## Section A. General Information on Requirements for Aid and Attendance (A&A) and Housebound Status Under 38 CFR 3.351 

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ---------- ------------------------------------------------ ------------
  Topic      Topic Name                                       See Page

  1          Overview of Requirements for A&A Status Under 38 2-A-2
             CFR 3.351                                        

  2          Overview of Requirements for Housebound Status   2-A-6
             Under 38 CFR 3.351                               

  3          General Information on Developing for A&A and    2-A-9
             Housebound Status                                
  ---------- ------------------------------------------------ ------------

#### 1. Overview of Requirements for Aid and Attendance (A&A) Status Under 38 CFR 3.351 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains an overview of requirements for   |
| troduction | > Aid and Attendance (A&A) status under 38 CFR 3.351.   |
|            | > It includes information on                            |
|            |                                                         |
|            | -   who may qualify for A&A status                      |
|            |                                                         |
|            | -   requirements for A&A status                         |
|            |                                                         |
|            | -   A&A qualification of                                |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   veterans entitled to pension                        |
|            |                                                         |
|            | -   surviving spouses and parents entitled to death     |
|            |     pension, Dependency and Indemnity Compensation      |
|            |     (DIC), or death compensation, and                   |
|            |                                                         |
|            | -   spouses of veterans who are receiving additional    |
|            |     compensation for a spouse, and                      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   applicable regulatory references.                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > May 14, 2007                                          |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > Individuals in the following categories may qualify   |
|  Who May Q | > for Aid and Attendance (A&A) status under [38 CFR     |
| ualify for | > 3.351](http://w                                       |
|  A&A Statu | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC): |
| s Under 38 |                                                         |
|  CFR 3.351 | -   a veteran who is receiving disability pension under |
|            |     [38 U.S.C.                                          |
|            |     1521(d)](http://straylight.law.cornell.edu          |
|            | /uscode/html/uscode38/usc_sec_38_00001521----000-.html) |
|            |                                                         |
|            | -   a veteran's spouse, if the veteran is receiving     |
|            |     additional compensation for him/her under [38       |
|            |     U.S.C.                                              |
|            |     1115](http://straylight.law.cornell.edu             |
|            | /uscode/html/uscode38/usc_sec_38_00001115----000-.html) |
|            |                                                         |
|            | -   a surviving spouse or parent receiving Dependency   |
|            |     and Indemnity Compensation (DIC) under [38 U.S.C.   |
|            |     1311(c)](http://straylight.law.cornell.edu          |
|            | /uscode/html/uscode38/usc_sec_38_00001311----000-.html) |
|            |     or [38 U.S.C.                                       |
|            |     1315(h)](http://straylight.law.cornell.edu/         |
|            | uscode/html/uscode38/usc_sec_38_00001315----000-.html), |
|            |     and                                                 |
|            |                                                         |
|            | -   a surviving spouse receiving                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   death pension under [38 U.S.C.                      |
|            |     1541(d)](http://straylight.law.cornell.edu/         |
|            | uscode/html/uscode38/usc_sec_38_00001541----000-.html), |
|            |     or                                                  |
|            |                                                         |
|            | -   death compensation under [38 U.S.C.                 |
|            |     1122](http://straylight.law.cornell.edu/            |
|            | uscode/html/uscode38/usc_sec_38_00001122----000-.html). |
+------------+---------------------------------------------------------+

Continued on next page

1\. Overview of Requirements for Aid and Attendance (A&A) Status Under
38 CFR 3.351, Continued

+------------+---------------------------------------------------------+
| #####      | > To qualify for A&A status, an individual must be      |
| b. Require |                                                         |
| ments for  | -   so helpless as to require the aid of another person |
| A&A Status |     to perform the personal functions required in       |
|            |     everyday living ([38 CFR                            |
|            |     3.352(a)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_352.DOC)) |
|            |                                                         |
|            | -   blind or so nearly blind as to have                 |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   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)](http://ww                              |
|            | w.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC)), |
|            |     or                                                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   a patient in a nursing home because of physical or  |
|            |     mental incapacity ([38 CFR                          |
|            |     3.351(c)(2)](http://ww                              |
|            | w.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC)). |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Increased Improved Pension based upon the need for  |
|            |     regular aid and attendance may be awarded without   |
|            |     regard to whether the need is permanent, per        |
|            |     *[VAOPGCPREC                                        |
|            |     21-94](http://www.va.gov/ogc/docs/PRC21-94.DOC).*   |
|            |                                                         |
|            | -   Beneficiaries may not receive increased Old Law     |
|            |     Pension or Section 306 Pension because of being A&A |
|            |     (or Housebound). If an Old Law or Section 306       |
|            |     Pension beneficiary claims Special Monthly Pension  |
|            |     (SMP), the case must be reviewed to determine if an |
|            |     election of Improved Pension would be to the        |
|            |     claimant's benefit.                                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > A veteran pensioner must generally have a single      |
|  A&A Quali | > disability rated 100 percent under a schedular        |
| fication o | > evaluation for a determination of need for regular    |
| f Veterans | > A&A under [38 CFR                                     |
|  Entitled  | > 3.352(a)](http://w                                    |
| to Pension | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_352.DOC). |
|            | >                                                       |
|            | > ***Note***: Greater disability is generally required  |
|            | > for entitlement to the additional allowance for       |
|            | > regular A&A than for entitlement to the Housebound    |
|            | > rate for veteran's pension.                           |
+------------+---------------------------------------------------------+

