Revised April 12, 2007
XIII.i.3.D.1.aEligibility for Medical Services Under 38 U.S.C. 1712 (d)
Under 38 U.S.C. 1712(d), Veterans receiving additional compensation or increased pension for aid and attendance (A&A) or housebound benefits are entitled to medical services, including
- outpatient treatment
- drugs, and
- medicines.
XIII.i.3.D.1.bProviding Notification of Eligibility to Veterans
Notify a Veteran of medical care eligibility and application information when A&A or housebound benefits are awarded. The information is provided on
- VA Form 21-8764, Disability Compensation Award Attachment, or
- VA Form 21P-8768, Disability Pension Award Attachment.
XIII.i.3.D.1.cProcessing Eligibility Requests
Follow the steps in the table below when an eligibility request is received for medical services under 38 U.S.C 1712(d).
| Step | Action |
|---|---|
| 1 | Complete VA Form 10-7131, Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action , to show entitlement. Note: A future examination diary control has no effect on entitlement. |
| 2 | Complete the Remarks section of Part II __ of VA Form 10-7131 __ to show the following, as appropriate: Veteran receiving[additional compensation/increased pension]by reason of being[in need of regular A &A/permanently housebound]. |
2Eligibility for Outpatient Medications for A&A Cases in Which Income Is Excessive
This topic contains information on eligibility for outpatient medications for A&A cases in which income is excessive, including
- income limitation for eligibility for medications
- cases involving the termination of pension awards
- processing message code 652
- establishing continued entitlement to medications
- requesting income information from the Veteran, and
- completing the Remarks section of VA Form 10-7131.
Revised April 13, 2020
XIII.i.3.D.2.aIncome Limitation for Eligibility for Medications
Per 38 U.S.C. 1712(d), the Department of Veterans Affairs (VA) continues to furnish outpatient medications to Veterans entitled to A&A, including those reduced under 38 CFR 3.552(b)(1), whose income exceeds the applicable limit by no more than $1,000.
XIII.i.3.D.2.bCases Involving the Termination of Pension Awards
If a pension award to a Veteran entitled to A&A (code 1 or 2) is terminated because of excess income, message code 652 , A &A Term—[Year]Income Over Limit by $_______ , is issued for routing to the pension management center.
XIII.i.3.D.2.cProcessing Message Code 652
To process message code 652, follow the steps in the table below.
| Step | Action |
|---|---|
| 1 | Review the claims folder to
|
| 2 | Annotate VA Form 20-6560 , Notice of Benefit Payment Transaction , with entry of the amount over the income limit in the message legend space “$________ ”. |
| 3 | Date and sign the form. |
| 4 | Send the form to the requesting medical facility. |
| 5 | Annotate the claims folder to show the income information furnished to the medical facility. |
XIII.i.3.D.2.dEstablishing Continued Entitlement to Medications
Establish continued entitlement to outpatient medications annually in those pension cases in which the current year income did not exceed the limit by more than $1,000. Individual requests from the medical facility for income information for the next calendar year are received on _VA Form 10-7131 _during the last three months of the current year.
XIII.i.3.D.2.eRequesting Income Information From the Veteran
Check the claims folder to determine if there is current data sufficient to permit furnishing income information for the next year. If the claims folder does not already contain sufficient income data for the next year,
- request that the Veteran complete the appropriate Eligibility Verification Report form, and
- in the transmittal letter, indicate the reason for the request and state that the completed form should be returned within 30 days.
XIII.i.3.D.2.fCompleting the Remarks Section of VA Form 10-7131
Upon receipt of the desired information, or at the end of 30 days, enter the response in the Remarks , section, Part II, of VA Form 10-7131. Use the table below to determine what to enter into Remarks when income information is received or not received from the Veteran.
| If … | Then … |
|---|---|
| indicate the amount by which income for the next year will exceed the applicable maximum income limit.
|
income information is not received |
|
End of Part XIII, Subpart i, Chapter 3, Section D