VA Form 21-2680 records the medical findings behind a request for aid and attendance or housebound benefits. The question is not simply which diagnoses you have. The examiner must explain what you can do during a typical day, where you need help, and how your conditions cause those limitations.

The current VA form page links to the June 2026 edition, which replaces February 2023. I checked all four pages on September 25, 2026. This edition has eight sections and 45 numbered items. The medical examiner's portion starts at Item 16, after your identification, benefit selection, hospitalization information, and signature.

Who uses it, and which benefit is involved?

The form serves more than one benefit program. Item 13 distinguishes Special Monthly Compensation (SMC) from Special Monthly Pension (SMP). The form's compensation category also addresses qualifying increased DIC for survivors.

For a veteran seeking compensation-based aid and attendance, the form explains that the disabilities causing the need must be related to service. Pension-based aid and attendance depends on eligibility for pension as well as the care-related requirements. A completed medical examination does not by itself establish the service, financial, relationship, or other requirements of the underlying benefit.

VA's pension aid-and-attendance page describes qualifying assistance with daily activities, being bedridden, nursing-home care, and specified vision limitations. It separately explains the pension housebound allowance. Do not turn the pension page into a universal rule for every SMC category.

Use 21-2680 when seeking the applicable increase or when VA requests the examination information. If you are also applying for the underlying pension or survivor benefit, include the appropriate application rather than expecting this medical form to answer its financial or service-history questions.

Sections I and II: Identify the veteran and claimant, Items 1 to 12

On the official PDF, Section I asks for:

  • 1: Veteran or beneficiary's name.
  • 2: Social Security number.
  • 3: VA file number, if applicable.
  • 4: Veteran's service number, if applicable.
  • 5: Birth date.

Section II identifies the claimant or person whose entitlement is involved:

  • 6 and 7: Claimant's name and Social Security number.
  • 8: Relationship to the veteran, selecting self, spouse, parent, or child as appropriate.
  • 9: Claimant's birth date.
  • 10: Mailing address.
  • 11: Optional telephone number.
  • 12: Optional email and electronic-correspondence agreement.

For a survivor claim, keep the veteran and claimant information distinct. The examination must describe the person needing assistance, not accidentally reuse the deceased veteran's medical history as the claimant's current condition.

Sections III through V: Benefit, hospital stay, and signature

13: Select one benefit category, SMC or SMP. Read the descriptions immediately beside the boxes. If you do not know which underlying benefit you receive or are claiming, check your award letter or ask VA before choosing.

14A: Is the claimant hospitalized? A yes requires 14B, admission date; 14C, hospital name; and 14D, hospital address. A no sends you to Section V. This asks about hospitalization, not simply whether you have ever had inpatient treatment.

15A and 15B: Veteran or claimant's signature and signing date. This is separate from the examiner's signature near the end. Do not overlook it because the appointment's main purpose is obtaining the medical portion.

Section VI: The examiner completes Items 16 to 37

The form says the rest must be completed by an examiner who is a medical doctor, doctor of osteopathic medicine, physician assistant, or advanced practice registered nurse. Bring the current form to an eligible clinician. A relative can provide observations to discuss, but should not fill the clinical section as if they performed the examination.

16: Examination date.

17: Complete diagnoses and the most significant symptoms for each condition. The form specifically links these diagnoses to the assistance described later in Items 26 through 37.

18: Conditions the examiner considers permanently and totally disabling. This is the examiner's clinical response, not a place to copy a combined rating percentage without explanation.

19A through 19C: Age, actual or estimated weight, and height. 20 and 21: Nutrition and gait. 22, 23, and 24: Blood pressure, pulse, and respiratory rate. 25: Disabilities restricting the activities and functions described.

These basic findings belong with the functional account. The examiner should make the connection between the condition and the help needed rather than leaving VA to infer it from a diagnosis list.

Items 26 through 30: Daily assistance, vision, and benefit management

26: If confined to bed, report hours during the two printed periods, 9 p.m. to 9 a.m. and 9 a.m. to 9 p.m. Ordinary time asleep and being confined to bed because of illness are not descriptions to casually substitute for one another.

27: Select all activities requiring help. This edition groups bathing, eating, dressing, medication management, hygiene, transfers, toileting, movement within the home, and additional activities. Specify other tasks such as meal preparation when applicable.

28A and 28B: Legal blindness, with an explanation if yes, and corrected vision for each eye. The clinician supplies the measurements; the claimant should not guess a qualifying number.

29: Whether nursing-home care is required, with an explanation if yes. The question concerns need for that care, not only the address where the person lives.

