Comment from The Veteran Benefit Desk on VA-2026-VHA-0166-0001

Re: Public Comment on Expanding Access to State Prescription Drug Monitoring Programs RIN: 2900 AS73 Docket: VA 2026 VHA 0166, if applicable To the Department of Veterans Affairs: The Veteran Benefit Desk is a veteran founded educational resource at veteranbenefitdesk.com. We are not affiliated with VA, are not a law firm, and do not provide individualized legal, medical, or claims advice. We submit this comment from the practical perspective of helping veterans and their families better understand VA rules and processes. We support the purpose of the proposed rule. Requiring VA disclosures to State Prescription Drug Monitoring Programs is a sound step. The proposed rule would update 38 CFR 1.515 to reflect the mandatory disclosure language in 38 U.S.C. 5701(l), as amended by the Jason Simcakoski Memorial and Promise Act. It would also clarify authorized user status for VA licensed health care providers and delegates under 38 U.S.C. 1730B. That clarification matters because VA care does not always fit neatly into state licensing systems. VA providers and delegates may work across state lines under federal authority, while state PDMP systems often depend on state based registration or licensing. The proposed rule helps close that practical gap. Concern 1: The interaction with 38 U.S.C. 7332 should be clear in the rule text. The preamble explains that some records subject to mandatory disclosure under 38 U.S.C. 5701(l) may also be protected under 38 U.S.C. 7332, including records related to drug abuse treatment. It also explains that 38 U.S.C. 7332(b)(2)(G) permits disclosure to State controlled substance monitoring programs to the extent necessary to prevent misuse and diversion of prescription medicines, and that the mandatory nature of 38 U.S.C. 5701(l) requires disclosure where both statutes apply. That explanation is helpful, but it should also be easy to find in the actual rule text. A front line pharmacist, delegate, or compliance staff member should not have to rely only on the preamble to understand how the 7332 issue works in practice. VA should add language to 38 CFR 1.515 clarifying that required PDMP disclosures include records protected by 38 U.S.C. 7332 when the conditions of 38 U.S.C. 7332(b)(2)(G) are met. Suggested language: “Disclosures required under this paragraph include records protected by 38 U.S.C. 7332 when the conditions of 38 U.S.C. 7332(b)(2)(G) are satisfied.” Concern 2: The practical scope of “delegate” should be easy to apply. The proposed definition of “delegate” appropriately includes certain VA clinical associates, administrative associates, investigators, researchers, automated systems, and individuals contracted by VA to provide health care while acting under their contractual agreement with VA. The proposed text also excludes individuals with whom VA contracts directly or indirectly pursuant to 38 U.S.C. 1703. That distinction is important, but it may not always be obvious to the people applying the rule day to day. VA should clarify how covered contracted personnel should identify their authority when querying a PDMP and how the protections under 38 U.S.C. 1730B apply if a State licensing body or PDMP administrator questions or audits a query. Concern 3: A real world scenario shows why this matters. Consider a veteran receiving buprenorphine through a VA opioid treatment program in a rural state. The prescribing VA physician may be licensed in a different state. Under the existing patchwork, a State PDMP may not recognize that VA provider or delegate as an authorized user. Under 38 U.S.C. 1730B and this proposed rule, that access is clarified and protected. But if the veteran’s record is also tied to treatment for substance use disorder, the pharmacist or delegate may reasonably ask whether 38 U.S.C. 7332 changes the disclosure obligation. The statute includes a PDMP disclosure exception at 38 U.S.C. 7332(b)(2)(G), but the answer should be clear in the rule itself. Recommendation VA should: 1. Add a direct cross reference to 38 U.S.C. 7332(b)(2)(G) in the regulatory text of 38 CFR 1.515; 2. Clarify the practical treatment of contracted delegates, including how covered contractors differ from excluded 38 U.S.C. 1703 community care arrangements; 3. Explain how VA personnel and covered delegates should document or identify their authorized user status when state PDMP administrators or licensing bodies question access; 4. Address in the final rule preamble how the mandate applies to prescriptions written before the effective date but not yet transmitted to a State PDMP. We ask VA to address these practical implementation points in the final rule preamble and, where appropriate, in the regulatory text of 38 CFR 1.515. Respectfully submitted, The Veteran Benefit Desk veteranbenefitdesk.com [admin@veteranbenefitdesk.com](mailto:admin@veteranbenefitdesk.com)