--- title: "Part IX, Subpart ii, Chapter 2, Section C Special Monthly Pension (SMP) Ratings" document: "M-21-1" section: "Part IX, Subpart ii, Chapter 2, Section C" canonical: "https://veteranai.co/va-regulations/m21-1/ix.ii.2.c-special-monthly-pension-smp-ratings" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000178522/M21-1-Part-IX-Subpart-ii-Chapter-2-Section-C-Special-Monthly-Pension-SMP-Ratings" updated: "2026-09-07T14:37:44.243782Z" --- March 17, 2025 ### IX.ii.2.C.1.a. Criteria for A&A Eligibility Per [38 CFR 3.352(a)](), to be eligible for the aid and attendance (A&A) allowance, a Veteran or surviving spouse must be so helpless that they require the aid of another person to * perform the personal functions required in everyday living, also called activities of daily living, or * protect themselves from hazards or dangers incident to daily life because of a mental or physical disability. Per [38 CFR 3.351(c)(1)](), a claimant who has bilateral vision of 5/200 or less, or contraction of the central visual field to five degrees or less, is eligible for A&A without the requirement of additional findings. **Note:** The need for A&A does not have to be permanent to be granted for Pension, see [VAOPGCPREC 21-1994](). ### IX.ii.2.C.1.b. Medical Evidence Used for A&A Ratings Determination of a claimant's need for A&A by rating is based on medical evidence. The following are some examples of medical evidence used for A&A ratings: * [_VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance_](), completed by a licensed health care professional, including the claimant's private medical provider * Department of Veterans Affairs (VA) medical center (VAMC) examinations, and * statements by licensed health care professionals meeting the requirements of [38 CFR 3.326(b)]() and [38 CFR 3.159(a)(1)](). _**Notes**_ : * The above medical evidence is also used for housebound ratings. * VAMC examinations of survivors are not generally conducted except at the discretion of the Pension Management Center Manager. * The following are examples of licensed health care professionals: * medical doctor * doctor of osteopathy * physician's assistant, or * advanced practice registered nurse (APRN). APRNs include: * certified nurse-midwives (CNM) * clinical nurse specialists, and * certified nurse practitioners. _**Important**_ : * APRNs are prepared by accreditation and certification to provide initial and ongoing comprehensive assessment, diagnosis and treatment _**when**_ it is within the scope of their respective practice, role, and patient population. For example, the scope of practice for a CNM patient population would encompass a full range of primary health care services for women. * Claims processors _**must**_ consider the type of APRN or other health care provider in the context of the full evidentiary record to determine the probative value of the examination report and/or opinion consistent with the requirements set forth in [38 CFR 3.326]() and [38 CFR 3.159(a)(1)](). _**References**_ : For more information on * A&A criteria, see [38 CFR 3.351(c)]() and [38 CFR 3.352(a)]() * 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 definition of adequate medical evidence for pension rating purposes, see [M21-1, Part IX, Subpart i, 2.2.f](). ### IX.ii.2.C.1.c. No Requirement for a Single 100-Percent Evaluation for A&A for Veterans Pension There is no statutory or regulatory requirement for a Veteran pensioner to have a single disability rated 100-percent disabling to be determined 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 special monthly pension (SMP) at the A&A rate even though the Veteran is not rated 100-percent disabled under the rating schedule. Code all claimed and noted disabilities, and show the evaluation of each disability, as appropriate._**Exception**_ : Rating evaluations for individual disabilities are not required when A&A can be granted * under the criteria listed above _**or**_ under [38 CFR 3.351(c)(1)](), _**and**_ * a rating determination of permanent and total (P&T) disability is not needed to establish eligibility for Veterans Pension as described in [M21-1, Part IX, Subpart ii, 2.A.1.a](). **Reference:** For more information on the statutory and regulatory requirements for SMP eligibility for Veterans Pension, see * [38 U.S.C. 1521(d) and (e)](), and * [38 CFR 3.352(a) and (b)](). ### IX.ii.2.C.1.d. Action to Take When There Is No 100-Percent Evaluation or Need for A&A Shown Use the table below to determine the action to take when the disability evaluation is less than 100 percent or there is no need for A&A. | **If ...**| **Then ...** * a current examination is of record, and * the disability evaluation is less than 100 percent after a current examination, but severe disability demonstrates a need for regular A&A | grant A&A. there is no need for A&A| dispose of the claim by discussing that finding in the _Reasons for Decision_ section of the rating decision. Include all applicable laws and regulations. **Reference:** For more information on the requirement to include all applicable laws and regulations, see [M21-1, Part VI, Subpart i, 1.B.1.b](). ### IX.ii.2.C.1.e. When to Infer a Claim for A&A or Housebound The table below shows when to infer a claim for A&A and housebound eligibility. | **If …**| **Then consider entitlement to …** a single disability of 100 percent is assigned| A&A. entitlement to A&A is specifically denied| housebound. **_**_ _**_** **_**_Important_**_** : Do not infer the issue of SMP eligibility merely to deny, if the evidence does not show the claimant would qualify. **Reference:** For more information on housebound eligibility, see * [38 CFR 3.351(d)](), and * M21-1, Part IX, Subpart ii, 2.C.2.a. ### IX.ii.2.C.1.f. Presuming the Need for A&A Based on Nursing Home Care A Veteran or surviving spouse entitled to pension is presumed to be in need of A&A if they are a patient in a nursing home on account of a mental or physical disability.