**§3.352 Criteria for determining need for aid and attendance and**

**"permanently bedridden."**

\(a\) *Basic criteria for regular aid and attendance and permanently
bedridden.* The following will be accorded consideration in determining
the need for regular aid and attendance (§3.351(c)(3)) inability of
claimant to dress or undress himself (herself), or to keep himself
(herself) ordinarily clean and presentable, 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
back etc.); 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
environment. "Bedridden" will be a proper basis for the determination.
For the purpose of this paragraph "bedridden" will be that condition
which, through its essential character, actually requires that the
claimant remain in bed. The fact that claimant has voluntarily taken to
bed or that a physician has prescribed rest in bed for the greater or
lesser part of the day to promote convalescence or cure will not
suffice. It is not required that all of the disabling conditions
enumerated in this paragraph be found to exist before a favorable rating
may be made. The particular personal functions which the veteran is
unable to perform should be 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 aid and attendance,
not that there be a constant need. Determinations that the veteran is so
helpless, as to be in need of regular aid and attendance will not be
based solely upon an opinion that the claimant's condition is such as
would require him or her to be in bed. They must be based on the actual
requirement of personal assistance from others.

\(b\) *Basic criteria for the higher level aid and attendance
allowance.*

\(1\) A veteran is entitled to the higher level aid and attendance
allowance authorized by §3.350(h) in lieu of the regular aid and
attendance allowance when all of the following conditions are met:

\(i\) The veteran is entitled to the compensation authorized under 38
U.S.C. 1114(o), or the maximum rate of compensation authorized under 38
U.S.C. 1114(p).

\(ii\) The veteran meets the requirements for entitlement to the regular
aid and attendance allowance in paragraph (a) of this section.

\(iii\) The veteran needs a "higher level of care" (as defined in
paragraph (b)(2) of this section) than is required to establish
entitlement to the regular aid and attendance allowance, and in the
absence of the provision of such higher level of care the veteran would
require hospitalization, nursing home care, or other residential
institutional care.

\(2\) Need for a higher level of care shall be considered to be need for
personal health-care services provided on a daily basis in the veteran's
home by a person who is licensed to provide such services or who
provides such services under the regular supervision of a licensed
health-care professional. Personal health-care services include (but are
not limited to) such services as physical therapy, administration of
injections, placement of indwelling catheters, and the changing of
sterile dressings, or like functions which require professional
health-care training or the regular supervision of a trained health-care
professional to perform. A licensed health-care professional includes
(but is not limited to) a doctor of medicine or osteopathy, a registered
nurse, a licensed practical nurse, or a physical therapist licensed to
practice by a State or political subdivision thereof.

\(3\) The term "under the regular supervision of a licensed health-care
professional," as used in paragraph (b)(2) of this section, means that
an unlicensed person performing personal health-care services is
following a regimen of personal health-care services prescribed by a
health-care professional, and that the health-care professional consults
with the unlicensed person providing the health-care services at least
once each month to monitor the prescribed regimen. The consultation need
not be in person; a telephone call will suffice.

\(4\) A person performing personal health-care services who is a
relative or other member of the veteran's household is not exempted from
the requirement that he or she be a licensed health-care professional or
be providing such care under the regular supervision of a licensed
health-care professional.

\(5\) The provisions of paragraph (b) of this section are to be strictly
construed. The higher level aid-and-attendance allowance is to be
granted only when the veteran's need is clearly established and the
amount of services required by the veteran on a daily basis is
substantial. (Authority: 38 U.S.C. 501(a), 1114(r)(2))

\(c\) *Attendance by relative.* The performance of the necessary aid and
attendance service by a relative of the beneficiary or other member of
his or her household will not prevent the granting of the additional
allowance.

\[41 FR 29680, July 19, 1976, as amended at 44 FR 22720, Apr. 17, 1979;
60 FR 27409, May 24, 1995; 61 FR 68666, Dec. 30, 1996\]

**Supplement *Highlights* references**: 16(2), 26(1).