Revised February 14, 2025
X.iii.1.C.1.aRegulatory Requirements of 38 CFR 3.552
The provisions of 38 CFR 3.552(b)(1) require the discontinuance of additional compensation or increased disability pension for aid and attendance (A&A) effective the first day of the second calendar month following the month of admission to a Department of Veterans Affairs (VA) medical center (VAMC), unless the disability is
- paraplegia involving paralysis of both lower extremities together with the loss of anal and bladder control
- Hansen’s disease, or
- in pension cases only , blindness (visual acuity 5/200 or less) or concentric contraction of visual field to 5 degrees or less.
Exception: When a Veteran entitled to additional compensation under 38 U.S.C. 1114(r) is hospitalized at U.S. Government expense, discontinuance of A&A is required under 38 CFR 3.552(b)(2).References: For more information on
- special monthly compensation (SMC) at the “L” level, see 38 CFR 3.350(b), and
- SMC, including hospitalization adjustments to discontinue A&A, see M21-1, Part VIII, Subpart iv, 4.A.
X.iii.1.C.1.bRecovery of the Cost of Care
Under 38 U.S.C. 1729, the U.S. has the right to recover or collect the cost of medical care VA furnishes to a Veteran for treatment of a non-service connected disability. Costs recoverable from insurance companies or other third parties liable under a healthcare contract are the amounts the Veteran or the service provider would be able to receive if the care had not been provided by the U.S. However, recovery of such costs does not limit the applicability of 38 CFR 3.552(b)(1).
X.iii.1.C.1.cScreening Centrally Automated Reports
Follow the steps in the table below to screen centrally automated reports of Veterans who are in receipt of the A&A allowance and
- currently active patients, or
- discharged at government expense.
| Step | Action |
|---|---|
| 1 | Screen the end product (EP) 330 established in connection with centrally automated reporting to ensure that its claim label accurately reflects the type of benefit the identified individual is receiving, making any necessary changes. Note: Adjusting the EP 330 to include the most appropriate compensation- or pension-specific claim label shown for centrally automated reporting, as outlined in M21-4, Appendix C, will route the work item for review and processing by Veterans Service Center or Pension Management Center personnel, as appropriate. |
| 2 | Screen each report against information in the corporate record and, if necessary, the claims folder to determine if an adjustment under 38 CFR 3.552 (as discussed in M21-1, Part X, Subpart iii, 1.C.1.a) is required. |
| 3 | Does the report require an adjustment under 38 CFR 3.552?
|
| 4 | Upload to the claims folder all Compensation and Pension Record Interchange (CAPRI) documentation relevant to the period of hospitalization in question, including
|
| 5 | If the beneficiary is receiving
|
| 6 | Establish an EP 600 and follow the instructions in M21-1, Part X, Subpart iii, 1.C.1.d. |
X.iii.1.C.1.dProviding Due Process Before Adjusting Benefits
Notice of proposed adverse action is required before discontinuing the A&A allowance. Provide proper notification by
- preparing two notices of proposed adverse action, sending
- one notice to the Veteran’s address of record, and
- one notice to the Veteran at the medical facility, and
- incorporating into the notice of proposed adverse action a description of any potential action to be taken if the Veteran is receiving pension that is subject to further reduction under 38 CFR 3.551 (as explained in M21-1, Part X, Subpart iii, 1.D).
Reference: For more information on notices of proposed adverse action, see M21-1, Part X, Subpart ii, 3.A.
X.iii.1.C.1.eActions to Take After the Due Process Period Expires
Sixty-five days after sending the notice of proposed adverse action referenced in M21-1, Part X, Subpart iii, 1.C.1.d (or sooner, if the Veteran asks VA to take action to reduce the amount of potential overpayment),
- discontinue payment of the A&A allowance effective the first day of the second calendar month following the month of admission
- determine the rate payable during hospitalization, as outlined in M21-1, Part X, Subpart iii, 1.C.1.f
- check CAPRI to determine whether the Veteran remains hospitalized, and
- send the Veteran a decision notice communicating the adjustment.
If CAPRI records indicate the Veteran is no longer hospitalized, take the actions described in the table below, concurrent with the actions described in the preceding bullets.
| Step | Action |
|---|---|
1 | If the Veteran is receiving
|
2 | Follow the instructions in the table below. If VA … Then … |
granted entitlement to A&A by rating decision prior to hospitalization |
|
did not grant entitlement to A&A by rating decision prior to hospitalization |
|
3 | Was the pre-hospitalization A&A entitlement based on a rating determination of permanent and total (P&T) disability?
|
4 | Refer the case to the rating activity for consideration of continued entitlement to A&A. |
References: For more information on using
-
CAPRI, see the CAPRI User Manual , and
-
VBMS Awards for the purposes of processing award adjustments, see the VBMS Awards User Guide.