Continued on next page

1\. Overview of Requirements for Aid and Attendance (A&A) Status Under
38 CFR 3.351, Continued

+------------+---------------------------------------------------------+
| ####       | > Surviving spouses and parents who are eligible for    |
| # d. A&A Q | > death pension, DIC, or death compensation may qualify |
| ualificati | > for A&A under [38 CFR                                 |
| on of Surv | > 3.351](http://w                                       |
| iving Spou | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC). |
| ses and Pa | >                                                       |
| rents Enti | > ***Note***: Death pension includes Improved Pension,  |
| tled to De | > Section 306 Pension, Old-Law Pension, and             |
| ath Pensio | > Spanish-American War Pension. However, beneficiaries  |
| n, DIC, or | > receiving Section 306 Pension and Old Law Pension can |
|  Death Com | > generally not receive a higher rate unless they elect |
| pensation  | > Improved Pension.                                     |
|            | >                                                       |
|            | > ***Reference***: For more information on conditional  |
|            | > elections, see M21-1MR, Part III, Subpart v, 4.A.3.   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### e. A | > Per [38 CFR                                           |
| &A Qualifi | > 3.351(a)(2)](http://w                                 |
| cation of  | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC), |
| Spouses of | > increased compensation is payable to a veteran by     |
|  Veterans  | > reason of the veteran's spouse being in need of A&A.  |
|            | >                                                       |
|            | > ***Note***: This provision applies only to veterans   |
|            | > who are receiving additional compensation for a       |
|            | > spouse.                                               |
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Continued on next page

1\. Overview of Requirements for Aid and Attendance (A&A) Status Under
38 CFR 3.351, Continued

+------------+---------------------------------------------------------+
| ##         | > Use the table below to review the legal provisions    |
| ### f. App | > for the A&A status issues listed.                     |
| licable Re |                                                         |
| gulatory R |                                                         |
| eferences  |                                                         |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| A&A Status Issue                 | Regulatory Reference              |
+----------------------------------+-----------------------------------+
| Rating decisions for A&A status  | -   [38 CFR                       |
| in disability pension cases.     |     3.351(c)(3                    |
|                                  | )](http://www.warms.vba.va.gov/re |
|                                  | gs/38CFR/BOOKB/PART3/S3_351.DOC), |
|                                  |     and                           |
|                                  |                                   |
|                                  | -   [38 CFR                       |
|                                  |     3.352(                        |
|                                  | a)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_352.DOC) |
+----------------------------------+-----------------------------------+
| A&A status based on nursing home | [38 CFR                           |
| patient status.                  | 3.351(c)(                         |
|                                  | 2)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_351.DOC) |
+----------------------------------+-----------------------------------+
| Determining the effective date   | -   [38 CFR                       |
| of A&A status.                   |     3.401(a)(                     |
|                                  | 1)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_401.DOC) |
|                                  |     (veterans)                    |
|                                  |                                   |
|                                  | -   [38 CFR                       |
|                                  |     3.401(a)(                     |
|                                  | 3)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_401.DOC) |
|                                  |     (spouse of a veteran)         |
|                                  |                                   |
|                                  | -   [38 CFR                       |
|                                  |     3.402(                        |
|                                  | c)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_402.DOC) |
|                                  |     (surviving spouse), and       |
|                                  |                                   |
|                                  | -   [38 CFR                       |
|                                  |     3.4                           |
|                                  | 04](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_404.DOC) |
|                                  |     (surviving parents).          |
+----------------------------------+-----------------------------------+
| Withdrawal of A&A status for any | [38 CFR                           |
| reason.                          | 3.103(b)(                         |
|                                  | 2)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_103.DOC) |
|                                  |                                   |
|                                  | ***Note***: The provisions of [38 |
|                                  | CFR                               |
|                                  | 3.103(b)(                         |
|                                  | 2)](http://www.warms.vba.va.gov/r |
|                                  | egs/38CFR/BOOKB/PART3/S3_103.DOC) |
|                                  | require sending a notice of       |
|                                  | proposed adverse action to a      |
|                                  | beneficiary.                      |
|                                  |                                   |
|                                  | ***Reference***: For more         |
|                                  | information on withdrawal of A&A  |
|                                  | status, see M21-1MR, Part V,      |
|                                  | Subpart iii, 4.1.                 |
+----------------------------------+-----------------------------------+

