--- title: "Part IX, Subpart ii, Chapter 1, Section A General Information on Requirements for Aid and Attendance (A&A) and Housebound Status Under 38 CFR 3.351" document: "M-21-1" section: "Part IX, Subpart ii, Chapter 1, Section A" canonical: "https://veteranai.co/va-regulations/m21-1/ix.ii.1.a-general-information-on-requirements-for-aid-and-attendance-a" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000015095/M21-1-Part-IX-Subpart-ii-Chapter-1-Section-A-General-Information-on-Requirements-for-Aid-and-Attendance-AA-and-Housebound-Status-Under-38-CFR-3351" updated: "2026-09-07T14:37:43.470846Z" --- September 1, 2021 ### IX.ii.1.A.1.a. Who May Qualify for A&A Status Under 38 CFR 3.351 Individuals in the following categories may qualify for aid and attendance (A&A) status under [38 CFR 3.351](): * a Veteran who is receiving pension under * [38 U.S.C. 1521(d)](), or * [38 U.S.C. 1513](), if the Veteran is a patient in a nursing home * a Veteran’s spouse, if the Veteran is entitled to receive additional compensation for the spouse under [38 U.S.C. 1115]() * a surviving spouse or parent receiving Dependency and Indemnity Compensation (DIC) under [38 U.S.C. 1311(c)]() or [38 U.S.C. 1315(g)](), and * a surviving spouse receiving * Survivors Pension under [38 U.S.C. 1541(d)](), or * death compensation under [38 U.S.C. 1122(b)](). **Notes:** * For pension purposes, a medical foster home recognized and approved under [38 CFR 17.73]() by the Department of Veterans Affairs (VA) is equivalent to a nursing home. * Veterans who receive disability compensation do not qualify for A&A under [38 CFR 3.351](). These beneficiaries may qualify for A&A under [38 CFR 3.352](). * Parents receiving death compensation under [38 U.S.C. 1122]() may also qualify for A&A, although they are not listed in [38 CFR 3.351](). **_**_Reference_**_** : For more information on medical foster homes, see [M21-1, Part X, Subpart iii, 1.A.3](). ### IX.ii.1.A.1.b. Requirements for A&A Status To qualify for A&A status, an individual must be * so helpless as to require the aid of another person to perform the personal functions required in everyday living ([38 CFR 3.352(a)]()), * 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 ([38 CFR 3.351(c)(1)]()), or * a patient in a nursing home (medical foster home) because of physical or mental incapacity ([38 CFR 3.351(c)(2)]()). **Notes:** * Increased pension based upon the need for regular A&A may be awarded without regard to whether the need is permanent, per [VAOPGCPREC 21-1994]() _._ * Beneficiaries may not receive increased Old-Law Pension or Section 306 Pension because of needing A&A or being housebound. If an Old-Law Pension or Section 306 Pension beneficiary claims special monthly pension (SMP), the case must be reviewed to determine if an election of current-law pension would be to the claimant’s benefit. ### IX.ii.1.A.1.c. A&A Qualification: Veterans Entitled to Pension There is no statutory or regulatory requirement for a Veteran pensioner to be rated 100-percent disabled to be determined to be in need of regular A&A. Therefore, if a Veteran pensioner meets the criteria for A&A under [38 CFR 3.352(a)](), the rating activity may grant SMP at the A&A rate even though the Veteran is not rated 100-percent disabled under the rating schedule. **Reference:** For more information on the statutory requirements for SMP at the A&A rate vs. the housebound rate for pension, see * [38 U.S.C. 1521(d)](), and * [38 U.S.C. 1521(e)](). ### IX.ii.1.A.1.d. A&A Qualification: Surviving Spouses and Parents Entitled to Survivors Pension, DIC, or Death Compensation Surviving spouses and parents who are eligible for Survivors Pension, DIC, or death compensation may qualify for A&A under [38 CFR 3.351](). **Note:** Survivors Pension benefits include current-law pension, Section 306 Pension, Old-Law Pension, and Spanish-American War Pension. However, beneficiaries receiving Section 306 Pension or Old-Law Pension cannot receive a higher rate unless they elect Survivors Pension. **Reference:** For more information on conditional election, see [M21-1, Part VI, Subpart ii, 1.A.1.c](). ### IX.ii.1.A.1.e. A&A Qualification: Veterans’ Spouses Entitled to Additional Compensation Per [38 CFR 3.351(a)(2)](), increased compensation is payable to a Veteran by reason of the Veteran’s spouse being in need of A&A. **Note:** This provision applies only to Veterans who are entitled to receive additional compensation for a spouse. ### IX.ii.1.A.1.f. Applicable Regulatory References for Certain A&A Status Issues Use the table below to review the legal provisions for the A&A status issues listed. | **A &A Status Issue** | **Regulatory Reference** Rating decisions for A&A status in Veterans Pension cases. | * [38 CFR 3.351(c)(3)](), and * [38 CFR 3.352(a)](). A&A status based on nursing home patient status. | [38 CFR 3.351(c)(2)](). Determining the effective date of A&A status. | * [38 CFR 3.401(a)(1)]() (Veterans) * [38 CFR 3.401(a)(3)]() (spouse of a Veteran) * [38 CFR 3.402(c)]() (surviving spouse), and * [38 CFR 3.404]() (surviving parents). Withdrawal of A&A status for any reason. | [38 CFR 3.103(b)(2)](). **Note:** The provisions of [38 CFR 3.103(b)(2)]() require sending a notice