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M21-1, Part IV, Subpart iii, Chapter 2, Section B – Special Monthly Benefits for Survivors


In This Section

This section contains the following topics:
Topic Name

1.  General Rating Issues


This topic contains information on general rating issues for survivors, including

Change Date

March 3, 2016

IV.iii.2.B.1.a.  Considering Disability or Nursing Home Status as Basis for a Claim for A&A or Housebound Benefits

Prior to March 24, 2015, consider any communication from a claimant or accredited representative indicating a desire for increased benefits because of disability or nursing home patient status as a claim for aid and attendance (A&A) or housebound benefits.
After March 24, 2015, applications for A&A or housebound benefits must come in on a prescribed form.
Reference:  For more information on special monthly pension (SMP), see M21-1, Part V, Subpart iii, 2.

IV.iii.2.B.1.b.  Evidence on Which to Base A&A and Housebound Determinations

Determination of a claimant’s need for A&A or housebound benefits is based on medical evidence.
Examples of licensed health care professionals:
  • medical doctor (MD)
  • doctor of osteopathy (DO)
  • nurse practitioner (NP), or
  • physician’s assistant (PA)
  • certified nurse practitioner (CNP), or
  • clinical nurse specialist (CNS).
Reference:  For more information on A&A criteria, see 38 CFR 3.351(c)(2).

IV.iii.2.B.1.c.  When a Rating Decision Is Required
A rating decision is required to determine a surviving spouse’s entitlement to either

  • the A&A rate, when the surviving spouse is not a patient in a nursing home, or
  • the Housebound rate.

IV.iii.2.B.1.d.  Adjusting Special Monthly Benefits Following Discharge From a Nursing Home
If a claimant is discharged from a nursing home, adjust A&A and Housebound benefits in accordance with the procedures for disability cases outlined in M21-1, Part V, Subpart iii, 2.B.3 and M21-1, Part V, Subpart iii, 2.B.4.

2.  Aid and Attendance (A&A) and Housebound Benefits

This topic contains information on A&A and housebound benefits for survivors, including

Change Date
March 10, 2016

IV.iii.2.B.2.a.  Who May Qualify for A&A Benefits Under 38 CFR 3.351
A&A benefits under 38 CFR 3.351 may be paid to surviving spouses and parents who are receiving or entitled to receive

  • Survivors Pension, including protected pension and Old War Service Pension,
  • DIC, or
  • Death Compensation.

IV.iii.2.B.2.b.  Who May Qualify for Housebound Benefits Under 38 CFR 3.351(e) and (f)
Only surviving spouses who are receiving or entitled to receive DIC or Survivors Pension may qualify for the Housebound rate under 38 CFR 3.351(e) and (f).

IV.iii.2.B.2.c.  Authorizing A&A Without a Rating Decision
Authorize the payment of A&A benefits without a rating decision if
  • evidence establishes the claimant is a patient in a nursing home or,
  • the surviving spouse was in receipt of A&A benefits on the Veteran’s award prior to the Veteran’s death.
If a period of hospitalization of 90 days or less results in a discharge to a nursing home, authorize payment of A&A benefits from the date of hospital admission, subject to the effective date provisions in 38 CFR 3.402(c) or 38 CFR 3.404.
Important:  Housebound benefits may not be authorized without a rating decision – except when the surviving spouse was receiving Housebound benefits on the Veteran’s award prior to the Veteran’s death.
Reference:  For more information on when to refer a claim to the rating activity to determine eligibility to A&A or housebound benefits, see M21-1, Part V, Subpart iii, 2.A.3.c.
03-03-16_KeyChanges_M21-1IV_iii_2_SecB.docx May 21, 2019 46 KB
Historical_M21-1IV_iii_2_SecB_06-15-15.doc May 21, 2019 85 KB
03-10-16_KeyChanges_M21-1IV_iii_2_SecB.doc May 21, 2019 158 KB
Change-July-25-2015-Transmittal-Sheet-M21-1IV_iii_2_SecB_TS.docx May 21, 2019 42 KB
Historical_M21-1MRIV_iii_2_SecB_06-15-2015.doc May 21, 2019 86 KB
Change-June-15-2015-Transmittal-Sheet-M21-1MRIV_iii_2_TS.docx May 21, 2019 45 KB
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