#### 2. Overview of Requirements for Housebound Status Under 38 CFR 3.351 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains an overview of requirements for   |
| troduction | > Housebound status under 38 CFR 3.351. It includes     |
|            | > information on                                        |
|            |                                                         |
|            | -   who may qualify for Housebound status under 38 CFR  |
|            |     3.351                                               |
|            |                                                         |
|            | -   determining a veteran's Housebound status           |
|            |                                                         |
|            | -   the definition of ***permanently housebound***      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > May 14, 2007                                          |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > The following individuals may qualify for Housebound  |
|  a. Who Ma | > status under [38 CFR                                  |
| y Qualify  | > 3.351](http://w                                       |
| for Houseb | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC): |
| ound Statu |                                                         |
| s Under 38 | -   veterans entitled to disability pension, and        |
|  CFR 3.351 |                                                         |
|            | -   surviving spouses entitled to                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Improved Pension                                    |
|            |                                                         |
|            | -   death compensation, or                              |
|            |                                                         |
|            | -   DIC.                                                |
+------------+---------------------------------------------------------+

Continued on next page

2\. Overview of Requirements for Housebound Status Under 38 CFR 3.351,
Continued

+------------+---------------------------------------------------------+
| #          | > Veterans eligible for disability pension qualify for  |
| #### b. De | > nonservice-connected (NSC) Housebound status if they  |
| termining  |                                                         |
| a Veteran' | -   have a single permanent disability rated 100        |
| s Housebou |     percent under a schedular evaluation, and           |
| nd Status  |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   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)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC), |
|            |     or                                                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   qualify under *Hartness v. Nicholson* (2006) when   |
|            |     pension was granted based on the veteran\'s being   |
|            |     age 65 or older.                                    |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   In NSC 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)](http://straylight.law.cornell.edu/         |
|            | uscode/html/uscode38/usc_sec_38_00001521----000-.html). |
|            |                                                         |
|            | > ***Reference***: For more information on adjudicating |
|            | > special monthly pension (SMP) cases where the veteran |
|            | > is 65 or older, see *Fast Letter 06-28.*              |
+------------+---------------------------------------------------------+

Continued on next page

2\. Overview of Requirements for Housebound Status Under 38 CFR 3.351,
Continued

+------------+---------------------------------------------------------+
| ####       | > Under [38 CFR                                         |
| # c. Defin | > 3.351(d)](http://w                                    |
| ition: Per | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_351.DOC), |
| manently H | > consider an individual ***permanently housebound***   |
| ousebound  | > if the individual is substantially confined to 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.                                 |
+------------+---------------------------------------------------------+

#### 3. General Information on Developing for A&A and Housebound Status

+------------+---------------------------------------------------------+
| ##### Int  | > This topic contains general information on developing |
| roduction  | > for A&A and Housebound status. It includes            |
|            | > information on                                        |
|            |                                                         |
|            | -   considering communications for increased benefits   |
|            |     from a claimant or his/her representative           |
|            |                                                         |
|            | -   acceptable medical reports for determining A&A or   |
|            |     Housebound status                                   |
|            |                                                         |
|            | -   redetermination of A&A or Housebound status         |
|            |                                                         |
|            | -   where to find additional information on A&A and     |
|            |     Housebound qualifications.                          |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > May 14, 2007                                          |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. C | > Accept any communication from the claimant or his/her |
| onsidering | > accredited representative indicating a desire for     |
|  Communica | > increased benefits because of disability or nursing   |
| tions for  | > home status as a claim for A&A or Housebound status,  |
| Increased  | > as applicable.                                        |
| Benefits F |                                                         |
| rom a Clai |                                                         |
| mant or Hi |                                                         |
| s/Her Repr |                                                         |
| esentative |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Determinations of a claimant's need for A&A or        |
| ## b. Acce | > Housebound are based, if possible, on medical reports |
| ptable Med | > and findings by private physicians or non-VA          |
| ical Repor | > facilities, rather than on VA examinations.           |
| ts for Det | >                                                       |
| ermining t | > ***Reference***: For information on administrative    |
| he Need fo | > grants of A&A based on nursing home status, see       |
| r A&A or H | > M21-1MR, Part V, Subpart iii, 2.B.                    |
| ousebound  |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

+------------+---------------------------------------------------------+
| ##         | > Refer the case to the rating activity for a           |
| ### c. Red | > redetermination of A&A or Housebound status if, after |
| eterminati | > the grant of A&A or Housebound, medical evidence is   |
| on of A&A  | > received indicating that                              |
| or Housebo |                                                         |
| und Status | -   the beneficiary's condition has improved, and       |
|            |                                                         |
|            | -   it appears he/she is no longer seriously disabled.  |
+------------+---------------------------------------------------------+

Continued on next page

3\. General Information on Developing for A&A and Housebound Status,
Continued

+------------+---------------------------------------------------------+
| ##         | > For additional information on A&A and Housebound      |
| ### d. Whe | > qualifications, see M21-1MR, Part V, Subpart ii, 3.   |
| re to Find |                                                         |
|  Additiona |                                                         |
| l Informat |                                                         |
| ion on A&A |                                                         |
|  and House |                                                         |
| bound Qual |                                                         |
| ifications |                                                         |
+------------+---------------------------------------------------------+