The VA's SCI/D Hub and Spoke System of Care is an integrated service delivery network. SCI Centers (hub) provide primary and specialty care for Veterans with SCI/D. All VA medical centers without an SCI Center (spoke) have responsibility for the provision of basic medical care, SCI/D primary care by designated and trained providers, and emergent medical care for Veterans with SCI/D. Designated catchment areas (See App. A) reflect longstanding linkages and are used for the transfer of Veterans from a local VA or community hospital to the SCI Center for care in accordance with VA travel regulations. For descriptive purposes in this Handbook, the terms SCI and SCI/D are used interchangeably.