The A - Z Guide: Veterans VA Disability Benefits
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Aid and Attendance
A & A
Update October 28th 2009
Title 38: PART 3
§ 3.352 Criteria for determining need for aid and attendance and “permanently bedridden.”
a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance (§3.351(c)(3): inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. “Bedridden” will be a proper basis for the determination. For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need. Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance from others.
(b) Basic criteria for the higher level aid and attendance allowance. (1) A veteran is entitled to the higher level aid and attendance allowance authorized by §3.350(h) in lieu of the regular aid and attendance allowance when all of the following conditions are met:
(i) The veteran is entitled to the compensation authorized under 38 U.S.C. 1114(o), or the maximum rate of compensation authorized under 38 U.S.C. 1114(p).
(ii) The veteran meets the requirements for entitlement to the regular aid and attendance allowance in paragraph (a) of this section.
(iii) The veteran needs a “higher level of care” (as defined in paragraph (b)(2) of this section) than is required to establish entitlement to the regular aid and attendance allowance, and in the absence of the provision of such higher level of care the veteran would require hospitalization, nursing home care, or other residential institutional care.
(2) Need for a higher level of care shall be considered to be need for personal health-care services provided on a daily basis in the veteran's home by a person who is licensed to provide such services or who provides such services under the regular supervision of a licensed health-care professional. Personal health-care services include (but are not limited to) such services as physical therapy, administration of injections, placement of indwelling catheters, and the changing of sterile dressings, or like functions which require professional health-care training or the regular supervision of a trained health-care professional to perform. A licensed health-care professional includes (but is not limited to) a doctor of medicine or osteopathy, a registered nurse, a licensed practical nurse, or a physical therapist licensed to practice by a State or political subdivision thereof.
(3) The term “under the regular supervision of a licensed health-care professional”, as used in paragraph (b)(2) of this section, means that an unlicensed person performing personal health-care services is following a regimen of personal health-care services prescribed by a health-care professional, and that the health-care professional consults with the unlicensed person providing the health-care services at least once each month to monitor the prescribed regimen. The consultation need not be in person; a telephone call will suffice.
(4) A person performing personal health-care services who is a relative or other member of the veteran's household is not exempted from the requirement that he or she be a licensed health-care professional or be providing such care under the regular supervision of a licensed health-care professional.
(5) The provisions of paragraph (b) of this section are to be strictly construed. The higher level aid-and-attendance allowance is to be granted only when the veteran's need is clearly established and the amount of services required by the veteran on a daily basis is substantial.
(Authority: 38 U.S.C. 501, 1114(r)(2))
(c) Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.
Update: 10/15/2009
My friend John Crotty is a CVSO in New York. John looked over my writing on the A & A benefit and was kind enough to let me know of a new twist to A & A:
"Hi Jim, Today’s Q&A on A&A caught my eye as I’ve been educating myself on this since my last communication with you on A&A.
The new 21-2680 [Jun 2008] is much much better for the Vet than the old one which left a lot of wiggle room for the VA to read in or out of the Veterans real disability status. On the new form items 21 thru 27 are yes and no. A phone call or letter to the doctor explaining what the VA needs to hear has been very effective to produce success."
Thanks John!
Click here for that VA Form 21-2680.
From The VA...
The A & A benefit is one of the more misunderstood of all. The best information comes directly from the VA web site. It's sometimes hard to find so I'll paste in in here for you.
The basics:
The documentation that should be provided must be perfect. Statements from physicians, financial statements, etc. must have everything required and more if you expect smooth sailing. No shortcuts are allowed and a shortcut is a sure way to see a speedy (or not so speedy) denial.
Caution: Don't confuse A & A or Housebound benefits with Special Monthly Compensation (SMC). Each of those benefits may add more money to a severely disabled veteran's award but each benefit has its own pathway.
From the VA:
What are Aid and Attendance and Housebound benefits?
* Aid and Attendance (A&A) is a benefit paid in addition to
monthly pension. This benefit may not be paid without eligibility to
pension. A veteran may be eligible for A&A when:
1. The veteran requires the aid of another person in order to
perform personal functions required in everyday living, such as
bathing, feeding, dressing, attending to the wants of nature,
adjusting prosthetic devices, or protecting himself/herself from the
hazards of his/her daily environment, OR,
2. The veteran is bedridden, in that his/her disability or
disabilities requires that he/she remain in bed apart from any
prescribed course of convalescence or treatment, OR,
3. The veteran is a patient in a nursing home due to mental
or physical incapacity, OR,
4. The veteran is blind, or so nearly blind as to have
corrected visual acuity of 5/200 or less, in both eyes, or concentric
contraction of the visual field to 5 degrees or less.
* Housebound is paid in addition to monthly pension. Like A&A,
Housebound benefits may not be paid without eligibility to pension.
A veteran may be eligible for Housebound benefits when:
1. The veteran has a single permanent disability evaluated as
100-percent disabling AND, due to such disability, he/she is
permanently and substantially confined to his/her immediate premises,
OR,
2. The veteran has a single permanent disability evaluated as
100-percent disabling AND, another disability, or disabilities,
evaluated as 60 percent or more disabling.
A veteran cannot receive both Aid and Attendance and Housebound
benefits at the same time.
How to Apply for Aid and Attendance and Housebound:
* You may apply for Aid and Attendance or Housebound benefits by
writing to the VA regional office having jurisdiction of the claim.
That would be the office where you filed a claim for pension benefits.
If the regional office of jurisdiction is not known, you may file the
request with any VA regional office.
* You should include copies of any evidence, preferably a report
from an attending physician validating the need for Aid and Attendance
or Housebound type care.
* The report should be in sufficient detail to determine whether
there is disease or injury producing physical or mental impairment,
loss of coordination, or conditions affecting the ability to dress and
undress, to feed oneself, to attend to sanitary needs, and to keep
oneself ordinarily clean and presentable.
* In addition, it is necessary to determine whether the claimant
is confined to the home or immediate premises.
* Whether the claim is for Aid and Attendance or Housebound, the
report should indicate how well the individual gets around, where the
individual goes, and what he or she is able to do during a typical
day.
