centralized positions.

generally permitted. Any exception requires the approval of the Under

Secretary for Health or designee. (See section G, paragraph 8, this

chapter.)

h. Credentialing Requirements (Including License Registration or

Certification). See section B of this chapter.

i. List of Excluded Individuals and Entities (LEIE) and Healthcare Integrity

and Protection Data Bank (HIPDB) Sanction List. See chapter 1, section B,

paragraph 2 of this part.

j. English Language Proficiency. No person will be appointed under authority of

38 U.S.C., chapter 73 or 74, to serve in a direct patient care capacity in VHA

who is not proficient in written and spoken English. (See appendix II-I of this

chapter.)

k. Physical Requirements.

(1) General.

(a) Guidelines for physical and mental fitness for appointment and

retention in VHA shall be established by the Under Secretary for

Health. (See VA Directive and Handbook 5019, Part II, [Employee]

Occupational Health [Service].)

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(b) Only those persons who are physically and mentally capable of

satisfactorily performing the duties of their assignments are to be

employed and retained in VHA.

discrimination for such reasons as age, race, color, religion, national

origin, sex, lawful partisan political affiliation, marital status, physical

or mental disability (when the individual is qualified to do the work) or

membership or non-membership in a labor organization.

(2) Pre-employment Physical Examinations.

(a) General. See VA Directive and VA Handbook 5019, Employee

Occupational Health Service. Pre-employment physical examination

is not required of residents and interns who furnish evidence of

satisfactory physical condition based on a physical examination within

the past 12 months. An examination is required for any action moving

an employee from a position not requiring an examination to one

requiring and examination.

(b) Scope and Conduct of Examination. See VA Directive and

Handbook 5019, [Employee Occupational Health Service], Part II.

l. Oath, Affidavit and Declaration of Appointee.

(1) All employees of VHA appointed under authority of 38 U.S.C., chapter 73

or 74 (except those utilized on a fee-basis) are required to take the oath of

office and execute the affidavit (subversive activity), affidavit (striking

against the Federal Government) and the declaration of appointee.

Noncitizens shall be required to execute only those affidavits on Standard

Form (SF) 61, Appointment Affidavit, outlined in the OPM Guide to

Processing Personnel Actions. The SF 61 shall be executed in accordance

with the requirements set forth in chapter 2, section A, paragraph 5e of this

part.

(2) Only employees delegated the authority will administer the oaths

necessary for effecting appointments in VHA.

m. Security Requirements for Employment. See VA Directive and Handbook

0710, Personnel Security and Suitability Program, for VA instructions concerning

security requirements.

n. Effective Date of Appointment. Appointments will be effective on the entrance-

on- duty day, except as follows:

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(1) Full-Time Physicians, Dentists, Podiatrists, Optometrists,

Chiropractors, and Other Personnel Appointed Under 38 U.S.C. §

7306. When an appointee is to enter on-duty on Monday, the appointment

will be effective on the preceding Sunday provided the employee is

available for duty on that day. Sunday will be considered an administrative

non-duty day. If Monday is a holiday, the appointment will be effective on

the entrance-on-duty-day.

(2) RNs, APNs, PAs, EFDAs, and Hybrid Title 38 occupations. When the

appointee is to enter on-duty on the first Monday in a pay period, the

appointment will be effective on the first Sunday of the pay period. If

Monday is a holiday, the appointment will be effective on the entrance-on-

duty-day.

(3) Restoration After Military Service or Compensable Injury. An exception

to these effective dates may be made if required to satisfy statutory or

regulatory provisions such as restoration after military service or

compensable injury.

o. Overseas Employment. See chapter 1, section C of this part.

p. Grade and/or Step Adjustments. If, on review of an appointment by the

appropriate supervisory official, in collaboration with Human Resources staff, it is

determined that an employee has been appointed at a grade or level within the

grade which is not commensurate with qualifications, the approving authority for

initial appointment may approve an adjustment in the grade, level, and/or step

rate within the grade. (See section E, paragraph 2, this chapter, for limitations on

adjusting step rates within the grade for this purpose). These adjustments in

grade and/or step rate will be effected as of the beginning of the next pay period

following approval. The nature of action on SF 50-B will be “Promotion” or

“Change to Lower Grade,” as appropriate. In the case of step rate adjustments,

the nature of action on SF 50-B will be “Administrative Pay Increase” or

“Administrative Pay Decrease,” as appropriate. The authority for such actions

will be “38 U.S.C.§ 7403.” The following statement will be placed in “Remarks”

on SF 50B for such actions: “Adjustment for consistency with standardized

qualification requirements.”

NOTE: Service in a lower step rate prior to adjustment of step(s) within

the grade will not be credited toward meeting the required waiting

period for periodic step increase.

4. PROBATIONARY PERIOD.

a. Requirement to Serve a Probationary Period.

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(1) Full-time permanent appointments of physicians, dentists, podiatrists,

optometrists, chiropractors, RNs, APNs, PAs and EFDAs made under

authority of 38 U.S.C. § 7401(1) are subject to a two-year probationary

period requirement as specified in 38 U.S.C. § 7403(b)(1). NOTE: Full-time

temporary appointments under 38 U.S.C. § 7405(a)(1) are excluded from

the requirement to serve a probationary period, and service in this time-

limited capacity is not creditable towards a probationary period as specified

in 38 U.S.C. § 7403(b)(1).

(2) Individuals appointed as of May 5, 2010, as part-time or intermittent RNs

under 38 U.S.C. § 7405(a)(1), are subject to a two-year probationary

period requirement, except as provided below. Upon completion of the

probationary period, the appointment is no longer considered temporary.

The following appointments are considered temporary, thus are not subject

to a probationary period. These appointments are on a time-limited basis of

three years or less:

(a) Part-time or intermittent appointments resulting from an academic

affiliation or teaching position in a nursing academy of the

Department;

(b) Appointments as a result of a specific research proposal or grant; or

7407(a).

(3) Full-time permanent appointments of hybrid title 38 employees made under

authority of 38 U.S.C. § 7401(3) are subject to the one-year title 5

probationary period requirements (see chapter 2, section A, paragraph 9,

of this part).

(4) Employees who satisfactorily completed the probationary period required

by 38 U.S.C. § 7403(b) will not serve a new probationary period upon

reappointment unless their separation was for cause.

b. Purpose of Probationary Period.

(1) The probationary period is an extension of the appointment process. It

provides the final test of the appointee’s qualifications, i.e., actual

performance on the job. During the probationary period, the employee’s

conduct and performance will be closely observed. The employee may be

separated from the service if not found fully qualified and satisfactory.

Thus, the probationary period provides a safeguard against retention of

any person who, despite having met legal and regulatory requirements for

appointment, is found in actual practice to be unsuited for retention in the

Veterans Health Administration (VHA). Retention of employees during the

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probationary period shall be contingent upon demonstrating that they are

fully qualified and satisfactory. Only those employees who satisfactorily

complete the probationary period shall acquire status as permanent

employees in VHA.

(2) The probationary period also affords an opportunity for fostering the

interest of the employee in a VA career. Thoughtful and considerate

treatment during the probationary period will have a lasting effect on the

employee’s career.

c. Length of Probationary Period.

(1) The probationary period for employees appointed under

38 U.S.C. § 7401(1), as well as employees appointed as part-time or

intermittent RNs/APNs under 38 U.S.C. § 7405(a)(1), on or after May 5,

2010, is two years. The probationary period for part-time RNs/APNs are

computed based on calendar time, in the same manner as for full-time

employees.

(2) The probationary period for intermittent RNs/APNs is computed based on

one day of credit for each day or part of a day in pay status. Individuals

appointed as intermittent RNs/APNs must serve 520 days in a pay status

to complete the required 2-year probationary period. The probationary

period, however, cannot be completed in less than two calendar years.

(3) Probationary requirements for hybrid employees appointed under

38 U.S.C. § 7401(3) is the same as those for title 5 employees and can be

found in chapter 2, section A, this part. The calculation for part-time and

intermittent creditable service is the same as above.

d. Last Day of Probationary Period.

(1) For full-time employees paid on a daily basis (physicians, dentists,

podiatrists, optometrists, and chiropractors), the probationary period ends

at midnight on the last calendar day before the employee’s anniversary

date, whether or not the employee is in a duty status that day. For

example, a probationary period beginning November 1, 2011, would

normally end at midnight on October 31, 2013.

(2) For full-time and part-time employees paid on an hourly basis (RNs, APNs,

physician assistants, and expanded-function dental auxiliaries) the

probationary period is completed at the end of the last scheduled tour of

duty before the employee's anniversary date. For the purposes of this

paragraph, scheduled duty includes normal and overtime duty, leave,

excused absence, including holidays and absence without leave. For

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example, an employee subject to a two-year probationary period beginning

November 1, 2011, is completed as follows:

(a) For an employee, whose last tour of duty prior to November 1, 2013,

occurs at 4:30 p.m. on October 31, 2013, the probationary period is

completed at 4:30 p.m. on October 31, 2013.

(b) For an employee, whose last tour of duty prior to November 1, 2013,

is from 11:00 p.m., October 31, 2013, to 7:00 a.m., November 1,

2013, the probationary period is completed at midnight on October

31, 2013.

(because of days off) is October 29, 2013, [the probationary period is

completed at midnight on October 29, 2013.]

(d) For an employee, whose last tour of duty prior to November 1, 2013,

is 4:30 p.m. on October 29, 2013, but he/she calls in sick for

scheduled tours of duty on October 30 and October 31, 2013, the

probationary period is completed at 4:30 p.m. on October 31, 2013.

(e) If completed satisfactorily, the employee will automatically complete

the required probationary period at the end of the last tour of duty

worked or scheduled to work.

e. Creditable Service. The following service is creditable toward completion of the

probationary period:

(1) Continuous service in an appointment under 38 U.S.C. §§ 7401(1), 7306 or

part-time or intermittent (including temporary) service for RNs/APNs

appointed under 38 U.S.C. § 7405(a)(1).

(2) Prior satisfactory probationary service of at least six months duration

followed by a break(s) in service totalling one year or less if the break was

not due to separation for cause. A break in service is defined for the

purpose of this subparagraph as a period during which no service is

rendered under 38 U.S.C. §§ 7306, 7401(1), or 7405(a)(1) for part-time or

intermittent RNs/APNs.

(3) Time spent in a probationary period served under 38 U.S.C. § 7403(b) prior

to holding some other type of appointment in VHA, if the employee is

subsequently appointed under 38 U.S.C. § 7401(1), provided all other

conditions of subparagraph d are met. Example: A full-time RN/APN

appointed under 38 U.S.C. § 7401(1) in July 2011 accepts a position of

Supervisory Health System Specialist (Domiciliary Administrator) under title

5 in December 2012. The individual returns to an RN/APN position under

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38 U.S.C. § 7401(1) in October 2014. The previous time served as an

RN/APN from July 2011 through December 2012 is not creditable towards

the completion of the probationary period because the time served under

the title 5 appointment was longer than one year.

(4) All leave with pay during creditable service.

(5) Leave without pay during the probationary period is considered creditable

service when it does not exceed a total of 40 calendar days for physicians,

dentists, podiatrists, optometrists or chiropractors, or 235 hours for RNs,

APNs, physician assistants, and expanded-function dental auxiliaries and

110 hours for part-time RNs. NOTE: When determining this total, each

hour of leave without pay taken by an RN or APN on the Baylor Plan is to

be multiplied by 1.667.

(6) Time before restoration during which a probationary employee received

work injury compensation from the Office of Workers' Compensation

Programs.

f. [Mid-Probationary Periodic Review and Probationary Review Board (PRB)

(1) Employees Covered. A mid-probationary periodic review will generally be

conducted by a Probationary Review Board (PRB) for covered title 38

probationary employees after they receive their first proficiency rating or

performance appraisal. These procedures apply to the following employees

serving a probationary period: employees appointed under

38 U.S.C. § 7401(1); and part-time RNs and APNs, including intermittent,

serving on a temporary permanent appointment under

38 U.S.C. § 7405(a)(1)(A). These procedures do not apply to: employees

appointed under 38 U.S.C., Chapter 3 or §§ 7306, 7401(2), 7401(3),

7401(4), 7405 (except part-time RNs and APNs serving on a temporary or

permanent employment) or 7406; or employees occupying positions

described in 38 U.S.C. § 7405(g)(3).

(2) Establishing PRBs. The need to establish a PRB on an ongoing or ad hoc

basis will be dependent upon the needs of the occupation or facility. In

some cases, the number of probationary employees at a facility may call

for establishing an ongoing/standing PRB for the occupation, e.g., for

registered nurses or physicians. In other cases, the number of probationary

employees in the occupation may be so limited or rare that the PRB will be

established on an ad hoc basis, e.g., chiropractors or ophthalmologists.

The authorizing official has discretion regarding the establishment of PRBs.

(3) Authorizing Officials and PRB Membership. The following identifies the

appropriate authorizing officials. Authorizing officials are responsible for

coordinating and establishing standing or ad hoc PRBs, as needed, and

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appointing PRB members, pursuant to the probationary employee’s

occupation or organizational assignment. For probationary employees in

the Veterans Health Administration Central Office (VHACO) the authorizing

official is the appropriate service director (or equivalent) position or above.

(a) For probationary VISN Directors, the authorizing official is the

Assistant Under Secretary for Health for Operations (AUSHO).

(b) For probationary VISN Chief Medical Officers (CMO), Quality

Management Officers (QMO) or Chief Nursing Officers (CNO) or

equivalent, the authorizing official is the VISN Director.

CNOs or equivalent, the authorizing official is the CMO, QMO, CNO

or equivalent, depending on the probationary employee’s

organizational alignment.

(d) For probationary VHA Facility/Medical Center Directors or Deputy

VISN Directors appointed under 38 U.S.C. § 7401(1), the authorizing

official is the VISN Director.

(e) For probationary VHA Medical Center Chief of Staffs (COS) or

equivalents, the authorizing official is the Facility Director.

(f) For probationary Associate Directors for Patient Care Services

(ADPCS) or equivalents, the authorizing official is the Facility

Director.

(g) For probationary Assistant/Associate Chiefs, Nursing Services and

RNs/APNs, Grade IV, the authorizing official is the ADPCS or

equivalent.

(h) For all other VHA probationary facility employees, the authorizing

official is the appropriate service chief or equivalent, depending upon

the probationary employee’s organizational alignment.

(4) Composition of the PRB.

(a) The authorizing official should attempt to convene a PRB with three

board members, appointed under title 38 in the same occupation as

the probationary employee being reviewed. However, if that is not

possible or practical, at least one PRB member will be in the same

title 38 occupation at the same grade or higher than the probationary

employee being reviewed. In the case of RNs/APNs, at least two

PRB members will be in the same occupation.

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(b) Persons selected to serve on the PRB will be fair, impartial, and

objective.

i If an authorizing official determines a local PRB cannot be properly

established, the authorizing official and the servicing HR Office will

facilitate the process for obtaining members from facilities other

than the reviewing employee’s facility to serve on an PRB.

ii Persons in a position to prejudice the action of a PRB, such as an

employee’s immediate or second level supervisor, may not serve

on an PRB.

(5) Mid-Probationary Periodic Review. The PRB has responsibility for

periodically reviewing the services of probationary employees for those

hired in occupations under 38 U.S.C. § 7401(1). At a minimum, at least one

formal periodic review will be done during the probationary period, in

accordance with the below.

(a) The servicing HR Office will establish monitors to ensure completion

of mid-probationary periodic reviews.

(b) The mid-probationary periodic review will be initiated by the

supervisor, typically following completion of the employee’s first

Proficiency Report or Performance Appraisal, but not later than 18

months after the employee’s appointment to the occupation. If the

supervisor believes the employee is satisfactory and there is a

standing PRB for the occupation at their facility, they will submit the

employee’s performance record (proficiency report or performance

appraisal, whichever is applicable) and qualifications record (VetPro

qualification verification or application/resume) to the PRB for further

review. If there is no applicable standing PRB, the supervisor should

alert the appropriate authorizing official so that one can be appointed.

If the supervisor believes the employee is unsatisfactory, they will

request that a Summary Review Board (SRB) review the employee in

accordance with the procedures set forth in VA Handbook 5021,

Employee/Management Relations.

record submitted by the supervisor, and determine whether the

employee is fully qualified and satisfactory to continue to work for the

VA. After review of the performance and qualification record, the PRB

members will convene at least once in person, telephonically or via

video teleconference to discuss their review of the performance and

qualification record, findings, and recommendations.

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(d) If the PRB determines the employee’s conduct, performance, and/or

qualifications are satisfactory, the PRB will record that finding by

endorsing the current Proficiency Report or by preparing a separate

memorandum report. The supervisor will advise the employee of the

satisfactory finding. The PRB’s findings and recommendation will be

recorded on VA Form 10-2543, Board Action.

(e) If the PRB does not determine that the employee’s conduct,

performance, and/or qualifications are satisfactory, the PRB will

submit their recommendation on the Board Action, notifying the

supervisor that an SRB must be convened. The supervisor must

submit the PRB’s recommendation to the authorizing official to

convene an SRB in accordance with the procedures set forth in VA

Handbook 5021, Part III, Chapter 1. The PRB’s recommendation on

the Board Action to the supervisor will include any records reviewed

and their assessment supporting this determination. The supervisor’s

submission to the authorizing official will also include this information.

(6) Ongoing Reviews.

(a) Supervisors will review the services of employees through

observation and evaluation of their performance and conduct during

the probationary period. When the employee has had an opportunity

to understand performance expectations, the supervisor should

consider any inadequacies in performance. The employee's

weaknesses should be discussed objectively with the employee and

suggestions made for improvement. If the employee's performance is

considered good or outstanding in some aspect, this fact should be

made known to the employee.

(b) If at any time during the probationary period, the employee's

performance or conduct are not satisfactory, the employee's

immediate or higher-level supervisor will submit a written request for

immediate review by an SRB in accordance with VA Handbook 5021,

Employee/Management Relations.]

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SECTION B. CREDENTIALING AND LICENSURE

1. GENERAL.

a. Scope.

(1) This section contains administrative requirements and procedures relating

to the credentialing and licensure of applicants and employees appointed

to occupations identified in 38 U.S.C. §§ 7306, 7401(1), and 7401(3); and

employees in those occupations who are appointed under 38 U.S.C. 7405,

including individuals utilized on an on-facility fee-basis, on-facility contract

or on-facility sharing agreement basis. This includes such employees as

physicians, dentists, podiatrists, optometrists, chiropractors, nurses, nurse

anesthetists, physician assistants (PAs), expanded-function dental

auxiliaries (EFDAs), and Hybrid Title 38 occupations. Provisions of this

section apply to Central Office employees who are employed in the

occupations indicated above under 38 U.S.C. §§ 7306, 7401(1), 7401(3),

or 7405. Individuals appointed under 38 U.S.C. § 7405, whether paid or

without compensation, on an intermittent or fee-basis, including consultants

and attendings, must be fully credentialed in accordance with provisions of

this section, although they are considered employees only during periods

when actually engaged in VA service.

(2) The provisions of this section should be used in conjunction with VHA

Handbook 1100.20 'Credentialing of Health Care Providers.'].

b. Residents. Medical, dental, podiatry, chiropractic, and optometry residents and

trainees appointed under 38 U.S.C. §§ 7405, 7406 are included within the scope

of this section. As indicated in paragraph 21 of this section, the appropriate

program director is responsible for certifying that the credentials and licensure of

residents and trainees have been verified prior to their appointment. Specific

procedures described in paragraphs 3 through 19 are not applicable to residents

functioning within the scope of their training program, but program directors,

where possible, should use verification procedures, which are generally

consistent with those described.

c. Definitions.

(1) Active, current, full, and unrestricted license or registration in a State.

Authorizes the licensee to practice outside VA without any change being

needed in the status of the license. An employee is responsible for paying

any fees necessary to maintain a full and active license in a State. If a

State waives fees for any reason, such as for an out-of-state practice or for

employment in a Federal facility, the employee may not accept the waiver if

this will place the license in an inactive or other restricted status.

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(2) Credentialing. The systematic process of screening and evaluating

qualifications and other credentials, including licensure, required education,

relevant training and experience, current competence and health status.

(3) Licensure. The official or legal permission to practice in an occupation, as

evidenced by documentation issued by a State in the form of a license

and/or registration.

(4) “Medical Center officials” and “facility director or designee” refer in Central

Office to the Under Secretary for Health or designee.

(5) Primary source verification. Documentation from the original source of a

specific credential that verifies the accuracy of a qualification reported by

an individual health care practitioner. This can be documented in the form

of a letter, telephone contact or secure electronic communication with the

original source.

(6) “Registration” or “Certification”. The official attestation by a professional

organization that one has fulfilled the requirements or met a standard skill

to practice the profession.

(7) State. Any of the states, territories, and possessions of the United States,

the District of Columbia, and the Commonwealth of Puerto Rico.

(8) VetPro. VHA’s electronic credentialing system which must be used for

credentialing all providers. The system is used by applicants and

practitioners to provide evidence of licensure, registration, certification,

and/or other relevant credentials for verification prior to appointment,

throughout the appointment process and upon transfer from another

medical facility. The system provides an electronic file for continued

maintenance of accurate, complete and timely credentials for all VHA

health care providers who claim licensure, certification or registration, and

are permitted by the facility to provide patient care services or oversee the

delivery of those services.

d. Responsibilities of VA Officials.

(1) The Under Secretary for Health or designee will establish additional

credentialing, licensure and/or registration requirements and procedures to

assure that only fully qualified and suitable candidates are appointed and

retained in VHA. Procedures will be established to thoroughly evaluate

applicant credentials, licensure and/or registration status and to monitor

these on a continuing basis for health care employees appointed under

38 U.S.C. §§ Chapter 73, 74.

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(2) Facility directors are responsible for implementing policy and procedures

outlined in this section and for providing necessary resources to ensure

that the verification of credentials and licensure is effectively and efficiently

managed. So that only fully qualified and suitable individuals are appointed

and retained under 38 U.S.C. §§ Chapter 73, 74, [clinical executives

(chiefs of staff, Chiefs of Patient Care Services, Nurse Executives), Service

Chiefs,] hiring officials [ ] and HR Officers will ensure that the qualifications

of candidates for appointment are thoroughly screened and evaluated. The

credentialing process includes verifying the individual’s licensure and/or

registration, relevant training and/or experience, current competence, and

physical and mental fitness. (See Appendix II-L of this chapter for a

credentialing checklist.) Officials described in this paragraph will ensure all

applicants and employees covered by this policy are made aware of their

responsibilities with respect to credentialing and licensure.

(3) The credentialing and licensure verification process is a shared

responsibility, requiring extensive interchange and continuing

communication between the Chief of Staff and HR Officer. Facility directors

will establish local policies and procedures delineating functions to be

accomplished by each of these officials to assure that responsibilities are

clearly understood and can be effectively carried out.

(4) Compliance with credentialing and licensure provisions of this section does

not obviate the responsibility to determine suitability for employment

following guidelines in 5 C.F.R, part 731 or to initiate background

investigations of employees using procedures specified in

5 C.F.R. § part 736.

e. Documentation. Information obtained through the verification process must be

documented in writing, either by letter, memo, report of contact or secure

electronic verification, as appropriate. Documentation will be filed permanently in

the VHA credentialing file, VetPro. Facsimile copy may be used with appropriate

authentication of the source providing the information via facsimile. This needs

to be independently authenticated and the authentication needs to be

documented, e.g., entry into comments section of VetPro. A coversheet by itself

is not considered independent authentication but may be scanned as the last

page of the document, not the first, as well as documentation of the independent

verification of the sender’s source. If independent authentication of the source

cannot be made, the facsimile copy must be followed up with an original

document.

