Is Eligible for the Aid and Attendance Pension Benefit?
Filing a claim can be
time-consuming and complicated. It's important to get help.
Applications for Pension that involve a rating, evidence of
prospective, recurring medical expenses, appointments for VA powers
of attorney and fiduciaries, and an understanding of the actual
application process should not be attempted without prior knowledge.
Applications can also involve reallocation of assets in order to
qualify should not be attempted without the help of a qualified
veterans aid and attendance benefit consultant.
Only someone who is Accredited is authorized
to assist in this process.
Check for Accredited Claims Agents on the
Eligibility Rules for Pension
To receive Pension, a veteran must have served on active duty, at least
90 days, during a period of war. There must be an honorable
discharge. Single surviving spouses of such veterans are also
eligible. If younger than 65, the veteran must be totally disabled.
If age 65 and older, there is no requirement for disability. There
is no disability requirement for a single surviving spouse.
The veteran household cannot have
income -- adjusted for unreimbursed medical expenses -- exceeding
the Maximum Allowable Pension Rate-- MAPR -- for that veteran's
Pension income category. If the adjusted income exceeds MAPR, there
is no benefit. If adjusted income is less than the MAPR, the veteran
receives a Pension income that is equal to the difference between
MAPR and the household income adjusted for unreimbursed medical
expenses. The Pension income is calculated, based on 12 months of
future household income, but paid monthly.
The Special Case for Long Term Care Costs
A special provision for calculating Pension income, allows household
income to be reduced by 12 months worth of future, recurring medical
expenses. Normally, income is only reduced by medical expenses
incurred in the month of application. These allowable, annualized
medical expenses are such things as insurance premiums, the cost of
home care, the cost of paying any person to provide care, the cost
of adult day care, the cost of assisted living and the cost of a
nursing home facility. In most cases, these expenses are only
deductible if there is a rating.
This special provision can allow veteran households
earning more than the annual MAPR to qualify for Pension. As an
example, a veteran household earning $6,000 a month could still
qualify for Pension if the veteran is paying $4,500 to $6,000 a
month for nursing home costs. The applicant must submit appropriate
evidence for a rating and for recurring costs in order to qualify
for this special provision. VA normally does not tell applicants
about this special treatment of medical expenses or how to qualify
for it. Our book provides ample information on this special
treatment and provides appropriate forms to present medical and cost
evidence in the most favorable manner.
For an explanation of the special annualized treatment
of unreimbursed long term care costs and insurance premiums please
go to the article entitled
"Understanding the special case of long term care medical costs."
Dealing with Assets That May Disqualify the
There is also an asset test to qualify for Pension. Any asset or
investment that could be easily converted into income might
disqualify the claimant. An asset ceiling of $80,000 is often cited
in the media as being the test. The $80,000 has to do with VA
internal filing requirements and is not an actual test. In reality,
there is no dollar amount for the test and any level of assets could
block the award. The asset test ultimately becomes a subjective
decision made by the veterans service representative, processing the
A home, used as a residence, vehicles and
difficult-to-sell property are generally excluded from the asset
test. VA will allow assets to be transferred or converted to income
in order to meet the asset test. There is no look back penalty for
transferring assets as there is with Medicaid. There are specific
rules governing transfers of assets and what constitutes income from
assets and it must be done correctly.
We recommend using a qualified aid and attendance
benefit consultant when dealing with assets that may disqualify. It
is extremely important that assets that might be gifted or converted
to income also meet Medicaid gifting rules in case the veteran or
the surviving spouse may have to apply for Medicaid. The consultant
can help avoid Medicaid penalties associated with reallocating
A rating for "aid and attendance" or "housebound" allows VA to pay
additional benefits beyond the regular Pension benefit ceiling in
order to help cover the additional costs associated with added
disabilities. A rating for these allowances is determined by a
veteran service representative who has been trained to recognize
from medical reports and interviews whether the veteran or his
surviving spouse needs the additional care.
Determinations of a need for aid and attendance or
housebound benefits may be based on medical reports and findings by
private physicians or from hospital facilities. Authorization of aid
and attendance benefits without a rating decision is automatic if
evidence establishes the claimant is a patient in a nursing home.
Aid and attendance is also automatic if the claimant is blind or
nearly blind or having severe visual problems.
