VA Form 21-2680
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.
- Who fills it
- doctor
- Journey phase
- Filing Your Claim
- Estimated time
- 30-60 minutes to brief your doctor; doctor typically needs 20-40 minutes to complete the exam.
- When to file
- With or shortly after your claim for A&A or Housebound SMC. The form must be completed by a licensed physician, nurse practitioner, physician assistant, or clinical psychologist.
Official VA form page: https://www.va.gov/find-forms/about-form-21-2680/
Gather before you start
- ▸A licensed provider willing to complete the form (your primary care physician is ideal)
- ▸Your complete list of diagnoses and current medications
- ▸Description of which activities of daily living (ADLs) you cannot perform independently
- ▸Description of any mobility limitations that restrict you to your home
- ▸Any recent hospitalization, surgery, or nursing home stays
- ▸Your VA disability ratings that are causing the need for A&A or housebound status
Attach with the form
- ▸Completed VA Form 21-2680 (doctor fills and signs)
- ▸If for nursing home: also file VA Form 21-0779
- ▸Supporting medical records, hospitalization notes, therapy records
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)
Common mistakes
- ×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.
Authority
- 38 CFR 3.352 - What counts as needing regular aid and attendance.
- 38 CFR 3.356 - What constitutes substantially confined to the immediate premises for housebound SMC.
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)
Common mistakes
- ×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.
Authority
- 38 CFR 3.352 - What counts as needing regular aid and attendance.
- M21-1 IV.iii.1.A - SMC categorical determinations.
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)
Common mistakes
- ×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.
Authority
- 38 CFR 3.352 - What counts as needing regular aid and attendance.
- 38 CFR 3.500 - When VA reduces or discontinues benefits.
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)
Common mistakes
- ×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.
Statutory and regulatory authority
- 38 CFR 3.350 - SMC categories L, M, N, O, P, R, S, T criteria.
- 38 CFR 3.351 - A&A and housebound criteria for pension recipients.
- 38 CFR 3.352 - What counts as needing regular aid and attendance.
- 38 CFR 3.356 - What constitutes substantially confined to the immediate premises for housebound SMC.
- 38 USC 1114 - Statutory authority for SMC categories including Aid and Attendance and Housebound.
- M21-1 IV.iii.1.A - SMC categorical determinations.