**Note:** For pension purposes, a medical foster home that VA has recognized and approved under [38 CFR 17.73]() is equivalent to a nursing home. **References:** For more information on * presumptive A&A based on nursing home care, see [M21-1, Part IX, Subpart ii, 1.B.1 and 2](), and * the necessary action following nursing home discharge, see * [M21-1, Part IX, Subpart ii, 1.B.3](), and * [M21-1, Part X, Subpart ii, 4.A.5](). ### IX.ii.2.C.1.g. When No Rating Decision Is Required to Grant A&A A rating decision is _not_ required in any claim where A&A is presumed unless other claimed issues need to be rated. If A&A has been granted based on nursing home or medical foster home status without a rating decision, and a claim is being considered on other issues, do not consider A&A in the rating decision. ### IX.ii.2.C.1.h. Future Employment and A&A Pension beneficiaries are required to inform the VA if there is a change in any condition affecting their right to continued payments. If a beneficiary who is receiving A&A by rating obtains employment, the rating activity should review the claim to determine whether the beneficiary still meets the statutory and regulatory requirements for A&A. If the requirements are no longer met, follow the procedures in [M21-1, Part X, Subpart ii, 4.A.5](). **Note:** Participation in a program of Compensated Work Therapy (CWT) alone does not affect VA pension, however, if a Veteran obtains employment following a CWT program, this suggests that they may no longer qualify for A&A. **References:** For more information on * A&A eligibility requirements, see * [38 CFR 3.351](), and * [38 CFR 3.352](), and * reductions in pension, see [38 CFR 3.105(f)](). ## 2. Ratings for Housebound Allowance This topic contains information on ratings for housebound benefits, including * criteria for qualifying for housebound * when a rating decision is required for a housebound claim * when to submit a housebound claim for an advisory opinion * permanency requirement for the 100-percent disability, and * requirement for the independently ratable 60-percent disability. February 19, 2019 ### IX.ii.2.C.2.a. Criteria for Qualifying for Housebound Veterans who are eligible to receive pension qualify for pension at the housebound rate if they have a single, permanent disability that is assigned a 100 percent schedular evaluation and * other disabilities independently ratable at 60 percent or more per [38 CFR 3.351(d)(1)](), or * are permanently housebound by reason of their disabilities per [38 CFR 3.351(d)(2)](). **Note:** Because the single 100-percent disability must be a schedular evaluation, a total evaluation based on unemployability under [38 CFR 4.17]() will not suffice. A surviving spouse eligible to receive pension or Dependency and Indemnity Compensation qualifies for increased benefits based on being housebound if they are permanently housebound by reason of their disabilities per [38 CFR 3.351(e) and (f)](). **Reference:** For more information on permanently housebound, see * [38 CFR 3.351(d)](), and * [M21-1, Part IX, Subpart ii, 1.A.2.c](). ### IX.ii.2.C.2.b. When a Rating Decision Is Required for a Housebound Claim A rating decision is required to dispose of all housebound claims and must include all applicable laws and regulations.**Reference:** For more information on the requirement to include all applicable laws and regulations, see [M21-1, Part VI, Subpart i, 1.B.1.b](). ### IX.ii.2.C.2.c. When to Submit a Housebound Claim for an Advisory Opinion Submit a claim for housebound eligibility to Pension and Fiduciary (P&F) Service for an advisory opinion if the disability * evaluation is less than 100 percent, but * is so severe as to render the claimant housebound. **Note:** A current examination must be of record before the claim may be submitted for an advisory opinion._**Reference**_ : For more information on requesting an advisory opinion from P&F Service, see [M21-1, Part X, Subpart v, 1.A](). ### IX.ii.2.C.2.d. Permanency Requirement for the 100- Percent Disability In pension claims, both the single 100-percent disability and the disability that causes the Veteran to be housebound (if different disabilities) must be permanent. A P&T evaluation protected under [38 CFR 3.951]() or [38 CFR 3.953]() is sufficient if it is based on a single 100-percent disability. Housebound based on a factual determination under [38 CFR 3.351(d)(2)]() requires the housebound state to be permanent. ### IX.ii.2.C.2.e. Requirement for the Independently Ratable 60-Percent Disability There is no requirement that the independently ratable 60-percent disability be permanent. If an independent 60-percent disability that is not permanent is an essential part of a housebound determination, control the claim for possible reduction following a future examination.