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M21-1, Part IX, Subpart i, Chapter 3 – Specially Adapted Housing (SAH) or Special Home Adaptation (SHA) Grants

Overview


In This Section

This section contains the following topics:

1.  Eligibility for SAH or SHA Grants

 


Introduction

This topic contains information about the eligibility for SAH or SHA grants, including

Change Date

March 8, 2019

IX.i.3.1.a.  General Information on SAH and SHA Grants

The Department of Veterans Affairs (VA) administers two types of grants to assist seriously disabled Veterans and service members in adapting housing to their special needs:
  • specially adapted housing (SAH), and
  • special home adaptation (SHA).
SAH grant basic entitlement
An eligible person may receive a grant of not more than 50 percent of the cost of a specially adapted house, up to the total maximum allowable by law.
SHA grant basic entitlement
An eligible person may receive a grant for the actual cost to adapt a house or for the appraised market value of necessary adapted features already in a house when it was purchased, up to the total maximum allowable by law.
Notes:
  • Under 38 U.S.C. 2101A38 CFR 3.809 and 3.809a, grants may be made to active duty members of the Armed Forces who meet the criteria for benefits based on disabilities incurred or aggravated in the line of duty.
  • Under 38 U.S.C. 2102(d), a claimant may receive up to three awards of SAH or SHA benefits, as long as the total amount received does not exceed the statutory amount of entitlement.

IX.i.3.1.b.  Eligibility for SAH Grants

Eligibility for assistance in acquiring SAH exists when a
  • Veteran is entitled to compensation under 38 U.S.C. Chapter 11 for apermanently and totally disabling qualifying condition, or
  • service member on active duty has a permanently and totally disablingqualifying condition incurred or aggravated in the line of duty.
Qualifying conditions are
  • amyotrophic lateral sclerosis (ALS)
  • loss or loss of use (L/LOU) of
    • both lower extremities, precluding locomotion without the aid of braces, crutches, canes, or a wheelchair
    • one lower extremity and one upper extremity affecting balance or propulsion, or
    • one lower extremity plus residuals of organic disease or injury affecting balance or propulsion such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair
  • L/LOU of both upper extremities precluding use of the arms at or above the elbow;
  • blindness in both eyes, having light perception only (LPO), and L/LOU of one lower extremity, or
  • a severe burn injury with full thickness or subdermal burns that have resulted in contractures with limitation of motion (LOM) of
    • two or more extremities, or
    • at least one extremity and the trunk.
Notes:
  • Compensation under 38 U.S.C. Chapter 11 includes compensation for service-connected (SC) disabilities and disabilities “as if” SC under 38 U.S.C. 1151.
  • “Preclude locomotion” means the necessity for regular, constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible.
  • The use of a prosthesis is eligible for entitlement to SAH, as a prosthetic device is the equivalent of the use of braces under the regulation.
  • Effective October 1, 2012, Public Law (PL) 112-154, “Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012,’’ added new, specialized criteria for SAH.  These are addressed in M21-1, Part IX, Subpart i, 3.1.f.
  • Although 38 CFR 3.809 provides that ALS is a qualifying condition for SAH when evaluated 100-percent disabling under 38 CFR 4.124a, diagnostic code (DC) 8017, whenever there is a diagnosis of ALS, there is a qualifying condition for SAH purposes.  Any diagnosis of ALS is sufficient to support the assignment of a permanent 100-percent evaluation under DC 8017 or a hyphenated DC (8017-XXXX) for the predominant complication of ALS.  Do not issue a denial when multi-system effects of ALS are separately evaluated with a single 100-percent evaluation assigned for a complication of ALS under a hyphenated DC.
  • The regulatory change to 38 CFR 3.809 allowing for qualification based on ALS (78 FR 72573) is applicable to all applications for SAH pending before VA on, or received after, December 3, 2013.
  • A Veteran’s entitlement to a total rating based on individual unemployability, pursuant to 38 CFR 4.16, satisfies the requirement for a total SC disability for SAH eligibility purposes.
  • In Jensen v. Shulkin, 29 Vet.App. 66 (2017), the Court of Appeals for Veterans Claims held that the standard for conceding L/LOU of an extremity for the purposes of establishing eligibility to SAH benefits is notdirectly equivalent to the L/LOU criteria discussed in 38 CFR 3.350(a)(2)(i), the relevance of which is limited to establishing entitlement to special monthly compensation.
References:  For more information on

