Requirements for Veterans Pension Ratings

Overview

In This Section

This section contains the following topics:

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1. Evidence of Disability for Veterans Pension Purposes

Introduction

This topic contains information on the evidence of disability for Veterans Pension purposes, including

• when a rating determination of permanent and total (P&T) disability
• is not required, and
• is required, and
• inclusion of service connected (SC) disabilities in a pension rating.

Change Date

September 6, 2019

IX.ii.2.A.1.a. When a Rating Determination of P&T Disability Is Not Required

A rating determination of permanent and total (P&T) disability is not required to establish eligibility for Veterans Pension when a Veteran is

• age 65 or older, or
• presumed to be totally and permanently disabled for pension purposes because he/she is
• a patient in a nursing home for long-term care because of disability, or
• disabled, as determined by the Commissioner of Social Security for purposes of any benefits administered by the Commissioner, such as Social Security Disability (SSD) benefits or Supplemental Security Income (SSI).

Notes:

• For pension purposes, a medical foster home that VA has recognized and approved under 38 CFR 17.73 is equivalent to a nursing home.
• Veterans who are age 62, 63, or 64 must be rated unless they
• provide a copy of the letter awarding SSI or SSD benefits
• are receiving SSI, or
• are receiving Social Security benefits and the date in the DATE OF INITIAL ENT field in the Veterans Benefits Management System (VBMS) is exactly six full months after the date in the DISABILITY ONSET DATE field in VBMS.

References: For more information on

• pension eligibility based on
• age-65 status, see 38 U.S.C. 1513, and
• P&T disability, see 38 U.S.C. 1502, and
• development of Veterans Pension claims, see M21-1, Part IX, Subpart i, 2.1.b.

IX.ii.2.A.1.b. When a Rating Determination of P&T Disability Is Required

If the Veteran does not meet the requirements of M21-1, Part IX, Subpart ii, 2.A.1.a, he/she must be shown by a rating to

• meet the disability percentage requirements set forth in 38 CFR 4.16 and 4.17 or have an extra-schedular evaluation approved under 38 CFR 3.321(b)(2), and
• be unable to secure and follow a substantially gainful occupation by reason of disabilities which are likely to be permanent

Notes:

• A Veteran must be unemployed or marginally employed to receive pension based on disability. “Unemployed” is not synonymous with and does not necessarily mean “unemployable.” However, the greater the disability, the less the need of other evidence of unemployability.
• For purposes of establishing disability for Veterans Pension, VA interprets 38 CFR 4.16(a) to mean that a combined 70 percent disability rating is only required if no single disability is rated at 60 percent disabling.

IX.ii.2.A.1.c. Inclusion of SC Disabilities in a Pension Rating

Service-connected (SC) disabilities may be included along with non-service-connected (NSC) disabilities in Veterans Pension ratings. Additionally, SC disabilities may be included in special monthly pension (SMP) aid and attendance (A&A) and housebound ratings.

Notes:

• If the evaluation of a particular SC disability is protected under 38 CFR 3.951 or 38 CFR 3.952, evaluate the disability at its protected level.
• The rating activity should avoid evaluating any condition for which a claim for SC is pending when completing a pension rating unless doing so will affect entitlement to Veterans Pension or SMP at the A&A or housebound rate.

Reference: For more information on determining a disability evaluation, see M21-1, Part V, Subpart ii, 3.C.1.a.

2. Veterans Pension Rating Percentage Requirements

Introduction

This topic contains information on the rating percentage requirements, including the

• history of pension eligibility based on age-65 status
• current disability rating requirement when necessary, and
• effective dates for the rating requirements.

Change Date

March 18, 2014

IX.ii.2.A.2.a. History of Pension Eligibility Based on Age-65 Status

Before October 31, 1990, there was a statutory presumption that Veterans who had attained age 65 were permanently and totally disabled for pension purposes.

The Omnibus Budget Reconciliation Act of 1990, Public Law (PL) 101-508, Section 8002, eliminated the statutory presumption for all claims filed after October 31, 1990.

Effective September 17, 2001, PL 107-103 eliminated the requirement for a rating determination of eligibility for Veterans 65 years of age or older. However, such Veterans are not presumed to be disabled. Instead, Veterans who have attained age 65 do not need to be disabled to qualify for pension at the basic rate.

IX.ii.2.A.2.b. Current Disability Rating Requirement When Necessary

In 1990, VA revised 38 CFR 4.17 to require for all Veterans, regardless of age, a single disability rated 60 percent or a combined evaluation of 70 percent, with one disability ratable at 40 percent or higher.

Note: Effective September 17, 2001, this requirement became moot for certain Veterans who had either attained age 65 or who were presumed disabled based on nursing home status or being found disabled by Social Security Administration.

Reference: For more information on a single disability rated 60 percent, see M21-1, Part IX, Subpart ii, 2.A.1.b.

IX.ii.2.A.2.c. Effective Dates for the Rating Requirements

Use the table below to determine the effective dates for the rating requirements.

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3. Veterans Pension Eligibility Under 38 CFR 3.321(b)(2)

Introduction

This topic contains information on eligibility under 38 CFR 3.321(b)(2), including

• when to consider eligibility under 38 CFR 3.321(b)(2)
• approval of an extra-schedular evaluation in Veterans Pension claims, and
• considering retroactive eligibility.

Change Date

February 19, 2019

IX.ii.2.A.3.a. When to Consider Eligibility Under 38 CFR 3.321(b)(2)

Consider extra-schedular eligibility under 38 CFR 3.321(b)(2) in all cases in which the Veteran does not meet the schedular requirements for pension.

Reference: For more information on extra-schedular pension rating decisions, see

• M21-1, Part IX, Subpart ii, 2.A.3.b, and
• M21-1, Part V, Subpart ii, 3.D.3.f.

IX.ii.2.A.3.b. Approval of Extra-Schedular Evaluation in Veterans Pension Claims

The table below shows the approval process for claims being considered for Veterans Pension on an extra-schedular basis under 38 CFR 3.321(b)(2).

Important: Discuss in the Reasons for Decision part of the rating decision why disability for pension can or cannot be granted under this regulation. The rating decision should contain sufficient information to clearly show the basis for the disability grant or denial.

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IX.ii.2.A.3.c. Considering Retroactive Eligibility

If eligibility for pension is established from a date subsequent to the date of the claim, consider whether retroactive eligibility may be established under 38 CFR 3.321(b)(2).

If retroactive eligibility under 38 CFR 3.321(b)(2) is not in order, provide an explanation in the Reasons for Decision section of the rating decision.

4. Rating Previously Discontinued Veterans Pension Claims

Change Date

September 1, 2021

IX.ii.2.A.4.a. When to Rate Reopened Pension Claims

If pension was previously discontinued because the Veteran’s income from wages exceeded the income threshold for marginal employment and the Veteran does not meet the relaxed disability guidelines under M21-1, Part IX, Subpart ii, 2.A.1.a, then disability for pension must be re-evaluated using the rating criteria in effect at the time the Veteran submits a new claim.

In all other reopened pension cases, no new rating decision is required.

Reference: For more information on the poverty threshold, see the United States Census Bureau Poverty website.