VA Benefits – Aid and Attendance (Part 2)

In a previous post, we talked about aid and attendance, a form of special monthly compensation, available for when the veteran’s family member requires regular aid and attendance.

In this post we will look at the other scenario, where a veteran is severely disabled and requires the regular aid and attendance of someone else, and A&A is warranted for the caretaker.

A&A is available for veterans who need help with their activities of daily living, are legally blind (or almost legally blind), are bedridden, or are a patient in a nursing home due to mental or physical incapacity. The following factors are considered in determining whether the veteran is entitled to SMC based on need for aid and attendance:

• Inability to dress or undress without assistance;
• Inability to keep ordinarily clean and presentable without assistance;
• Inability to feed one’s self without assistance;
• Inability to go to the bathroom unassisted;
• Incapacity that requires care or assistance on a regular basis to protect the veteran from the hazards or dangers of one’s daily environment.

The VA will also look to see how well the veteran gets around, if they are confined to their home, and what the veteran is able to do during a typical day, in order to show that they are in regular need of aid and attendance.

A veteran does not need to show that they need aid and attendance to accomplish every single task that the VA lists or looks at described above. The personal functions that the veteran is not able to perform should be considered in connection with the veteran’s condition as a whole. A veteran also does not need to establish that they are so helpless as to be in constant need of aid and attendance, only that it is needed on a regular basis. And a veteran does not need to submit evidence proving that the disabling condition requires the veteran to stay in bed. A&A only requires that the veteran requires personal assistance from others.  If the veteran is bedridden, however, they are entitled to A&A. Being bedridden requires that the veteran remain in bed; it is not enough for the veteran to just voluntarily take to bed or for a physician to prescribe rest in bed for the greater part of the day until their condition is cured.

A&A also does not require that the veteran be rated at 100% for their disability. A greater degree of disability is required to be entitled to A&A than for housebound benefits because the veteran has to show that they need the aid of someone else to help them accomplish many of the simple tasks associated with daily living. The assistance can be provided by the spouse, a family member, or even a neighbor of the veteran. It does not have to be provided by a medical professional or outsider. But if the veteran does require personal health-care services of a licensed professional, they are eligible to receive more compensation as we will discuss below.

Keep in mind that many of the difficulties associated with aid and attendance do not have to only apply to physical disabilities. It can also apply to veterans with mental disorders, such as inability to keep themselves ordinarily clean and presentable, and incapacity that requires assistance on regular basis to protect them from hazards or dangers incident to the daily environment.

There are also special aid and attendance benefits for veterans who are severely disabled. This is when:

• The veteran is receiving the maximum rate or a rate equal to the maximum rate of SMC, and
• The veteran meets the requirement for entitlement to the basic or regular aid and attendance.

This is known as SMC r-1.

There is also a higher level of SMC for higher level of care, when the veteran

• Receives the maximum rate or a rate equal to the maximum rate of SMC, and
• The veteran meets the requirements for entitlement to the basic or regular aid and attendance, and
• The veteran needs a higher level of care.

This is known as SMC r-2.

The table below demonstrates the current rates of payments for each of the above benefits, depending on whether or not the veteran has children.

Without Children, SMC-N 1/2 through SMC-S

With Children, SMC-N 1/2 through SMC-S

Need for a higher level of care is considered to be need for personal health care services provided on a daily basis in the veterans home by a licensed health care professional (or under their supervision). A licensed health care professional would be a doctor of medicine or osteopathy, a registered nurse or a licensed practical nurse, or a physical therapist. Personal health care services include:

• Physical therapy
• Administration of injections
• Placement of indwelling catheters
• Changing of sterile dressings, or
• Other functions that require professional health care training or the regular supervision of a trained health care professional.

To be under the regular supervision of a licensed health care professional means that an unlicensed person performing personal health care services is following a regimen of personal health care services prescribed by a health care professional. So if the person who is performing personal health care services is a relative of the veteran (or other member of the veteran’s household), they would still have to be a licensed health care professional or under the regular supervision of one. This higher level of aid and attendance is only granted when the veteran’s need is clearly established and the amount of services the veteran requires on a daily basis is substantial.

There are also special provisions for aid and attendance for veterans with residuals of traumatic brain injury. Veterans who are not otherwise eligible for the higher level of aid and attendance, but because of their TBI residuals: 1) are in need of aid and attendance, and 2) would require hospitalization, nursing home care, or other residential institutional care, will receive SMC at the higher level rate.