of proposed adverse action to a beneficiary. **Reference:** For more information on discontinuing awards involving SMP, see [M21-1, Part IX, Subpart iii, 2.B.1](). ### IX.ii.1.A.1.g. Claims for SMP, Including A&A and Housebound Benefits **_Prior_** to March 24, 2015, consider any communication from a claimant or their representative a “claim for SMP” (A&A or housebound benefit) if it indicates a desire for increased benefits because of * a non-service-connected disability, or * nursing home patient status. **_Effective_** March 24, 2015, all claims **_must_** be received on the prescribed form. Refer the claim to the rating activity **_unless_** the evidence establishes that the claimant is a patient in a nursing home. **Note:** If the evidence establishes that the claimant is a patient in a nursing home, refer the claim for development, if necessary. Otherwise, refer the claim to the authorization activity to grant A&A without a rating. **Reference:** For more information on prescribed forms for special monthly compensation (SMC) and SMP claims, see [M21-1, Part II, Subpart iii, 1.A.1.a](). ## 2. Overview of Requirements for Housebound Status Under 38 CFR 3.351 This topic contains an overview of requirements for housebound status under 38 CFR 3.351, including * who may qualify for housebound status under 38 CFR 3.351 * determining a Veteran’s housebound status for pension, and * definition of permanently housebound. February 14, 2014 ### IX.ii.1.A.2.a. Who May Qualify for Housebound Status Under 38 CFR 3.351 The following individuals may qualify for housebound status under [38 CFR 3.351](): * Veterans eligible for pension, and * surviving spouses eligible for * pension or * DIC. ### IX.ii.1.A.2.b. Determining a Veteran’s Housebound Status for Pension Veterans eligible for pension qualify for housebound status if they have a single permanent disability rated 100 percent under a schedular evaluation, and * have other disabilities independently ratable at 60 percent or more, or * are permanently housebound by reason of their disabilities, per [38 CFR 3.351(d)](). **Notes:** * In pension claims, the single 100-percent disability and the disability that causes the Veteran to be housebound _must_ be permanent. * A finding of housebound in this manner is sometimes referred to as “statutory housebound” because it is required by [38 U.S.C. 1521(e)](). ### IX.ii.1.A.2.c. Definition: Permanently Housebound Under [38 CFR 3.351(d)](), consider an individual **_permanently housebound_** if the individual is substantially confined to their home (ward or clinical areas, if institutionalized) or immediate premises because of disability or disabilities that are reasonably certain to be permanent. **Note:** Leaving home for medical purposes cannot, by itself, serve as the basis for finding that an individual is not substantially confined for purposes of housebound status. ## 3. General Information on Developing for A&A and Housebound Status This topic contains general information on developing for A&A and housebound status, including * medical evidence required for A&A or housebound status * redetermination of A&A or housebound status, and * additional information on A&A and housebound qualifications. March 7, 2022 ### IX.ii.1.A.3.a. Medical Evidence Required for A&A or Housebound Status Determinations of a claimant’s need for A&A or housebound are based, if possible, on medical reports and findings by private health care professionals or Federal entities to include treatment records from a VA medical center rather than on VA examinations requested by the Veterans Benefit Administration (VBA) and conducted by a VA examination facility or VBA designated contractor. Effective March 24, 2015, VA will only recognize A&A or housebound claims if they are submitted on the required standard forms. **References:** For more information on * the prescribed form needed for SMP, see [M21-1, Part II, Subpart iii, 1.A.1.a]() * medical evidence used for A&A ratings, see [M21-1, Part IX, Subpart ii, 2.C.1.b](), and * evidence on which to base A&A and housebound determinations, see [M21-1, Part XII, Subpart i, 2.B.1.b](). ### IX.ii.1.A.3.b. Redetermination of A&A or Housebound Status Refer the case to the rating activity for a redetermination of A&A or housebound status if, after the grant of A&A or housebound, medical evidence is received indicating that * the beneficiary’s condition has improved, and * it appears the beneficiary is no longer seriously disabled. **Note:** If the claimant is already in receipt of A&A for pension and there are no changes in condition or competency, and a subsequent application for A&A is received, treat the application as a duplicate request for SMP, unless it can be accepted as a claim for SMC. **Reference:** For more information on processing a duplicate request for SMP or determining if the claim can be accepted as a claim for SMC, see [M21-1, Part II, Subpart iii, 1.A.3.a](). ### IX.ii.1.A.3.c. Additional Information on A&A and Housebound Qualifications For additional information on A&A and housebound qualifications, see [M21-1, Part IX, Subpart ii, 2.C](), or administrative grants of A&A based on nursing home status, see [M21-1, Part IX, Subpart ii, 1.B]().