NOTE: Authentication of the source of the facsimile requires the

recipient to document knowledge that the appropriate source that

owned the verification information transmitted the facsimile. For

example, if the recipient of the facsimile confirmed with the verifying

entity that the facsimile was indeed transmitted by the verifying entity

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then this confirmation should be documented on the facsimile

coversheet, signed and dated by the individual completing the

independent authentication, to include name and title of both

transmitting and confirming individuals and date of confirmation.

f. Action Prior to Credentialing.

(1) No appointment action will be taken, nor will an employment commitment

be made, in any case where officials have reason to question a candidate’s

suitability for VA employment. All information obtained through the

credentialing process will be carefully considered before an employment

decision is made. An RN, APN, PA, EFDA or candidate for appointment to

an occupation identified in 38 U.S.C. § 7401(3), may be appointed under

38 U.S.C. § 7405(a)(1) pending completion of the full credentialing process

referenced in [VHA Directive 1100.20, Credentialing of Health Care

Providers]. However, a physician, dentist, podiatrist, optometrist or

chiropractor will be appointed only after credentialing information is

received [ ] except as noted in paragraph 2 below.

(2) In exceptional circumstances and where required to meet an emergent

patient care situation, the facility director may approve the temporary

appointment of a physician, dentist, podiatrist, optometrist or chiropractor

under 38 U.S.C. § 7405 [ ] following the procedures in [VHA Directive

1100.20, Credentialing of Health Care Providers]. The [facility] director will

document for the record the specific circumstances and patient care

situation which warranted such an appointment. The appointment will be

made only after evidence of current, full and unrestricted licensure has

been obtained and a judgment has been made that the individual is fully

qualified for the assignment.

g. Applicant and Employee Responsibilities. Applicants and employees will

provide evidence of licensure, registration, certification, and/or other relevant

credentials, for verification prior to appointment and throughout VA employment

as requested. They are responsible for keeping VA apprised of anything that

would adversely affect or limit the credentials discussed in this section, and for

advising VA of anything that would adversely affect or otherwise limit their

clinical privileges. Failure to keep VA fully informed on these matters may result

in administrative or disciplinary action.

h. Verification of Credentials After Short Breaks in Service. An applicant who

has had a break in VA service of no more than 15 workdays may be reappointed

in the same occupation without the full credentialing process required for initial

appointment (i.e., verification of education background, licensure status,

certifications by professional organizations, references, etc.). The applicant must

complete a new employment application form [ ]. Facility officials will verify any

licensure or qualification information that has not previously been documented in

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the personnel folder or the Credentialing and Privileging Folder, as appropriate.

The official designated by the facility director will note in the appropriate folder

the reason that credentials were not reverified. Typically, the reason will be that

the break in service was for less than 15 workdays. Reverification of credentials

is not required for residents or trainees who rotate for training during the

academic year between a VA facility and its affiliate(s). (See paragraph 20 for

resident credentialing procedures.)

NOTE: For those subject to the credentialing and privileging provisions

of [VHA Directive 1100.20, Credentialing of Health Care Providers], any

break in service requires the verification of those credentials (time-

limited) which could have changed since last verified (State licensure,

Drug Enforcement Administration (DEA) certification, board certification,

etc.).

2. APPLICATION.

a. Application Forms. Candidates seeking employment under 38 U.S.C. §§

Chapter 73 or 74, must complete one of the following application forms:

(1) VA Form 10-2850, Application for Physicians, Dentists, Podiatrists,

Optometrists, and Chiropractors;

(2) VA Form 10-2850a, Application for Nurses and Nurse Anesthetists, nurse

practitioners, and graduate nurse technicians;

(3) VA Form 10-2850b, Application for Residency;

(4) VA Form 10-2850c, Application for Associated Health Occupations;

(5) Optional Form 612, Optional Application for Federal Employment is

[obsolete, but can] be used by applicants for whom none of the above

forms are appropriate; primarily, this includes applicants for medical

support, students, trainees or nonmedical consultant appointments. The

OF 612 is not required for USA Staffing recruitments. In USA Staffing, a

resume is preferred.

b. Application Review. The HR Officer or designee will thoroughly review each

employment application to assure that all questions are answered, and that

additional information is provided where required. Applicants are to be asked to

account for any gaps in their work history. This information shall be documented

on the employment application, and, along with reference checks and other

information obtained in the credentialing process, considered in the selection

process. Incomplete applications are to be returned and applicants notified that

they will not be considered for employment until their application has been fully

completed. The HR Officer or designee will review applications for compliance

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with administrative and regulatory requirements. Applicants who do not meet

appointment requirements should be so notified.

3. EDUCATIONAL CREDENTIALS.

a. Verification of Educational Credentials.

(1) For independent practitioners, educational credentials relating to

qualifications for employment are to be verified through primary source(s)

whenever feasible. This includes education used to qualify for appointment,

advancement or which is otherwise related to an individual’s employment.

This verification should also include a comparison of the educational

institution(s) cited on the application against existing lists of accredited

institutions on the Department of Education web site to guard against

institutions or “diploma mills” which sell fictitious college degrees and other

professional credentials. The accrediting agency or body for verifying the

accreditation status of schools is identified in the appropriate VA

qualification standard.

(2) For dependent practitioners, educational credentials relating to

qualifications for employment are to be verified as follows:

(a) If most recent licensure for the occupation was issued in 1990 or

later: Only education used to qualify for an appointment (i.e., first

nursing degree) is required to be verified; and this verification may be

accomplished by a secondary source (i.e., copy of diploma or

transcript is acceptable). Advanced education credentials above the

initial qualifying degree are to be primary source verified. This

verification also needs to include a comparison of the educational

institution(s) cited on the application against existing lists of

institutions or “diploma mills” which sell fictitious college degrees and

other professional credentials. The accrediting agency or body for

verifying the accreditation status of schools are identified in the

appropriate VA qualification standard.

(b) If most recent licensure for the occupation was issued prior to 1990:

Educational credentials relating to qualifications for employment are

to be verified through the primary source(s), whenever feasible. This

includes education used to qualify for appointment or advancement.

This verification also needs to include a comparison of the

educational institution(s) cited on the application against existing lists

of institutions or “diploma mills” which sell fictitious college degrees

and other professional credentials. The accrediting agency or body

for verifying the accreditation status of schools is identified in the

appropriate VA qualification standard. The appropriate document

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from the primary source must be used for the actual verification of the

credential but could include a transcript.

(3) For individuals who will have clinical privileges, written verification of

internships, residencies, fellowships, advanced education, clinical practice

programs, etc., from the appropriate program director or school is required.

For foreign medical graduates, facility officials must verify with the

Educational Commission for Foreign Medical Graduates (ECFMG) that the

applicant has met requirements for certification, and must obtain a copy of

the ECFMG certificate, if claimed by the applicant.

(4) In cases of graduates of foreign schools of professional nursing,

possession of current, full, active, and unrestricted registration will meet the

requirement of graduation from an approved school of professional nursing

[equal to an associate degree/diploma level education]. Documentation

from the Commission on Graduates of Foreign Nursing Schools (CGFNS)

will serve as primary source verification of education, if applicable. [In order

to credit nursing education at a level higher than the associate

degree/diploma level, a VA-recognized credentials evaluation service must

be utilized to verify foreign degree equivalency to a US-based nursing

degree.]

(5) For Physical Therapists, documentation from the Foreign Credentialing

Commission on Physical Therapists (FCCPT) will meet the requirement of

graduation from an approved school.

(6) For Occupational Therapists, documentation from the National Board for

Certification in Occupational Therapy (NBCOT) will meet the requirement

of graduation from an approved school.

(7) If education cannot be verified because the school has been closed,

because a school is in a foreign country and no response can be obtained,

or for other similar reasons, all efforts to verify the applicant’s education will

be documented. In any case, facility officials must verify that candidates

meet appropriate VA qualification standard educational requirements prior

to appointment.

b. Transcript of Higher Education.

(1) An applicants may be asked to provide a transcript of their qualifying

education for evaluation [prior to appointment. If an individual has a degree

in a related field, consideration should be given to obtaining a transcript of

this program as well. Transcripts may be requested from other applicants,

including APNs, PAs, EFDAs, and candidates selected for appointment to

an occupation identified in 38 U.S.C. § 7401(3).

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(2) Transcripts should be evaluated to consider the specific course work

completed, grades received and overall level of difficulty of the program.

c. Educational Profile for Physicians. Facilities may obtain, from the American

Medical Association, a profile listing all medical education a physician candidate

has received in this country and available licensure information for follow-up as

necessary. It should be noted, however, that this is a secondary source and, by

itself, is not considered sufficient for verification purposes.

4. EMPLOYMENT RECORD AND PREEMPLOYMENT REFERENCES.

a. References. Due diligence should be exercised in checking references before

making an offer of employment. Facilities at the local level have the discretion to

decide how many references are required prior to appointment. VA will still require

a total of three, but only one reference (preferably from the applicant’s current or

most recent employer(s)) is required prior to appointment and the remaining two

within 90 days after appointment. The references should be obtained from

employer(s) or other individuals who are knowledgeable about the applicant’s

work record (i.e., performance, aptitude, conduct, etc.).

(1) For any candidate whose most recent employment has been private

practice, facility officials will contact institution(s) where clinical privileges

are and/or were held, professional organizations, [professional] references

listed on the application form and/or other agencies, institutions or persons

who would have reason to know the individual’s qualifications.

(2) The VA Form Letter 10-341a, Appraisal of Applicant, may be used to

obtain references on applicants. However, supplemental information may

be required to fully evaluate the educational background and/or prior

experiences of an applicant (see subparagraph (3) below). Initial and/or

follow-up telephone or personal contact with those having knowledge of an

applicant’s qualifications and suitability are encouraged as a means of

obtaining a complete understanding of the composite employment record.

All references must be documented in writing. Written records of telephone

or personal contacts must report who was spoken to, that person’s

position, the date of the contact, a summary of the information provided,

and the reason why a telephone or personal contact was made in lieu of a

written communication. Reports of contact are to be filed with other

references in the personnel folder and, as appropriate, in the Credentialing

and Privileging Folder, as appropriate.

(3) Ideally, references should be from authoritative sources, which may require

that facility officials obtain information from sources other than the

references listed by the applicant. As appropriate to the occupation for

which the applicant is being considered, references should contain specific

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information about the individual’s scope of practice and level of

performance. For example, information on:

(a) The number and types of procedures performed, range of cases

managed, appropriateness of care offered, outcomes of care

provided, etc.

(b) The applicant’s clinical judgment and technical skills as reflected in

results of quality assurance activities and peer review, where

appropriate.

position and, if applicable, to areas where clinical privileges are being

sought.

b. Former Federal Employees. For an applicant with prior Federal service, the

personnel folder should be obtained before the individual is given a probationary

or permanent appointment. If an applicant has prior VA service, a reference

must be obtained from the last two assignments or all VA assignments in the last

5 years, whichever is longer.

5. PREEMPLOYMENT INTERVIEW. A personal interview is recommended prior to

the appointment of any candidate under 38 U.S.C. Chapter 73 or 74. The interview

should normally be conducted at the VA facility where the individual is to be

employed. Arrangements may be made for the interview to be conducted at another

VA facility convenient to the applicant. The interview will be conducted by the

appropriate official(s) designated by the facility director. An interview report will be

completed and filed with the application. Travel expenses for preemployment

interviews may be paid only under provisions of 5 C.F.R., Part 572. The appropriate

chief consultant in Central Office may require that a personal interview be conducted

for individuals in any occupation included within the scope of this section. [ ].

6. VERIFYING LICENSURE, REGISTRATION AND CERTIFICATION. As part of the

credentialing process, the status of the applicant’s licensure and/or registration and

that of any required or claimed certifications will be thoroughly reviewed and verified.

Specific requirements for these verifications are contained in paragraphs 13 through

17 for independent practitioners and VHA policy for the credentialing of health care

professionals.

7. VERIFYING SPECIALTY CERTIFICATION.

a. Definition. For the purposes of this paragraph, specialty certification means

having fully completed the requirements of a recognized specialty board or other

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certifying organization, including the successful passing of the board or certifying

examination, as appropriate.

b. Applicants. Prior to appointment, specialty certification will be verified from the

primary source. The chief of staff will confirm evidence of specialty certification

claimed by a physician, dentist, podiatrist or chiropractor, and certify that

verification in the VHA credentialing folder, VetPro. At the request of the chief of

staff, the facility director may delegate responsibility for obtaining information

about a candidate’s board certification. However, the chief of staff must

personally certify in the VHA credentialing file that the documentation is of

record. For other applicants, the official designated by the facility director will

document verification of specialty certification where required in the VHA

credentialing file. See paragraph (d) for procedures on documenting specialty

certification.

c. On-Duty Employees. On-duty employees attaining specialty certification will

have their certification verified under Paragraph (d).

d. Verification Procedures. If listings of specialists are used to verify specialty

certification, these schedules must be maintained by the primary source with a

disclaimer regarding authenticity and be from current or recently issued copies

of the publications as follows:

(1) Physicians. Board certification may be verified through the Compendium

of Medical Specialists, published by the American Board of Medical

Specialists, the Directory of American Medical Specialists, published by

Marquis’ Who’s Who, or by direct communication with officials of the

appropriate board. A letter from the board is acceptable for those recently

certified. (The address and telephone number of the board may be

obtained from the latest Directory of Approved Residency Programs

published by the Accreditation Council for Graduate Medical Education).

Copies of documents used to verify certification are to be filed in the VHA

credentialing file.

(2) Dentists. Board certification may be verified by the listings in the American

Dental Directory published annually by the American Dental Association or

by contacting the appropriate Dental Specialty Board. Addresses of these

boards may be obtained from the American Dental Association, 211 East

Chicago Avenue, Chicago, Illinois 60611.

(3) Podiatrists. Three specialties are currently recognized by the House of

Delegates, American Podiatric Medical Association and VA: the American

Board of Podiatric Surgery, American Board of Podiatric Orthopedics, and

American Board of Podiatric Public Health. Addresses of these boards may

be obtained from the latest American Podiatric Directory.

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(4) Other Occupations. Board certification and other specialty certificates will

be verified by contacting the appropriate specialty board or certifying

organization.

e. Evidence of Continuing Certification. For professions or occupations in which

current certification is required, employees must present evidence of such

certification upon request throughout VA employment.

8. DRUG ENFORCEMENT ADMINISTRATION CERTIFICATION.

a. Background. Physicians, dentists, podiatrists, and certain other professional

persons may apply for and be granted renewable certification by the Drug

Enforcement Administration (DEA)/Controlled Dangerous Substance (CDS),

Federal and/or State to prescribe controlled substances as a part of their

practice. However, certification will be verified as indicated below for individuals

who claim on the employment application form to currently hold or to have held

DEA/CDS certification in the past.

b. Application Form. Each applicant in these occupations must provide, on the

appropriate VA employment application form, information about his or her

current or most recent DEA/CDS certificate, if applicable. Any applicant whose

DEA/CDS certificate has ever been revoked, suspended, limited, restricted in

any way or voluntarily relinquished shall be required to provide a detailed

explanation of such action at the time of application for employment.

c. Restricted Certificates. A State licensing board may obtain a voluntary

agreement from an individual not to apply for renewal of certification or may

decide not to approve the individual’s application for renewal as a part of a

disciplinary action taken in connection with the individual’s professional practice.

While there are a number of reasons a license may be restricted which are

unrelated to DEA/CDS certification, an individual’s State license is considered

restricted or impaired for purposes of VA employment if a State licensing board

has suspended the person’s authority to prescribe controlled substances or

other drugs; selectively limited the individual’s authority to prescribe a particular

type or schedule of drugs; or accepted an individual’s offer or voluntary

agreement to limit authority to prescribe. (See Paragraphs 13 and 17.)

d. Verification. Current DEA/CDS certification will be verified prior to appointment

and documented in the VHA credentialing file. Automatic verification of Federal

DEA/CDS certification can be performed in VetPro when a match can be made

against the current Federal DEA certification information maintained and

electronically updated monthly. If verification cannot be made automatically, an

authenticated copy of the DEA/CDS certificate must be entered into VetPro.

Current DEA certification will also be sighted during VA employment at the same

time as State licensure. (See Paragraphs 13 and 17.) The employee will be

asked to fully explain in writing if DEA certification has been revoked,

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suspended, limited, restricted or voluntarily relinquished since last verified. Upon

receipt of such explanation, the chief of staff will initiate a review of the

employee’s clinical privileges, if appropriate.

e. Required Action by VA Officials.

(1) If action taken on an employee’s DEA/CDS certificate has the effect of

restricting the individual’s only State license, immediate action will be

initiated to separate the employee under provision of VA Directive and

Handbook 5021, Employee/Management Relations, Part VI.

(2) If, as a result of the review of clinical privileges, a decision is made to

propose revocation of an employee’s clinical privileges, separation action

will be initiated using procedures in VA Directive and Handbook 5021,

Employee/Management Relations, Part II.

9. CLINICAL PRIVILEGES.

a. Review of Clinical Privileges. Applicants completing VA application forms will

be required to respond to questions concerning clinical privileges at VA and non-

VA facilities. If possible, copies of clinical privileges will be obtained for review

from the applicant or from the institutions where privileges are or were most

recently held.

b. Evaluation of Privileges. As part of the credentialing process, information on

clinical privileges will be evaluated by appropriate facility officials. Details

concerning any limitation(s) on privileges will be carefully considered prior to

appointment.

c. On-Going Review. Clinical privileges will be established and reviewed

throughout the individual’s employment following standards and guidelines

issued by VHA and established in the VA facility’s medical staff bylaws. The

clinical privileging process must be completed prior to initial appointment.

NOTE: Additional VHA policy concerning clinical privileges is contained in [VHA

Directive 1100.20, Credentialing of Health Care Providers.]

10. MALPRACTICE CONSIDERATIONS.

a. Applicants. VA employment applications forms require applicants to give

detailed written explanations of any involvement in administrative, professional

or judicial proceedings, including Federal torts claims proceedings, in which

malpractice is or was alleged. If an applicant has been involved in such

proceedings, a full evaluation of the circumstances will be made by officials

participating in the credentialing, selection and approval processes prior to

making any recommendation or decision on the candidate’s suitability for VA

employment.

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b. Employees. Each employee will be asked to indicate at the time of licensure

verification any involvement in proceedings described in subparagraph a, and to

provide a written explanation of the circumstances, if appropriate. A review of

clinical privileges, as appropriate, will be initiated if clinical competence issues

are involved.

c. Evaluation of Circumstances. Facility evaluating officials will consider

VA’s obligation as a health care provider to exercise reasonable care in

determining that individuals are properly qualified, recognizing that

many allegations of malpractice are proved groundless. Facility officials

will evaluate employee to provide copies of documents pertaining to the

case. Reasonable efforts will be made to assure that only individuals

who are well-qualified to provide patient care are permitted to do so.

Questions concerning legal aspects of a particular case should be

directed to the Regional Counsel.

11. DEANS COMMITTEE, MEDICAL ADVISORY COMMITTEES, AND OTHER

ADVISORY BODIES. At healthcare facilities with teaching programs, the Under

Secretary for Health will approve the establishment of a Deans Committee, Medical

Advisory Committees, and other advisory bodies (See VHA Handbook 1400.03,

Veterans Health Administration Educational Relationship for more information). The

Deans Committee may nominate, for consideration by the facility director,

physicians, and dentists for appointment to the professional staff of the facility,

including chiefs of service. Nominees may include individuals appointed on a paid or

without compensation assignment on a full-time, part-time or intermittent basis; to

those appointed on an on-facility fee-basis; and to consultants and attendings. The

facility director should consider the Deans Committee’s recommendations, but the

facility director has the final appointment decision.

12. SUITABILITY.

a. General. If facility officials obtain adverse information during the credentialing

process, they will review this against suitability criteria and make a determination

in accordance with 5 C.F.R. § 731. The District Counsel can answer questions

concerning the use of adverse information in making suitability determinations or

the legality of adverse determinations and personal liability involvement.

b. Applicants. If there is any question about an applicant’s suitability, no

appointment action will be taken, nor will an employment commitment be made,

until the matter is resolved.

c. Employees. Conclusive evidence of preemployment unsuitability (character

traits, past work performance, etc.) may arise after an individual’s appointment

under 38 U.S.C. Chapter 73, 74. If continued employment is not in the best

interest of the service, the employee’s appointment will be terminated under VA

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Handbook 5021, Employee/Management Relations, Part VI, Employee Title 38

Separations Not Covered by Parts II and III of this Handbook.

13. GENERAL LICENSURE AND REGISTRATION REQUIREMENTS.

a. General. Specific licensure, registration and certification requirements for

individuals appointed under 38 U.S.C. Chapters 73 or 74 are included in

paragraphs which follow and in the appropriate qualification standard for the

occupation. This paragraph contains definitions and general provisions which

apply to all occupations for which licensure and/or registration are required.

Applicants must possess at least one active, current, full, and unrestricted

license, registration or certification which must be verified by primary source

verification from the state licensing board (SLB), to be eligible for appointment, if

required for the occupation in the appropriate qualification standard. If all

licenses, registrations or certifications are impaired, the individual is ineligible for

appointment in VA. Additionally, if the applicant’s sole license is considered to

be inactive by the state issuing the license (e.g., the state considers the license

to be “inactive” because the individual is not practicing in the state where the

license is held), the individual is ineligible for appointment in VA.

b. Definitions.

(1) Active Licensure. An active, current, full, and unrestricted license,

registration or certification in a state is one which authorizes the licensee to

practice outside VA without any change needed in the status of the license.

Employees are responsible for paying fees necessary to maintain a full and

active license in a state. If a state waives fees for any reason, such as for

an out-of-state practice or for employment in a Federal facility, the

employee may not accept the waiver if this will place the license in an

inactive or other restricted status.

(2) Primary Source Verification. Primary source verification is documentation

from the original source of a specific credential verifying the accuracy of a

qualification.

(3) State. The term “state” means any of the states, territories, and

possessions of the United States, the District of Columbia, and the

Commonwealth of Puerto Rico.

c. Qualification Requirements Pursuant to 38 U.S.C. § 7402(f). Covered

licensure actions are based on the date the credential was required by statute or

VA qualification standard for the occupation.

(1) For the purposes of 38 U.S.C. § 7402(f), “for cause” means professional

misconduct, professional incompetence, substandard care or any issue

requiring VA to report a provider to a SLB under 38 C.F.R. § 47.2. The

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District Counsel will address questions concerning interpretation of “for

cause" or an assessment of whether a matter constitutes “for cause.” The

following are examples of reasons a license may be revoked, terminated or

voluntarily relinquished that would be considered “for cause.” This is not a

comprehensive, exhaustive or exclusive list, and a “for cause” assessment

should be reviewed on a case-by-case basis.

