Veteran/beneficiary Claim For Reimbursement Of Travel Expenses Page 2

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Box 4: Treating facility. Examples: VA Medical Center La Jolla, VA Clinic Mission Valley, VA
Clinic Chula Vista, VA Clinic Oceanside, VA Clinic Sorrento Valley, VA Clinic Escondido, and VA
Clinic El Centro.
Box 5: List address only if care facility was through Non-VA Care or the Choice Program such as
a doctor’s office in the local community in which the VA paid for the care. If you are requesting
reimbursement for VA approved care that was provided in a Non-VA care facility, please
attach documentation from the doctor’s office showing: 1) date(s) of completed
appointments and, 2) the address where you received the care as this is necessary so we can
calculate the miles travelled for reimbursement purposes.
Section C
Please sign and date. Unsigned and/or undated forms cannot be accepted.
Submitting Completed Form
Please ensure all blocks have been completed including your signature and date. You may
submit your completed form one of four ways:
1. Drop the completed form in the wall mounted box in the travel lobby on the first floor
of the VA Medical Center in La Jolla.
2. Mail your completed form to the VA using the following address:
San Diego VA Medical Center
ATTN: Beneficiary Travel Office (136C)
3350 La Jolla Village Drive
San Diego, CA 92161
3. If you are at one our Community Based Outpatient Clinics located in Escondido,
Oceanside, Sorrento Valley, Mission Valley, Chula Vista, or El Centro, you may give your
completed form to clinic staff and they will forward it to the travel office at the VA
Medical Center in La Jolla.
4. Fax your completed and signed form to the VA Beneficiary Travel office at 858-642-
Upon receiving the completed form, travel office staff will process your claim. Funds will be
electronically deposited into your bank account within 10-12 business days. Please note that
per 38 CFR, Part 70, VA Beneficiary Travel regulations, all claims for mileage reimbursement
must be submitted within thirty calendar days from the date care was received. If you have any
questions, please contact the Beneficiary Travel office directly at 858-552-8585, extension
5491 or 3826 Monday through Friday between the hours of 8:00a.m. and 4:30p.m. Thank you.


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