Since 1948 VA has provided adaptive housing assistance grants to eligible individuals who have certain service-connected disabilities to construct an adapted home or modify an existing home to accommodate their disabilities. Today, VA provides adaptive housing assistance primarily through two programs—Specially Adapted Housing (SAH) and Special Housing Adaptation (SHA). The SAH grant program provides financial assistance to service members and veterans who are entitled to compensation for permanent and total service-connected disability due to the loss or loss of use of multiple limbs, blindness and limb loss, or a severe burn injury. In general, eligible individuals may receive up to three SAH grants totaling no more than 50 percent of the cost of constructing or acquiring a specially adapted house or remodeling an existing house with adaptations. As shown in table 1, the maximum aggregate grant amount was $63,780 for fiscal year 2010 and is adjusted annually based on a cost-of-construction index. Grants may be used to construct a house or remodel an existing house, or they may be applied against the unpaid principal mortgage balance of a specially adapted house. The SHA grant program is similar to SAH but is for individuals with slightly less severe disabilities and may be used for slightly different purposes; for fiscal year 2010, the maximum amount was $12,756, which also is adjusted annually based on a cost-of-construction index. SAH and SHA are administered by VA’s Veterans Benefits Administration. In 2006 Congress created the TRA benefit, which allows veterans to apply for a grant to adapt a home owned by a family member with whom they are temporarily residing. The benefit was further extended to active-duty service members with the passage of the Housing and Economic Recovery Act of 2008. The TRA grant program enables service members and veterans eligible under the SAH and SHA programs to use up to $14,000 and $2,000, respectively, to modify a family member’s home. As shown in table 1, a TRA grant can only be used once and counts as one of the three grants allowed under either SAH or SHA. TRA grants also count toward the maximum allowable amount, $63,780 under SAH and $12,756 under SHA. The TRA grant program will expire on December 31, 2011, unless Congress extends it before then. Only 18 TRA grants have been used since the inception of the program. The age of these grantees and the cause of their disabilities varied, and the majority of the grantees have used the maximum allowable TRA grant amount of $14,000, although some adaptations have cost more than this amount. Use of the TRA grant program has been low—since the TRA program’s creation on June 15, 2006, through April 4, 2010, VA has processed a total of 18 TRA grants. Of these, four grants were processed in 2007, five grants in 2008, eight grants in 2009, and one grant in 2010, as of April 4. While comprehensive data are not available on the total number of service members and veterans who have a disability rating qualifying them for adaptive housing assistance, our analysis of VA data indicates that this number is well in excess of 10,000. As a result, only a very small proportion of those potentially eligible for adaptive housing assistance have used TRA. Because VA does not track the specific living arrangements of individuals eligible for adaptive housing benefits, it is not known how many of these individuals would have also met the criteria that would be required specifically to receive a TRA grant. As shown in table 2, the age of the 18 TRA grant recipients when they were approved for a grant ranged from 23 to 92. Half of these grantees were under the age of 40 and half were over the age of 40. The average age of those under 40 was 26 years. Among those over 40, seven were over the age of 60. In addition, of the 16 grantees for whom a discharge date was available, 7 had been discharged prior to 1974. All 18 TRA grantees qualified under the SAH (rather than SHA) grant program, which, as noted earlier, is for individuals with more severe service-connected disabilities. According to the 11 grant recipients or their caregivers with whom we spoke, all of the grantees had lost the use of both legs and required the use of a wheelchair or walker. Some of these grantees suffered from a spinal cord injury, and one was paralyzed from the neck down. In addition, three grantees suffered from brain trauma and one from a hearing impairment. The cause of the disabilities varied among the 11 grantees. Three of the grantees were injured abroad while serving in Operation Iraqi Freedom, four grantees were injured domestically in a vehicle or sporting accident, and four grantees suffered an illness, such as multiple sclerosis. Five of the 11 TRA grantees we spoke with used the grant to adapt the home of a parent, 2 to adapt the home of a son or daughter, and 4 to adapt the