M21-1 Manual / Part XII, Subpart i, Chapter 2, Section B
Aid and Attendance (A&A) and Housebound Determinations for Survivors
M21-1, Part XII, Subpart i, Chapter 2, Section B
Overview
In This Section | | This section contains the following topics: | Topic | Topic Name |
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| 1 | General Rating Issues | | 2 | A&A and Housebound Benefits |
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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.
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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.
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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.
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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.
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Change Date | | March 10, 2016 |
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. |
Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part XII, Subpart i, Chapter 2, Section B (U.S. government work, reproduced for reference). Browse all sections →