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Level of Medical Need Required for Aid & Attendance or Housebound VA Pensions Eligibility 

Page Reviewed / Updated - February 25, 2010

Aid & Attendance and Housebound Pension Descriptions

The Aid and Attendance Pension and the Housebound Pension are medical ratings that allow for additional monetary benefits for low-income veterans and their surviving spouses over and above the VA Basic Pension. To be clear, one must be eligible for the Basic Pension, and then, and only then, can one receive the additional monthly payment of the Aid and Attendance or Housebound Pension. The Basic Veteran’s Pension with the additional benefit of the Aid and Attendance Pension or Housebound Pension is often referred to as an Improved Pension, an Enhanced Pension, or a Special Monthly Pension. Please note, one may not receive both the Aid and Attendance Pension and Housebound Pension simultaneously.

For Who is the Aid and Attendance Pension?

The Aid and Attendance Pension is for veterans and their surviving spouses who require assistance with daily living activities, such as mobility, dressing and undressing, bathing, and eating. The assistance they require does not need to stem from their military service. The help they receive can be provided in one’s home, an assisted living residence, or in a nursing home facility.

For Who is the Housebound Pension?

The Housebound Pension is for veterans and their surviving spouses who are unable to leave their home without the assistance of another person due to a permanent disability (which does not have to stem from their military service). One can also receive this disability rating while living in the home of a relative or while institutionalized (if confined to their room or unit).

 To avoid confusion, it’s important to mention that many people use the terms Aid and Attendance Pension (also called the Aid and Attendance Allowance) and Veteran’s Basic Pension (also known as simply Veteran’s Pension) interchangeably. However, they are not the same VA benefit. A veteran or surviving spouse must first be eligible for the Veteran’s Basic Pension in order to receive the Aid and Attendance Pension (or the Housebound Pension).  


Level of Medical / Care Needs for Aid & Attendance Eligibility

The Aid and Attendance Pension is a medical rating and in order to receive this medical rating and the additional monetary benefit, one must require aid with two or more Activities of Daily Living (ADLs). ADLs are routine tasks that one performs on a daily basis. Without the ability to perform these tasks, one could not live independently. Examples include bathing/showering, grooming, dressing/undressing oneself, eating, mobility, and using the toilet. The inability to adjust prosthetic devices is also considered in the case of the Aid and Attendance benefit.

If a veteran or surviving spouse has a physician diagnosis of Alzheimer’s Disease or a related dementia, such as Parkinson’s Disease, an Aid and Attendance medical rating is nearly always granted. This is because, due to the disease, the individual requires a protected environment for their safety and wellbeing. That said, if the individual has mild dementia and does not require assistance with at least two ADLs, it is strongly recommended that one’s doctor provide a statement explaining why the individual is in need of a protected environment.

Veterans and surviving spouses may also meet the functional need for the Aid and Attendance rating if they are bedridden, a patient in a nursing home facility due to a physical or mental disability, or have very poor eyesight (visual acuity of 5/200 or less in both eyes even with corrective measures).

One might hear several terms and phrases used to describe “medical need”, some of which are more formal, while others are very casually used. Examples of terms one might hear used interchangeably include “level of disability”, “functional need”, and “disability rating”.

Example Qualifying Situations

The following are examples in which a Veteran or surviving spouse would most likely meet the disability requirement for the Aid and Attendance Pension:

  • Bill is a 70-year-old Veteran who lives at home with his wife and is “bedridden” due to rheumatoid arthritis. Due to his condition, he is unable to perform basic daily living tasks, including getting up and walking from his bed to the bathroom. While his wife provides as much assistance as possible, she cannot provide around the clock care. Therefore, a home health aid comes to the home to provide assistance in meeting Bill’s needs.
  • Roy is a Veteran who is 95-years-old and is a resident of a nursing home facility. While he does not have any major health issues, he is frail and can no longer live at home. He requires and receives regular assistance with daily living activities in the nursing home simply due to the natural process of aging.
  • Joann is a surviving veteran’s spouse who is 83-years-old and has been diagnosed with Alzheimer’s Disease. She lives with her adult daughter who works a full time job. The majority of the time, Joann does not require assistance with her daily living activities, but does require 24-hour supervision due to memory problems, confusion, and poor judgment as a result of the disease. While Joann’s daughter is at work, an attendant care worker stays with Joann to provide supervision.


Level of Medical / Care Needs for Housebound Eligibility

The Housebound Pension is a medical rating that allows veterans and their surviving spouses an additional monthly pension amount in addition to the Veteran’s Basic Pension. In order to receive this disability rating, one must be unable to leave home (this can be one’s personal home, the home of a relative, or a facility) without the assistance / supervision of someone else due to a permanent disability. One may live at home, the home of a family member, or in an institution.

Example Qualifying Situations

The following are examples in which a veteran or surviving spouse would most likely meet the disability requirement for the Housebound Pension:

  • George is a 72-year-old veteran who lives at home with his wife in the suburbs. He has epilepsy, and as a result, cannot drive a motor vehicle. Due to his inability to drive, he has no means to get to the grocery store, the doctor, or do any errands, without the assistance of his wife.
  • Ezra is a 67-year old veteran widower who lives with his brother and sister-in-law. He requires an oxygen tank and gets around the home without a problem. However, he is unable to leave the home without help from his family.
  • Sally is an 87-year-old veteran who resides in a nursing home facility and cannot walk. Without the assistance of the nursing home staff, she is unable to leave her ward.


How is Functional Need Determined? 

An Aid and Attendance or a Housebound disability rating is determined by a Rating Veterans Service Officer in the VA’s regional office. This determination is made based on a physician examination and the completion of VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance).

As a failure to receive the rating can have a significant financially impact on the candidate, it is recommended that an applicant provide proof of receiving aid and attendance care services. Veterans planning professionals can assist in the preparation of the documentation which is done using Form FV13 (Care Provider Certification of Services). It can also be helpful to provide receipts of paying care providers for long-term care assistance. If an applicant is in a nursing home, VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance) should be filled out instead of Form FV13.


How to Apply / Professional VA Assistance

In order to be eligible for the Aid and Attendance Pension or the Housebound Pension, one must first be eligible for the VA Basic Pension. If one is not currently receiving the Basic Pension, one must apply for it using VA Form 21P-527EZ. Additional information on the Basic Pension, Aid and Attendance Pension, or Housebound Pension is available here or to apply, one should contact their regional VA office.

Please make note, applying for Veteran’s benefits can be a complicated process. It’s highly advised one seek the counsel of a professional VA planner for assistance. To find a Veterans Benefits Advisor in your area, click here.