(2) Such care or services are not possible for the insured through a VA institution, contract or sharing agreement. For the purposes of this subparagraph, hospital care, medical services or extended care services are not available through a VA facility, contract or sharing agreement if the VA determines that the health of the person concerned, the associated travel, the type of care or services, or a combination of these factors, allow the use of a VA facility. Contract or release agreement that is not feasible or discouraged. (3) A statement of the substantive areas of agreement and disagreement; Section 17.4110 implements the 38 U.S.C certification process.