home of another relative, such as an uncle or sibling. Nine of the 11 grantees still lived in their relative’s adapted home at the time we contacted them, and in some cases, the grantee or caregiver indicated the grantee would likely continue to live there for an extended period of time. Five caregivers told us the grantee was unable to care for himself or herself and would likely require long-term live-in assistance. Four other grantees told us that they lived independently or planned to do so in the future. For example, one grantee lived with his parents for about 2 months while he recovered from injuries and subsequently purchased his own home. Another grantee continued to live in the home owned by her brother but was able to live independently. As shown in table 3, the dollar amount of the 18 TRA grants that had been processed as of April 4, 2010, ranged from $3,575 to $14,000. Eleven of these grants were for the maximum allowable amount of $14,000, and three others were near that maximum. Our review of VA’s case files found that in 8 of 18 cases, the cost to adapt the relative’s home, as recorded in the file, exceeded $14,000. For example, in one case, the cost to adapt a bedroom and bathroom was $62,115. According to the file, the TRA grant was supplemented by a grant of $23,865 from a nonprofit organization, and the grantee paid the remaining uncovered cost of $24,250. In another case, the cost of adapting a bathroom, replacing a sliding door, building a platform in the sun porch, and adding a ramp to the exterior door was $24,500. According to the file of this grantee, $10,500 not covered by TRA was funded by the grantee’s uncle and by donations from contractors. Some TRA grantees made adaptations to a home prior to using the TRA grant. The cost of those adaptations would not necessarily be included in VA’s case file and thus would not be reflected in table 3. For example, a caregiver of a grantee told us that prior to using the TRA grant, the family spent more than $50,000 installing hardwood flooring throughout the house to make it wheelchair accessible. We were not able to identify comprehensive and up-to-date data on the typical costs for adapting a home to accommodate severe disabilities like those experienced by individuals eligible for adaptive housing grants. However, VA’s 2004 Report to Congress: Assessment of the Adequacy of VA Authorities to Provide Specially Adaptive Housing provided some information on typical costs for making certain home adaptations. The report cited the typical cost for adapting a bathroom to make it handicapped accessible as $22,000, which included installing a bidet that washes and dries, a toilet or urinal with an automatic flush sensor, and a shower or bathtub with automatic soap and shampoo dispensers. The typical cost to adapt a kitchen was cited as $8,000, which included installing an automatic shut-off stove, raising a dishwasher, lowering countertops, and installing a side-by-side refrigerator. The report also noted that the cost of widening four doorways, which a typical home might require, was $2,400. The VA report did not address the TRA program in particular, but it did note that the SHA grant amount of $12,000 would typically not cover the full cost of adaptations needed to accommodate a grantee’s disabilities. The median number of days from the submission of a grant application to VA’s approval of the 12 grants approved after June 15, 2006, was 299, with a range from 34 to 641 days. After a veteran or service member submits an application for adaptive housing assistance and decides to take advantage of the benefit, he or she must make a number of decisions related to the project—including arranging for mortgage and construction financing, hiring architects, working with VA to review and approve adaptation plans, and soliciting bids from and selecting contractors— before VA approves the grant. VA staff told us that the length of time from application to approval is often driven by the amount of time needed by the recipient for project design. After VA approves a veteran’s or service member’s grant, construction begins on the project. Among the 16 TRA grants for which construction was completed as of April 4, 2010, the construction phase of the grant process—that is, the period between the grant approval date and VA’s final payment for services—ranged from 20 days to 233 days, with a median of 45 days. Most of the TRA grantees or their caregivers with whom we spoke generally said that once the grant was approved, they did not experience any problems in the construction phase of the grant process. To explore the underlying reasons for low use of TRA, we interviewed 50 service members and veterans under the age of 35 who were eligible for adaptive housing but had not used TRA. Half these individuals had applied for some form of adaptive housing assistance and half had not.