Part IX, Subpart ii, Chapter 1, Section AGeneral Information on Requirements for Aid and Attendance (A&A) and Housebound Status Under 38 CFR 3.351

Revised 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.

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.

2Overview 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.

Revised 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.

3General 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.

Revised 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.