Select Page

M21-1, Part V, Subpart ii, Chapter 3 – Special Monthly Pension (SMP) Ratings

Overview


In This Chapter

This chapter contains the following topics:
   

1.  Ratings for A&A Allowance


Introduction

This topic contains information on ratings for increased benefits based on the need for A&A, including

Change Date

February 19, 2019

V.ii.3.1.a.  Criteria for A&A Eligibility

Per 38 CFR 3.352(a), to be eligible for the aid and attendance (A&A) allowance, a Veteran or surviving spouse must be so helpless that he/she requires the aid of another person to
  • perform the personal functions required in everyday living, also called activities of daily living, or
  • protect himself or herself from hazards or dangers incident to daily life because of a mental or physical disability.
Per 38 CFR 3.351(c)(1), a claimant who has bilateral vision of 5/200 or less, or contraction of the central visual field to five degrees or less, is eligible for A&A without the requirement of additional findings.
Note:  The need for A&A does not have to be permanent to be granted for Pension, see VAOPGCPREC 21-1994.

V.ii.3.1.b.  Medical Evidence Used for A&A Ratings

Determination of a claimant’s need for A&A by rating is based on medical evidence.
The following are some examples of medical evidence used for A&A ratings:
Notes:
  • The above medical evidence is also used for housebound ratings.
  • VAMC examinations of survivors are not generally conducted except at the discretion of the Pension Management Center Manager.
  • The following are examples of licensed health care professionals:
    • medical doctor
    • doctor of osteopathy
    • nurse practitioner, or
    • physician’s assistant.

V.ii.3.1.c.  No Requirement for a Single 100-Percent Evaluation for A&A for Veterans Pension

There is no statutory or regulatory requirement for a Veteran pensioner to have a single disability rated 100-percent disabling to be determined in need of regular A&A.
Therefore, if a Veteran pensioner meets the criteria for A&A under 38 CFR 3.352(a), the rating activity may grant special monthly pension (SMP) at the A&A rate even though the Veteran is not rated 100-percent disabled under the rating schedule.  Code all claimed and noted disabilities, and show the evaluation of each disability, as appropriate.
Reference:  For more information on the statutory and regulatory requirements for SMP eligibility for Veterans Pension, see

V.ii.3.1.d.  Action to Take When There Is No 100-Percent Evaluation or Need for A&A Shown

Use the table below to determine the action to take when the disability evaluation is less than 100 percent or there is no need for A&A.
If…
Then…
  • a current examination is of record, and
  • the disability evaluation is less than 100 percent after a current examination, but severe disability demonstrates a need for regular A&A
grant A&A.
there is no need for A&A
dispose of the claim by discussing that finding in the Reasons for Decisionsection of the rating decision.  Include all applicable laws and regulations.
Reference:  For more information on the requirement to include all applicable laws and regulations, see M21-1, Part III, Subpart v, 2.B.1.b.

V.ii.3.1.e.  When to Infer a Claim for A&A or Housebound

The table below shows when to infer a claim for A&A and housebound eligibility.
If …
Then …
a single disability of 100 percent is assigned
consider entitlement to A&A.
entitlement to A&A is specifically denied
consider entitlement to the housebound benefit
 
Important:  Do not infer the issue of SMP eligibility merely to deny, if the evidence does not show the claimant would qualify.
Reference:  For additional information on housebound eligibility, see

V.ii.3.1.f.  Presuming the Need for A&A Based on Nursing Home Care

A Veteran or surviving spouse entitled to pension is presumed to be in need of A&A if he/she is a patient in a nursing home on account of a mental or physical disability.
Note:  For pension purposes, a medical foster home that VA has recognized and approved under 38 CFR 17.73 is equivalent to a nursing home.
References:  For more information on

V.ii.3.1.g.  When No Rating Decision Is Required to Grant A&A

A rating decision is not required in any claim where A&A is presumed unless other claimed issues need to be rated.
If A&A has been granted based on nursing home or medical foster home status without a rating decision, and a claim is being considered on other issues, do not consider A&A in the rating decision.

V.ii.3.1.h.  Future Employment and A&A

Pension beneficiaries are required to inform the VA if there is a change in any condition affecting their right to continued payments.  If a beneficiary who is receiving A&A by rating obtains employment, the rating activity should review the claim to determine whether the beneficiary still meets the statutory and regulatory requirements for A&A.  If the requirements are no longer met, follow the procedures in M21-1, Part III, Subpart iv, 8.D.5.
Note:  Participation in a program of Compensated Work Therapy (CWT) alone does not affect VA pension, however, if a Veteran obtains employment following a CWT program, this would suggest that he/she may no longer qualify for A&A.
References:  For additional information on

2.  Ratings for Housebound Allowance


Introduction

This topic contains information on ratings for housebound benefits, including

Change Date

February 19, 2019

V.ii.3.2.a.  Criteria for Qualifying for  Housebound

Veterans who are eligible to receive pension qualify for pension at the housebound rate if they have a single, permanent disability that is assigned a 100 percent schedular evaluation and
Note:  Because the single 100-percent disability must be a schedular evaluation, a total evaluation based on unemployability under 38 CFR 4.17 will not suffice.
A surviving spouse eligible to receive pension or Dependency and Indemnity Compensation qualify for increased benefits based on being housebound if they are permanently housebound by reason of their disabilities per 38 CFR 3.351(e) and (f).
Reference:  For additional information on permanently housebound, see

V.ii.3.2.b.  When a Rating Decision Is Required for a Housebound Claim

A rating decision is required to dispose of all housebound claims and must include all applicable laws and regulations.
Reference:  For more information on the requirement to include all applicable laws and regulations, see M21-1, Part III, Subpart v, 2.B.1.b.

V.ii.3.2.c.  When to Submit a Housebound Claim for an Advisory Opinion

Submit a claim for housebound benefits to the Pension and Fiduciary Service (21P1) for an advisory opinion if
  • the disability evaluation is less than 100 percent, but
  • the disability is so severe as to render the claimant housebound.
Note:  A current examination must be of record before the claim may be submitted for an advisory opinion.

V.ii.3.2.d.  Permanency Requirement for the 100- Percent Disability

In pension claims, both the single 100-percent disability and the disability that causes the Veteran to be housebound (if different disabilities) must be permanent.
A permanent and total evaluation protected under 38 CFR 3.951 or 38 CFR 3.953is sufficient if it is based on a single 100-percent disability.
Housebound based on a factual determination under 38 CFR 3.351(d)(2) requires the housebound state to be permanent.

V.ii.3.2.e.  Requirement for the Independently Ratable 60- Percent Disability

There is no requirement that the independently ratable 60-percent disability be permanent.
If an independent 60-percent disability that is not permanent is an essential part of a housebound determination, control the claim for possible reduction following a future examination.
11-20-15_Key-Changes_M21-1V_ii_3.doc May 20, 2019 138 KB
Historical_M21-1V_ii_3_12-13-17.doc May 20, 2019 121 KB
Historical-M21-1V_ii_3_11-20-15.doc May 20, 2019 115 KB
2-19-19_Key-Changes_M21-1V_ii_3.docx May 20, 2019 46 KB
Transmittal-M21-1MR_V_ii_TS.doc May 20, 2019 70 KB
Historical_M21-1MRV_ii_3_04-21-15.doc May 20, 2019 97 KB
12-13-17_Key-Changes-M21-1IV_ii_3.docx May 20, 2019 51 KB
Change-April-21-2015-Transmittal-Sheet-M21-1MRV_ii_3_TS.docx May 20, 2019 38 KB
Did this article answer your question?

Leave a Reply





Pin It on Pinterest

Share This