(a) Higher than expected radiology misinterpretations;

(b) Higher than expected surgical complication rates;

(d) Failure to adequately document patient care;

(e) Diversion of drugs;

(f) Providing or intending to provide patient care while under the

influence of drugs or alcohol;

(g) Inappropriate relationship with patient;

(h) Patient abuse;

(i) Intentional harm of a patient;

(j) Research malfeasance;

(k) Exhibiting a pattern of poor professional judgment and skill; and/or

(l) Egregious instances of unacceptable actions related to patient care

(inadvertently leaving a clamp in a patient after a surgical procedure).

(2) Applicants seeking appointment on or after November 30, 1999, (see

Veterans Millennium Health Care and Benefits Act, P.L. 106-117), who

have been licensed, registered or certified, as applicable to the occupation

for which they are seeking employment, in more than one state and who

are being credentialed for a position identified in 38 U.S.C. § 7402(b), other

than a facility director, are not eligible for appointment in that occupation if:

(a) The applicant’s license, registration or certification has ever been

revoked or terminated “for cause” by any of those states; or

(b) The applicant has voluntarily relinquished a license, registration or

certification in any of those states, after being notified in writing by

that state of potential revocation or termination for cause.

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i Such individuals may only be eligible for appointment in the

occupation if their revoked, terminated or voluntarily relinquished

license, registration or certification is restored to a full and

unrestricted status.

ii Covered licensure actions are based on the date the credential

was required by statute or the VA qualification standards for the

occupation. For example, if VA first required the credential in 1972,

the credential was terminated or voluntarily relinquished in 1983,

and the individual applies, or was appointed, to VA after November

30, 1999, the individual is not eligible for VA employment in the

covered occupation unless the terminated or voluntarily

relinquished credential is restored to an active, current, full and

unrestricted status. However, if the credential was terminated or

voluntarily relinquished in 1970, before it was a VA requirement,

eligibility for VA employment would not be affected. For guidance

regarding eligibility for employees with an impaired license,

registration or certification, and for those employees appointed

before November 30, 1999, with an impaired license refer to

paragraph 17 below-Continuing Licensure, Registration and/or

Certification Requirements for Employees.

(3) If an individual has voluntarily surrendered their license, registration or

certification, applicable to the position, VA must confirm from the primary

source that the individual was notified in writing of the potential for

termination for cause. If the entity verifies written notification was provided,

the applicant is not eligible for employment unless the surrendered

credential is fully restored to an active, current, full and unrestricted status.

(4) Where the state licensing, registration or certifying entity fully restores the

revoked, terminated or voluntarily relinquished credential, the provider’s

eligibility for employment is restored. These individuals are subject to the

same employment process that applies to all individuals in the same job

category who are entering the VA employment process. In addition to the

credentialing requirements for the position, facility officials must conduct a

complete review of the facts and circumstances concerning the action

taken against the state license, registration or certification and the impact

of the action on the professional conduct of the applicant. Facility officials

must document this review in the licensure section of the credentials file.

(5) This guidance applies to licensure, registration or certification required as

applicable to the position subsequent to the publication of this policy and

required by statute or VA qualification standards, effective with the date the

credential is required.

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d. Primary Source Verification. Information obtained through the verification must

be documented in writing, either by letter, memo, report of contact or secure

electronic verification (e.g., website) in the VHA credentialing file. Facility

officials must verify licensure from a primary source at the time of initial

appointment, reappointment and expiration in accordance with policy in VHA

Handbook 1100.20, “Credentialing and Privileging” and VHA Directive 2006-067,

“Credentialing of Health Care Professionals.”

e. Changes in Authority to Prescribe. The license of an individual in an

occupation authorized to prescribe is considered to be restricted or impaired if

the SLB has suspended the individual’s authority to independently prescribe

controlled substances or other drugs; selectively limited the individual’s authority

to prescribe a particular type or schedule of drugs; or accepted an individual’s

offer or voluntary agreement to limit the authority to prescribe. The state’s action

may be taken in connection with the individual’s Drug Enforcement

Administration (DEA) certification and/or with a separately issued state

authorization to prescribe. (See paragraph 8 of this section.) This is only one

example of a situation in which an individual’s license may be restricted or

impaired.

f. Changes in State Licensure Requirements. Employees are responsible for

complying with any changes in licensure and/or registration requirements which

may be imposed by the state(s) of licensure. If employees show they were not

notified of the new requirement and proceeded in good faith under the

assumption that the license remained full and unrestricted, this is accepted as

prima facie evidence of licensure up until discovery of the change in

requirements. When employees are notified through any source of a change in

requirements, they must act immediately to make the license whole at the

earliest possible date, normally no more than 15 workdays after notification. If

employees are unable to make the license whole and, as a result, holds no full

unrestricted license in a state, actions to separate for failure to meet qualification

requirements must be taken under VA Handbook 5021, Employee/Management

Relations.

g. Administrative Delay by State Licensing Board (SLB).

(1) Facility officials who learn that a SLB has declared a system-wide delay in

processing renewal applications of registration prior to the expiration date

and has granted a special grace period as a result of the delay, should

notify Office of the Chief Human Capital Officer (OCHCO), Recruitment

and Placement Policy Service (RPPS) so a general notice to all VHA

facilities can be issued. The delay must be general rather than personal in

scope and impact. If no such notice has been issued by OCHCO, RPPS,

facility officials should verify with the state board that VA employees are

considered to be fully licensed, registered or certified during the delay

period. Verification of current licensure, registration or certification may be

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obtained through telephone contact with the state board pending receipt of

the renewal. Typically, this will involve a large amount of license renewals

and would not pertain to the individual renewal license.

(2) Under these unique circumstances, if employees are unable to present

evidence of current licensures, registrations or certifications prior to the

expiration date, facility officials must verify through written or telephone

contact with the SLB that the employees’ applications for renewal are

received and the employees are considered to be fully licensed, registered

or certified. If officials are unable to verify this with the SLB prior to the

expiration date of licensure, employees will be required to provide evidence

that the application for renewal was made in a timely manner (e.g., 30

days) in order to be permitted to continue in a work status. Where possible,

a facility official must cite evidence of the employees’ application for

licensure, registration or certification renewal and appropriately document

in the VHA credentialing file until primary source verification of renewal is

received. Employees are notified in writing that separation actions may be

initiated under provisions of VA Handbook 5021, Part II, Part III or Part VI,

if evidence of renewal is not received within 30 workdays of the expiration

date. Some states authorize a “grace period” after the licensure,

registration and/or certification expiration date, during which an individual is

considered to be fully licensed, registered and/or certified whether or not

the individual has applied for renewal on a timely basis. Facility officials

must not initiate separation procedures for failure to maintain licensure,

registration or certification on a practitioner whose only license, registration

and/or certification has expired if the state has such a grace period and

considers the practitioner to be fully and currently licensed, registered or

certified.

h. Questionable Licensure Status. Facility officials must consult with District

Counsel if circumstances cause them to question the status of an employee’s

license, registration or certification or if it meets statutory or regulatory

requirements. See subparagraph 17.c. of this section for additional information.

i. Payment of Licensure or Registration Renewal Fees. VA employees are

responsible for paying any required fees in a timely basis to ensure their

licensures, registrations or registrations are maintained in a current, active

status. If an affiliated institution normally pays the fees for VA employees who

work part-time or have teaching agreements at that institution, employees are

still responsible for assuring that licensures, registrations or certifications are

maintained in an active, current status.

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14. LICENSURE FOR PHYSICIANS, DENTISTS, PODIATRISTS, OPTOMETRISTS,

AND CHIROPRACTORS.

a. General. Any physician, dentist, podiatrist, optometrist or chiropractor appointed

under 38 U.S.C. Chapters 73 or 74 is required to possess an active, current, full

and unrestricted license to practice medicine, surgery, osteopathy, dentistry,

podiatry or optometry, as appropriate, in a state, and must furnish evidence of

this prior to appointment. Current registration will be maintained in accordance

with the requirements of the state of licensure and evidence of such licensure

and registration must be presented by the employee for verification periodically

as requested throughout VA employment. A limited license or any other license

less than a full, unrestricted state license; however, denominated (e.g.,

temporary, limited or institutional), will not meet the licensure requirement for

appointment under 38 U.S.C. Chapters 73 or 74.

b. Exceptions. The only exceptions to the licensure requirements are:

(1) Individuals meeting all the professional requirements for admission to the

state licensure examination and passed the examination but possess a

state license limited on the basis of non-citizenship or not meeting the

residence requirements of the state.

(2) Individuals granted an institutional license by the state which permits

faculty appointments and full, unrestricted clinical practice at a specified

educational institution and its affiliates, including the VA healthcare facility;

or an institutional license permitting full, unrestricted clinical practice at the

VA healthcare facility. This exception is used only to appoint individuals

who are well-qualified, recognized experts in their fields, such as visiting

scholars, clinicians, and/or research scientists and only under authority of

38 U.S.C. § 7405. It may not be used to appoint individuals whose

institutional licenses are based on actions taken by SLBs as described in

paragraph 13c above.

(3) Individuals meeting all the professional requirements for admission to the

state licensure examination and have passed the examinations, but who

have been issued time-limited or temporary state licenses or permits

pending a meeting of the state licensure board to give final approval to the

candidates’ request for licensure. The licenses must be active, current, and

permit a full, unrestricted practice. Appointments of individuals with such

licenses must be made under authority of 38 U.S.C. § 7405 and will be

time-limited not to exceed the expiration date of licensure.

(4) Residents holding licenses which geographically limit the area which

practice is permitted or which limits residents to practice only in specific

healthcare facilities but authorizes them to independently exercise all the

professional and therapeutic prerogatives of the occupation. In some

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states, such licenses may be issued to residents to permit them to engage

in outside professional employment during the period of residency training.

This exception does not permit the employment of a resident who holds a

license which is issued solely to allow the individual to participate in

residency training.

c. Verification. The facility chief of staff will ensure physicians, dentists,

podiatrists, optometrists, and chiropractors licensures and registrations are

verified prior to their appointment under 38 U.S.C. §§ 7306, 7401 or 7405. This

includes all individuals serving on a full-time, part-time, intermittent or on-facility

fee-basis (including consultants and attendings), whether paid or without

compensation.

(1) Licensure Verification with State Boards. The facility chief of staff Chief

of Staff will confirm in the VHA credentialing file, VetPro, the status of all

licenses claimed by physicians, dentists, podiatrists, optometrists, and

chiropractors, are verified with the appropriate SLB for all states in which

the applicant lists having ever held a license. This includes licenses which

the applicant lists as active, current, full, and unrestricted as well as

licenses the applicant lists which were held at any time in the past and

which have been allowed to lapse or which are no longer current for any

reason. [The] facility Chief of Staff or designee is responsible for sighting

verification of the licensure of these individuals.

(2) Review of Employment Application. Facility officials must contact the

state board to ensure that no restriction or revocation action has occurred

for candidates with recent employment in a state in which no licensure is

indicated on the application form.

(3) Physician Screening with Federation of State Medical Boards (FSMB).

Facility officials must conduct a mandatory FSMB query and document the

results in the VHA credentialing file, VetPro.

d. Licensure History. For guidance on appointments, refer to Paragraph (13.c.),

Qualification Requirements Pursuant to of 38 U.S.C. § 7402(f).

e. Waiver of Licensure Requirement.

(1) The appointing official may waive the licensure requirement of physician,

dentist, podiatrist, optometrist, or chiropractor occupations if the candidates

are being appointed to a research, academic or administrative position

when they have no direct responsibility for patient care.

(2) The facility director may waive the licensure requirement if the individual is

serving in a country other than the United States and licensure is in that

country (i.e., Philippines).

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15. REGISTRATION FOR [REGISTERED] NURSES [RNS] AND [ADVANCED

PRACTICE] NURSES [APNS].

a. General. Any [RN or APN] appointed under 38 U.S.C. Chapters 73 or 74 is

required to possess active, current, full, and unrestricted registration as a

graduate professional nurse in a state, which must be verified by primary source

verification from the SLB prior to appointment. Information obtained through the

verification process must be documented in writing, either by letter, memo,

report of contact or secure electronic verification. Documentation will be filed

permanently in the official personnel folder. A limited registration or any other

registration less than a full, unrestricted state registration does not meet the

registration requirement for appointment. [See VA Handbook 5005, Part II,

Appendix G6a-G6d for additional information on specific licensure and

certification requirements for APNs.]

b. Verification. The HR Officer or nurse executive or designee, must obtain

primary source verification from the SLB of the registration of all [RNs and

APNs] prior to their appointment under 38 U.S.C. Chapters 73 or 74. This

includes full-time, part-time, intermittent and on-facility fee-basis [RNs or APNs]

(including consultants), whether they are paid or serving without compensation.

[RNs and APNs] utilized on an on-facility contract or on-facility sharing

agreement basis are also covered by provisions of this paragraph.

(1) Except as provided in subparagraph d, every VHA [RN and APN] must

have at least one active, current, full and unrestricted registration as a

graduate professional nurse in a state.

(2) The appropriate official will certify in the VHA credentialing file, VetPro, that

the status of all registration(s) has been verified with the appropriate state

board(s) for all state(s) in which the applicant lists having ever held

registration. This includes registration(s) which the applicant lists as active,

current, full, and unrestricted as well as registration(s) the applicant lists

which were held at any time in the past and which have been allowed to

lapse or which are no longer current for any reason.

(3) For [RNs or APNs] with recent employment in a state in which no

registration is indicated on the application form, the state board will be

contacted to assure that no restriction or revocation action has occurred.

c. Impaired Registration. Appointing officials may approve the appointment or

reappointment of a [RN or APN] who has previously had impaired registration,

provided the candidate currently has full and unrestricted registration (refer to

paragraph 17c of this section).

d. Waiver of Registration Requirement. The facility director may waive the

registration requirement of a [RN or APN] if the individual is serving in a country

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other than the United States and the registration is in that country (i.e.,

Philippines).

16. LICENSURE, REGISTRATION, AND/OR CERTIFICATION FOR TITLE 38

ASSOCIATED HEALTH PERSONNEL.

a. General. Any employee in a physician assistant (PA) or expanded-function

dental auxiliaries position appointed under 38 U.S.C. §§ 7401(1) or

7405(a)(1)(A) must meet licensure, registration or certification requirements as

specified in the appropriate qualification standard. Individuals appointed under

38 U.S.C. § 7401(3) or under 38 U.S.C. §§ 7405(a)(1)(B), 7306 to occupations

listed in 38 U.S.C. § 7401 must meet licensure, registration and/or certification

requirements in the appropriate qualification standard for the occupation.

Applicants will provide evidence of current licensure, registration and/or

certification and other relevant credentials for verification prior to appointment

and throughout the appointment process as requested. Using the VHA

credential process, facility officials will verify credentials from a primary source

prior to appointment. Once appointed, employees must maintain multiple

licenses, registrations and/or certifications in good standing and keep VA

officials apprised of anything that would adversely affect or otherwise limit their

appointment, e.g., health issues, proposed and final actions against a claimed

credential, etc. A limited license, registration or certification or any status of

these which is less than full and unrestricted will not meet the qualification

standard requirement for the occupation.

b. Verification. Prior to appointment, each applicant’s credentials will be checked

as follows and verified in accordance with applicable VHA credentialing policy

for dependent practitioners and documented in the VHA credentialing folder,

VetPro, by officials designated by the facility director as follows:

(1) The facility director designates the official(s) responsible for documenting

the status of all licenses, registrations or certifications with the appropriate

state boards for all states the applicant lists ever having licensure,

registration or certification on VA Form 10-2850C, Application for

Associated Health Occupations. This includes licenses registrations or

certifications which the applicant lists as active, current, full and

unrestricted as well as license(s), registration(s) or certification(s) the

applicant lists which were held at any time in the past and which have been

allowed to lapse or which are no longer current for any reason.

(2) Candidates for appointment under 38 U.S.C. § 7401(3) or

38 U.S.C. § 7405(a)(1)(B) and expanded-function dental auxiliaries

(EFDAs) appointed under 38 U.S.C. §§ 7401(1), 7405(a)(1)(A) must

present evidence of license, registration or certification by the appropriate

national certifying body prior to appointment. The official(s) designated by

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the facility director documents the verification in the VHA credentialing file,

VetPro.

(3) PAs must present evidence of certification by the appropriate national

certifying body prior to appointment for verification by the official(s)

designated by the facility director in the VHA credentialing file, VetPro.

Licensure is required for PAs to practice outside VA in some states,

although it is not required for VHA employment. If a PA claims licensure in

any state(s), the official(s) designated by the facility director verifies

licensure status with the SLBs as a part of the credentials review and

documents the verification in the VHA credentialing file.

(4) The appropriate official(s) must contact state boards to ensure that no

restriction or revocation has occurred for candidates with recent

employment in a state in which no licensures, registrations or certifications

are indicated on the application form. Such verification must be

documented in the VHA credentialing file.

c. Impaired Licensure. Appointing officials may approve the appointment or

reappointment of an individual covered by this paragraph who has previously

had an impaired license, registration or certification, provided the candidate

currently has full/unrestricted license, registration or certification (refer to

paragraph 17c of this section).

17. CONTINUING LICENSURE, REGISTRATION, AND/OR CERTIFICATION

REQUIREMENTS FOR EMPLOYEES.

a. Verification of Primary License.

(1) The expiration date of an appointee’s primary license, registration, and/or

certification, is coded for follow-up purposes [ ]. For coding purposes, the

appointee will specify the state in which primary licensure is claimed. The

facility director will designate the official(s) who is responsible for the

follow-up verification of these credentials. Facility designees will verify

licensure, certification, and registration by primary source verification from

SLB. Information obtained through the verification process must be

documented in writing, either by letter, memo, report of contact or secure

electronic verification (e.g., website). Documentation is filed permanently in

the employee’s VHA credentialing file.

(2) Only the initial and latest verification must be maintained in the VHA

credentialing file. HR staff are not required to code follow-up expiration

dates for employees whose registration or certification is issued on a one-

time basis for whom there is no continuing requirement to maintain

currency.

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b. Other Verification.

(1) Individuals with multiple licenses, registrations, and/or certifications are

responsible for maintaining these credentials in good standing and of

informing the facility director or designee of any changes in the status of

these credentials.

(2) Employees must provide confirmation for any active license that is not

renewed at the time of expiration or at the time of reappraisal that such

license expired in good standing.

(3) Facility directors are responsible for establishing a mechanism for assuring

that such multiple licenses, registrations, and/or certifications are

consistently held in good standing or, if allowed to lapse, are relinquished

in good standing. For any such credentials which were held previously, but

which are no longer held or no longer full and unrestricted, the employee

will be asked to provide a written explanation of the reason(s). The

verifying official will contact the state board(s) or issuing organization(s) to

verify the reason(s) for any change.

c. Impaired Licensure.

(1) When facility officials learn an employee with an active, current, full, and

unrestricted license, registration or certification in a state has had any other

license or registration or certification to practice, as applicable to their

current occupation, revoked or terminated for cause, or such license,

registration or certification was voluntarily relinquished after being notified

in writing by that state of the potential termination for cause, they must

determine if the employee is eligible to maintain their appointment. See

paragraph 2 below and 38 U.S.C. § 7402(f).

(2) In those cases where the license, registration or certification has been

revoked, terminated or the employee has voluntarily relinquished such

license, registration or certification after being notified in writing by that

state of the potential termination for reasons other than “for cause,” facility

officials will investigate to ascertain the full circumstances and, if

appropriate, will initiate a review of clinical privileges, take disciplinary

action and/or separation procedures.

(3) If the findings of the investigation determine the employee did not violate

38 U.S.C. § 7402(f), then the employee may be retained. In cases where

the license, registration or certification has been suspended, denied,

restricted, limited, issued/placed on probationary basis, facility officials will

engage in the same process identified in paragraph (2).

(4) The following individuals are not eligible for continued appointment:

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(a) Individuals who were appointed before November 30, 1999, to a

position identified in 38 U.S.C. § 7402(b) (other than a facility

director) who have maintained continuous appointment since that

date and are identified as having been licensed, registered or certified

(applicable to their current position) in more than one state and, on or

after November 30, 1999, have had such license, registration or

certification revoked or terminated for cause by any of those states;

(b) Individuals who were appointed before November 30, 1999, to a

position identified in 38 U.S.C. § 7402(b) (other than a facility

director) who have maintained continuous appointment since that

date and are identified as having been licensed, registered or certified

(as applicable to their current position) in more than one state and, on

or after November 30, 1999, voluntarily relinquished a license,

registration or certification in any of those states after being notified in

writing by that state of potential termination for cause.

(5) Individuals who were appointed prior to November 30, 1999, and have

been on a continuous appointment since that date are not disqualified for

employment by any license, registration or certification revocations or

terminations for cause, or voluntary relinquishment after being notified in

writing by that state of potential termination for cause that predate

November 30, 1999, provided they possess one full and unrestricted

license applicable to the position. See 38 U.S.C. § 7402(f).

d. Failure to Maintain Current Licensure, Registration or Certification.

(1) An employee who does not maintain an active, current, licensure,

registration and/or certification (if required), or who fails to show evidence

of such when requested, must be separated under appropriate procedures

in VA Handbook 5021, Part VI, [Employee/Management Relations]. The

District Counsel will answer questions about whether to separate an

employee based on failure to maintain current licensure, registration or

certification.

(2) Some states authorize a grace period after the licensure, registration,

and/or certification expiration date, during which an individual is considered

to be fully licensed, registered, and/or certified whether or not the individual

has applied for renewal on a timely basis. Facility officials will not initiate

separation procedures for failure to maintain licensure, registration or

certified on an employee whose only license, registration, and/or

certification has expired if the state has such a grace period and considers

the employee to be fully and currently licensed/registered/certified.

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18. REPORTING TO STATE LICENSING BOARDS. Licensed, registered, and/or

certified employees and former employees will be reported to state licensing,

registration or certifying boards and/or to other monitoring bodies in accordance with

provisions VHA Handbook 1100.18, Reporting and Responding to SLBs. This

requirement applies to all licensed, registered, and/or certified employees included

within the scope of this chapter, including residents.

19. HEALTH STATUS OF APPLICANTS AND EMPLOYEES.

a. General. The credentialing process includes an evaluation of the health status

of applicants as well as employees. Policies and procedures related to physical

requirements for applicants and employees are contained in VA Handbook

5019, Employee Occupational Health Service, Part II, Examinations and

Evaluations.

b. Preemployment Physical Examination. All full-time, part-time and intermittent

employees are required to satisfactorily complete a preemployment physical

examination prior to appointment as required for positions with positive physical

and mental requirements outlined in VA Handbook 5019[ Employee

Occupational Health Service].

c. Certification of Physical and Mental Fitness. All applicants and employees,

whether paid or appointed on a without compensation basis, who request clinical

privileges, including those utilized on a full-time, part-time or intermittent basis,

as consultants or attendings or on a fee-basis, and including those utilized on an

on-facility contract or on-facility sharing agreement basis, are required to certify

that they are physically and mentally capable of performing the requested

privileges. Service chiefs will be required to certify that, to the best of their

knowledge, the applicant or employee is physically and mentally capable of

satisfactorily performing the requested clinical privileges. In cases where the

service chief is a nonphysician, certification of satisfactory health status must

also be obtained from a physician who is familiar with the duties the individual is

privileged to perform.

20. CREDENTIALS OF RESIDENTS AND TRAINEES.

a. General. Medical, dental, podiatry, optometry, and chiropractic residents and

trainees appointed under 38 U.S.C. §§ 7405, 7406 must meet the licensure

requirements for residents and trainees specified in the appropriate qualification

standard for the occupation. If licensure is required, evidence of licensure must

be furnished prior to appointment and periodically throughout VHA employment

as requested.

