Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
This form is completed by a physician to document the need for Aid and Attendance (A&A) or Housebound benefits. These benefits provide additional monthly compensation for veterans who need help with daily activities or are substantially confined to their home.
Used in these claim stages:
Last updated by VA: January 1, 2024
How to Complete This Form
This form must be completed by a licensed physician:
**Part I - Veteran Information**
Basic identifying information about the veteran.
**Part II - Medical Findings**
The physician documents:
- Diagnoses and conditions
- Whether the veteran can dress/undress without assistance
- Whether the veteran can keep themselves clean and presentable
- Whether the veteran needs assistance with bathroom needs
- Whether the veteran can feed themselves
- Whether the veteran needs protection from daily hazards
- Whether the veteran is blind or has severe visual impairment
- Whether the veteran is bedridden
- Whether the veteran is confined to the home
**Part III - Certification**
Physician signs certifying the examination findings.
Helpful Tips
- Have your regular doctor complete this if possible - they know your condition best
- Make sure the doctor documents your WORST days, not your best
- Be honest with the doctor about all assistance you need
- If you need help with ANY daily activity, make sure it's documented
- The doctor should explain WHY you need assistance, not just check boxes
- If your condition fluctuates, document the frequency of bad days
- Bring a list of all your conditions and limitations to the appointment
Common Mistakes to Avoid
- Having the form completed on a 'good day' that doesn't reflect typical needs
- Doctor not providing enough detail about functional limitations
- Not documenting all conditions that contribute to need for assistance
- Forgetting to mention cognitive issues that require supervision
- Not explaining the need for protection from daily hazards
Deadline Information
No specific deadline. File when you believe you qualify for Aid and Attendance or Housebound benefits. The examination should reflect your current condition.