X.iii.1.C.1.fDetermining the Rate Payable During Hospitalization
Use the table below to determine the award rate payable when discontinuing the A&A allowance during hospitalization of the Veteran.
| If the benefit is ... | Then ... |
|---|---|
| pension | award the housebound rate effective the date of reduction per 38 CFR 3.552(e), subject to further reduction under one of the following, as appropriate:
Notes:
|
| compensation | determine entitlement to the housebound or other appropriate hospitalized rate, as shown in the Disability Compensation – SMC Rates table, under whichever of the following provisions applies: |
2Granting or Discontinuing an A&A Award During Hospitalization
This topic contains information on
- granting an A&A award during hospitalization, and
- discontinuing an A&A award during hospitalization.
Revised April 21, 2015
X.iii.1.C.2.aGranting an A&A Award During Hospitalization
Use the table below to determine the appropriate actions to take when granting an A&A award during hospitalization of a Veteran.
| If the grant ... | Then ... |
|---|---|
is from an effective date prior to the first day of hospitalization |
|
involves an effective date of initial entitlement that is on or after the date of hospitalization |
|
Note: Payment of the housebound rate is subject to the 38 CFR 3.551 reduction requirement in pension cases
X.iii.1.C.2.bDiscontinuing an A&A Award During Hospitalization
If entitlement to the A&A allowance or the housebound rate while hospitalized is discontinued by rating while the Veteran is hospitalized,
- continue the hospitalized rate
- send notice of proposed adverse action to the Veteran
- set a control for 65 days from the date the notice of proposed adverse action is sent, and
- reduce the award and send the Veteran a decision notice of the final action after the control period ends.
Note: If the IVAP exceeds the housebound rate, see M21-1, Part X, Subpart iii, 1.C.1.f.
3Adjusting an A&A Award When a Veteran Leaves or Returns to a Hospital
This topic contains information on adjusting an award when a Veteran is discharged from, granted an authorized absence from, or returns after an absence from a hospital, including
- resuming the payment of benefits at the A&A rate upon discharge from a hospital
- adjusting for hospital absences of 30 days or more
- actions to take when
- an authorized absence of 30 days or more occurs during an initial period of hospitalization, and
- a Veteran returns from an authorized absence of 30 days or more
- example of a report of a 30-day authorized absence received during an initial period of hospitalization
- retroactive adjustments for hospital absences of less than 30 days, and
- readmission for hospitalization following an irregular discharge.
Revised February 14, 2025
X.iii.1.C.3.aResuming the Payment of Benefits at the A&A Rate Upon Discharge From a Hospital
After receiving a notice of discharge from VA hospitalization, follow the steps in the table below.
| Step | Action |
|---|---|
1 | Did the Contract Nursing Home (CNH) Report of Admissions/Discharges referenced in M21-1, Part X, Subpart iii, 1.A, serve as the notice of discharge?
|
2 | If the Veteran is receiving
|
3 | Follow the instructions in the table below. If … Then … |
VA granted entitlement to A&A by rating decision prior to hospitalization |
|
VA did not grant entitlement to A&A by rating decision prior to hospitalization |
|
4 | Change the pending EP 330 to an EP
|
5 |
|
6 | Was the pre-hospitalization A&A entitlement based on a rating determination of P&T disability?
|
7 | Upload to the claims folder all CAPRI documentation relevant to the period of hospitalization in question, including
|
8 | Refer the case to the rating activity for consideration of continued entitlement to A&A. |
Reference : For more information on the A&A allowance for Veterans in receipt of pension and in a nursing home, see M21-1, Part IX, Subpart ii, 1.B.2.
X.iii.1.C.3.bAdjusting for Hospital Absences of 30 Days or More
Adjust benefit payments for authorized absences from the hospital of 30 days or more as follows:
- After receiving a report showing an authorized absence of 30 days or more, amend compensation or pension to restore payment at the full A&A rate effective the date the Veteran left the hospital, under 38 CFR 3.401(a)(2).
- After receiving a report showing hospitalization resumed, discontinue the additional allowance for A&A effective the date of readmission to a VA hospital or the resumption of hospitalization at VA expense, under 38 CFR 3.556(a)(2), for Section 306 Pension. Reduce Section 306 Pension to $50.
X.iii.1.C.3.cActions to Take When an Authorized Absence of 30 Days or More Occurs During an Initial Period of Hospitalization
Under 38 CFR 3.556(a)(1), do not continue a reduced payment for Section 306 Pension when a report showing non-bed care status or authorized absence of 30 days or more is received during an initial period of hospitalization. When notice of non-bed care status or authorized absence of 30 days or more is received, restore the regular pension rate for Section 306 Pension effective the date of departure from the hospital. For Section 306 Pension, if entitlement to the A&A allowance had been established, resume payment at the A&A rate effective the date of departure from the hospital.
X.iii.1.C.3.dActions to Take When a Veteran Returns From an Authorized Absence of 30 Days or More
Take the following actions under 38 CFR 3.556(a)(2) when a Veteran resumes hospitalization after an authorized absence of 30 days or more:
- discontinue any allowance for A&A from the date of readmission, and
- reduce Section 306 Pension to $50 effective the date of readmission, under 38 CFR 3.551(c).