IX.i.3.1.c.  Eligibility for SHA Grants

Eligibility for assistance in acquiring SHA exists when
  • a Veteran is entitled to compensation under 38 U.S.C. Chapter 11 for a qualifying condition, or
  • a service member on active duty has a qualifying condition incurred or aggravated in the line of duty.
Qualifying conditions are
  • blindness with visual acuity of 20/200 or less in each eye
  • permanent and total disability from (L/LOU) of both hands, or
  • permanent and total disability from a severe burn injury
    • deep partial thickness burns that have resulted in contractures with LOM of
      • two or more extremities, or
      • at least one extremity and the trunk
    • full thickness or subdermal burns that have resulted in contracture(s) with LOM of
      • one or more extremities, or
      • the trunk, or
    • residuals of an inhalation injury, including, but not limited to
      • pulmonary fibrosis
      • asthma, or
      • chronic obstructive pulmonary disease (COPD).
Notes:
  • Eligibility only exists for SHA if the claimant is not entitled to, and has not previously received, SAH.
  • Compensation under 38 U.S.C. Chapter 11 includes compensation for SC disability as well as for disabilities “as if” SC under 38 U.S.C. 1151.
  • Blindness is assessed based on central distance visual acuity with the use of a standard correcting lens.
  • For SHA purposes, a visual field that subtends an angle no greater than 20 degrees is considered the equivalent of 20/200 visual acuity.  This is synonymous with average contraction of the visual field to no more than 20 degrees.
  • Effective October 1, 2012, PL 112-154
    • changed the visual acuity standard for SHA from 5/200 to 20/200
    • added the visual field equivalent, and
    • removed the requirement that visual impairment be permanently and totally disabling.
  • Qualification for SHA based on a respiratory disorder requires more than a showing of permanent and total disability from a respiratory diagnosis such as pulmonary fibrosis, asthma or COPD.  The diagnosis must have resulted from an inhalational injury caused by breathing steam or toxic inhalants, such as fumes, gases and mists present in a fire environment (including, but not limited to, acrolein, chlorine, phosgene, and nitrogen dioxide).
References:  For more information on

IX.i.3.1.d. SAH or SHA Claims Based on Paired Organs or Extremities

Even though compensation may be payable under 38 CFR 3.383, claimants do not qualify for SAH or SHA grants if they suffered a loss of paired SC and non-service-connected (NSC) organs or extremities.
Reference:  For more information on entitlement to compensation for loss of SC and NSC organs and extremities, see

IX.i.3.1.e.  Reduction of Benefits Due to Tort Judgment or Settlement

SAH or SHA benefits must be reduced by an “offset amount” in cases where a judgment or settlement of a tort claim against the United States is granted for disability established under 38 U.S.C. 1151, if the tort judgment or settlement
  • becomes final
    • on or after December 10, 2004, but
    • before the date VA awards SAH benefits, and
  • includes an amount specifically designated for housing.
Notes:
  • Contact local Regional Counsel to determine whether a judgment or settlement qualifies for offset under 38 CFR 3.363.
  • If the offset amount exceeds the amount of the SAH benefits awarded, the excess amount is offset against VA compensation.
Reference:  For more information on the offset of disability compensation under 38 U.S.C. 1151, see M21-1, Part IV, Subpart ii, 3.D.

IX.i.3.1.f.  SAH Criteria Introduced by PL 112-154

Section 202 of PL 112-154 amended 38 U.S.C. 2101(a)(2) to expand eligibility for SAH for Veterans who served and became permanently disabled on or after September 11, 2001.  The statutory change went into effect October 1, 2012.
The amendment adds a basis for qualification for SAH: permanent L/LOU of one or more lower extremities, severely affecting the functions of balance or propulsion as to preclude locomotion without the use of braces, crutches, canes, or a wheelchair.
Notes:
  • Although the Section 202 amendment refers to “Veterans”, under 38 U.S.C. 2101A, any reference to “Veterans” in the chapter includes active duty service members with a qualifying disability incurred or aggravated in the line of duty.
  • The L/LOU described in 38 U.S.C. 2101(a)(2)(C) does not have to be totally disabling.
  • In any fiscal year, the Secretary may not approve payment of more than 30 applications for assistance to the population of Veterans described in38 U.S.C. 2101(a)(2)(A)(ii).  This does not affect regional office (RO) processing of SAH issues.