NOTE: See VHA Handbook 1400.01, Supervision of Physician, Dental,

Optometry, Chiropractic, and Podiatry Residents.

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b. Verification.

(1) The program director for an integrated program must send the Trainee

Qualifications and Credentials Verification Letter (TQCVL) (formerly the

Residents/Trainees Credentials Verification Letter or RCVL) through the

facility chief of staff to the facility director for approval prior to the facility

director’s approval of the appointment of any resident or trainee, whether

paid or without compensation. If the residency or training program is not

integrated with an affiliate, the VA facility program director must verify all

credentials of residents or trainees and sign the TQCVL. A new TQCVL is

required for each academic year that the resident or trainee is appointed to

a VA facility.

(2) The TQCVL contains certification that all the documents needed for the

appointment of that particular individual into the program are in order. For

medical residents, these documents must be in compliance with the

requirements of the Accreditation Council for Graduate Medical Education

(ACGME) and must also meet all requirements of the program. The

program director must verify all credentials (diplomas, letters of reference,

certificates of advanced training and, where applicable, Educational

Council for Foreign Medical Graduates (ECFMG) certification, DEA

certification and all state professional licenses held prior to entry into the

program or obtained during residency training), and affirm the resident or

trainee is physically and mentally fit to take care of patients. (See appendix

II-K of this chapter for sample TQCVL letter.)

(3) The program director will notify the facility director if a resident or trainee

has had any credentialing problems. Specifically, this will include any

problems relating to diplomas, references, previous residency or other

training, licensure, clinical privileges, DEA certification, and/or professional

liability insurance as indicated on the employment applications. (VA Form

10-2850b, Application for Residency, for medical and dental residents and

VA Form 10-2850c for other residents and trainees.)

(4) Residents functioning within the scope of their training program must meet

clinical practice requirements as specified in VHA Handbook 1400.01,

[Supervision of Physician, Dental, Optometry, Chiropractic, and Podiatry

Residents]. The program director, or in certain cases, by the appropriate

VA service chief must provide the TQCVL that confirms that ACGME-

established criteria for the essentials and special requirements for

residency training programs have been followed. Such residents are

generally excluded from clinical privileging requirements required for VHA

staff physicians, except as provided for in subparagraph d of this

paragraph.

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(5) Appendix II-K of this chapter contains a sample format for the TQCVL. It

must include a list of all the paid or without compensation residents or

trainees to be rotated at any time during the academic year to the VA

facility.

(6) The facility chief of staff will retain the original TQCVL from each program

director for the academic year in a Resident/Trainee Credentials

Verification File for five years.

(7) Until the facility director countersigns the program director’s TQCVL, a

resident or trainee will not be allowed to participate in any of the patient

care activities at the VA facility. There will be no exceptions to this policy.

c. Application Form. Prior to appointing any resident or trainee, the facility chief of

staff or the facility director’s designee will document in the VHA credentialing file

evidence of current, full, and unrestricted licensure, registration, and/or

certification has been verified by primary source from the SLB in which the

applicant claims to have ever been licensed. The TQCVL may be cited as

evidence of licensure verification and as evidence of verification of other

required credentials. If the TQCVL is cited as evidence of credentials

verification, this will be noted on the VA Form 10-2850b and 10-2850c or on VA

Form 4682, Certification of Licensure, Registration, or Bar Membership.

d. Employment of Residents as Admitting Physicians. Medical residents

functioning outside the scope of their training program who are appointed as

admitting physicians must meet VA physician qualification standard

requirements, including licensure in a state, be fully credentialed in accordance

with provisions of this section, and be privileged in accordance with provisions

applicable to VHA staff physicians.

[ ]

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SECTION E. GENERAL APPOINTMENT PROVISIONS

UNDER 38 U.S.C. CHAPTER 74

1. APPOINTMENT PROCESSING REQUIREMENTS.

a. Applications Received by Facilities. Applications received by facilities will be

referred promptly to the Human Resources (HR) Office. The HR Office staff will

review applications for compliance with administrative and regulatory

requirements. Candidates who fail to meet these requirements and thus fail to

qualify for appointment will be notified by the Human Resources Management

Officer. Applications from selectees who meet VA requirements for appointment

under 38 U.S.C § 7401(1) will be referred to the appropriate [supervisory official]

for necessary action as follows:

NOTE: See section F of this part for those occupations under

38 U.S.C. § 7401(3)):]

(1) Selection and Appointment Action.

(b) The [supervisory official, in collaboration with HR,] will evaluate

qualifications and recommend a grade level and step based on VA

qualification standard requirements. Except for physicians, dentists,

and podiatrists, the [supervisor] will also recommend a rate of pay

with due consideration being given to prior service and professional

achievement. (See VA Directive and Handbook 5007, Pay

Administration, Part II.) [ ] For physician service chiefs and

comparable positions, see appendix II-H1.

(d) For optometrists, see appendix II-H4.

(e) For chiefs of nurse anesthesiology sections, see appendix II-H6.

[ ]

(f) For Chiefs of Pharmacy Service (all grades), [ ] see appendix II-H8.

(g) For occupational and physical therapists as section chief, see

appendix II-H9.

(h) For registered nurses [and advanced practice nurses] at grades IV

and V, see appendices II-H5.

(i) For Dentists and EFDAs, see appendix II-H2.

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(j) For doctor of chiropractic, see appendix II-H10.

NOTE: See section B, paragraph 11 of this chapter for provisions

relating to Deans Committee recommendations.

(2) Action When No Facility Vacancy Exists. When a facility receives an

application and no appropriate vacancy exists at that facility, and the

applicant wishes employment elsewhere, the HR Officer will advise the

applicant to consult the VHA vacancy database [www.vacareer.va.gov] for

the location of current vacancies. At the applicant’s request, the application

will be referred for employment consideration to the VA facility of the

applicant’s choice which has a suitable vacancy.

b. Applications Received by Central Office. If the applicant is to be considered

for facility assignment, the application will be referred to the facility of the

applicant’s choice and processed as provided in subparagraph (1). If the

applicant is to be considered for Central Office assignment, an interview may be

conducted in Central Office or at a VA facility determined to be more convenient.

The [hiring official] will consider the applicant’s professional qualifications [ ] and

forward [selection] to the appropriate approving authority. The [servicing HR

Office for VA] Central Office will take the necessary appointment action.

c. Applicants Not Recommended for Appointment. When an applicant is not

recommended for appointment [ ], the applicant will be notified in a letter, signed

by the facility chief of staff or appropriate approving authority that the individual’s

appointment has not been recommended. The letter will briefly state the basis

for the action. The letter should be reviewed by the HR Officer for adherence to

technical requirements.

2. APPOINTMENT ABOVE THE MINIMUM FOR SUPERIOR QUALIFICATIONS.

a. Full-time, part-time or intermittent podiatrists, optometrists, chiropractors, RNs,

APNs, PAs, and EFDAs, who meet the qualification requirements for

appointment, may have their initial rate of pay fixed at a step rate above the

minimum of the appropriate grade in recognition of superior qualifications,

experience, and/or achievement exceeding the expected standards for the

grade. The initial rate of pay may be set at any step rate within the grade (See

VA Directive and Handbook 5007, Pay Administration, Part II.)

NOTE: Physicians and dentists are not eligible for appointment above the

minimum rate of the grade. The step rate for a physician or dentist is determined

by the number of total years of service the individual has worked in the VHA as

reflected by his/her VA service date. However, superior qualifications for

physicians and dentists can be addressed through the use of market pay. See

part IX of VA Handbook 5007, Pay Administration.

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b. Individuals appointed under authority of 38 U.S.C. § 7401(3), or under authority

of 38 U.S.C. 7405 to occupations identified in 38 U.S.C. § 7401(3), may be

appointed above the minimum step of the grade under provision of VA Directive

and Handbook 5007, Pay Administration. This includes hybrid title 38

occupations. The step rate for occupations under 38 U.S.C. § 7401(3) cannot be

based on the number of years of experience alone. The specific criteria for steps

above the minimum rate in VA Handbook 5007, Pay Administration, Part II,

Chapter 3, Paragraph 3b must be justified.

c. Appointment at a step rate above the minimum shall be based on conclusive

evidence of superior qualifications which equates to the step rate assigned.

Qualifications used to meet minimum grade level requirements in the

qualification standard will not be used to also justify appointment at a step rate

above the minimum of the grade. Determinations as to whether an individual

should be appointed at a step rate above the minimum will be made fairly,

consistently and according to Department criteria. The following are examples of

appropriate criteria:

(1) Significant and distinguished contribution in some phase of the appropriate

occupation as evidenced by difficult and original research, writing, and

publications in professional media of stature or special recognition in

teaching, or professional practice.

(2) Special competence in the occupation as evidenced by service with

professionally recognized committees, groups or responsible offices in

professional societies above the local level, or consultative services within

the occupation. The competence attained must be supported by

achievement of renown on a regional or wider basis.

(3) Educational preparation that clearly exceeds requirements for the grade,

expertise in specialized treatment modalities, outstanding competence as a

clinical practitioner or significant contributions concerning some aspect of

the occupation.

(4) Eligibility for certification or certification by an American Specialty Board.

(5) Certification by the appropriate national certifying body to formally

recognize a level of excellence based on demonstrated superior

performance in clinical practice, assessment of knowledge and colleague

endorsement.

(6) Other appropriate evidence of professional stature.

d. [ ] Processing. The approval of step rates above the minimum is subject to the

following requirements:

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(1) RNs/APNS. The facility director (or nurse executive, if so delegated) [ ]

may approve the appointment of RNs at any step above the minimum of

the grade.

(2) APNs (CNAs). The facility director [(or chief of staff or nurse executive, if

so delegated)] may approve the appointment of APNs (CNAs) to any step

above the minimum of the grade. APNs (CNAs) appointed on or after May

4,1993, may not be appointed at a step rate above the minimum for the

grade based on certification by the Council on Certification of Nurse

Anesthetists. Certification is a condition of employment and may not be

used as a basis for appointment above the minimum step of the grade on

initial appointment or reappointment.

(3) PAs. The facility director [ ] may approve the appointment of PAs to any

step above the minimum of Chief grade or below.

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SECTION F. APPOINTMENTS UNDER

38 U.S.C. § 7401

1. GENERAL. The primary consideration, prior to making selections and appointments

under this authority, is to evaluate qualifications and personal characteristics as they

relate to what is essential to successful performance of assigned responsibilities.

Prior to effecting appointments under this authority, [ ] HR staff [ ] and hiring officials

are required to determine that the candidate’s professional qualifications, physical

and mental capacity, emotional stability, and any other pertinent qualifying factors,

warrant a permanent appointment. The use of this appointment authority should

essentially provide tenure for the employee and ensure the continuation of quality

service for VHA. (See section G for procedures concerning full-time temporary, part-

time, intermittent or fee-basis appointments under 38 U.S.C. § 7405.)

2. APPOINTMENTS UNDER 38 U.S.C. § 7401(1). Only full-time permanent

appointments of physicians, dentists, podiatrists, optometrists, chiropractors, RNs,

APNs, PAs, and EFDAs are made under authority of section 7401(1). These

appointments are subject to a two-year probationary period requirement as specified

in 38 U.S.C. § 7403(b)(1). (See Sections A and G of this chapter for probationary

period requirements for individuals appointed as part-time or intermittent registered

nurses under 38 U.S.C. § 7405(a)(1)).

a. [The appropriate supervisor will obtain approval to fill a vacant position in

accordance with local facility procedures. Once approval is obtained, the service

will initiate the recruitment action and contact the servicing HR Office.

b. Before recruitment is initiated, HR staff will work in collaboration with the hiring

official and/or designated occupational subject matter expert (SME) to identify

the eligibility and qualifications requirements pertaining to the assignment and

grade level for the position to be filled in accordance with the qualification

standards found in VA Handbook 5005, Part II, Appendix G. If the hiring official

is not a SME in the profession, the supervisor must consult with the profession’s

SME throughout the recruitment and onboarding process for the vacant position.

c. Once applications are received, HR staff will determine eligibility and

qualifications in accordance with standards found in VA Handbook 5005, Part II,

Appendix G, document the determination as instructed by VHA national policy

office and recommend the appropriate grade to the hiring official for

appointments, promotions, reassignments, details, and change to lower grades.

The qualification determination for each applicant must be documented by HR

completing a separate VHA qualification form for each of the applicants.

d. HR staff will notify candidates who fail to meet the requirements and fail to

qualify for appointment.

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e. Processing requests for promotions, reassignments, and change to lower grades

must be made in compliance with VA Handbook 5005, Staffing, Part III, Chapter

4, paragraph 9.

f. The hiring official will receive a list of qualified applicants from HR staff for

consideration of the vacancy. If the hiring official is not a SME for the profession,

the hiring official must consult with the profession’s SME throughout the

recruitment and onboarding process for the vacant position. The hiring official

and/or occupational SME will review applicant(s) referred for selection. This may

take the form of a panel.

(1) Acceptable SMEs may be identified by national program offices for specific

assignments.

(2) If a SME designation is not made by the national program office for the

assignment, then a SME is a person with direct knowledge or with bona

fide expert knowledge of what is performed in the job.

(3) An SME must have received training on the requirements in the

qualification standard for the occupation/assignment and should typically

be at or above the grade levels being considered for the candidate.

g. The SME will resolve any issues and/or concerns with HR regarding functional

statements, announcements, and qualification determinations of applicants

being referred and considered.

h. When there is a disagreement on the interpretation of a qualification standard for

the development of a functional statement, posting of vacancy or qualification

standard determination, the servicing HR Office will request guidance,

interpretation, and decision from the Office of Workforce Management and

Consulting (WMC). WMC will seek guidance from the designated national

program office. If further resolution is needed, WMC will consult with the

OCHCO, Recruitment and Placement Policy Service (059).

i. The Facility/Medical Center Director/Network Director or delegated officials will

(for personnel under their jurisdiction) review and serve as the deciding official

on requests for above the minimum entrance rate on appointments. (See VA

Handbook 5007, Pay Administration, Part VI, chapter 6.)

j. The Under Secretary for Health or delegated/designated Central Office Officials

will (for personnel under their jurisdiction) review and serve as the deciding

official on requests for above the minimum entrance rate on appointments.]

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3. APPOINTMENTS UNDER 38 U.S.C. § 7401(3). Only full-time permanent

appointments of hybrid title 38 employees are made under authority of section

7401(3). These appointments are subject to title 5 probationary period requirements.

(See chapter 2, section A, paragraph 9, this part.)

a. The supervisor at the appropriate level will obtain an approval to fill a vacant

position in accordance with local procedures. Once approval is obtained the

service will initiate recruitment action and contact the servicing HR Office.

b. Before recruitment is initiated, HR staff will work in collaboration with the

[selecting official and/or designated occupational subject matter expert (SME)] to

determine the eligibility and qualifications requirements that pertain to the

assignment and grade level for the position to be filled in accordance with the

qualification standards found in VA Handbook 5005, Part II Appendices found in

Appendix G. If the [selecting official] is not a subject matter expert in the

profession, the supervisor must consult with the profession’s subject matter

expert throughout the recruitment and onboarding process for the vacant

position.

c. HR staff will determine eligibility and qualifications in accordance with standards

found in VA Handbook 5005, Part II found in Appendix G, document the

determination as instructed by VHA national policy office and recommend the

appropriate grade to the selecting official for appointments, promotions,

reassignments, [details] and change to lower grades. The qualification

determination for each applicant must be documented by HR staff completing a

separate VHA qualification form for each of the applicants.

d. HR staff will notify candidates who fail to meet the requirements and fail to

qualify for appointment.

e. Processing requests for promotions, reassignments and change to lower grades

in compliance with VA Handbook 5005, Part III, Chapter 4, paragraph 9.

f. [The selecting official will receive a list of qualified applicants from HR staff for

consideration of the vacancy. If the selecting official is not a SME for the

profession, the selecting official must consult with the profession’s SME

throughout the recruitment and onboarding process for the vacant position. The

selecting official and/or the occupational SME will review applicant(s) referred for

selection. This may take the form of a panel.

g. An SME is one who holds a position that is designated by the national program

office as the SME (e.g., Social Work Chief) through guidance provided in policy;

or if the SME designation is not made by the national program office, then an

SME is a person with direct knowledge or with bona fide expert knowledge of

what is done in the job. An SME must have received training on the qualification

standard of the occupation and assignment. The SME will address any issues

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and/or concerns with HR regarding functional statements; announcements; and

qualification determinations of applicants being referred and considered. When

there is a disagreement on the interpretation of a qualification standard for the

development of a functional statement, posting of vacancy or qualification

determination, the servicing HR Office will request guidance, interpretation, and

decision from the Office of Workforce Management and Consulting (WMC).

WMC will seek guidance from the designated national program office and/or

Recruitment and Placement Policy Service (059) when appropriate and/or

necessary.]

h. Once a selection is made the supervisor will consult with HR and the profession

subject matter expert (if applicable) and submit supporting documentation for

utilization of pay setting flexibilities (if applicable) found in VA Handbook 5007,

Pay Administration, Part II, Chapters 2, 3 and 4, pertaining to hybrid title 38.

i. Facility/Medical Center Director or Network Director will (for personnel under

their jurisdiction) review and serve as the deciding official on requests for

additional steps above the minimum on appointments.

NOTE: For more information on probationary periods, see section A, paragraph

4 of this chapter and VA Directive and Handbook 5021, Employee/Management

Relations, Part III.

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SECTION G. APPOINTMENTS UNDER 38

U.S.C. § 7405

1. TEMPORARY FULL-TIME APPOINTMENTS UNDER 38 U.S.C. § 7405(a)(1).

a. General. Temporary full-time appointments are made under authority of 38

U.S.C. § 7405(a)(1). These appointments may be made when they are in the

best interest of the service, such as under the following circumstances:

(1) To employ individuals in occupations identified in sections 7401(1) and

7401(3) when the work to be performed by the employee is of a temporary

nature and can be completed within a 3-year or shorter period.

(2) To employ [temporary full-time RNs, APNs, PAs, EFDAs or hybrid title 38

employees pending processing of probationary appointments when the

applicants meet the basic requirements for appointment. [ ] This includes

appointments above the minimum step of the grade for temporary full-time

RNs, APNs, PAs, and EFDAs provided the application and related

documentation show evidence of superior qualifications as described in

section E, paragraph 2 of this chapter.

(3) To employ physicians pending processing of probationary appointments

when probationary appointments require the approval of the Under

Secretary for Health or designee.

(4) To employ residents who have just completed their formal VA residency

training and are awaiting probationary appointment.

(5) To reemploy annuitants.

(6) To employ noncitizens when it is not possible to recruit qualified citizens for

necessary services.

(7) To employ non-licensed physicians, dentists, podiatrists, optometrists, and

chiropractors for utilization in research or academic positions or in positions

where there is no direct responsibility for the care of patients. (See section

B, paragraph 14.)

(8) To employ non-licensed physicians, dentists, podiatrists, optometrists,

chiropractors, or unregistered nurses and nurse anesthetists when the

individual is to serve in a country other than the United States and the

individual is licensed or registered in the country in which the individual is

to serve. (See section B, paragraphs 14 and 15.)

(9) To employ physicians in the Research and Development Program as

research associates [ ].

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(10) To employ physicians in the Distinguished Physician Program [ ].

b. Duration of Appointments. Temporary full-time appointments may be made for

any period up to three years depending on the needs of the service. Such

appointments may be renewed, but the aggregate period of temporary service

normally will not exceed six years. The facility director may grant exceptions to

permit renewals (in increments of up to three years) beyond six years when this

type of appointment best meets the needs of the VA medical program.

c. Consideration for Probationary or Permanent Appointment. Individuals

serving under this type of appointment who meet requirements in 38 U.S.C. §

7402 and in the appropriate VA qualification standard may be considered [ ] for

an appointment under 38 U.S.C. §§ 7401(1) or 7401(3), as appropriate, on

recommendation of the appropriate service chief or equivalent position. If their

services are needed for an indefinite period, they should be considered for such

an appointment in connection with any consideration for an additional 3-year

appointment.

d. Processing. Applicants for temporary full-time appointments will be processed

in the same manner as regular full-time appointees, except the qualifications of

RN, APN, PA, and hybrid title 38 applicants being considered for temporary full-

time appointments pending processing of a probationary appointment will be

reviewed by the appropriate service chief or equivalent position. The service

chief will make a recommendation for appointment to the facility director [or

delegated deciding official].

2. PART-TIME AND INTERMITTENT APPOINTMENTS UNDER 38 U.S.C. §

7405(a)(1).

a. Use of Part-Time and Intermittent Personnel.

(1) It is VHA policy to use the services of qualified individuals on a part-time or

intermittent basis when necessary to alleviate recruitment difficulties and in

all cases where VHA work requirements do not support employment on a

full-time basis. Decisions concerning utilization of part-time or intermittent

employees must be related to patient care and other VA work requirements

and supported by relevant staffing guidelines. Part-time physicians on

adjustable work hours are also to be held accountable for providing the

expected level of patient care and other services to VA as outlined in the

Worksheet for Determining Percentages on Memorandum of Service Level

Expectations, Appendix B, VA Handbook 5011, Hours of Duty and Leave.

(2) A part-time appointment shall be utilized when an employee’s services are

required on less than a full-time basis. An intermittent appointment shall be

used when the need for services is of such a nature that it is not possible

or desirable to establish a regular and prearranged schedule.

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(3) Part-time or intermittent appointments may be made either on a time-

limited basis or without time limit depending on the needs of the facility.

(4) Part-time and intermittent appointments shall be reviewed on a regular

periodical basis and when vacancies occur and when there are significant

workload changes to as certain whether the utilization specified is realistic

and meets the objectives of the organizational unit’s staffing plan. Network

and medical center directors must document each review assessing

whether or not the position meets VA’s needs. When actual utilization does

not meet original expectations, the appointment action shall be amended to

show the new conditions of utilization. For part-time physicians on

adjustable work service level agreement.

b. Special Provisions for Part-Time Physicians on Adjustable Work Hours.

Part-time physicians on adjustable work hours must sign a memorandum related

to service level expectations as outlined in VA Handbook 5011, Hours of Duty

and Leave. Physicians may decide to discontinue complying with the

Memorandum of Service Level Expectations at any time. However, this must be

done in writing as a current, signed memorandum related to service level

expectations is required to participate in adjustable work hours. In addition, a

memorandum related to service level expectations does not alter the

applicability of VHA regulations and procedures concerning terms, conditions,

and duration of employment, nor does this memorandum constitute an

employment contract.

c. Processing Appointments.

(1) Part-time and intermittent appointments made under authority of

38 U.S.C. § 7405(a)(1) will be processed (including Board Action for

occupations under 38 U.S.C. § 7401(1)) in the same manner as regular

full-time appointments. Appointees must meet the basic requirements for

appointment in VHA.

(2) For part-time employees, the expected number of hours to be performed

during the service year will be determined before an appointment is

affected. The expected number of hours will also be recorded on SF 50-B

and will not be exceeded unless the facility director authorizes the excess. [

]

(3) A part-time or intermittent employee [appointed under 38 U.S.C. §

7405(a)(1) (except Physicians)] may not be scheduled for employment

which will exceed [1872] hours [ ] of full-time employment during a

[calendar] year. Generally, for employees who hold more than one type of

appointment (i.e., fee-basis and part-time or intermittent), the combination

of basic pay and fees may not exceed the basic salary of a seven-eighths

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part-time employee in the same grade and step in a fiscal year. (See VA

Directive and Handbook 5007, Pay Administration.)

