Aid and Attendance (A&A) and Housebound Determinations for Survivors

Overview

In This Section

This section contains the following topics:

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1. General Rating Issues

Introduction

This topic contains information on general rating issues for survivors, including

• claims indicating a desire for increased benefits because of disability or nursing home status
• evidence on which to base A&A and housebound determinations
• when a rating decision is required, and
• adjusting A&A and housebound benefits following discharge from a nursing home.

Change Date

November 20, 2024

XII.i.2.B.1.a. Claims Indicating a Desire for Increased Benefits Because of Disability or Nursing Home Status

Prior to March 24, 2015, consider any communication from a claimant or accredited representative indicating a desire for increased benefits because of disability or nursing home patient status as a claim for aid and attendance (A&A) or housebound benefits.

After March 24, 2015, applications for A&A or housebound benefits must be received on a prescribed form.

Reference: For more information on special monthly pension, see M21-1, Part IX, Subpart ii, 1.A.1.g.

XII.i.2.B.1. b. Evidence on Which to Base A&A and Housebound Determinations

Determination of a claimant’s need for A&A or housebound benefits is based on medical evidence.

Notes:

• Examinations of survivors by the Department of Veterans Affairs (VA) are not generally conducted except at the discretion of a designee specified by the Pension Management Center Manager.
• Statements by licensed health care professionals meeting the requirements of 38 CFR 3.326(b) and 38 CFR 3.159(a)(1) are acceptable for rating purposes.
• Statements by responsible officials of nursing homes are acceptable to establish resident status without the need for a physical examination and may be provided on VA Form 21-0779, Request for Nursing Home Information in Connection With Claim for Aid and Attendance. Pertinent or missing information may also be obtained by telephone and documented on VA Form 27-0820b, Report of Nursing Home or Assisted Living Information.
• VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, for survivors may be
• accepted, and
• issued to claimants, as needed, for completion by their medical providers.
• Examples of licensed health care professionals can be found in M21-1, Part IX, Subpart ii, 2.C.1.b.

References: For more information on

• A&A criteria, see 38 CFR 3.351(c)(2) and 38 CFR 3.352(a)
• medical evidence used for A&A ratings and examples of licensed healthcare professionals to include advanced practice registered nurse (APRN), see M21-1, Part IX, Subpart ii, 2.C.1.b
• housebound criteria, see 38 CFR 3.351(d)
• examiner qualifications and signature requirements, see M21-1, Part IV, Subpart i, 3.A.1.b
• determining the probative value of evidence, see M21-1, Part V, Subpart ii, 1.A.2.e
• full practice authority for APRN in VA, see 38 CFR 17.415, and
• acceptable medical evidence and the definition of adequate medical evidence for pension rating purposes, see M21-1, Part IX, Subpart i, 2.2.f.

XII.i.2.B.1.c. When a Rating Decision Is Required

A rating decision is required to determine a surviving spouse’s entitlement to either the

• A&A rate, when the surviving spouse is not a patient in a nursing home, or
• housebound rate.

XII.i.2.B.1.d. Adjusting A&A and Housebound Benefits Following Discharge From a Nursing Home

If a claimant is discharged from a nursing home, adjust the A&A and housebound benefits in accordance with the procedures for disability cases outlined in M21-1, Part IX, Subpart ii, 1.B.3 and 4.

2. A&A and Housebound Benefits

Introduction

This topic contains information on A&A and housebound benefits for survivors, including

• who may qualify for
• A&A benefits under 38 CFR 3.351, and
• housebound benefits under 38 CFR 3.351(e) and (f), and
• authorizing A&A without a rating decision.

Change Date

March 10, 2016

XII.i.2.B.2.a. Who May Qualify for A&A Benefits Under 38 CFR 3.351

A&A benefits under 38 CFR 3.351 may be paid to surviving spouses and parents who are receiving or entitled to receive

• Survivors Pension, including protected pension and Old-Law Pension
• Dependency and Indemnity Compensation (DIC), or
• Death Compensation.

XII.i.2.B.2.b. Who May Qualify for Housebound Benefits Under 38 CFR 3.351(e) and (f)

Only surviving spouses who are receiving or entitled to receive DIC or Survivors Pension may qualify for the housebound rate under 38 CFR 3.351(e) and (f).

XII.i.2.B.2.c. Authorizing A&A Without a Rating Decision

Authorize the payment of A&A benefits without a rating decision if

• evidence establishes the claimant is a patient in a nursing home, or
• the surviving spouse was in receipt of A&A benefits on the Veteran's award prior to the Veteran's death.

If a period of hospitalization of 90 days or less results in a discharge to a nursing home, authorize payment of A&A benefits from the date of hospital admission, subject to the effective date provisions in 38 CFR 3.402(c) or 38 CFR 3.404.

Important: Housebound benefits may not be authorized without a rating decision except when the surviving spouse was receiving housebound benefits on the Veteran's award prior to the Veteran's death.

Reference: For more information on when to refer a claim to the rating activity for pension claims, see M21-1, Part IX, Subpart i, 2.5.a.