Various disabilities prevent many veterans from independently performing everyday living activities (see fig. 1). VA offers enhanced monthly benefits that help such individuals obtain needed services. These services can be provided at home, in an assisted living facility, or a nursing home and can be provided by private providers, family and friends, and VHA. VA is required to ensure that potential recipients are informed about available benefits and to the maximum extent possible are offered assistance applying for them. VBA administers enhanced monthly benefits as well as other monetary and nonmonetary benefits, and conducts outreach through its 57 regional offices and Benefits Assistance Service and other VA offices. Veterans may be eligible for A&A benefits if they establish a factual need for A&A, when considering many factors, including an ability to perform everyday personal functions such as bathing, dressing, eating, adjusting prosthetic devices, and protecting themselves from hazards or dangers in their daily environment; are a patient in a nursing home; are bedridden; or are blind or nearly blind. Veterans may be eligible for Housebound benefits if they have a disability rated at 100 percent and, as a result, are permanently or substantially confined to their homes, or a disability rated at 100 percent, and at least one other disability rated at 60 percent or more—although these individuals are legally classified as Housebound, they may be able to leave their homes. A&A and Housebound benefits both offer assistance that helps veterans function more independently, but A&A benefits are only for those who are in need of regular aid and attendance of another person, whereas Housebound benefits are for those who may be substantially confined to their homes. In addition to individual requirements specific to A&A and Housebound benefits, individuals have to meet the eligibility requirements for basic disability compensation or pension benefits. When A&A or Housebound benefits are received as part of disability compensation benefits, the combined payment is called enhanced disability compensation. To qualify for disability compensation benefits, veterans must have disabling injuries or illnesses that occurred or were made worse by their active military service. Such veterans must also have received a discharge or release under conditions other than dishonorable. Per VA’s policy manual, VA is supposed to automatically consider the need for the A&A or Housebound benefit when awarding veterans a disability rating of 100 percent and may grant the benefit when there is sufficient medical evidence to support the individual’s need for aid and attendance. The total monthly enhanced disability compensation benefit amount for A&A varies based on the veteran’s level of disability and family composition, whereas the amount of the Housebound benefit varies based only on the veteran’s family composition. For example, depending upon a veteran’s level of disability, the total monthly enhanced disability compensation payment for a single veteran receiving A&A benefits can range from approximately $3,300 to approximately $7,700 while the monthly payment for a veteran with a spouse and one child can range from approximately $3,600 to approximately $7,900. In contrast, the total monthly payment with Housebound benefits is approximately $3,000 for a single veteran and approximately $3,300 for a veteran with a spouse and child. For veterans receiving either A&A or Housebound benefits, the monthly amount is increased by $136 if the spouse requires A&A, by $75 for each child in excess of one, and by $240 for each school child over the age of 18. When veterans receive A&A or Housebound benefits as part of a VA pension, the combined payment is called an enhanced pension. Veterans who served during a period of war and meet other service requirements may receive a VA pension if they are 65 or older, or at any age if they have disabilities unrelated to their military service that render them permanently and totally disabled, among other requirements. Because VA pension benefits are offered to help veterans or their surviving spouses of limited means, potential recipients must not exceed certain income and asset thresholds. Table 1 shows the differences in the maximum annual pension benefit limits for 2010 based on family composition for a VA pension recipient without enhanced benefits, with the A&A benefit, and with the Housebound benefit. Veterans may have other sources of income, such as Social Security disability and retirement benefits, Medicaid, and private insurance, some of which may be counted in determining whether a veteran meets income eligibility requirements for a pension. For example, Social Security retirement benefits are counted as part of a veteran’s income, whereas public assistance benefits such as Social Security’s Supplemental Security Income is not. In addition to income, VA considers the net worth of individuals, excluding the value of the person’s home and vehicle. The standard that VA uses to determine eligibility for these benefits is whether the individuals’ resources are sufficient to meet their basic needs without assistance from VA. While there is no specified limit on the amount of resources individuals may have, if they have assets of $80,000 or more, per VA’s policy manual, VA is supposed to conduct an assessment to determine if their assets are sufficient to meet their basic needs. Assets counted toward the “sufficient means” figure of $80,000 