Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
You need help with daily activities (bathing, dressing, eating, toileting, transferring) OR you are substantially confined to your home due to a disability. This form unlocks higher monthly benefits under SMC.
Gather before you start
Attach with the form
What to Tell Your Doctor - A&A vs Housebound Criteria
Doctor Brief 1Explain the difference between A&A and Housebound to your doctor
AID AND ATTENDANCE (higher level): VA pays A&A if the veteran (1) needs help performing daily personal functions such as bathing, dressing, eating, toileting, or adjusting prosthetic devices; OR (2) is bedridden due to disability; OR (3) is a patient in a nursing home; OR (4) is blind or nearly blind. HOUSEBOUND (lower level): VA pays Housebound if the veteran is substantially confined to their immediate premises due to service-connected disability and has a single rating of 100% OR a combined rating of 100% with an additional 60%+ disability.
(print this section and bring to your doctor's appointment)
- Asking your doctor to just "sign the form" without explaining what VA raters look for - an uninformed completion that does not use the right language may result in denial.
- Applying for Housebound when A&A is actually the right fit - A&A is broader and often easier to qualify for.
What Your Doctor Must Document - Activities of Daily Living
Doctor Brief 2Tell your doctor to document each ADL limitation specifically
Ask your doctor to document in detail which of these the veteran cannot perform without assistance: (1) BATHING - can the veteran independently bathe/shower? (2) DRESSING - can the veteran dress/undress independently? (3) EATING - can the veteran feed themselves? (4) TOILETING - can the veteran manage toileting/incontinence? (5) TRANSFERS - can the veteran move from bed to chair independently? (6) WALKING - can the veteran ambulate safely without assistance? The form has checkboxes but documentation in the narrative section carries more weight.
(checklist for your doctor appointment)
- Doctor checking "needs assistance" without describing how severe or how often - raters need specifics like "requires 2-person assist for transfers daily" not just a checkbox.
- Doctor not completing the narrative section at the bottom of the form - this is where the clinical picture is painted and it matters most.
What Your Doctor Must Document - Diagnosis and Prognosis
Doctor Brief 3Tell your doctor to list diagnoses and state whether the need is permanent
The form requires the doctor to list all medical conditions contributing to the functional limitations. Critically, the doctor must state whether the need for A&A or housebound care is PERMANENT AND TOTAL (expected to continue for life). VA prefers the word "permanent" - without it, the award may be temporary and subject to re-examination.
(remind your doctor to state "permanent" if it applies)
- Doctor leaving the prognosis section blank - VA may treat the award as temporary.
- Doctor only listing service-connected conditions - list ALL conditions contributing to the need, even non-service-connected ones, as they can be considered for pension A&A claims.
Returning the Completed Form
ChecklistReview the completed form before submitting to VA
Before mailing the completed form to VA, verify: (1) All fields are completed by the doctor, (2) The doctor's license type and number are included, (3) The doctor signed and dated the form, (4) The narrative section describes specific functional limitations, not just diagnoses, (5) The form states whether the condition is permanent.
(review checklist before submitting)
- Submitting a form where the doctor only signed but left the narrative blank - VA will request a new exam.
- Submitting the form without also filing the primary A&A or housebound claim on 21-526EZ (for compensation) or 21P-527EZ (for pension) - the 21-2680 is evidence, not the claim itself.