The VA Caregiver Program – Eligibility for the Program

In a previous blog post, we discussed the basics of VA Caregiver Program—what the program involves and how to apply for it. This post will talk about eligibility for the Caregiver Program.

The VA regulations  on the Caregiver Program, 38 U.S.C 1720G (a), defines “serious injury” as ‘any injury, including traumatic brain injury, psychological trauma, or other mental disorder, incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001, that renders the veteran or serviceperson in need of personal care services.’

Eligibility for the Caregiver Program

In determining whether a veteran is eligible for the Caregiver Program, the VA considers the following 7 criteria:

1. Veteran (or Servicemember undergoing medical discharge) incurred or aggravated a serious injury in the line of duty on or after September 11, 2001.
2. This serious injury renders the Veteran or Servicemember in need of a Family Caregiver to:
3. Support the Veteran or Servicemember’s health and well-being;
4. Perform personal functions required in everyday living;
5. Ensure the Veteran or Servicemember remains safe from hazards or dangers incident to his or her daily environment.
6. The Veteran or Servicemember requires at a minimum six months of continuous and approved caregiver support, based on the scenarios outlined below.
7. The Family Caregiver Program is in the best interest of the Veteran or Servicemember because it is:
   1. Likely to significantly enhance the Veteran or Servicemember’s ability to live safely in a home setting;
   2. Supports the Veteran or Servicemember’s potential progress in rehabilitation, if such potential exists;
   3. Creates an environment that supports the health and well-being of the Veteran or Servicemember.
8. The Veteran or Servicemember will receive care at home once caregiver training is complete
9. The Veteran or Servicemember will receive ongoing care from a Patient Aligned Care Team (PACT) or other VA health care team as a requirement for participation in the program
10. Personal care services provided to the Veteran or Servicemember by the Family Caregiver will not be simultaneously and regularly provided by or through another individual, entity, or program.

The regulations for the Caregiver Program establish four scenarios in which a veteran can be determined to be “in need of personal care services” (for determination purposes, the veteran needs only to identify with one of these scenarios):

1. If the veteran is unable to perform one or more of the Activities of Daily Living (ADLs).
2. If the veteran shows need for supervision, protection or assistance based on symptoms or residuals of neurological or other impairment or injury (including Traumatic Brain Injury, psychological trauma or other mental disorders).
3. If the veteran was awarded service connection for a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service on or after 9/11/01, has been rated 100% disabled for that serious injury, and has been awarded SMC that includes an aid and attendance allowance.
4. Veterans and Servicemembers whose serious injury is a psychological trauma or mental disorder, and who have received Global Assessment of Functioning (GAF) scores of 30 or less continuously for a 90-day period immediately preceding the VA’s receipt of the application for a Caregiver.

Once the VA medical center receives an application for the Caregiver Program, it will schedule a Compensation and Pension (C&P) exam that will establish the veteran’s eligibility based on the seven criteria outlined above. The C&P exam will also determine the veteran’s tier based on his/her score on the Activities of Daily Living (ADL) and Supervision Scales. The veteran’s score determines the stipend amount for the primary caregiver.