include bank accounts, certificates of deposit, money market accounts, investment accounts, annuities, retirement accounts, and life insurance cash surrender values. To assess ongoing eligibility and benefit levels, VA requires pensioners who have income other than Social Security to file an annual income report. In addition to enhanced monthly benefits, VA provides other benefits to help veterans perform daily living activities. For example, VBA provides benefits to help veterans purchase or convert an automobile to accommodate their disability. VHA offers other services, including the Home-Based Primary Care program, adult medical foster care, and adult day health care. VA data at the end of fiscal year 2010 showed that for the overall enhanced monthly benefit population (including veterans and survivors), most recipients were veterans, over age 65, receiving the benefit as part of their monthly pension benefit, and receiving the A&A supplement, but the composition and characteristics of the recipient population is changing (see fig. 2). According to VA’s data, more than 271,000 veterans and survivors received enhanced monthly benefits at the end of fiscal year 2010—a 52 percent increase since the end of fiscal year 2000. While veterans over age 65 comprised the majority of the overall enhanced monthly benefit population from fiscal years 2000 to 2010, there was an increased share of survivors, recipients age 65 or younger, those receiving the benefits under the disability compensation program, and those receiving the Housebound benefit enhancement. These changes were primarily driven by veterans age 65 or younger receiving these benefits—particularly those ages 46 to 65—-as well as younger veterans receiving enhanced compensation benefits that included the Housebound enhancement. Changes in the characteristics of the overall population of veterans and survivors who received enhanced monthly benefits were also mirrored in the population of veteran recipients. For example, the data showed that younger veterans are an increasing share of the veteran enhanced monthly benefit population. Although veterans over age 65 continued to comprise the majority of enhanced monthly benefit recipients at the end of fiscal year 2010, their share of the veteran enhanced monthly benefit population has decreased steadily. Specifically, at the end of fiscal year 2010, veterans over age 65 who received enhanced monthly benefits accounted for a 64 percent share of all veterans receiving these benefits compared with a 76 percent share in fiscal year 2000. Meanwhile the share of veteran enhanced monthly benefit recipients age 65 or younger increased from 24 percent to 36 percent over this time period (see fig. 3). While this increase was primarily driven by veterans ages 46 to 65, there was also a substantial increase in the percentage of veterans ages 18 to 45. Also for veterans who received enhanced monthly benefits, VA data showed that most received enhanced pension benefits that included the A&A benefit. This was particularly true for veteran recipients over age 65, although their share of these benefits declined from 62 percent in fiscal year 2000 to 50 percent in fiscal year 2010. For veterans age 65 and under receiving enhanced pension benefits with the A&A benefit, their share remained about the same—14 percent in fiscal year 2000 compared with 13 percent in fiscal year 2010 (see fig. 4). By the end of fiscal year 2010, the percentage of veteran recipients age 65 or younger who received enhanced disability compensation benefits that included the Housebound benefit almost tripled from 6 percent in fiscal year 2000 to 17 percent in fiscal year 2010. VA’s data also showed that most veterans receiving enhanced monthly benefits served during earlier war periods, but the number of recipients from more recent war periods is growing. The majority of recipients served during World War II, the Korean Conflict, and the Vietnam War (see fig. 5). Although Persian Gulf War (Gulf War) veterans comprised a relatively small proportion of veteran recipients, their numbers increased at a greater rate during fiscal years 2000 to 2010 (from less than 1,300 to nearly 11,000—more than a sevenfold increase) than veterans from any other period of service. Appendix II provides more information on the periods of service that qualify veterans for enhanced monthly pension benefits. In addition to analyzing the overall characteristics of veterans who received enhanced monthly benefits, we specifically analyzed the disabling conditions of Gulf War veterans. Consistently, the most common categories of disabling conditions during that time period were skeletal conditions, neurological conditions and convulsive disorders, and mental and eating disorders. However, there were significant changes among other disabling conditions and categories of disabling conditions. For example, ear conditions increased from ninth most common in 2000 to fourth most common in fiscal year 2010, while cardiovascular conditions went from sixth most common in fiscal year 2000 to eighth most common in fiscal year 2010. In addition, the proportion of Gulf War veteran enhanced monthly benefit recipients reporting diagnoses of Post Traumatic Stress Disorder grew dramatically from 8 percent at the end of fiscal year 2000 to 28 percent at the end of fiscal year 2010. Additionally, 7 percent of veteran enhanced monthly benefit recipients from the Gulf War reported diagnoses of traumatic brain injuries at the end of fiscal year 2010.