X.iii.1.C.3.eExample: Report of a 30-Day Authorized Absence Received During an Initial Period of Hospitalization
Situation : A Veteran receiving Section 306 Pension at the A&A rate is
- admitted for VA hospitalization on August 10
- granted a 30-day absence on November 15, and
- readmitted for VA hospitalization on January 5 of the following year.
Actions:
- Reduce the Veteran’s award to
- the housebound rate, effective October 1, under 38 CFR 3.552(b)(1), and
- $50, effective November 1.
- Resume the payment of pension at the A&A rate effective November 15, the date of the authorized absence of 30 days or more.
- Reduce the Veteran’s award to $50 effective January 5, the date of readmission to the hospital.
X.iii.1.C.3.fRetroactive Adjustments for Hospital Absences of Less Than 30 Days
Make no adjustment to pay benefits at the A&A rate for periods of authorized absence of less than 30 days until after discharge from hospitalization. When a retroactive award is prepared to resume the full A&A rate, from a date earlier than the date of discharge in order to cover several short periods of authorized absence from hospitalization, annotate the award to show the total number of days of absence. Example:Situation:
- A Veteran entitled to special monthly pension (SMP) at the A&A rate
- was admitted to a VAMC for hospitalization on September 15, and
- received a regular discharge on December 12.
- While hospitalized, the Veteran had an authorized absence from
- November 8 through November 11, and
- November 21 through November 24.
Actions:
- Reduce the Veteran’s award to the hospitalized rate effective November 1, under 38 CFR 3.552(b)(1).
- Restore SMP at the A&A rate, following the regular discharge, effective December 4. This adjusted effective date allows for the eight days of authorized absence.
X.iii.1.C.3.gReadmission for Hospitalization Following an Irregular Discharge
If notice is received of a Veteran’s readmission for hospitalization
- within six months of the date of an irregular discharge, discontinue the allowance for A&A effective the date of readmission, per 38 CFR 3.552(b)(3), or
- six months or more after the date of an irregular discharge, discontinue the allowance for A&A effective the first day of the second calendar month following the month of readmission.
Important: Follow the due process procedures described in M21-1, Part X, Subpart iii, 1.C.1.d, before taking the actions described in the preceding bullets.Reference: For a definition of irregular discharge, see M21-1, Part X, Subpart iii, 1.B.3.g.
4Expedited SMP Entitlement Determinations for Chronic Invalids Hospitalized at VA Expense
This topic contains information on expedited SMP entitlement determinations for Veterans who are chronic invalids, including
- rationale for expediting an SMP entitlement determination, and
- actions taken by the
- medical facility, and
- regional office (RO).
Revised July 1, 2019
X.iii.1.C.4.aRationale for Expediting an SMP Entitlement Determination
In some instances, an expedited determination of entitlement to SMP may be warranted. There are Veterans who are patients in VAMCs or maintained by VA in other hospitals who
- are permanently and totally disabled, and
- may be entitled to SMP by rating decision because they require A&A or are housebound due to chronic invalidism or incapacity for self-care.
These individuals do not require hospital treatment and might leave the VAMCs and return to their homes or enter private nursing homes if they were assured prior to leaving that they would receive the increased pension because VA recognizes they require A&A or are housebound. In addition, if rated as being in need of regular A&A, such individuals may also be entitled to housebound benefits while still hospitalized.
X.iii.1.C.4.bActions Taken by the Medical Facility
After identifying the type of case described in M21-1, Part X, Subpart iii, 1.C.4.a, the VAMC or the Chief, Medical Administrative Specialist (MAS), determines whether
- it is medically feasible to authorize the Veteran’s discharge from the hospital
- the Veteran is willing to accept discharge, and
- arrangements can be made to ensure adequate care of the Veteran at home or at some other suitable place.
If the conditions described in the preceding bullets are met, the Chief, MAS, or other authorized medical center official
- completes VA Form 21-2680 , Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
- sends the form to the regional office (RO), and
- informs the RO of its proposal to discharge the Veteran.
X.iii.1.C.4.cActions Taken by the RO
The table below describes how the RO processes the VA Form 21-2680 referenced in M21-1, Part X, Subpart iii, 1.C.4.b.
| Stage | Description |
|---|---|
| 1 | The rating activity determines whether the Veteran requires A&A or is housebound. Notes:
|
| 2 | After the rating activity makes a decision, the authorization activity takes action to award the
|
| 3 | After receiving a discharge report, the authorization activity adjusts the award to pay benefits at the A&A rate effective the date of discharge. |
Notes:
- The DOC may be the date of a VA examination or the date of admission for hospitalization.
- If evidence of eligibility for SMP is received within one year of the notification of basic pension eligibility, A&A may be paid from the effective date of the award of basic pension.
End of Part X, Subpart iii, Chapter 1, Section C