3. UTILIZATION OF CONSULTANTS AND ATTENDINGS.

a. General. This paragraph contains procedures for the employment of consultants

and attendings on an individual basis under the authority of

38 U.S.C. § 7405(a)(1) or (2).

b. Definitions.

(1) Consultant. A well-qualified specialist in an occupation identified in

38 U.S.C. 7401(1) or (3) who is capable of giving authoritative views and

opinions on subjects in the consultant’s particular field. A consultant’s

expertise may consist of broad administrative or professional experience

enabling the consultant to give advice of distinctive value.

(2) Attending. An individual in an occupation identified in

38 U.S.C. §§ 7401(1) or (3) of demonstrated ability in the field who is

employed to perform or supervise the performance of duties related to

various professional activities such as teaching, patient treatment, etc.

(3) Nonmedical Consultant. An individual, not in one of the occupations

indicated in subparagraphs (1) and (2), who has excellent qualifications

and a high degree of attainment in the consultant’s field. Because of

superior knowledge, and mastery of principles and practices, the

consultant is regarded as an authority or practitioner of unusual

competence.

(4) Lump-Sum Fee. A method of paying consultants and attendings by the

payment of a flat sum for each visit or period of service rendered. It

consists of the fee for services to be rendered, plus the cost of

transportation if required, and per diem at the applicable rate if travel is

involved. The service fee is that portion of the fee exclusive of travel and

per diem allowances.

(5) Per Annum Salary. A method of paying consultants and attendings on a

per annum basis. The salary is computed by multiplying the number of

projected visits to be made during the year by the fee authorized per visit.

(6) Salary Limitation. A ceiling placed on the amount of compensation a

consultant or attending may receive from VA during the fiscal year.

(7) Visit. Attendance at a VA facility for consultation or conference work of a

continuing nature dealing with one or more cases or matters of a

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professional nature. If a visit is interrupted by an overnight break, services

performed on subsequent days are counted as additional visits.

c. Appointment and Reappointment Approving Authorities.

(1) The Under Secretary for Health or designee is the approval authority for

appointments and reappointments of VHA Central Office consultants.

(2) The facility director is the approval authority for appointments and

reappointments not requiring approval of the Under Secretary for Health or

designee.

d. Types of Utilization.

(1) Authority. Consultants and attendings, including nonmedical consultants,

are normally employed under the authority of 38 U.S.C. §§ 7405(a)(1) and

7405(a)(2). Section 7405(a)(1) will be used for all consultants and

attendings paid on a per annum basis and section 7405(a)(2) for those

paid on a lump-sum fee-basis.

(2) Methods of Pay.

(a) Per annum. Employment of consultants and attendings on this basis

is predicated on general availability for recurring and regularly

scheduled duty to meet the anticipated needs of VA.

i When a consultant or attending is available for duty but is not

called to render service on a particular day of the scheduled tour,

no recovery proceedings for payment will be instituted.

ii When a consultant or attending is unavailable for a particular

period, the individual will be in a non-pay status and the salary

reduced for the number of projected visits missed. If the individual

is frequently unavailable for call, a change to lump-sum fee-basis

utilization should be considered.

iii Normally, the number of visits made during the fiscal year will

equal or exceed the projected number used in computing the per

annum salary. The exception would be those cases of reducing

salary for unavailability as outlined in subparagraph 2. However, if

experience during the fiscal year shows that the original projection

of the need for services was too high or too low, the chief of staff

will notify the HR Officer to modify the appointment to reflect the

new conditions of utilization. The action will be effective at the

beginning of the next pay period.

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(b) Lump-Sum Fee-Basis. This type of utilization is required for

intermittent services. In addition, it is required in the employment of

consultants and attendings who have been authorized to perform

services at other than VA facilities; and when travel is performed on a

day immediately before and/or after service is rendered. At the option

of local management, lump-sum fee-basis may also be used for

regularly scheduled services.

attendings may be accepted on a WOC basis under the same

conditions applying to other WOC individuals covered in paragraph 7

of this section.

e. Employment Requirements and Determinations.

(1) Qualification Requirements. Consultants, attendings, and nonmedical

consultants must meet the basic requirement of 38 U.S.C. § 7402 and/or

appropriate qualification standards, in addition to having outstanding

professional ability in their respective fields. [ ]

(2) Duration of Employment. Consultants and attendings will be employed

for a fiscal year or fraction thereof, depending on the need. All appointment

and reappointment actions will be made to terminate not later than

September 30 of each year. Past appointments will be reviewed annually

by the HR Officer and reappointments effected only for those consultants

and attendings the facility expects to use during the upcoming fiscal year.

(3) Dual Employment. The dual employment of consultants or attendings may

be approved in accordance with the provisions of section A, paragraph 3b,

this chapter. It is the responsibility of facility officials to as certain whether

or not a consultant or attending serves another VA facility or another

Federal agency and to make sure that the individual is not paid by VA for

more than one visit a day. The apportionment of the maximum annual pay

limitation for each type of employment should be furnished by the facility

requesting dual employment.

f. Appointment and Reappointment Procedures.

(1) Recommendations for Approval. See section B of this chapter for

application, interview and credentialing requirements relating to the

appointment of consultants and attendings.

(2) Processing.

(a) Central Office Consultants. For Central Office consultants, FL 10-

332, Letter of Appointment on a Lump-Sum Fee-Basis, will be used

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for appointments and reappointments and will be prepared for the

signature of the Under Secretary for Health. Reappointment letters

will be automatically produced by the Austin Automation Center

(AAC).

(b) Security Forms - Dual Employment.

i The HR Officer will ascertain whether the required security forms

have been processed in order to avoid duplication of effort. It

generally should be possible to determine this by review of the

application form or contacting the individual to find out whether the

person is being utilized by another VA facility or another

Government agency. In that case the necessary information may

be secured from the particular VA facility or the Government

agency and a copy of any correspondence placed in the

employee’s file folder to obviate further processing of security

forms.

ii When processing of security forms is required, the HR Officer

located nearest the residence of the consultant or attending, or as

agreed on locally by the HR Officers of the applicable facilities, will

prepare the necessary security forms. The HR Officer, after

processing the forms, will notify the HR Officer(s) of the other

facilities where the individual is being utilized. Evidence of such

notification will be filed by each facility in the employee’s file folder.

NOTE: See VA Directive and Handbook 0710, Personnel

Suitability and Security Program.

appointments of consultants and attendings.

i Per Annum. Appointment actions for consultants and attendings

on a per annum basis under authority of 38 U.S.C. § 7405(a)(1)

will be effected using SF 50 B, Notification of Personnel Action. SF

50-B will reflect the following information:

(A) The nature of action will be “Excepted appointment NTE

9/30/(YR) .

(B) Indicate under item 20 the per annum salary.

of $ is based on an estimated visits at $ per visit

during the fiscal year 20(YR). Entitlement to salary is based

on availability for duty.”

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(D) In some cases, it may be necessary to modify an

appointment to reflect new conditions of utilization. The

“Remarks” section will show the revised basis of computation

of the per annum salary.

ii Lump-Sum Fee-Basis. FL 10-332, Letter of Appointment on a

Lump-Sum Fee-Basis, will be issued to appoint consultants and

attendings on a lump-sum under authority of

38 U.S.C. § 7405(a)(2), including nonmedical consultants. A new

letter will be issued if needs of the service and conditions of

utilization change during the first year of appointment.

(d) Reappointments.

i Per Annum. Per annum consultants and as described in

subparagraph (c) 1, except that the nature of action will be

“Conversion to excepted appointment NTE 9/30(YR) .”

ii Lump-Sum Fee-Basis. Fee-basis consultants and attendings will

be reappointed using FL-10-332a, Letter of Reappointment on a

Lump-Sum Fee-Basis, in accordance with current VHA

instructions. The form will be signed by the facility director, chief of

staff, or HR Officer.

(e) Disposition of Forms.

i Applications and other forms for consultants and attendings will be

placed in a file folder with a tab listing the individual’s name, date

of birth, and social security number.

ii Folders will be maintained alphabetically by appointment category

and filed in location designed by the facility.

4. APPOINTMENT OF PROFESSIONAL AND TECHNICAL PERSONNEL ON A FEE-

BASIS UNDER 38 U.S.C. § 7405(a)(2).

a. General. On recommendation of the facility chief of staff, the facility director may

appoint professional and technical personnel on an on-facility fee-basis under

authority of 38 U.S.C. § 7405(a)(2). The Chief, Dental Service, will recommend

appointments of dentists and EFDAs. Appointments may be made for an

indefinite period of time.

b. Application. Applicants will submit an appropriate application form to the facility

where they seek employment. Forms to be used are VA Form 10-2850,

Application for Physicians, Dentists, Podiatrists, Optometrists, and

Chiropractors; VA Form 10-2850a, Application for Nurses and Nurse

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Anesthetist; VA Form 10-2850c, Application for Associated Health Occupations

or OF 612 [ ]. All items will be completed in sufficient detail to enable the

responsible official to make determinations concerning citizenship, licensure or

registration, and other qualifications. In emergency situations, the facility director

may approve appointments of individuals who have not completed an application

if applicants meet appropriate qualification requirements. (See section B, this

chapter, for credentialing requirements, including those related to emergency

appointments.)

c. Selection.

(1) The facility chief of staff will determine qualifications, select and

recommend physicians, podiatrists, chiropractors, optometrists, RNs,

APNs, and PAs. The Chief, Dental Service will do this for dentists and

EFDAs.

(2) The HR Officer will determine qualifications for other professional and

technical personnel consistent with VA or Office of Personnel Management

requirements. The appropriate program officials will select and recommend

employment for these individuals.

d. Appointment.

(1) Approval Authority. The facility director will approve appointments.

(2) Letter of Appointment. The facility director or HR Officer will sign a letter

of appointment giving all pertinent details. The original of the letter will be

given to the appointee, with copies to the servicing HR Office, Fiscal

Service and the utilizing service.

(3) Disposition of Forms. Records of personnel appointed under this

paragraph will be placed in a file folder (not personnel folder) with a tab

listing the individual’s name, date of birth, and social security number.

These records will be maintained alphabetically by appointment category

and filed in a location designated by the facility.

e. Pay. See VA Directive and Handbook 5007, Pay Administration, Part II.

NOTE: Persons authorized to provide outpatient services at VA

expense on an off-facility fee-basis in professional offices, clinics or

other non-VA facilities are not considered employees for the purposes

of this chapter. Instructions for their utilization are contained in VHA

Manual M-1, part I, chapter 18.

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5. APPOINTMENT OF STUDENTS AND OTHER TECHNICIANS UNDER 38 U.S.C. §

7405 (a)(1)(D).

a. General.

(1) Student Technicians.

(a) A student enrolled in an approved nursing school, an approved

school of nurse anesthesia or enrolled in an approved training or

educational program for an occupation identified in

38 U.S.C. § 7405(a)(1)(A) or (B), may be appointed on a temporary

full-time, part-time or intermittent basis under the provisions of

38 U.S.C. § 7405(a)(1)(D) for a period not to exceed the duration of

the individual’s program.

(b) The appointment of student technicians can help meet patient care

needs and also enhance the recruitment of promising students for

career service with VA. With the proper orientation to the assignment

and under appropriate professional supervision, students can perform

duties consistent with the courses they have successfully completed.

For example, a student nurse technician could give medications

under supervision of the registered nurse, give baths, check vital

signs, provide tracheotomy care, and detect signs and symptoms of

bleeding and respiratory problems.

(2) Other Student Employment.

(a) General. [Directors of health care facilities] may approve

appointments of students in occupations other than those cited in

paragraph (1) under authority of 38 U.S.C. § 7405(a)(1)(D).

(b) Selection.

i Candidates normally will be selected from among students whose

interests or career objectives are in health care areas.

ii Normally, a panel will be established for the purpose of screening

qualifications and ranking student applicants for selection

consideration. Preference will be given to students whose

qualifications, personal traits, and career motivation appear to offer

the best potential for service in VHA and for future contributions to

the career field in general. The hiring official will choose applicants

for employment from the listing developed by the qualification-

screening panel.

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iii VA student volunteer workers who have demonstrated interest in a

health-related career should be encouraged to apply for student

employment. Selection of qualified students from this group

encourages continued volunteer youth participation and acts as an

incentive to other students to serve as volunteers.

iv The Human Resources Officer is responsible for the administration

of this program, including determining the extent to which the

program is publicized and the selection process to be used by the

facility. This official is also responsible for documenting all such

determinations once they are made.

i Available facility funds must be used. If research funds are used,

appointments of students for medical research activities will be

approved by the facility’s Research and Development Committee.

Education funds are not to be used for the employment of

students.

ii This employment has no relation to authorized training programs

or clinical clerkships under which paid or without compensation

(WOC) students receive credits from affiliated universities.

(3) Nurse Technician Pending Graduation.

(a) In a limited number of states, students who have completed a

designated segment of their nursing studies but have not yet

graduated are permitted to obtain registration as a graduate

professional nurse.

(b) A student enrolled in an approved nursing school who possesses

active, current registration to practice nursing in a State may be

appointed on a temporary full-time, part-time or intermittent basis

under the provision of 38 U.S.C. § 7405(a)(1)(D) for a period not to

exceed the duration of the individual’s academic program.

(4) Graduate Technicians.

(a) A graduate nurse who has successfully completed a full course of

nursing in an approved nursing school; a graduate physician

assistant who has completed a full course of training as a physician

assistant in an approved program; or a graduate of an approved

training or educational program in an occupation identified in

38 U.S.C. § 7405(a)(1)(B), whose licensure or registration in a state,

or certification by the appropriate national certifying organization, is

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pending may be appointed on a temporary full-time, part-time or

intermittent basis under the provisions of 38 U.S.C. § 7405(a)(1)(D)

for a period not to exceed 2 years (e.g., graduate nurse technician,

graduate physical therapy technician, graduate pharmacy technician,

etc.). Appointments may not be extended.

(b) A graduate nurse or LPN who fails to qualify for registration [upon two

attempts within 120 days of appointment,] will be separated from the

service on 2 weeks’ notice regardless of the termination date of the

temporary appointment. In [unusual circumstances, the 120-day

period for obtaining registration may be extended on a case-by-case

basis (i.e., delays in State Nursing Boards ability for timely

examination). Extensions must be requested in writing through the

ADPCS, or equivalent, for a formal decision by the VISN Chief Nurse

Officer (CNO), or equivalent. See VA Handbook 5005, Part II,

Appendices G6a-G6d for information on graduate nurses for APN

assignments.]

for licensure, registration or certification when required will be

permitted to remain on VA rolls pending results of reexamination

provided reexamination occurs prior to the expiration date of the

temporary appointment.

(d) Graduate technician experience can be credited as successful

nursing practice or as successful experience which may be used in

meeting grade level requirements as indicated in the appropriate

qualification standard.

b. Approved Training or Educational Programs. Approved programs must be in

schools or educational institutions approved by the Secretary as indicated in the

appropriate qualification standard.

c. Approval Authority. On recommendation of the appropriate service chief or

equivalent, the facility director may approve technician appointments. The facility

director may delegate approval authority for hybrid title 38 employees as

indicated in paragraph 2 of section A, this chapter.

d. Processing.

(1) Student technicians will submit OF 612 [ ]. Nurse technicians pending

graduation and graduate nurse technicians will submit VA Form 10-2850a.

Other graduate technicians will submit VA Form 10-2850c.

(2) After determining that the applicant meets qualification requirements, the

appropriate service chief or equivalent will forward SF 52, Request for

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Personnel Action, to the HR Officer. Following approval by the facility

director, the HR Officer will effect the appointment. [ ].

e. Pay. See VA Directive and Handbook 5007, Pay Administration.

f. Conversions. Processing technicians for conversion should be initiated prior to

their eligibility dates whenever possible [ ]. Conversions will be effected the first

day of the pay period following administrative approval.

(1) Student Technicians. A student technician who graduates from an

approved school and is pending licensure or registration in a State, or

certification by the appropriate national certifying organization, may be

converted to a graduate technician appointment. [ ].

(2) Nurse Technicians Pending Graduation. Following graduation from an

approved nursing school, a nurse technician selected for continued VA

employment will be converted to a registered nurse appointment under

38 U.S.C. §§ 7401(1) or 7405(a)(1)(A) at the grade and step rate for which

qualified, without regard to any other restrictions. [ ]

(3) Graduate Technicians. Following attainment of licensure or registration in

a State or certification by the national certifying organization, a graduate

technician selected for continued VA employment will be converted to an

appointment in the appropriate occupation under 38 U.S.C. §§ 7401(1),

7401(3), 7405(a)(1)(A) or 7405(a)(1)(B).

6. [ ] APPOINTMENT OF MEDICAL SUPPORT PERSONNEL UNDER 38 U.S.C.

§7405(a)(1).

a. General.

(1) 38 U.S.C. § 7405(a)(1) is primarily used to obtain the services of

physicians, dentists, RNs, APNs and other individuals in occupations

identified in 38 U.S.C. § 7401(1) and 7401(3). However, it may be used

under certain conditions to obtain the services of medical support

personnel in occupations other than those identified in

38 U.S.C. §§ 7401(1) and 7401(3). Appointments of medical support

personnel, other than trainees and students, may be made on a temporary

full-time basis for a period not to exceed three years, or on a part-time or

intermittent basis for a period not to exceed one year. Full-time

appointments under this authority may be renewed for one or more

additional periods not in excess of three years each. Part-time and

intermittent appointments are non-renewable. Appointments of associated

health trainees and students in occupations other than those identified in

38 U.S.C. § 7401(1) and 7401(3) may be made on a temporary full-time

basis not to exceed three years, or on a part-time or intermittent basis for a

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period of time consistent with individual training program requirements.

(See subparagraph b. below.)

(2) The use of this authority is desirable and appropriate for the employment of

trainees accepted in VA associated health training programs; high school

graduates and college students participating in the VHA summer

employment program; students and others, particularly those engaged in

the medical research programs, when it is determined impracticable to

obtain the necessary services through regular competitive employment

procedures. Under no circumstances may this authority be used to

circumvent the competitive employment procedures, the competitive

system pay limitations and the qualification requirements for competitive

appointments.

b. Appointment of Associated Health Trainees.

(1) Type of Appointment. Appointments of trainees in VA associated

health training programs are made by the facility director under the

authority of 38 U.S.C. § 7405(a)(1) on a full-time basis, not to exceed 3

years, or on a part-time or intermittent basis for a period consistent with

individual training program requirements. (See [VHA Handbook

1400.08, Education of Associated Health Professions and] Section H

for discussion of limited circumstances when associated health

trainees may be appointed under 38 U.S.C. § 7406.).

(2) Qualification Requirements. Trainees must meet citizenship

requirements and shall be qualified as prescribed in appendices II-D of this

part. Requests for approval to appoint paid noncitizen trainees will be

forwarded to the Assistant Deputy Under Secretary for Health (10N_/143).

Without compensation (WOC) appointments of noncitizen trainees may be

approved by the facility director.

(3) Selection and Appointment of Candidates. Handbook 1400.08,

Education of Associated Health Professions sets forth the selection

process and the approval authority for appointment of trainees.

(4) Appointment Action. The HR Officer, with the approval of the facility

director, will affect the appointment on SF 50-B. The type of action will be

“Excepted Appointment NTE (date)”.

c. Appointments of Other Medical Support Personnel.

(1) Criteria for Approval of Appointments

(a) Full-time appointments must be temporary not to exceed 3 years and

are renewable for like periods. Part-time and intermittent

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appointments must be temporary not-to- exceed 1 year and are non-

renewable.

(b) Qualifications of appointees must be comparable to those required for

competitive service employees performing similar duties.

service employees occupying similar positions which are subject to

the requirements of 5 U.S.C. Chapter 51. (See VA Directive and

Handbook 5007, Pay Administration.)

(2) Approval Authority. Facility directors are authorized to approve

appointments of medical support personnel, except for paid noncitizen

associated health trainees. (See paragraph 3.b.(2) above.)

(3) Documentation. All appointments effected under the provisions of this

paragraph will be properly documented to support the action.

(4) Processing. Applicants will submit the OF 612 [ ] to be processed for

appointment in the same manner as other similar appointees.

7. ACCEPTANCE OF SERVICES ON A WITHOUT COMPENSATION BASIS UNDER

38 U.S.C. § 7405(a)(1).

a. General. The acceptance of the services of qualified individuals who may be

directly or indirectly involved in patient care activities on a WOC basis is

permissible. It is not intended that the services of individuals utilized on a WOC

basis be accepted in place of those which are usually expected to be performed

by personnel for whom funds are provided on a continuing basis.

b. Occupations Identified in 38 U.S.C. § 7401(1) and (3).

(1) Authority for Appointment. Services will be accepted under the authority

of 38 U.S.C. § 7405(a)(1), except that any resident requiring a

disbursement agreement will be appointed under authority of

38 U.S.C. § 7406. Appointments will be recommended by the Chief of Staff

and approved by the facility director. (See section B of this chapter for

credentialing requirements.)

(2) Processing.

(a) VA Forms 10-2850, 10-2850a, 10-2850b, 10-2850c or 10-2850d (for

trainees) as appropriate, will be submitted by individuals who desire

to participate in the VA medical program on an uncompensated basis.

(b) VA Form Letter 10-294, [WOC Personnel Authorization], will be

issued setting forth the terms of utilization. Following approval of the

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appointment by the facility director, the letter will be signed by the

individual attesting to agreement to the conditions specified and

countersigned by the HR Officer. The form letter will be prepared in

duplicate, with the original given to the employee and the duplicate

filed in a location designated by the facility and later disposed of in

accordance with existing VHA instructions.

c. Student Trainees, Residents, Research Personnel, and All Others.

(1) Classes. The classes of personnel who may be utilized on a WOC basis

are:

(a) Medical and dental students who serve as clinical clerks.

(b) Nursing students who are enrolled in hospital, college or university

schools of nursing and who are assigned for clinical experience and

instruction.

associated health care occupations, such as all physical medicine

and rehabilitation therapists and coordinators, orientation and mobility

specialists, social workers, psychologists, medical technicians or

technologists, medical radiology technicians, hospital librarians,

pharmacists, medical record librarians, dietitians, dental hygienists,

dental assistants, dental laboratory technicians, and other

occupations listed in 38 U.S.C. §§ 7401(1) and 7401(3).

NOTE: Students in associated health care occupations who

successfully complete an affiliated clinical education training program

in a VA health care facility may be eligible for noncompetitive

appointment under title 5 following graduation from an accredited

institution of post-secondary education in accordance with

38 U.S.C. § 7403(g). (See Appendix II-C, this part.)

(d) Scientific and technical personnel and laboratory assistants who are

utilized in a medical research program. Usually, individuals utilized on

this basis are employed by associated medical or dental schools or

universities to engage in medical or dental research for which a grant

has been made under auspices of the VHA Office of Research and

Development and their policies and procedures.

(e) The facility director is the approving authority for WOC appointments

at facilities.

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(2) Full or Part-Time Utilization. WOC appointments may be made on a

temporary full- time or part-time basis, depending on the objective of the

program.