2.  Responsibility for Determinations in SAH or SHA Claims

 


Introduction

This topic contains information on the responsibility of different VA divisions for making determinations in SAH or SHA claims, including the responsibility for

Change Date

July 15, 2015

IX.i.3.2.a.  Responsibility for Determining SAH/SHA Eligibility and Entitlement

The table below lists the relative responsibilities of the Loan Guaranty Division’s Regional Loan Center (RLC) and the Veterans Service Center (VSC) in determining SAH/SHA eligibility and entitlement.
The RLC is responsible for …
The VSC is responsible for …
determining entitlement to, and payment of, SAH and SHA.
Conditional approval includes consideration of
  • disability requirements
  • feasibility and suitability, and
  • usage or dollar amounts of assistance available vs. any amounts previously paid.
Final approval requires consideration of property requirements including
  • details of proposed adaptations
  • ownership
  • certifications
  • insurance, and
  • geographical limitations.
making determinations on basic eligibility disability requirements listed in M21-1, Part IX, Subpart i, 3.1.band c, under the circumstances listed in M21-1, Part IX, Subpart i, 3.3.a.
Note:  Each VSC must designate a point of contact for SAH/SHA claims who will
  • maintain the SAH/SHA mailbox, and
  • correspond with the RLC of jurisdiction when necessary.
References:  For more information on

IX.i.3.2.b.  Responsibility for Medical Feasibility Determinations in SAH/SHA Claims

determination of medical feasibility is needed when a Veteran is hospitalized or undergoing long-term care in a nursing home or other type care facility.
This determination is made by a Veterans Health Administration physician at the request of Loan Guaranty, with no involvement from the VSC.

3.  Processing Claims for SAH or SHA


Introduction

This topic contains information on processing claims for SAH or SHA, including

Change Date

March 8, 2019

IX.i.3.3.a.  When the VSC Will Make an SAH/SHA Basic Eligibility Determination

The VSC will make an SAH/SHA basic eligibility determination when
Exception:  The VSC will not make a basic eligibility determination when basic eligibility has already been established.
References:  For more information on

IX.i.3.3.b.  VA Form Requirement for SAH/SHA

A Veteran or service member seeking SAH or SHA must complete a VA Form 26-4555.
Important:
  • VA Form 26-4555 is a prerequisite to the allowance of SAH/SHA by the RLC but is not a prerequisite to VSC action on the determination of basic entitlement.
  • If basic eligibility to SAH/SHA has been previously denied by rating decision, VA Form 26-4555 must be accompanied by a qualifying request for decision review under 38 CFR 3.2500.  Otherwise, treat the submission as a request for application in accordance with procedures found in M21-1, Part III, Subpart ii, 2.C.6.

IX.i.3.3.c.  Claims Filed With the RLC on VA Form 26-4555

When a claimant seeks to initiate a claim for SAH/SHA by submitting a VA Form 26-4555 to an RLC, the following activities occur:
  • for electronic submissions, the information from the VA Form 26-4555 is transferred into the SAHSHA system automatically
  • for paper submissions, the RLC will manually enter the information from the application into SAHSHA
  • SAHSHA automatically creates an 890 work item (890WI) when the electronic VA Form 26-4555 is received or the information from the application is entered, and
  • RLC staff will determine if a rating from the VSC has previously established basic eligibility.
    • If so, the RLC will proceed with a determination on entitlement following its policies and procedures.  Since 890WIs are automatically generated, the VSC in these cases will subsequently review and clear the 890WI once it is determined that eligibility has already been established.
    • If not, the 890WI will prompt an eligibility determination by the VSC as provided in M21-1, Part IX, Subpart i, 3.3.g.
Note:  Loan Guaranty uses the SAHSHA system to process and track VA Forms 26-4555 electronically.

IX.i.3.3.d.  Claims Filed With the VSC on VA Form 26-4555

When a claimant seeks to initiate a claim for SAH/SHA by submitting VA Form 26-4555 to the VSC
  • date stamp the VA Form 26-4555
  • forward the application to the RLC of jurisdiction by
  • take any action required by the table below.
If basic eligibility to SAH/SHA …
Then …
has previously been established by rating
no end product (EP) control or further VSC action is needed; the RLC will make the entitlement determination.
has not been previously addressed by rating
make a basic eligibility determination as provided in M21-1, Part IX, Subpart i, 3.3.g.
Important:  Enter a note in the Veterans Benefits Management System (VBMS) indicating that the VA Form 26-4555 was sent to the RLC.
Note:  In the event a VA Form 26-4555 is inadvertently scanned into the Centralized Mail Portal, VSC personnel must utilize the download functionality within the portal to download the mail image. Once in portable document format (PDF), send the document, via encrypted e-mail, toLGYADMINCORR.VBACO@va.gov.

IX.i.3.3.e.  Claims Filed With the VSC on Any Other Prescribed VA Form

When a claim is received by the VSC on a prescribed VA form other than VA Form 26-4555, take any action required by the table below.
If basic eligibility to SAH/SHA …
Then …
has previously been established by rating
no EP control or further VSC action is needed; the RLC will make the entitlement determination based on its own policies and procedures.
  • has not been previously established by rating, or
  • has been previously denied
make a basic eligibility determination as provided in M21-1, Part IX, Subpart i, 3.3.g.
Reference:  For more information on prescribed VA forms, see M21-1, Part III, Subpart ii, 2.B.1.b.