30: Whether the patient can manage benefit payments or direct someone else to do so. If no, the examiner identifies the disabling conditions and explains the conclusion. Needing physical help does not itself answer this separate mental-capacity question.

Items 31 through 37: Explain the restrictions

31: Posture and general appearance.

32: Restrictions in each upper extremity, including grip, fine movements, feeding, fastening clothing, shaving, and attending to toileting needs.

33: Restrictions in each lower extremity, including motion, muscle loss, contractures, weight bearing, balance, and propulsion where relevant.

34: Restrictions involving the spine, trunk, and neck.

35: Other conditions affecting self-care, such as dizziness, memory loss, balance problems, or bowel and bladder difficulties. Describe what the impairment changes in daily life.

36: How often the person leaves home and under what circumstances, including assistance required. Report real trips and their frequency. Do not describe someone as never leaving if they attend appointments with another person's help.

37: Whether a cane, brace, crutches, or another person's assistance is needed for movement. If yes, select or specify the applicable distance. A distance estimate should reflect the examiner's findings and the patient's actual limitations.

Sections VII and VIII: Examiner verification, Items 38 to 45

38 and 39 identify the examiner's printed name and title. 40 and 41 are the required examiner signature and signing date.

42 asks for the examiner's National Provider Identifier. 43 through 45 ask for the facility name, address, and telephone number.

Before leaving the appointment, check that the examiner has completed the applicable questions and both signature areas are addressed by the appropriate person. You can notice a blank field without changing or supplying the clinician's answer yourself.

Fictional example: Describe the task and the help

This is an invented preparation exercise, not a completed examination, diagnosis, or medical recommendation. It illustrates the kinds of facts a claimant could bring to the examiner.

Assume a person reports needing another adult beside them while getting into and out of the shower, help fastening clothing, and accompaniment to two medical appointments each month. They can feed themselves and can explain how they want their benefit payments used.

The relevant form questions are:

  • 27: Which daily tasks actually require assistance?
  • 30: Can the person manage payments or direct someone else?
  • 32 through 35: Which clinical restrictions explain the reported help?
  • 36: What trips outside the home occur, and what assistance makes them possible?
  • 37: Are movement aids or another person's physical assistance needed, and over what distance?

The examiner must independently assess these facts and supply the medical findings. The example does not justify checking every assistance box, declaring the person housebound, or adding a diagnosis.

Before the appointment, Raven Scribe can help organize your own account of daily limitations into an editable statement. Its free personal-statement builder is available without an account. Keep that account accurate and separate from the examiner's answers.

Where to submit 21-2680

Online: VA's form page links to its online aid-and-attendance application. The medical examiner still needs to complete the examination information. If submitting evidence for an existing compensation claim, follow VA's evidence-upload guidance or the request letter.

Mail for pension or survivor benefits: VA's aid-and-attendance page gives Department of Veterans Affairs, Pension Intake Center, P.O. Box 5365, Janesville, WI 53547-5365.

Mail for a veteran's compensation claim: VA's compensation intake instructions identify Claims Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. Keep the examination with the compensation claim or evidence submission it supports. Do not select the pension address merely because the same medical form serves both programs.

Fax: The 2680 PDF does not print a form-specific fax. VA's general intake directory lists 844-531-7818 for compensation and 844-655-1604 for pension and survivors. Follow your letter's instructions or confirm the correct route at 800-827-1000 before faxing.

Check for an old edition, the wrong benefit box, a missing claimant signature, a missing examiner signature, or a diagnosis list with no explanation of assistance. Make sure leaving-home and mobility answers agree with the actual circumstances.

Related forms include 21P-527EZ for Veterans Pension, 21P-534EZ for survivor benefits, and 21-0779 for nursing-home information. The official 2680 page links the nursing-home form, and VA's pension guidance says nursing-home applicants also need it.

After submission, VA evaluates the examination with the rest of the benefit evidence. It may need more information before deciding. Keep a copy of the completed report and receipt, and read requests and the eventual decision carefully. The examiner's description supports the claim; it does not itself authorize payment.

Sources and scope

Verified September 25, 2026: the June 2026 21-2680 PDF, its form page, VA's pension aid-and-attendance guidance, evidence-upload guidance, and general intake instructions. This guide concerns completing the examination form and does not cover every SMC entitlement route. The example is fictional and supplies no clinical findings.

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Disclaimer

I'm Landon, founder of Claim Raven and a U.S. Army veteran, not a lawyer, VSO, or VA-accredited representative. Claim Raven is data analysis, not legal, medical, or VA-accredited advice. Medical findings belong to the examiner. Ask an accredited representative about the benefit category and evidence for your circumstances.