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M21-1, Part V, Subpart iii, Chapter 2, Section A – General Information on Requirements for Aid and Attendance (A&A) and Housebound Status Under 38 CFR 3.351


In This Section

This section contains the following topics:


1.  Overview of Requirements for A&A Status Under 38 CFR 3.351


This topic contains an overview of requirements for A&A status under 38 CFR 3.351, including

Change Date

April 22, 2015

Who May Qualify for A&A Status Under 38 CFR 3.351

Individuals in the following categories may qualify for aid and attendance (A&A) status under 38 CFR 3.351:
  • For pension purposes, a medical foster home that VA has recognized and approved under 38 CFR 17.73 is equivalent to a nursing home.
  • Veterans who receive disability compensation do not qualify for A&A under 38 CFR 3.351.  These beneficiaries may qualify for A&A under 38 CFR 3.352.
  • Parents receiving death compensation under 38 U.S.C. 1122 also may qualify for A&A, although they are not listed in 38 CFR 3.351.
Reference:  For more information on medical foster homes, see M21-1, Part III, Subpart v, 6.A.3.

V.iii.2.A.1.b. Requirements for A&A Status

To qualify for A&A status, an individual must be
  • so helpless as to require the aid of another person to perform the personal functions required in everyday living (38 CFR 3.352(a)),
  • blind or so nearly blind as to have
    • corrected visual acuity of 5/200 or less, in both eyes, or
    • concentric contraction of the visual field to 5 degrees or less (38 CFR 3.351(c)(1)), or
  • a patient in a nursing home (medical foster home) because of physical or mental incapacity (38 CFR 3.351(c)(2)).
  • Increased pension based upon the need for regular A&A may be awarded without regard to whether the need is permanent, per VAOPGCPREC 21-1994.
  • Beneficiaries may not receive increased Old-Law Pension or Section 306 Pension because of being A&A (or housebound).  If an Old-Law Pension or Section 306 Pension beneficiary claims special monthly pension (SMP), the case must be reviewed to determine if an election of current-law pension would be to the claimant’s benefit.

V.iii.2.A.1.c.  A&A Qualification of Veterans Entitled to Pension

There is no statutory or regulatory requirement for a Veteran pensioner to be rated 100-percent disabled to be determined to be in need of regular A&A.
Therefore, if a Veteran pensioner meets the criteria for A&A under 38 CFR 3.352(a), a the rating activity may grant SMP at the A&A rate even though the Veteran is not rated 100-percent disabled under the rating schedule.
Reference:  For more information on the statutory requirements for SMP at the A&A rate vs. the housebound rate for pension, see

A&A Qualification of Surviving Spouses and Parents Entitled to Survivors Pension, DIC, or Death Compensation

Surviving spouses and parents who are eligible for Survivors Pension, DIC, or death compensation may qualify for A&A under 38 CFR 3.351.
Note:  Survivors Pension benefits include current-law pension, Section 306 Pension, Old-Law Pension, and Spanish-American War Pension.  However, beneficiaries receiving Section 306 Pension or Old-Law Pension cannot receive a higher rate unless they elect Survivors Pension.
Reference:  For more information on conditional elections, see M21-1, Part III, Subpart v, 4.A.3.

A&A Qualification of Spouses of Veterans Who Are Entitled to Receive Additional Compensation for a Spouse

Per 38 CFR 3.351(a)(2), increased compensation is payable to a Veteran by reason of the Veteran’s spouse being in need of A&A.
Note:  This provision applies only to Veterans who are entitled to receive additional compensation for a spouse.

V.iii.2.A.1.f.  Applicable Regulatory References for Certain A&A Status Issues

Use the table below to review the legal provisions for the A&A status issues listed.
A&A Status Issue
Regulatory Reference
Rating decisions for A&A status in Veterans pension cases.
A&A status based on nursing home patient status.
Determining the effective date of A&A status.
Withdrawal of A&A status for any reason.
Note:  The provisions of 38 CFR 3.103(b)(2)require sending a notice of proposed adverse action to a beneficiary.
Reference:  For more information on withdrawal of A&A status, see M21-1, Part V, Subpart iii, 4.1.

2.  Overview of Requirements for Housebound Status Under 38 CFR 3.351


This topic contains an overview of requirements for housebound status under 38 CFR 3.351, including

Change Date

February 14, 2014

V.iii.2.A.2.a.  Who May Qualify for Housebound Status Under 38 CFR 3.351

The following individuals may qualify for housebound status under 38 CFR 3.351:
  • Veterans eligible for pension, and
  • surviving spouses eligible for
    • pension or
    • DIC.

V.iii.2.A.2.b.  Determining a Veteran’s Housebound Status for Pension

Veterans eligible for pension qualify for housebound status if they have a single permanent disability rated 100 percent under a schedular evaluation, and
  • have other disabilities independently ratable at 60 percent or more, or
  • are permanently housebound by reason of their disabilities, per 38 CFR 3.351(d).
  • In pension claims, the single 100-percent disability and the disability that causes the Veteran to be housebound must be permanent.
  • A finding of housebound in this manner is sometimes referred to as “statutory housebound” because it is required by 38 U.S.C. 1521(e).

V.iii.2.A.2.c.  Definition:  Permanently Housebound

Under 38 CFR 3.351(d), consider an individual permanently housebound if the individual is substantially confined to his or her home (ward or clinical areas, if institutionalized) or immediate premises because of disability or disabilities that are reasonably certain to be permanent.
Note:  Leaving home for medical purposes cannot, by itself, serve as the basis for finding that an individual is not substantially confined for purposes of housebound status.

3.  General Information on Developing for A&A and Housebound Status


This topic contains general information on developing for A&A and housebound status, including

Change Date

May 10, 2016

V.iii.2.A.3.a.  Acceptable Medical Reports for Determining the Need for A&A or Housebound Status

Determinations of a claimant’s need for A&A or housebound are based, if possible, on medical reports and findings by private physicians, certified nurse practitioners, clinical nurse specialists, physician assistants, or non-VA facilities, rather than on VA examinations.
Reference:  For information on administrative grants of A&A based on nursing home status, see M21-1, Part V, Subpart iii, 2.B.

V.iii.2.A.3.b.  Redetermination of A&A or Housebound Status

Refer the case to the rating activity for a redetermination of A&A or housebound status if, after the grant of A&A or housebound, medical evidence is received indicating that
  • the beneficiary’s condition has improved, and
  • it appears he/she is no longer seriously disabled

V.iii.2.A.3.c.  Additional Information on A&A and Housebound Qualifications

For additional information on A&A and housebound qualifications, see M21-1, Part V, Subpart ii, 3.
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