(3) Processing. Employees should be processed and appointed as outlined in

subparagraph b (2). When a large group of students is to be appointed,

facility directors may adapt the FL 10-294 to a mass action type document

for appointment purposes provided they retain its basic content.

Applications for employment need not be solicited unless they are needed

to comply with the requirements of section A, paragraph 3 and/or

credentialing requirements of section B, this chapter.

(4) Payments in Kind. When facilities are available, students in certain

designated programs approved by the Under Secretary for Health or

designee, in return for services rendered, may be furnished quarters and

subsistence during the whole or any part of the training period. Uniforms

also may be laundered by VA if facilities are available. [ ]

d. Noncitizens. Noncitizens may be utilized on a WOC basis when no qualified

citizens are available, and it is deemed to be in the interest of the facility.

8. OVERSEAS EMPLOYMENT OF NON-U.S. CITIZENS UNDER TITLE 38 U.S.C. §

7405 (a)(1).

a. Scope. This paragraph contains basic policies and procedures for appointing

non-U.S. citizens at the VA Regional Office Outpatient Clinic, Manila, Republic

of the Philippines in the following occupations:

(1) Physicians, dentists, podiatrists, optometrists, chiropractors, RNs, nurse

anesthetists, PAs and EFDAs appointed under 38 U.S.C. § 7405(a)(1).

(2) Individuals appointed under 38 U.S.C. § 7405(a)(1) to occupations listed in

38 U.S.C. § 7401(3).

(3) Medical support personnel.

(4) Trainees in health care or associated health care occupations appointed

under 38 U.S.C. § 7405(a)(1).

b. Appointment Authority. The Regional Office Director may appoint the following

personnel:

(1) The categories of personnel listed in paragraph a (1) and (2) may be

appointed on a temporary full-time, part-time, intermittent, without

compensation or fee-basis.

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(2) Medical support personnel may be appointed on a temporary full-time

basis not to exceed three years, or on a temporary part-time or intermittent

basis not to exceed one year.

(3) Trainees in health care or associated health care occupations may be

appointed on a full-time, part-time or intermittent basis with or without a

time limit.

c. Qualification and Licensure Requirements.

(1) VA Qualification Standards will be used to determine the appropriate grade

levels for applicants appointed under provisions of this paragraph. The

Regional Office Director may, under unusual circumstances, approve a

deviation from the grade requirements when the composite record of

qualifications justifies the action.

(2) The Regional Office Director may waive the licensure, registration or

certification requirements for the occupation, provided the individual is

properly credentialed in the Philippines.

[ ]

d. Physical Requirements. The physical requirements and procedures for

determining fitness for duty are governed by the provisions of VA Directive and

Handbook 5019, Employee Occupational Health Service.

9. APPOINTMENT OF STUDENTS AND RECENT GRADUATES THROUGH THE VA

CHOICE AND QUALITY EMPLOYMENT ACT OF 2017.

a. Policy. This paragraph establishes policy for appointing additional categories of

students and recent graduates of qualifying educational institutions through the

VA Choice and Quality Employment Act of 2017 (the Act). The Act, established

through Public Law 115- 46, gives the Secretary of VA the authority to make

excepted service appointments for students and recent graduates that lead to

career or career conditional appointments, as applicable. This authority applies

to title 5 occupations and extends appointment eligibility to students and recent

graduates who fall in one of the following categories:

(1) Those employed in a qualifying internship or fellowship program at the

Department;

(2) Those employed in the Department in a volunteer capacity and who are

performing substantive duties comparable to those of individuals in

internship or fellowship programs and who meet the required number of

hours for conversion;

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(3) Those employed in the Department under a contract or agreement with an

external non-profit organization and who are performing substantive duties

comparable to those of individuals in internship or fellowship programs;

(4) Those who have received Post 9/11 Educational Assistance under chapter

33 of title 38, United States Code (U.S.C.).

b. Guidance. Specific guidance for making excepted appointments and

subsequent noncompetitive conversions using this authority are in Appendix II-

D, Noncompetitive Appointment of Students and Recent Graduates through the

VA Choice and Quality Employment Act of 2017, of this part.

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APPENDIX H1. PROCEDURES FOR APPOINTING PHYSICIANS TO SERVICE

CHIEF AND COMPARABLE POSITIONS

1. SCOPE. This appendix covers appointments of physicians to service chief or

comparable positions. (For information on comparable positions, See VA Handbook

5007, Pay Administration.) It does not apply to those in an “acting” capacity.

2. PROCEDURES.

a. The facility initiates recruitment and contacts the appropriate VA Central Office

program office, which may recommend additional candidates for consideration.

b. Candidates are screened, interviewed and tentatively selected at the facility.

c. If the candidate is board certified in an appropriate specialty or specialties, the

Chief of Staff or designee discusses the proposed selection with the appropriate

VA Central Office program official who may provide comments or

recommendations concerning the proposed selection within five working days.

For candidates who are not board certified or who are certified in a specialty or

specialties not appropriate to the proposed assignment, the Chief of Staff or

designee will forward the candidate’s curriculum vitae, employment application,

and credentialing/privileging information to the Office of Patient Care Services

(11), which will provide comments concerning the proposed selection within 15

working days.

d. The Chief of Staff recommends a candidate to the facility director [ ]. The

recommendation shall include any comments made by the VA Central Office

program official.

e. The facility obtains the concurrence of the Dean’s or Medical Advisory

Committee, where appropriate.

f. The facility director approves or disapproves the appointment.

g. The facility advises the program official and the Network Director that the

selection has been approved.

NOTE 1: Special pay agreements must be approved in VA Central

Office if the candidate’s total pay (basic, special pay and bonus or

allowance) would exceed $190,000. See VA Directive and Handbook

5007, Pay Administration.

NOTE 2: Communications with VA Central Office officials need not be in a

formal written format.

NOTE 3: Facility officials are to maintain documentation regarding their

recruitment process. This documentation is to include: (1) A summary

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of any comments from Department of Veterans Affairs Central Office

program officials regarding the recommended candidate; and (2) If the

position is advertised and a noncitizen candidate is selected, the

names of all citizen applicants and the reason(s) why the citizen

applicants were not qualified for the position.

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APPENDIX H2. PROCEDURES FOR APPOINTING DENTISTS AND EFDAs

1. SCOPE. This appendix covers appointments of dentists to position of Chief, Dental

Service and comparable positions. It does not apply to those “acting” in such

positions. It also covers the appointment of staff dentists and EFDAs (Expanded-

Function Dental Auxiliaries).

2. APPOINTMENT TO POSITION OF CHIEF, DENTAL SERVICE, AND

COMPARABLE POSITIONS.

a. The facility initiates recruitment and contacts the Office of Dentistry (112D)

which may recommend additional candidates for the position. Vacancy

announcements are to be accomplished by the facility. These announcements

need to reach all potential VA candidates and allow employees the opportunity

to be informed of, and compete for, vacancies.

b. Candidates are screened, interviewed, and tentatively selected at the facility.

c. The facility chief of staff or designee discusses the proposed selection with the

Office of Dentistry which has five working days to make comments or

recommendations concerning the proposed selection.

d. The facility chief of staff recommends a selection to the facility Director.

Recommendations related to advancements and assignments shall include any

comments made by the Office of Dentistry. [ ]

e. The facility obtains the concurrence of the Dean’s or Medical Advisory

Committee, if appropriate.

f. The facility director approves or disapproves the appointment or assignment.

g. The Office of Dentistry and the network directors are notified.

3. APPOINTMENT TO STAFF DENTIST POSITIONS.

a. The facility initiates recruitment and contacts the Office of Dentistry (112D),

which may recommend additional candidates for the position. Vacancy

announcements are to be accomplished by the facility. These announcements

need to reach all potential VA candidates and allow employees the opportunity

to be informed of and compete for vacancies.

b. On notification of a dentist vacancy by a facility, the VA Health Care Staff

Development and Retention Office will forward to the facility HR Office the

applications and related materials of qualified candidates who have indicated

availability for that facility or geographical area.

c. Candidates are screened, interviewed and tentatively selected at the facility.

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d. The Chief of Dental Service or designee is to discuss the proposed selection

with the Office of Dentistry, which has five working days to make comments or

recommendations concerning the proposed selection.

e. The recommendation is forwarded through channels to the facility Director for

consideration. The recommending official shall include any comments made by

the Office of Dentistry.

f. The facility obtains the concurrence of the Dean’s or Medical Advisory

Committee, if appropriate.

g. The facility director approves or disapproves the appointment or assignment.

h. The facility advises the Office of Dentistry of the selection.

4. APPOINTMENT OF EFDAS.

a. When an EFDA vacancy occurs, the facility initiates recruitment and contacts the

Office of Dentistry, which may recommend additional candidates for the position.

b. The service Chief screens, interviews and tentatively selects a candidate.

c. A recommendation is forwarded through channels to the facility Director [ ].

d. The facility Director approves or disapproves the appointment or assignment.

e. The facility advises the Office of Dentistry of the selection.

[ ]

NOTE 1: Facility communications with the Office of Dentistry in Central

Office need not be in a formal written format.

NOTE 2: Facility officials are to maintain documentation regarding the

process of recruiting dentists and EFDAs. This documentation is to include:

• A summary of any comments from Central Office program

officials regarding the recommended candidate; and

• If the position is advertised and a noncitizen candidate is selected,

the names of all citizen applicants and the reason(s) why the citizen

applicants were not qualified for the position.

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APPENDIX H3. PROCEDURES FOR APPOINTING PODIATRISTS

1. SCOPE. This appendix establishes the procedures for the appointment of all

podiatrists in VHA.

2. PROCEDURES.

a. The facility initiates recruitment and contacts the Director of Podiatry Service

who may recommend additional candidates for the position.

b. The appropriate official screens, interviews, and tentatively selects a candidate

for the position.

c. [ ] The Chief of Staff or designee discusses the proposed selection with the

Director of Podiatry who has five working days to make comments or

recommendations concerning the proposed selection.

d. The recommendation is forwarded through channels to the facility director for

consideration. Recommendations are to include the comments of the Director of

Podiatry Service. [ ]

e. The facility obtains the concurrence of the Dean’s or Medical Advisory

Committee, if appropriate.

f. The facility director approves or disapproves the appointment or assignment.

g. The facility advises the Director of Podiatry Service of the selection.

[ ]

NOTE 1: Facility communications with VA Podiatry Service officials need

not be in a formal written format.

NOTE 2: Facility officials are to maintain documentation regarding their recruitment

process. This documentation will include:

• A summary of any comments from Central Office program

officials regarding the recommended candidate; and

• If the position is advertised and a noncitizen candidate is selected,

the names of all citizen applicants and the reason(s) why the citizen

applicants were not qualified for the position.

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APPENDIX H4. PROCEDURES FOR APPOINTING OPTOMETRISTS

1. SCOPE. This appendix establishes the procedures for the appointment of all

optometrists in VHA.

2. PROCEDURES.

a. The facility initiates recruitment and contacts the Director of Optometry Service

who may recommend additional candidates for the position.

b. The appropriate official screens, interviews, and tentatively selects a candidate

for the position.

c. [ ] The Chief of Staff or designee discusses the proposed selection with the

Director of Optometry who has five working days to make comments or

recommendations concerning the proposed selection.

d. The recommendation is forwarded through channels (including the Dean’s or

Medical Advisory Committee, where appropriate) to the facility director for

consideration. Recommendations are to include the comments of the Director of

Optometry Service. [ ]

e. The facility director approves or disapproves the appointment or assignment.

f. The facility advises the Director of Optometry Service of the selection.

NOTE 1: Facility communications with VA Central Office Optometry Service

[program] officials need not be in a formal written format [ ]

NOTE 2: Facility officials are to maintain documentation regarding their recruitment

process. This documentation will include:

• A summary of any comments from VA Central Office Optometry Service

program officials regarding the recommended candidate; and

• If the position is advertised and a noncitizen candidate is selected,

the names of all citizen applicants and the reason(s) why the citizen

applicants were not qualified for the position. [ ]

NOTE 3: Information concerning promotion of optometrists can be found in Part III,

Appendix M, this handbook.

NOTE 4: Additional program information covering optometrists can be obtained

through the Director of Optometry Service or the VHA Optometry Service website via

the following link: http://vaww1.va.gov/optometry/.

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APPENDIX H5. RECRUITMENT, APPOINTMENT, ADVANCEMENT, CHANGE IN

ASSIGNMENT, AND REASSIGNMENT OF REGISTERED NURSES (RNs) AND

[ADVANCED PRACTICE NURSES (APNS) IN GRADES IV AND V]

1. SCOPE. This appendix covers recruitment, appointments, advancements, changes

in assignment, and reassignments of RNs [and APNs (certified nurse practitioner,

clinical nurse specialist, certified nurse mid-wife) in grades IV and V assignments.

(See Appendix G6d for APN (CNA) Nurse IV and V assignments.)]

2. RECRUITMENT, APPOINTMENT, ADVANCEMENT, CHANGE IN ASSIGNMENT,

AND REASSIGNMENT OF KEY NURSING PERSONNEL.

a. Recruitment. [The appropriate supervisory official will collaborate with HR to

determine the best recruitment flexibilities to utilize in filling the position which

may or may not include formal vacancy announcements or advertisements, use

of a search committee, utilization of recruitment and relocation incentives or

other incentives, direct selection of a qualified candidate, etc.

b. Qualification. HR staff will evaluate all candidate(s) to determine if the basic

qualification requirements for the grade level and assignment have been met

and refer qualified candidates to hiring official.

c. Selection.

(1) The hiring official will review applications referred for selection. Hiring

officials who are not SMEs must consult SMEs when evaluating

applications. SMEs must be at or above the grade level of the position

being considered. SME review may take the form of a panel or consultation

with the SME for the profession. NOTE: Office of Nursing Services will

identify appropriate SMEs for Nurse IV and V grade level assignments.

(See Chapter 3, Section F for additional information on SME

requirements.)

(2) Once a selection is made, the supervisor will consult with HR staff and the

profession’s SME (if applicable) and submit supporting documentation for

utilization of pay setting flexibilities (if applicable), found in VA Handbook

5007, Part II, for consideration by the deciding official.]

d. Reassignments and Changes in Assignment. A reassignment is a change

from one position to another. A change in assignment is a change in the duties

and responsibilities of a specific position.

(1) Reassignment. If a nurse is reassigned and the reassignment does not

involve a change in grade, [no additional review is required, and the

supervisory official may move forward with an appropriate reassignment

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action in collaboration with HR staff.] If a change in grade is involved, the

procedures in paragraph 2c will be used.

(2) Change in Assignment. If the duties and responsibilities of a position are

significantly changed, the procedures in paragraph [2c] will be used to

determine whether the employee should be advanced to a higher grade.

Minor changes in duties and responsibilities may be accomplished by

revising or amending the employee’s functional statement.

3. [ ] APPOINTMENT, ADVANCEMENT, REASSIGNMENT, AND CHANGE IN

ASSIGNMENT OF NURSE EXECUTIVES. Procedures for the recruitment,

appointment, advancement, change in assignment, and reassignment of nurse

executives are the same as in paragraph 2. However, when a selection is made for

one of these positions, facility officials will notify the appropriate network director and

the Office of Nursing Services in VA Central Office.

[ ]

4. CRITERIA FOR GRADING [RN AND APN] LEADERSHIP POSITIONS AT

[GRADE] IV AND [GRADE V]. Assignment of the Nurse IV and Nurse V grade

levels is based on the complexity and responsibility of the assignment and the

individual’s qualifications. [ ]Criteria for determining whether the complexity of an

assignment warrants placement at the [RN or APN] grades [IV and V] are outlined in

paragraph 5 below.

5. COMPLEXITY OF ASSIGNMENT REQUIRED FOR PLACEMENT AT [GRADE] IV

AND V.

a. General. [RNs and APNs] are appointed and promoted to grades IV and V

[grade levels] based on the scope and complexity of their assignment and

qualifications. Assignments of IV and V grade levels are position specific. This

appendix provides guidance for determining whether facility, VISN or Central

Office [ ] positions meet the criteria for placement at [grade IV or V].

b. Nurse Executive Positions. The term “Nurse Executive” refers to the top

nursing management position at a VHA healthcare facility/system. Nurse

executives are members of the senior management team. The organizational

title of the Nurse Executive position will vary (e.g., Chief Nurse, Nurse Executive,

Associate Director for Nursing Services, Associate Director for Patient Care

Services) but must be consistent with senior management titles recognized by

VA Central Office. Appointment or advancement to a Nurse Executive position is

based on the complexity of the position. [ ]. Generally, Nurse Executives are

appointed at the Nurse V grade level [ ].

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c. Key Nursing Personnel.

(1) Comparability to Nurse Executive Positions. VA policy provides that

[RNs and APNs] in assignments other than Nurse Executive may be

appointed or advanced to [grade IV or V].

(2) Establishing Positions. The facility, VISN or VACO Program Office

should establish a formal process for approving the design and

implementation of such positions. Responsibilities in new positions should

not duplicate or otherwise reduce responsibilities of other positions if the

grades of those other positions are based the responsibilities involved.

(3) Key Nursing Assignments Warranting [Grade] IV or V. Positions at

these grades are typically located in organizational settings where there is

a high rate of activity and a broad mission involving a full range of complex

programs and/or services. Program responsibility includes full responsibility

for program design, integrating the program with other related programs

and organizational goals, monitoring, as well as responsibility for

evaluating and administering the program. Positions at IV and V grades

also have full accountability for program outcomes.

(a) Examples of [Grade] IV Positions [include but are not limited to:]

i Managers for Service Lines;

ii Positions in VISN offices that have broad program responsibility for

a single program that covers all facilities within the network; and

iii Positions at facilities with full program responsibilities that meet

criteria in [appendix G6d, Part II].

(b) Examples of [Grade] V Positions [include but are not limited to:]

i VISN positions with broad program responsibility for multiple

programs covering all facilities within the network;

ii Positions with substantial sphere of influence across multiple sites

or programs and across the full continuum of care;

iii [Service Line Executives in complex settings.]

iv Positions with substantial involvement in multi-site, regional, and/or

national professional and health related issues; and

v Positions at tertiary facilities that have full program responsibility

for more than one of the following programs: clinical, education,

research or quality management.

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(4) Consideration Procedures. Nurse Executives and facility directors must

initially determine that a position meets the scope and complexity

requirements before an individual can be considered for appointment or

promotion. [ ]. Procedures for such determinations and employee

consideration are outlined in VA Handbook 5005, Part III, chapter 4 [ ].

d. Vacancies and Reassignments. [Grades] IV and V are based on a

combination of assignment characteristics and individual qualifications [ ].

Positions of individuals at the Nurse IV or Nurse V grade should not be

significantly modified, nor should individuals in these positions be assigned to

other positions or duties, which may not warrant IV or V [grade level.] [ ].

6. [EXAMPLES OF APN-SPECIFIC GRADE IV AND V ASSIGNMENTS (excludes

CNA IV and V that are covered in Part II, Appendix G6d). The roles below are

examples that meet the scope and complexity of grade IV and V assignments. Other

roles may also be developed to address organizational, VISN or VHA needs if the

role meets the scope and complexity.

(1) Nurse IV. APN positions in this grade execute clinical and administrative

leadership that is characterized by substantial and continuous

responsibility and accountability for population groups or integrated

programs at the facility, VISN or program office level. Roles include but are

not limited to APN Facility Lead, APN Facility Lead or Residency Program

Director, and APN Clinical Leader/Administrative Leader.

(a) APN Facility Lead. Facility lead APNs have a thorough

understanding of the various functions involved in patient care

delivery, and the ability to interact effectively with a diverse health

care team. Demonstrates knowledge and expertise pertaining to APN

employment, credentialing and clinical practice. Serves as a mentor

and monitors work to include clinical standards of practice, polices

and regulatory standards. Influences others to improve care and

provides feedback on fellow APNs’ work performance. Required

experience may include progressive leadership responsibilities, such

as serving on local committees, workgroups or taskforces. The Lead

APN represents the interests of the APN profession and serves as a

liaison for professional APN practice.

(b) APN Facility Education Lead or Residency Program Director.

APN Facility Education Leads or APN Residency Program Directors

are responsible for the management, structure and administration of

the APN clinical trainee program. Ensures programs comply with VA

Office of Academic Affiliation standards and accrediting bodies of

sponsoring affiliated institutions while activities are being held at VA

facilities. Develops, implements and enhances APN clinical education

training programs. Required experience may include one or more of

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the following educational assignments: precepting APNs or medical

students, setting up continuing education for local VHA APNs,

participating in community health events, serving as an APN assistant

or coordinator in a VHA residency program or stipend program and

serving as a member or staff of an academic APN program.

Clinical/Administrative APN Leaders are engaged with strategic

planning and administrative/managerial responsibilities for integrated

programs that cross service and/or discipline lines and influence

organizational mission and health care. Monitors or evaluates

services or programs with interaction of senior administration.

Required experience may include one or more of the following:

leadership assignments that involved formulating program objectives

and priorities, implementing plans and practices and interpreting

regulatory and organizational guidance to develop and implement

policies and/or procedures.

(2) Nurse V. APN positions at this grade may include but are not limited

to: APN Service Chief/Service Line Executive, APN VISN Program

Manager/Lead, APN Central Office Executive/Lead or administrative

clinical leadership positions of an executive nature, comprised of complex

leadership and administrative components, associated with critical health

care issues and activities that influence agency or organizational mission,

health care, and policy.

(a) APN (Service Line Executive). APN (Service Line Executive)

manages a complex multi-disciplinary service line providing direct

oversight to program operations. Provides leadership, direction, and

guidance on all aspects of the program(s). Coordinates with network

and facility executives in developing and establishing the long and

short-range organizational goals for the program(s), ensuring

organizational goals and policies are aligned with Medical Center,

VISN, and national goals. Evaluates, develops, coordinates,

implements, and improves program operations. Manages the overall

service budget, to include determining resource needs, allocating

resources, and ensuring proper utilization in productivity, efficiency,

and cost effectiveness of operations. Responsible for clinical practice,

program management, education and personnel management.

Establishes and maintains effective interpersonal relationships at all

organizational levels. Manages healthcare system staff to perform the

functions and activities expected. Interprets and applies national

policy, as well as leads policy-making activities for the program(s).

Forecasts technological changes, analyzes current and projected

utilization patterns/workload/staffing and cost comparisons to provide

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feedback and recommendations to executive leaders. Exhibits

leadership that reflects current standards and expectations provided

by VHA Central Office (VHACO). Required experience may include

assignments that involved directing and evaluating complex patient

care or administrative programs, services or operations for a

healthcare system or at multiple sites. The assignments would have

required planning, organizing and assessing healthcare services or

programs; implementing national initiative and organizational targets;

developing long and short-term program goals, and analyzing

developing options; and implementing solutions to health care

operational or administrative problems.