According to 38 CFR Part Three, the following criteria
are used to determine the need for aid and attendance:
• inability of claimant to dress or undress
himself (herself), or to keep himself (herself) ordinarily clean and
• frequent need of adjustment of any special
prosthetic or orthopedic appliances which by reason of the
particular disability cannot be done without aid (this will not
include the adjustment of appliances which normal persons would be
unable to adjust without aid, such as supports, belts, lacing at the
• inability of claimant to feed himself
(herself) through loss of coordination of upper extremities or
through extreme weakness;
• inability to attend to the wants of nature;
• or incapacity, physical or mental, which
requires care or assistance on a regular basis to protect the
claimant from hazards or dangers incident to his or her daily
Not all of the disabling conditions in the list above
are required to exist before a favorable rating may be made. The
personal functions which the veteran is unable to perform are
considered in connection with his or her condition as a whole. It is
only necessary that the evidence establish that the veteran is so
helpless as to need "regular" (scheduled and ongoing) aid and
attendance from someone else, not that there be a 24-hour need.
"Bedridden" is a definition that allows a rating for
aid and attendance by itself. "Bedridden" is a condition which
requires that the claimant remain in bed. A person who has
voluntarily taken to bed or who has been told by the doctor to
remain in bed will not necessarily receive the favorable rating for
aid and attendance. There must be an actual need for personal
assistance from others.
Housebound means "permanently housebound by reason of
disability or disabilities." This requirement is met when the
veteran or his or her widow is substantially confined to his or her
dwelling and the immediate premises or, if institutionalized, to the
ward or clinical area, and it is reasonably certain that the
disability or disabilities and resultant confinement will continue
throughout his or her lifetime.
A person who cannot leave his immediate premises
unless under the supervision of another person is considered
housebound. This might include the inability to drive because of the
A housebound rating does not mean a person needs to be
confined to a personal residence. It can apply to any place where
the person is living whether in a facility or in the home of someone
In order to receive one of these ratings the claimant
must check the "Yes" box on VA Form 21-526 (claim for a living
veteran) or VA Form 21-534 (claim for death Pension from a surviving
spouse) that states: "Are you claiming a special monthly Pension
because you need the regular assistance of another person, are
blind, nearly blind, or having severe visual problems, or are
housebound?" Failure to check this box may result in no rating and
in some cases a denial of the claim as well as a loss of the rating
Medical evidence for a rating for "aid and attendance"
or "housebound" for living arrangements other than a nursing home
should be submitted with the application to avoid a delay in the
approval process. Waiting for the regional office to order medical
records is a time-consuming process, mainly because doctors offices
don't respond quickly to these kinds of requests.
We recommend a report completed by the physician, and
obtained by the family prior to submission of the claim. This report
is then included with the initial application. We provide in our
book a form entitled "Form 1 -- Statement of Attending Physician
(used to determine rating for A&A or HB)." This document is similar
to a form used internally by VA to obtain information from veterans
medical facilities for determining a rating. It is in a format that
a veterans service representative would recognize.
Ratings are requested by checking the appropriate box
for aid and attendance or housebound on VA Form 21-526 or VA Form
How Pension Is Calculated
The monthly award is based on VA totaling 12 months of estimated future
income and subtracting from that 12 months of estimated future,
recurring and predictable medical expenses. Allowable medical
expenses are reduced by a deductible to produce an adjusted medical
expense which in turn is subtracted from the estimated 12 months of
The new income derived from subtracting adjusted
medical expenses from income is called "countable" income or IVAP
(Income for Veterans Affairs Purposes). This countable income is
then subtracted from the Maximum Allowable Pension Rate -- MAPR --
and that result is divided by 12 to determine the monthly income
Pension award. This award is paid in addition to the family income
that already exists. See examples below.
Example #1 -- Veteran is in assisted
living with aid and attendance allowance. Monthly family income is
$4,000 a month. Spouse is living at home. Unreimbursed medical
expenses include prescription drugs, Medicare premiums, Medicare
supplement premiums, and 12 months of prospective assisted living
monthly costs. Family meets the asset test.
Example #2 -- Veteran receiving paid
home care with aid and attendance allowance. Monthly family income
is $1,900 a month. Unreimbursed medical expenses include
prescription drugs, Medicare premiums, Medicare supplement premiums,
and 12 months of prospective home health aide monthly costs. Family
meets the asset test.
Example #3 -- Surviving spouse
receiving paid home care with aid and attendance allowance. Monthly
income is $850 a month. Unreimbursed medical expenses include
prescription drugs, Medicare premiums, Medicare supplement premiums,
and 12 months of prospective home health aide monthly costs.
Surviving spouse meets the asset test.