Chiropractors in the VA and Federal Practice

To work as a staff chiropractor at the Department of Veterans Affairs, you need a Doctor of Chiropractic degree from a college the VA approves and a chiropractic license in a state (38 U.S.C. § 7402(b)(12)). The license does not have to be from the state where you work. Under 38 C.F.R. § 17.419, a VA health care professional may practice the VA profession in any state, irrespective of the state where the license is held, when state requirements would otherwise prevent or unduly interfere with practice within the scope of VA employment. The Department of Defense has a comparable rule for its own clinicians (10 U.S.C. § 1094(d)). Both stop at the edge of federal duties: private practice on the side, and community care under contract, need a license where the patient is.

How many VA sites offer chiropractic?

Federal law requires it widely. Section 204 of Public Law 107-135, as amended in 2018 and printed as a note to 38 U.S.C. § 1710, directs the VA to run a chiropractic care program for enrolled veterans through VA medical centers and clinics. The program had to reach at least two medical centers or clinics in each Veterans Integrated Service Network by December 31, 2019, and at least 50 percent of all medical centers in each network by December 31, 2021. The VA staffs it by appointing licensed chiropractors and through personal service contracts.

What exactly does 38 C.F.R. § 17.419 allow?

The regulation defines a "health care professional" as someone appointed to a VHA occupation under the listed authorities who is not a VA-contracted health care professional and who, among other qualifications, has an active, current, full and unrestricted license in a state. When a state law or licensing requirement prevents or unduly interferes with practice within the scope of VA employment, the professional follows federal duties: he or she may practice the VA profession in any state irrespective of the state of licensure, and within the VA's national standard of practice. Conflicting state requirements have no force as applied to actions within the scope of VA employment, under the Supremacy Clause.

Three limits are built in:

• It is for VA appointees. The definition expressly excludes VA-contracted health care professionals.
• It covers VA duties only. Treating private patients on a weekend in the same state is ordinary state practice and needs that state's license.
• It needs a valid license somewhere. The license must be active, current, full and unrestricted. Letting it lapse removes the foundation.

What about the military and DoD?

Under 10 U.S.C. § 1094(d), a member of the armed forces, a DoD civilian employee, a personal services contractor under section 1091, or another professional credentialed and privileged at a designated federal location, who has a current license in a health profession and is performing authorized DoD duties, may practice that profession at any location in any state, D.C. or U.S. territory, regardless of where the professional or the patient is, within the scope of those duties. The same structure applies: a current license in one state, federal duties only.

Does community care work fall under the federal rule?

No. A chiropractor who treats veterans in a private clinic under the VA's community care program, or TRICARE beneficiaries as a network provider, is a private practitioner. The state license rules apply in full, and the network enrollment is a separate process. White Glove Credentialing covers TRICARE and VA community care enrollment.

How do I keep my state license ready while in federal service?

Most federal DCs eventually return to private practice, and the state license is what makes that possible. A license kept active and clean is worth far more than a lapsed one:

• Renew on time and keep CE current. Federal work does not usually exempt you from the state's renewal and CE rules unless the state says so. Texas is one that has military provisions: a licensee who was a military member, veteran or military spouse during part of the 12 months before the renewal date is exempt from that year's CE, and members of the military get two extra years for CE and other renewal requirements (22 Tex. Admin. Code §§ 73.1, 72.14). Check your own state's rule.
• Do not let it go inactive without a plan. Some states make reactivation easy and some do not; Alaska requires a new application after a five-year lapse.
• Track your practice hours. Endorsement routes count years of practice. Texas wants three years of practice immediately before applying, and Nevada seven of the last ten. Ask the board in advance whether VA or DoD practice counts, and keep employment verification letters.
• Keep NBCE scores reachable. Some boards look at the age of scores; Nebraska asks applicants not currently practicing with scores over three years old to take SPEC.

Planning the move out

If you know where you will settle, apply for that state's license 6 to 12 months before separating, because boards set their own pace. If your state of licensure is not where you want to practice, compare the endorsement route with the exam route: see endorsement or the exam route, and for spouses, military spouses and chiropractic licensing. Our Chiropractic Licensure Readiness Review ($149 one-time) checks your file against your target states, and License by Endorsement ($499 per state) handles the application. Board fees are extra, and the board decides.