(b) APN (VISN Program Manager/Lead). APN (VISN Program

Manager/Lead) manages one or more large, complex patient care or

administrative programs across one or more VISNs. Responsible for

the program(s) and significantly influences overall functioning of the

program(s) throughout the VISN(s). Provides leadership, direction,

and guidance on all aspects of the program(s). Coordinates with

network and facility executives in developing and establishing the

long and short-range organizational goals for the program(s), ensures

organizational goals and policies are aligned with VISN and national

goals. Evaluates, develops, coordinates, implements and improves

program operations within the VISN(s). Manages the overall budget

for the program VISN-wide, to include determining resource needs,

allocating resources, and ensuring proper utilization in productivity,

efficiency, and cost effectiveness of operations. Responsibility for

clinical practice, program management, education and human

resources management of the program. Establishes and maintains

effective interpersonal relationships with all levels of stakeholders at

the facility, network or beyond. Interprets and applies national policy,

as well as develops VISN-wide supplemental guidance regarding the

program(s). Assist in policy-making activities and the overall

functioning of administrative and clinical programs. Collaborates with

other staff to establish and maintain programs that cross service

and/or discipline lines and influence organizational mission and

health care. Utilizes forecasts of technological changes, utilization

patterns, future workloads, staffing projection, and cost comparisons

to provide feedback and recommendations to VISN leadership that

reflects current standards and expectations provided by VHACO.

Required experience may include assignments that involved directing

and evaluating complex patient care or administrative programs,

services or operations for a healthcare system or at multiple sites.

The assignments would have required planning, organizing, and

assessing healthcare services or programs; implementing national

initiative and organizational targets; developing long and short-term

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program goals and analyzing developing options, and implementing

solutions to health care operational or administrative problems.

Program Executive/Lead) manages a national VHA program or

programs and provides overall administration of all aspects of the

program(s) throughout VHA, to include planning, directing, and

executing the program(s). Analyzes and develops program specific

plans, programs and budgets for a national program office. Provides

leadership and direction for the assigned program(s) that significantly

impacts the overall functioning of the program(s) VHA-wide, to

include ensuring the program(s) meet VA mission requirements.

Develops succession plans, monitors trending program data and

academic preparation for the profession(s). Develops national

policies, directives, informal letters, white papers, and other guidance

regarding the program(s). Coordinates and collaborates with Federal

and state regulatory agencies, national program offices such as

Regulatory Affairs, Legislative Affairs, and General Counsel when

developing national policies, procedures, and operations for the

program(s). Provides agency-level interpretation and clarification of

national policies and directives. Writes or provides technical reviews

of proposed legislation regarding the program for the agency.

Responds to Congressional offices and other high-level inquiries from

internal and external organizations related to the program(s) and/or

program office. Required experience may include assignments which

involved directing and evaluating complex patient care or

administrative programs, services or operations for a healthcare

system or at multiple sites. The assignments would have required

planning, organizing, and assessing healthcare services or programs;

implementing national initiative and organizational targets; developing

long and short-term program goals; and analyzing developing

options, and implementing solutions to health care operational or

administrative problems.]

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APPENDIX H6. PROCEDURES FOR APPOINTING [ADVANCED PRACTICE NURSE

(ANESTHETISTS)] TO SECTION CHIEF POSITIONS

1. SCOPE. This appendix covers the appointment of nurse anesthetists as Chief of the

Nurse Anesthesiology Section. It does not apply to those in an “acting” capacity.

2. PROCEDURES.

a. When a position becomes vacant, the facility will initiate recruitment (where

appropriate) and contact the Deputy Director for Nurse Anesthetists, VA

Anesthesiology Service, who may recommend additional candidates for

consideration.

b. Candidates are screened, interviewed, and tentatively selected by the

appropriate facility official.

c. The facility chief of staff or designee is to discuss the proposed selection with

the Deputy Director for Nurse Anesthetists who has five working days to make

comments or recommendations concerning the proposed selection.

d. The recommendation is forwarded through channels to the facility Director for

consideration. Recommendations are to include the comments of the Deputy

Director for Nurse Anesthetists. [ ]

NOTE 1: Communications with program officials need not be in a formal written

format.

NOTE 2: Facility officials are to maintain documentation regarding their

recruitment process. Documentation will include:

• A summary of any comments from Central Office program officials regarding

the recommended candidate; and

• If the position is advertised and a noncitizen candidate is selected,

the names of all citizen applicants and the reason(s) why the citizen

applicants were not qualified for the position.

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[ ]

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APPENDIX H8. PROCEDURES FOR APPOINTING CHIEFS OF PHARMACY

SERVICE (ALL GRADES) [ ]

1. SCOPE. This appendix covers appointment of all Chiefs of Pharmacy Service [ ]. It

does not apply to those in any of these positions in an “acting” capacity.

2. PROCEDURES [FOR CHIEFS OF PHARMACY SERVICE].

[ ].

a. Recruitment efforts are initiated. [ ] Candidates are interviewed, screened, and

tentatively selected at the facility.

b. The Chief of Staff or designee discusses the proposed selection with Pharmacy

Benefits Management Strategic Health Group (119), which has five working

days to comment or make recommendations concerning the proposed selection.

c. The appropriate facility official recommends the selection to the facility director. [

] The facility director approves or disapproves the action.

d. The facility notifies the Pharmacy Benefits Management Strategic Health Group

and the Network Director of the selection.

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APPENDIX H9. PROCEDURES FOR APPOINTING OCCUPATIONAL AND

PHYSICAL THERAPISTS AS SECTION CHIEF

1. SCOPE. This appendix covers the appointment of occupational and physical

therapists to section chief positions. It does not apply to those in an acting capacity.

2. PROCEDURES.

a. Local recruitment efforts are initiated by the facility.

b. The service chief or equivalent screens and interviews candidates.

c. The service chief or equivalent forwards the recommended candidate through

channels to the facility director for consideration. [ ]

d. The facility director approves or disapproves the action.

[ ]

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APPENDIX H10. PROCEDURES FOR APPOINTING AND ADVANCING DOCTORS

OF CHIROPRACTIC

1. SCOPE. This appendix establishes procedures for the appointment and

advancement of all doctors of chiropractic in VHA.

2. APPOINTMENT PROCEDURES.

a. The facility initiates recruitment procedures and contacts the VHA Director of

Chiropractic Service, who may recommend additional candidates for the

position.

b. The appropriate facility officials screen, interview, and tentatively select a

candidate for the position.

c. [The] facility Chief of Staff or designee discusses the proposed selection with the

VHA Director of Chiropractic Service who has five working days to make

comments or recommendations concerning the proposed selection.

d. [The] recommendation is forwarded to the facility director for consideration.

Recommendations are to include the comments of the VHA Director of

Chiropractic Service. [ ]

e. [The] facility director will approve or disapprove the recommendation for

appointment.

f. The facility advises the VHA Director of Chiropractic Service of the selection.

NOTE 1: The Director of Chiropractic Service may be contacted through the VA

Connecticut Healthcare System as follows:

Director, VHA Chiropractic Service

VA Connecticut Healthcare System

950 Campbell Avenue

Mail Stop 111D

West Haven, CT 06516

[ ]

NOTE 2: The facility must maintain documentation regarding the recruitment

process that was used to solicit applications. This documentation will include:

• A summary of any comments from VHA Central Office Director of

Chiropractic Service regarding the recommended candidate;

• Copies of any paid advertisement that may have been done; and

• If the position is advertised and a noncitizen candidate is selected,

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the names of all citizen applicants and the reason(s) why the citizen

applicants were not qualified for the position.

NOTE 3: Additional program information covering chiropractors may be obtained

through the Director of Chiropractic Service or the VHA Chiropractic Service.

[ ]

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CHAPTER 4. TITLE 38 AND HYBRID TITLE 38 PROMOTIONS AND INTERNAL

PLACEMENTS

SECTION A. PROMOTION OR CHANGE IN ASSIGNMENT AND INTERNAL

PLACEMENT OF TITLE 38 EMPLOYEES

1. GENERAL.

a. This section contains instructions and procedures governing the advancement of

podiatrists, optometrists, chiropractors, registered nurses (RNs), advanced

practice nurses (APNs), physician assistants (PAs), and expanded-function

dental auxiliaries (EFDAs) appointed under authority of 38 U.S.C. §§ 7401(1) or

7405(a)(1)(A); and medical and dental residents appointed under authority of

38 U.S.C. § 7406.

NOTE 1: Residents serving under a disbursement agreement are excluded from

coverage under the provisions of this section.

NOTE 2: VHA physicians and dentists are excluded from coverage for

promotion procedures as described in this section. See VA Handbook 5007, Pay

Administration, Part IX, for guidance for pay regulations and procedures.

NOTE 3: Promotions for occupations covered under 38 U.S.C. § 7401(3) can be

found in, Section B of this part.

b. The promotion system shall provide advancement opportunities for employees,

predicated upon the recognition of the quality of service rendered, additional

experience and professional attainment as determined by a thorough review of

the employee’s individual record.

c. To meet the criteria for promotion, the individual must meet the criteria for the

next higher grade level in the applicable VA qualification standard. A review of

the individual’s total record must show evidence that the contribution to VA

medical service is of sufficient value to warrant promotion. Potential for

continuously greater contribution is also a prerequisite. Reviews and

recommendations of [supervisory officials] will be sufficient to ensure that

promotion is fully merited and not recommended based on meeting

administrative requirements alone. The individual’s total record and professional

stature will be carefully evaluated and supported by documentary evidence as

necessary.

d. Promotion actions will be taken without regard to age, race, color, religion, sex,

national origin, lawful partisan political affiliation, marital status, physical or

mental disability (when the employee is qualified to do the work), membership or

non-membership in a labor organization or any other non-merit factor.

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e. Promotion actions will conform to the restrictions governing the employment of

relatives. (See VA Handbook 5025, Legal.)

[ ]

2. [RESPONSIBILITIES.

a. Human Resources (HR) Staff.

(1) Before recruitment is initiated, work in collaboration with the supervisor to

determine the eligibility and qualifications requirements that pertain to the

assignment and grade level for the position to be filled in accordance with

the qualification standards found in VA Handbook 5005, Part II,

Appendices G. If the supervisor is not a subject matter expert in the

profession, the supervisor must consult with the subject matter expert

throughout the recruitment and onboarding process for the vacant position.

(2) Determine eligibility and qualifications in accordance with standards found

in VA Handbook 5005, Part II, Appendices G.

(3) Recommend the appropriate grade to the selecting official for

appointments, promotions, reassignments and changes to lower grades.

(4) Document qualification determinations for each applicant by completing a

separate VHA qualification form for each applicant.

(5) Consult with the profession’s subject matter expert during the development

of the assignment, recruitment and onboarding of the selected candidate.

(6) Notify candidates who fail to meet the requirements and fail to qualify for

appointment.

(7) Process requests for appointments, promotions, reassignments and

changes to lower grades.

b. Supervisory Official.

(1) Obtain approval to fill a vacant position in accordance with local

procedures.

(2) Initiate recruitment action with the servicing HR Office.

(3) Review application packages referred for selections.

(a) Supervisors who are not subject matter experts must consult a

subject matter expert when evaluating applications. This may take the

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form of a panel or consultation with the subject matter expert for the

profession.

(b) Supervisors who are subject matter experts at or below the grade

being filled must consult with the profession’s subject matter expert

that is at the grade or higher.

(4) Consult with HR staff and the profession’s subject matter expert (if

applicable).

(5) Submit supporting documentation for utilization of pay setting flexibilities (if

applicable) found in VA Handbook 5007, Pay Administration, Part II,

Chapters 2, 3 and 4, pertaining full and hybrid title 38 positions.

(6) Make or review requests or recommendations for promotions.]

3. PROMOTION.

a. This section contains instructions and procedures governing the promotion of

employees appointed under 38 U.S.C. §§ 7401(1) and 7405(a)(1)(A). Promotion

is an advancement to a higher grade level and recognizes that an employee is

providing a higher level of service to VA.

b. The promotion system shall provide advancement opportunities for employees,

predicated upon the recognition of the quality of service rendered, additional

experience and professional attainment as determined by an examination of the

employee’s individual record.

c. To meet the criteria for promotion, the individual must meet the criteria for the

next higher grade level in the qualification standard. Examination of the

individual’s total record must reveal evidence that the contribution to VA medical

service is of sufficient value to warrant promotion. Potential for continuously

greater contribution is also a prerequisite. Reviews and recommendations of

supervisors and HR staff will be sufficient to ensure that promotion is fully

merited and not recommended based on meeting administrative requirements

alone. [ ].

4. PROMOTION – GENERAL.

a. Administrative Requirements for Consideration.

(1) A current proficiency rating or Executive Career Field (ECF) rating of

“Satisfactory/Successful” or higher.

(2) The experience, education and assignment requirements set forth in the

qualification standard. Employees must meet the same grade

requirements, including the specified demonstrated accomplishments, as

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for appointment. Any deviation or exception to these requirements will be

limited to those specified in the qualification standard.

b. Promotions Based on Additional Experience and/or Education. Promotions

based solely on additional experience acquired by the employee shall be limited

to advancements of one grade or grade interval at a time. If an employee has

attained a higher level of education that, when combined with their additional

experience, is qualifying for a grade higher than the next grade or grade interval,

the employee may be promoted to whatever grade in the qualification standard

the additional education warrants.

5. PROMOTION CONSIDERATION.

a. Eligibility. Full-time, part-time and intermittent employees shall be considered

periodically for promotion in their current occupation. Eligibility for such

promotion considerations shall be based upon fully meeting prescribed

administrative requirements.

(1) Approximately 60 days prior to the date the employee meets the required

period for promotion consideration, HR Officers will notify the appropriate

supervisory officials that the employee is eligible for promotion

consideration to the next higher grade level. The supervisor will notify the

employee no later than 30 days prior to the employee’s anniversary date.

The employee shall then be given 30 days to submit to their supervisor a

self-assessment of their qualifications for promotion consideration.

Employees may also notify their supervisor in writing that they are declining

to submit a self-assessment during this 30-day period. If this is done, the

supervisor will proceed with a recommendation. If a self-assessment or

declination is not submitted the supervisor will proceed with the

recommendation at the end of the 30-day period.

(2) The supervisory official will review the duties of the position. If the

supervisor is not an occupational subject matter expert or they are

considering an employee for a grade higher than occupied by the

supervisor, the supervisor must consult with a subject matter expert when

considering promotion eligibility. The supervisory official must determine

whether the duties being performed meet the definition of a higher level

assignment within the qualification standard. The supervisory official must

also take into consideration the information provided in the employee’s

self-assessment, if provided. Supervisors are to apply position

management and make sound management decisions. The process and

action taken for promotion is to be documented using VHA Form “Request

for T38 Promotion”.

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b. Promotion to “Person” Based Grades not Specific to an Assignment.

(1) Promotions to grades based exclusively on the qualifications of a “person”

and not specific to a grade level based on assignment, will be on the

recommendation of the immediate supervisor, with a recommendation of

approval by the second level supervisor and personnel action approved by

HR Officer. Upon receipt of the employee's self-assessment or written

declination or expiration of the 30-day time period, the immediate

supervisor will make a recommendation on promotion to the second level

supervisor. The immediate supervisor’s recommendation] is to be acted

upon by the second level supervisor within 30 days of the submission of

the self-assessment or written declination by the employee or expiration of

the 30-day time whichever comes first.

(2) Employees who have demonstrated the capability to successfully perform

at the next higher-grade level will be recommended for promotion. (NOTE:

Anniversary date of grade for Nurse I is based on advancement to a higher

level within the grade.)

(3) Employees who have not demonstrated such capability will be informed in

writing by the immediate supervisor that they are not being recommended

for promotion. The written notice will state the reason(s) why the employee

does not meet the criteria for promotion. The immediate supervisor may

recommend the employee for promotion at a later date if it is determined

that the employee has met the appropriate criteria. If not promoted during

the intervening period, the employee is entitled to promotion consideration

on the next anniversary date of grade. Employees who are not promoted

may request promotion reconsideration under paragraph 6 below.

c. Promotion to Grades Specific to an Assignment.

(1) Employees who are selected for a position and grade that requires a

combination of personal qualifications and assignment characteristics must

meet the administrative requirements for promotion.

(2) Promotions to positions based on a combination of personal qualifications

and assignment characteristics will become effective on the first day of the

first full pay period following approval by the approving official, unless a

future date set by the approving authority and at the election of the

employee when doing so would benefit the employee (i.e., an employee is

due a within grade increase), and that does not violate law or negotiated

agreement.

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6. PROMOTION RECONSIDERATION AND REVIEW.

a. Coverage. This paragraph applies to individuals appointed under

38 U.S.C. §§ 7401(1) or 7405(a)(1)(A).

b. Notice of Decision. Employees are to be advised by their supervisors in writing

of any decision not to promote them, of the reason(s) for the decision, of their

right to request reconsideration and that reconsideration must be preceded by

an informal discussion with their supervisor.

c. Informal Discussion. Employees and their supervisor must meet to discuss the

recommendation not to promote prior to the employee submitting a request for

reconsideration under paragraph d below.

d. Reconsideration Requests.

(1) To “Person” Based Grades not Specific to an Assignment

(a) If promotion to a “person” based grade that is not assignment based,

the employee may, within 30 days of being notified of the decision,

submit a written request through the immediate supervisor to the

second level supervisor for reconsideration. The employee’s written

request for reconsideration must indicate when the informal

discussion was held with the immediate supervisor and cite the

specific reason(s) why the employee believes the decision was not

proper. The [facility] director, network director or appropriate higher-

level designee (whichever is applicable), may extend the 30-day

period at the written request of the employee if the employee is

unable to submit the information for reasons beyond the employee’s

control.

(b) Second level supervisors are to review the employee’s request within

30 days and determine whether to promote the employee. If the

second level supervisor determines that a promotion is not warranted,

that supervisor will provide the reasons for this decision to the

employee in writing.

determination to not promote, the employee can request within 30

days to have the determination reviewed and recommendation made

by the next higher-level manager. The employee’s request for

reconsideration and the supervisor’s explanation will be forwarded to

the next higher-level manager within 30 days.

(d) The next higher-level manager will make a recommendation within 30

days and submit through the servicing HR Office to the [facility]

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director, network director or appropriate higher-level designee

(whichever is applicable), who will make a final decision within 30

days.

(e) If the promotion is approved, the employee is to be promoted on the

first day of the first pay period following the anniversary date of grade

on which the promotion was based.

e. Action by Human Resources. Upon receipt of the reconsideration file, HR staff

shall take one of the following actions within 15 days:

(1) [ ] In no case, will the promotion be in effect later than the first day of the

first full pay period after the anniversary date of grade on which the

promotion was based.

(2) If disapproved, HR staff will notify the employee of the decision in writing.

7. COVERAGE AS EMPLOYEE GRIEVANCE. Requests for promotion

reconsideration are excluded from the Agency Grievance Procedure. See VA

Handbook 5021, Employee/Management Relations, Part IV, Chapter 3, paragraph

16. Promotion reconsideration decisions are excluded from the negotiated grievance

procedure pursuant to 38 U.S.C. § 7403(f)(1)(B). The decision of whether or not to

promote a bargaining unit employee is not subject to the negotiated grievance

procedure but a failure on the part of the agency to follow the

promotion/reconsideration procedure in this policy may be.

8. EFFECTING ADVANCEMENT AND PROMOTION ACTIONS.

a. Effective Date.

(1) Promotion (to include advancement to a higher level within a grade) based

on entitled anniversary date of grade reviews, will be made effective by the

HR Officer on the first day of the pay period following the anniversary date

of grade on which the promotion was based. A promotion may also be

made effective at a future date set by the approving authority and at the

election of the employee, that does not violate law or negotiated agreement

when doing so would benefit the employee (i.e., an employee is due a

within grade increase). Promotion recommendations and actions that are

administratively delayed beyond the time limits specified in paragraphs 6

above will be made retroactive. All other promotion actions will be made

effective the first date of the first pay period after approval of the promotion.

(2) If an employee becomes eligible for promotion while on LWOP for

purposes for which they have a statutory entitlement to receive promotion

consideration (e.g., military service, OWCP), no action will be taken until

the employee returns to duty. If the employee, on return to duty meets all

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the requirements for promotion consideration, he or she will be considered

for promotion as if he or she had been continuously employed in the

position.

NOTE: See chapter 6, this part, for effecting promotion actions upon return

from military service.

9. [TEMPORARY PROMOTIONS].

a. An employee may be temporarily promoted to a higher graded position where

the grade of the position is based on the complexity of the assignment. The

employee must meet the administrative and qualification requirements for

promotion and such promotions are to be processed using the procedures in

paragraphs 2 and 3 above.

b. On expiration or termination of the promotion, the grade and salary of the

employee will be adjusted in accordance with the provisions of VA Handbook

5007, Pay Administration. In applying the provisions of this handbook, the salary

will be adjusted to the salary held previously, unless a higher rate is warranted

by reason of periodic step increases. On assignment, the following statement

will be placed in the “Remarks” item of the SF 50-B, Notification of Personnel

Action: “Employee informed of conditions of temporary grade promotion.”

10. [OTHER GRADE CHANGES].

a. Change to Lower Grade.

(1) General. As provided by 38 U.S.C. § 7403(e) where an employee’s grade

level and salary are based on both the nature of the assignment and the

employee’s personal qualifications and the assignment is subsequently

changed, the grade and salary may be adjusted as appropriate. Such

action may be taken by the Under Secretary for Health or designee for Title

38 employees in centralized assignments and by the facility director for all

Title 38 employees in noncentralized assignments. The facility director may

delegate the authority to the chief of staff, associate director, nurse

executive, and pharmacy chief for occupations under their respective

purview.

(2) Title 38 employees. Employees appointed under authority of

38 U.S.C. § 7401(1) and permanent part-time employees appointed under

38 U.S.C. § 7405 (a)(1)(A) who are placed in a lower grade for reasons

other than cause or at the employee’s request will have their pay set at the

lowest step of the lower grade which equals or exceeds their existing rate

of basic pay. If there is no such step, employees are entitled to pay

retention.

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(a) Assignment Change. If an employee is [involuntarily] placed in a

different assignment which does not warrant the employee’s current

grade level, the employee will not be eligible for grade retention. The

employee’s entitlement to pay retention will be determined in

accordance with VA Handbook 5007, Pay Administration.

(b) Assignment Change for Cause or at the Employee’s Request. If

an employee is changed to an assignment which does not warrant

the employee’s current grade level for cause or at the employee’s

request, the employee is not eligible for grade or pay retention.

NOTE: Directed transfers or reductions in grade approved under this

paragraph will not be considered adverse actions under

38 U.S.C. § 7461, provided they are not based on charges related to

conduct or performance. The actions are, however, grievable under

the provisions of VA Handbook 5021, Employee/Management

Relations.

[ ]

11. DETAILS, TEMPORARY CHANGE IN ASSIGNMENT, TEMPORARY

REASSIGNMENTS, AND TEMPORARY PROMOTIONS FOR TITLE 38

EMPLOYEES APPOINTED UNDER 38 U.S.C. §§ 7401(1), 38 U.S.C. 7401(3), AND

38 U.S.C. 7405.

a. Details. When a title 38 or hybrid title 38 position is vacant, the facility director

may detail another title 38 or hybrid title 38 employee to the position. Generally,

details will not exceed 1 year and may be terminated prior to the expiration date.

The facility director may approve extensions of the detail when circumstances

warrant.

b. Temporary Change in Assignment. Individuals paid from physician and dentist

pay schedules may receive a market pay adjustment and/or tier change after

serving in the assignment for 60 days or more. Generally temporary change in

assignment will be for a period not to exceed one year and may be terminated

prior to the expiration date. The facility director may approve the extension of a

temporary change in assignment not to exceed 1 additional year when

circumstances warrant. On expiration or termination of the temporary

assignment, the market pay and/or tier of the employee will be adjusted in

accordance with the provisions of VA Handbook 5007, Pay Administration. Upon

change in assignment, the following statement will be placed in the “Remarks”

item of the SF 50-B, Notification of Personnel Action: “Employee informed of

conditions of temporary [tier] assignment.”

c. Temporary Promotions. If an individual is temporarily reassigned to a higher

grade [assignment], the facility director may temporarily promote the individual.