IX.i.3.3.f.  Subordinate Issue of Basic Eligibility to SAH/SHA Raised by the Record

When there is not a claim for SAH/SHA but the evidence and disposition of an issue demonstrates basic eligibility to SAH/SHA as provided in M21-1, Part III, Subpart iv, 6.B.2, take action as required by the table below.
If basic eligibility to SAH/SHA …
Then …
has previously been established by rating
do not include an SAH/SHA issue in the rating decision but do ensure the corporate database reflects the SAH/SHA eligibility grant.
  • has not been previously established by rating, or
  • has been previously denied
make a basic eligibility determination as provided in M21-1, Part IX, Subpart i, 3.3.g.

IX.i.3.3.g.  VSC SAH/SHA Basic Eligibility Determination Process

The table below describes the stages of a VSC SAH or SHA basic eligibility determination process when a determination is necessary as provided in this topic.
Where basic eligibility to SAH/SHA arises as a subordinate issue raised by the disposition of a claimed issue, as discussed in M21-1, Part IX, Subpart i, 3.3.f, the process starts with Stage 3.
Stage
Who Is Responsible
Description
1
VSC authorization activity
  • Establishes an appropriate EP using guidance found in M21-4, Appendix B, and
  • issues a Section 5103 notice, if required.
Notes:
  • In cases where a basic eligibility determination is triggered by an 890WI, the authorization activity must not clear the 890WI until the issue of eligibility has been addressed via rating decision (as discussed in Stage 3), and the concurrent EP cleared.
  • Clearance of the 890WI will notify the RLC that the case is ready for an award determination.
2
VSC authorization activity
Refers the claim to the rating activity after either
  • development is complete, or
  • no development is required and the 30-day Section 5103 notice response period has expired.
3
VSC rating activity
Prepares a rating decision on basic eligibility.
4
VSC authorization activity
  • Receives the rating decision
  • sends a decision notice to the claimant, and
  • clears the controlling EP to include the 890WI, if applicable.
Important:  Due to the functionality of the SAHSHA program, there is no need for the VSC to send a copy of the rating decision to the RLC.
References:  For information on
Important:  The SAH/SHA VSC point of contact or another designated VSC employee should run a list in the Veterans Service Network (VETSNET) Operations Report (VOR) on a regular basis to identify pending 890WIs, and distribute for processing per local work assignments. For guidance on viewing 890WIs in VOR, see M21-1, Part III, Subpart v, 10.A.1.c.
Note:  It may be necessary to update the corporate record if a previous rating decision establishing eligibility to SAH or SHA does not appear in the system.
References:  For more information on

IX.i.3.3.h.  Further Processing by the RLC After a VSC Basic Eligibility Determination

The table below describes the stages of processing after the RLC receives notice in the SAH/SHA system of a VSC determination that there is basic eligibility to SAH/SHA.
If the eligibility determination …
Then …
  • was not initiated by a VA Form 26-4555 submitted to the RLC (or forwarded to the RLC by the VSC), and
  • the form is not otherwise of record.
before they can complete processing of the claim and determine entitlement,
  • the RLC sends VA Form 26-4555to the Veteran or service member,and
  • the Veteran or service member must complete and return the form to the RLC.
  • was initiated by a VA Form 26-4555 submitted to the RLC or forwarded to the RLC by the VSC, or
  • the form is otherwise of record
the RLC completes processing of the claim and determines entitlement.

IX.i.3.3.i.  SAH/SHA Mailbox Addresses at RLCs

The table below shows the encrypted SAH/SHA mailbox addresses to use when corresponding with the RLCs of jurisdiction.
RLC of Jurisdiction
SAH/SHA Mailbox Address
Atlanta
Cleveland
Denver
Honolulu
Houston
Roanoke
Phoenix
St. Paul
St. Petersburg
Reference:  For information on each RLC’s area of jurisdiction, see the RLC Contact Information page.

4.  Handling Disagreements With Denials of Basic Eligibility for SAH/SHA


Change Date

March 8, 2019

IX.i.3.4.a.  Handling Disagreements With Denials of Basic Eligibility for SAH/SHA

If a claimant disagrees with a denial of basic eligibility for SAH/SHA, the VSC is responsible for handling the legacy notice of disagreement (NOD) or appeal, or request for decision review under 38 CFR 3.2500, in accordance with appropriate procedures.
If the claimant files a legacy appeal document or request for decision review on an SAH/SHA matter other than on basic eligibility, forward the submission to the RLC of jurisdiction for disposition.
References:  For more information on
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