Aid and Attendance and Housebound Benefits
Aid and Attendance (A&A) and Housebound are increased VA payments for a veteran who needs the regular help of another person or who meets the housebound criteria described below; despite the name, those criteria can be met without being confined to the home. VA pays them under two separate programs with separate rules: disability compensation, for service-connected disabilities, and Veterans Pension under 38 U.S.C. 1521. The criteria for each are in different regulations.
In disability compensation, these are levels of Special Monthly Compensation (SMC) under 38 CFR 3.350. SMC-L is payable for anatomical loss or loss of use of both feet, or of one hand and one foot; blindness in both eyes with visual acuity of 5/200 or less; or being permanently bedridden or so helpless as to be in need of regular aid and attendance (3.350(b)). The housebound level is SMC-S, payable where the veteran has a single service-connected disability rated as 100 percent and either has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent disability and involving different anatomical segments or bodily systems, or is permanently housebound by reason of service-connected disability (3.350(i)). A veteran receiving the maximum rate under 38 U.S.C. 1114(o) or (p), or the intermediate rate between 1114(n) and (o) plus SMC-K, who is in need of regular aid and attendance or a higher level of care is entitled to an additional allowance under 1114(r) (3.350(h)).
In Veterans Pension, the criteria are in 38 CFR 3.351. A veteran is considered in need of regular aid and attendance if he or she is 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; is a patient in a nursing home because of mental or physical incapacity; or establishes a factual need under 3.352(a) (3.351(c)). The pension housebound rate in 38 U.S.C. 1521(e) applies to a veteran who is not in need of regular aid and attendance and who has a single permanent disability rated 100 percent disabling, not including ratings based on unemployability under 38 CFR 4.17, and either has additional disability or disabilities independently ratable at 60 percent or more, separate and distinct and involving different anatomical segments or bodily systems, or is permanently housebound (3.351(d)). Because the housebound rate is for a veteran not in need of aid and attendance, a pension award is paid at one rate or the other.
In both programs, a factual need for aid and attendance is judged under 38 CFR 3.352(a). It considers inability to dress or undress or to keep ordinarily clean and presentable; frequent need of adjustment of a special prosthetic or orthopedic appliance that cannot be done without aid; inability to feed oneself through loss of coordination of the upper extremities or extreme weakness; inability to attend to the wants of nature; and physical or mental incapacity that requires care or assistance on a regular basis for protection from the hazards or dangers of the daily environment. Being bedridden, meaning a condition that actually requires remaining in bed, is a proper basis. Not every listed condition has to be present, and the evidence must show a need for regular aid and attendance, not a constant need. Care given by a relative or household member does not prevent the award (3.352(c)).
Section 3.351 also covers related increases for family members: increased compensation payable to a veteran whose spouse is in need of aid and attendance (38 U.S.C. 1115(1)(E)), and increased dependency and indemnity compensation or survivors pension for a surviving spouse who needs aid and attendance or is housebound. To apply, submit a statement from your doctor detailing your care needs along with your claim. The medical evidence should specifically describe what activities you need help with and why.
Note: This article references sections of the VA's M21-1 Adjudication Procedures Manual. The VA periodically reorganizes the M21-1 and section numbers may have changed since this article was written. For the most current section references, visit the VA's public M21-1 Web Automated Reference Material System (WARMS).