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III-50

Such action will be taken only after the facility director considers the

recommendation of the [supervisor]. Generally, temporary promotions will be for

a period not to exceed one year and may be terminated prior to the expiration

date. The facility director may approve the extension of a temporary promotion

not to exceed 1 additional year when circumstances warrant. On expiration or

termination of the temporary promotion, the grade and salary of the employee

will be adjusted in accordance with the provisions of VA Handbook 5007, Pay

Administration. On approval of the temporary promotion, the following statement

will be placed in the “Remarks” section of the SF 50-B: “Employee informed of

conditions of temporary promotion.”

NOTE: In accordance with VA Handbook 5005, Part III, Appendix N, the

utilization of title 38 employees in competitive civil service positions is prohibited,

unless approved by the Office of Personnel Management.

12. [OTHER GRADE CHANGES OR CHANGE IN ASSIGNMENT].

a. Change to Lower Grade or Changes in Assignment

(1) General. As provided by 38 U.S.C. § 7403(e), where an employee’s grade

or tier level and salary are based on both the nature of the assignment and

the employee’s personal qualifications, and the assignment is

subsequently changed, the grade and salary may be adjusted as

appropriate.

(2) Key Nursing Personnel [ ] in Nurse IV and V Whose Grade is Based on

Both Their Personal Qualifications and Responsibilities of Their

Assignment.

(a) Placement in a Lower Grade for the Good of VA. Employees

placed in a lower grade for reasons other than cause or at the

employee’s request will have their pay set at the lowest step of the

lower grade which equals or exceeds their existing rate of basic pay.

If there is no such step, employees are entitled to pay retention.

(b) Voluntary Changes to a Lower Grade. Employees who take a

voluntary change to a lower grade may have their pay set at any step

of the grade that does not exceed their highest previous rate.

However, the employee is not eligible for pay retention, and, if the

employee changes facilities, the pay rates of the gaining facility shall

be applicable. The employee must submit a written request, through

channels, for the employment change. The employee’s signed

request is to be filed on the right side of the employee’s personnel

folder.

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b. Review of Assignments of Key Nursing Personnel [(Nurses Other Than

Nurse Executives) and APN (Certified Nurse Anesthetists)] in Nurse IV and

Above Whose Grade is Based on Both Their Personal Qualifications and

Responsibilities of Their Assignment.

(1) Facility directors or officials in Central Office may request review of an

assignment if they believe it no longer warrants the current grade; the

assignment cannot be restructured within the requesting official’s scope of

responsibilities; and the employee will not voluntarily accept a change to a

lower grade. The responsible program official will initiate such a review if

there has been a significant change in the assignment or an accretion or

erosion of responsibilities suggests that the assignment would be more

appropriately placed in a different grade.

(2) Recommendations related to [RN and APN assignments] will be sent to the

Office of Nursing Services. Those related to [APN (CNA)] assignments will

be sent to the Central Office [ ] Office of Patient Care Services. If it is

determined that the grade is inappropriate, the correct grade will be

identified, and the following action will be taken:

(a) Any promotion or advancement will be effected on the first day of the

first pay period following the approving official’s determination.

(b) If the Central Office program official determines that the current grade

is no longer warranted:

i The facility’s request is forwarded to the Assistant Deputy Under

Secretary for Health (10N). This office will attempt voluntary or

involuntary placement of the employee in a more appropriate

assignment. If no placement opportunities are available, the

request will be returned to the facility.

ii The requesting official shall reduce the employee to the

appropriate grade. Such employees are eligible for pay retention.

NOTE: Directed transfers or reductions in grade approved under

this paragraph will not be considered adverse actions under 38

U.S.C. § 7461, provided they are not based on charges related to

conduct or performance. The actions are, however, grievable

under the provisions of VA Handbook 5021,

Employee/Management Relations.

[ ]

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CHAPTER 5

III-66

CHAPTER 5. CONVERSIONS OR CHANGE IN ASSIGNMENTS (TITLE 38)

1. Change in assignment for physicians and dentists will be processed by a

Compensation Panel. (See VA Handbook 5007, Pay Administration, Part IX.) All

personnel actions changing an employee from one type of appointment to another

under authority of 38 U.S.C., chapter 73 or 74 and not involving a break in service

will be processed as conversions except changes from or to fee-basis appointments

under authority of 38 U.S.C. § 7405(a)(2) and lump-sum fee-basis appointments of

consultants and attending’s under authority of 38 U.S.C. § 7405(a)(2), and without

compensation appointments under 38 U.S.C. § 7405(a)(1). These actions will be

processed as new appointments. Changes in grades or levels for employees on

time-limited appointments under 38 U.S.C. § 7405(a)(1) will be processed as

conversions.

NOTE: Conversion or change in assignment to another appointment giving the

employee fewer rights and benefits will not be made until the employee has been

advised in writing of the conditions of employment under the new appointment and

the employee has submitted a written resignation or other written evidence clearly

indicating voluntary separation from the previous employment.

2. UTILIZATION ON A FEE-BASIS.

a. Individuals who render service to VA on a fee-basis, such as employees paid

according to a schedule of fees or consultants or attending’s used by letter of

appointment (see part II, section G, this handbook) may not be converted to

appointments under the provisions of 38 U.S.C. §§ 7306, 7401(1), 7401(3), and

7405(a)(1). Fee-basis employees will be terminated prior to appointment under

these authorities.

b. Full-time, part-time or intermittent employees appointed under 38 U.S.C. §§

7306, 7401(1), 7401(3), or 7405(a)(1), may not be converted to utilization on a

fee-basis. An employee must resign or the appointment must be terminated prior

to rendering service on a fee-basis except for instances in which dual

appointment has been approved. (See part II, chapter 3, section A.)

3. ACTION BY [SUPERVISORY OFFICIAL OR COMPENSATION PANEL]

a. A [supervisor] will be responsible for making recommendations to the approving

authority concerning any conversion action to a probationary appointment under

38 U.S.C. § 7401(1) or servicing HR Office for those under 38 U.S.C. § 7401(3),

whichever is applicable, as well as RNs [or APNs] appointed part-time or

intermittent under 38 U.S.C. § 7405(a)(1), and on any conversion involving a

change in grade and/or step rate within the grade.

b. No [additional action] will be required on conversion from an appointment under

38 U.S.C. §§ 7401(1), 7401(3) or 7405(a)(1) for individuals appointed as part-

VA Handbook 5005/161 January 29, 2024

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III-66

time or intermittent RNs [or APNs], provided the employee has previously

acquired permanent status under 38 U.S.C. §§ 7401(1) or 7401(3) or completed

a probationary period under 38 U.S.C. § 7405(a)(1) for individuals appointed as

part-time or intermittent RNs [or APNs], as appropriate, and has had continuous

service under 38 U.S.C., chapter 73 or 74 since acquiring such status.

c. The [supervisor] will determine that the employee’s past and expected future

performance and physical, mental and emotional ability warrants the change in

employment status. [ ]

d. The Compensation Panel will document any change in assignment on VA Form

10-0432a, Compensation Panel Action, along with a recommendation to the

approving official.

4. APPROVAL AUTHORITY. All conversion actions or change in assignments may be

approved by the facility director except those involving a change in grade or step

rate or tier level for which the approving authority is vested in Central Office or where

Central Office approval is specifically required.

5. PROCESSING REQUIREMENTS.

a. Personnel actions necessary to effect conversions to appointments or change in

assignments under 38 U.S.C., chapter 73 or 74 generally will be effective the

first day of the pay period following approval of the conversion or change in

assignment except where otherwise specified. When necessary, in order to

prevent a break in service caused by the expiration of an appointment prior to

the first day of the next pay period, the action may be made effective the first

day following the expiration of such appointment.

b. The nature of action will indicate conversion or change in assignment to an

appropriate excepted appointment under the authority of 38 U.S.C., chapter 73

or 74. For individuals converted to an appointment under 38 U.S.C. § 7401(1),

as well as individuals converted to an appointment as a part-time or intermittent

RN [or APN] under 38 U.S.C. § 7405(a)(1), the “Remarks” section of the SF 50-

B will, when appropriate, state “Appointment subject to probationary period of 2

years.” When appropriate, it will also show the amount of any prior service which

is creditable toward completion of the required probationary period or a remark

that the probationary period was completed.

c. A new application is not required for conversions or change in assignments

when one is already on file and VA Form 10-2850, 10-2850a, or 10-2850c is not

specifically required.

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6. CONVERSION OR CHANGE IN ASSIGNMENTS TO APPOINTMENT UNDER 38

U.S. C. § 7401(1) FROM APPOINTMENT UNDER 38 U.S.C. § 7306. Employees

serving under 38 U.S.C. § 7306 appointments will notify the Under Secretary for

Health (10) if they desire full-time appointments under 38 U.S.C. § 7401(1). (See

part II, chapter 3, section A, this handbook.) [The supervisory official] will

recommend to the Under Secretary for Health the grade and rate of pay and type of

assignment which should be made on conversion. The Central Office Compensation

Panel for physicians and dentists will recommend a tier determination to the Under

Secretary for Health on changes in assignment. On approval of the [ ]

recommendation by the Under Secretary for Health, personnel action will be taken to

affect the conversion or change in assignment.

[ ]

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX J

III-J-1

APPENDIX J. DOCUMENTATION OF ADVANCEMENTS ON SF 50-B,

NOTIFICATION OF PERSONNEL ACTION

Category of

Employee

Appointmen

t Authority

Nature of Action

Legal

Authority

VA Required Remarks

Podiatrists,

Optometrists,

Chiropractors,

Registered

Nurses,

[Advanced

Practice

Nurses],

Physician

Assistants,

and

Expanded-

Function

dental

Auxiliaries [ ]

38 U.S.C. §

7401(1)

“Promotion”

“Pay

Adjustment”

Promotion” or

“Change to

Lower Grade,”

as appropriate

“Change to

Lower

Grade”

38 U.S.C.

§7403

“Special Advancement for

Performance”

“Grade Adjustment. For

consistency with

(promotion requirements).”

Will be shown for

promotion grade

adjustments.

“Grade Adjustment. For

consistency with (duty

assignment).” Will be shown

when employee changed

from level of assignment

where grade is based on

both nature of assignment

and personal qualifications.

“Pay Adjustment”

“Special Advancement for

Achievement”

“Pay Adjustment”

Use when a Nurse I is

advanced to a higher

level within Nurse I

grade.

Podiatrists,

optometrists,

chiropractors,

registered

nurses,

[advanced

practice

nurses],

physician

assistants, and

expanded-

function dental

auxiliaries [ ]

38 U.S.C. §

7405(a)(1)

(A)

“Promotion”

“Pay

Adjustment”

“Promotion” or

“Change to

Lower Grade,”

as appropriate

“Change to

Lower

Grade”

38 U.S.C. §

7405(b)

“Special Advancement for

Performance”

“Grade Adjustment. For

consistency with

(promotion requirements).”

Will be shown for

promotion grade

adjustments.

“Grade Adjustment. For

consistency with (duty

assignment

).” Will be shown

when employee changed

from level of assignment

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX J

III-J-2

where grade is based on

both nature of assignment

and personal qualifications.

“Pay Adjustment”

“Special Advancement for

Achievement”

“Pay Adjustment”

Use when a Nurse I is

advanced to a higher level

within Nurse I grade.

Applicable to part- time or

intermittent appointments

without time limitations.

Medical

38 U.S.C. §

“Promotion”

38 U.S.C. §

and dental

7406

residents

Career

Residents

38 U.S.C. §

7406

“Promotion”

38 U.S.C. §

7406

“Special Advancement for

Performance” or “Special

Advancement for

Achievement”

“Pay Adjustment”

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX J

III-J-3

DOCUMENTATION OF ADVANCEMENTS ON SF 50-B,

NOTIFICATION OF PERSONNEL ACTION (CONTINUED)

Category of

Employee

Appoint

ment

Authori

Nature of Action

Legal

Authority

VA Required Remarks

All Hybrid

Occupations

38 U.S.C.

7401(3)

“Promotion”

38 U.S.C. §

7403

“Pay Adjustment”

“Special Advancement for

Performance”

“Promotion”

or “Change

to Lower

Grade,” as

appropriate

“Grade Adjustment. For

consistency with (promotion

requirements).” Will be shown

for promotion grade

adjustments.

“Change to

Lower

Grade”

“Grade Adjustment. For

consistency with (duty

assignment).” Will be shown

when employee changed from

level of assignment where grade

is based on both nature of

assignment and personal

qualifications.

“Pay Adjustment”

“Special Advancement for

Achievement”

All Hybrid

Occupations

38 U.S.C.

7405(

a)(1)

(B)

“Promotion”

“Pay Adjustment”

38 U. S. C. §

7405(b)(2)

“Special Advancement for

Performance”

“Promotion”

or “Change

to Lower

Grade,” as

appropriate

“Grade Adjustment. For

consistency with (promotion

requirements).” Will be shown

for promotion grade

adjustments.

“Change to

Lower

Grade”

“Grade Adjustment. For

consistency with (duty

assignment).” Will be shown

when employee changed from

level of assignment where grade

is based on both nature of

assignment and personal

qualifications.

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX J

III-J-4

“Pay Adjustment”

“Special Advancement for

Achievement”

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Part III

APPENDIX K

III-K-1

APPENDIX K. PROMOTIONS, ADVANCEMENT TO A HIGHER LEVEL WITHIN THE

GRADE OR CHANGE IN ASSIGNMENTS APPROVED BY THE UNDER

SECRETARY FOR HEALTH OR A DESIGNEE, NETWORK DIRECTORS AND

FACILITY DIRECTORS

NOTE: The term advancement in this appendix refers to advancement to a higher level

within the grade for [registered nurses (RNs) and advanced practice nurses (APNs)],

not special advancements for achievement or performance.

1. UNDER SECRETARY FOR HEALTH OR DESIGNEE.

NOTE: All actions affecting directors of medical and VISNs requiring

approval of the Under Secretary for Health or designee, will also require

the concurrence of the Under Secretary for Benefits.

a. Promotion of employees to positions centralized to the Under Secretary for

Health as outlined in VA Handbook 5005, Appendix G15 Chiefs of Pharmacy

Service to GS-15.

b. Promotion of VHA Central Office employees.

c. Promotion reconsideration requests from VHA Central Office employees.

d. Promotion reconsideration requests from RNs [and APNs] will be processed in

accordance with VA Handbook 5005, Part III, Chapter 4, Section A, paragraph

7d.

e. Promotion reconsideration for VISN employees.

2. NETWORK DIRECTORS.

a. Promotion of VISN employees.

b. Reconsideration requests for promotion or change in assignment from

employees at field facilities within the respective VISNs. This applies to all

occupations except RNs [and APNs].

c. Temporary change in assignments to chief of staff or comparable positions in

tier 4 for renewable periods not to exceed one year.

3. FACILITY DIRECTORS.

a. Promotion of employees to grades GS-13 and below and to GS-14 grade levels

as delegated by the Network Director.

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APPENDIX K

III-K-2

b. Promotion of Pharmacists. Facility directors may delegate to the Chief of

Pharmacy Service the promotion of pharmacists in noncentralized assignments

below GS-13, Assistant Chiefs of Pharmacy Service at GS-13.

c. Promotion of all other hybrids, which may be delegated to the chief of staff, the

associate director or nurse executive, as appropriate.

d. Promotion of Optometrists.

e. Promotion of Chiropractors.

f. Promotion of Podiatrists.

g. Change in assignment of Dentists (staff dentists, service chiefs, and positions

comparable to service chief).

h. Promotion of Expanded-Function Dental Auxiliaries.

i. Promotion of Physician Assistants [at PA IV and PA V, which may not be

delegated to the chief of staff or lead PA].

j. Change in assignments of Physicians.

k. Promotion or advancement to a higher level within the grade of APN (Certified

Nurse Anesthetists).

l. Promotion of Registered Nurses at Nurse III and below, which may be delegated

to the Associate Director for Patient Care Services or nurse executive.

m. Promotion of Registered Nurses at Nurse IV and Nurse V, which may not be

delegated to the Associate Director for Patient Care Services or nurse executive.

n. Reconsideration requests for promotion up to the full performance level from

employees appointed under 38 U.S.C. §§ 7401(3) or 7405(a)(1)(B) at field

facilities.

NOTE: When an employee on a time-limited appointment is advanced in grade

or level within the grade (Nurse I), those actions must be processed as a

conversion action after consideration by the appropriate approving official. Refer

to VA Handbook 5005, Part III, Chapter 5, paragraph 5.

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Part III

APPENDIX M

III-M-1

APPENDIX M. PROCESSING TITLE 38 PROMOTIONS AND ADVANCEMENTS

HOW TO PROCESS A PROMOTION FOR [ ] TITLE 38 HYBRID OCCUPATIONS

If full-time, part-time or

intermittent employee is in a

then take these steps for promotion up to the full

performance level

Hybrid title 38 occupation

Upon receipt of Notice of Pending Personnel Action, the

HR Office will forward the original to the employee’s

service chief. A duplicate copy will be retained in the HR

Office as a suspense copy.

The immediate supervisor will notify employee of

eligibility for promotion, and employee will be given 30

days to submit a self-assessment. The immediate

supervisor will make a formal promotion

recommendation to the approving official based on an

evaluation of employee’s self -assessment,

performance, experience, and/or education, as

appropriate. Recommendation will meet criteria

described in section B, chapter 4, this part. .

Upon concurrence of the promotion recommendation by

the approving official, the appropriate personnel action

will be prepared and submitted along with supporting

documentation to the HR Office. In no case will the

promotion be effected later than the employee’s

anniversary date unless a future date, set by the

approving authority and at the election of the employee

when doing so, would benefit the employee (i.e., an

employee is due a within grade increase), and that does

not violate law or negotiated agreement.

If promotion is not recommended, the immediate

supervisor will notify the employee in writing that they

are not being recommended for promotion. The written

notice will state the reason(s) why the employee does

not meet the criteria for promotion, the right to

reconsideration, and that requests for reconsideration

must be preceded by an informal discussion with their

supervisor. Reconsideration request procedures will

follow criteria described in paragraph 7 of chapter 4, this

part.

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX N

III-N-1

APPENDIX N. UTILIZATION OF TITLE 38 EMPLOYEES

(APPOINTMENT/ASSIGNMENT TO NON-CLINICAL DUTIES)

1. SCOPE. This appendix contains VHA policy on the assignment of non-patient care

duties to title 38 employees and when placement of title 38 employees in competitive

civil service positions is required; it establishes procedures for ongoing review of

these assignments; and it provides information on the conversion of title 38

employees to appointments under title 5 United States Code (U.S.C.). This appendix

sets forth VHA policy that title 38 employees are to be appropriately utilized.

2. POLICY. It is VHA policy that responsible officials assign title 38 employees duties

requiring clinical skills; that the utilization of title 38 employees in competitive civil

service positions is prohibited [(unless approved by the Office of Personnel

Management)]; and that positions which do not require clinical skills be placed in the

competitive civil service.

3. ACTION.

a. Network directors, facility directors and officials in VA Central Office are

responsible for:

(1) Ensuring that positions that require clinical knowledge, skills, and abilities

of an occupation covered by title 38 are not placed under title 5.

(2) Ensuring that positions that do not require the knowledge, skills, and

abilities of a health care professional are not removed from the competitive

civil service by placing a title 38 employee in the position. NOTE: Such

actions are contrary to title 5 U.S.C.§ 3302 and title 5 Code of Federal

Regulations (C.F.R.), part 1 (Civil Service Rule 1), and, in certain

instances, are considered a prohibited personnel practice as defined by

title 5 U.S.C. § 2302(b)(6).

(3) Controlling the degree to which title 38 employees are assigned duties that

do not require clinical skills. However, when such action is necessary,

these officials must ensure that:

(a) Staffing is sufficient to provide patient care, continuous quality

improvement, health care education, research, etc.

(b) The assignment of the non-clinical duties is consistent with good

position management principles. The provision of administrative

support services needs to be evaluated in a comprehensive manner

at the organization and position levels. For example, would putting

employees performing related non-clinical duties under the control of

clinical managers result in improved services? Positions can also be

reengineered so non-clinical responsibilities can be assigned to

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX N

III-N-2

competitive service employees, making more clinical staff available

for patient care services. Positions that involve a mixture of clinical

and non- clinical duties are to be evaluated to determine if title 38

employees might be used on a part-time, consultative, collateral or

rotational basis. Also, non-clinical duties assigned to title 38

employees are to be reduced to a minimum and assigned to title 5

employees.

routinely required to perform administrative or support functions that

do not require the services of a health care professional. This

includes title 38 employees assigned to evening, night, weekend, and

holiday tours of duty.

i Working with the chief of staff, nurse executive, HR Officer, and

other appropriate officials to apply the policies in this appendix

consistently throughout the organization. This includes reviewing

and bringing into conformance appointments or assignments

inconsistent with this appendix.

ii Converting positions that do not require clinical skills to the

competitive civil service, and either reassigning the incumbent title

38 employee or offering the employee the opportunity to voluntarily

convert to the competitive civil service using the Interchange

Agreement in appendix III-C. However, such conversion actions

must be based upon a [supervisor’s finding in collaboration with

profession’s SMEs and HR staff] finding that the position does not

require the services of a health care professional. Employees

requesting conversion must be advised, in writing, of the

implications of the decision on their pay and benefits (e.g.,

differences in leave accrual rates and, since conversion is

voluntary, these employees would not be eligible for pay retention).

In addition, new, current or converting title 5 employees who are

licensed in a title 38 occupation (e.g., M.D., R.N.) are to be advised

in writing that they are prohibited from engaging in professional

practice in their VA position. Copies of these statements are to be

placed on the left-hand side of the employee’s Merged Records

Personnel Folder. When employees are reassigned to patient care

positions, management must ensure that the employee’s

competencies and credentials (e.g., license) are current.

Reasonable measures must also be taken to reduce or eliminate

potential adverse effects on employees being reassigned. There

may be labor relations responsibilities to fulfill when an employee

is involuntarily reassigned from one bargaining unit position to

another. Managers are to consult with their labor relations advisor

to determine whether an obligation exists. NOTE: If the [finding

VA Handbook 5005/161 January 29, 2024

Part III

APPENDIX N

III-N-3

identifies that] the position requires a title 38 employee,

responsible officials are to evaluate the position to ensure it is

consistent with the criteria in preceding subparagraphs a (1) and a

(2).

b. Network directors, facility directors and officials in VHA Central Office cannot:

(1) Assign title 5 employees or former title 38 employees who have converted

to title 5 positions, any clinical responsibilities associated with a title 38

occupation. Such responsibilities can only be assigned to employees

appointed under title 38.

(2) Convert title 38 employees to title 5 positions to avoid pay limitations,

required waivers of qualification standards, competitive civil service

procedures, credentialing requirements or to circumvent provider-patient

ratios.

(3) Establish title 5 positions in the occupations listed in 38 U.S.C. 7401(1) or

(3).

4. FOLLOW-UP RESPONSIBILITY. The Director, Workforce Management and

Consulting (106A) is responsible for the contents of this appendix.