What is the Aid and Attendance or Housebound Allowance with DIC?

If a DIC beneficiary is receiving the aid and attendance of another person or the beneficiary is considered housebound, meaning he or she is basically confined to living quarters for life, there are additional payments available as monetary allowances.

Please do not confuse the meaning of "aid and attendance" or "housebound." These phrases pertain to medical ratings and 16 different monetary allowances available with Veterans Pension, Survivor's Pension, Disability Compensation, Dependency and Indemnity Compensation (DIC) and certain forms of Special Monthly Compensation (SMC). The phrase "aid and attendance" is especially confusing because most individuals have been led to believe this is the name for Veterans Pension or Survivor's (Death) Pension. Unfortunately, the media has chosen to call both forms of Pension "Aid and Attendance."

There is no such VA disability benefit as an "Aid and Attendance Benefit."

When we talk about aid and attendance or housebound benefits with Compensation or DIC or SMC, most people think we are talking about Pension. This is not the case.

Aid and attendance and housebound allowances are medical ratings and additional amounts of money available with all VA disability income benefits to help individuals receiving these benefits cope with the added burden of helplessness or being housebound.

Aid and attendance and housebound allowances require a Rating Veterans Service Officer in the Regional Office to determine the need and issue a rating for either category.

A Sad Commentary on DIC Recipients Who Should Be Receiving Allowances but Aren't

As discussed previously, a surviving spouse who is currently receiving monthly payments for Dependency and Indemnity Compensation (DIC) is entitled to an additional aid and attendance allowance if that person needs aid and attendance or to an additional housebound allowance if that person is considered housebound. It should be noted that a large number of surviving spouses are receiving DIC.

In fact, more survivors are receiving DIC than are receiving Survivor's Pension with Aid and Attendance. In 2017, 411,590 individuals were receiving DIC and 201,031 individuals were receiving Survivor's Pension with Aid and Attendance. It is a sad commentary that so much attention in the community is placed on getting Survivor's Pension with Aid and Attendance for older individuals and no attention is given at all to increasing monthly DIC payments for the same reason. DIC with aid and attendance is $1,645.81 a month and is not subject to any means testing. Survivor's Pension with Aid and Attendance is $1,228 a month and is subject to constant scrutiny from VA to make sure that the means testing is being met. DIC with housebound is $1,472.12 a month.

Number of Beneficiaries – 2017		Younger than 65	Age 65 and Older	Total all Ages	Average Monthly $ or % Total
Disability Compensation		3,023,867	1,528,357	4,552,224	$1,281
DIC for Surviving Spouse		152,149	259,441	411,590	$1,323
Veterans Pension		69,246	207,305	276,551	$1,009
Survivors Pension for Spouse		26,787	175,405	201,031	$704
100% Disabled				609,325	13.4%
Individual Unemployability (Paid at 100% Disabled Rate)				348,512	7.7%
Special Monthly Compensation				648,311	14.2%
Tinnitus and Hearing Loss – Most Prevalent Disabilities				2,944,565	64.7%
Healthcare System Enrolled				9 million +
Source:  VA Annual Benefits Report 2017, DVA 2019 Budget Proposal

It is most likely that perhaps 15% to 20% or more of the number of those on DIC might be eligible for the aid and attendance or housebound allowances but are not receiving this extra income simply because the beneficiaries don't know the allowances exist. Probably only a paltry percentage of these beneficiaries are actually receiving allowances currently. The reason we estimate so many could be eligible is because about 60% of all of those on DIC are age 65 and older and many of them are probably in their 80s or even 90s because they are survivors of World War 2 and Korean veterans – the largest cohort of any veterans in recent history. Statistically, people that old are often housebound or in need of aid and attendance.

Aid and attendance or housebound allowances with DIC are not advertised anywhere. VA does not send out notices to beneficiaries of DIC that they might be eligible simply because it would be a huge commitment of resources and besides VA would have no way of knowing if any of these beneficiaries would qualify or not. There is no requirement for someone on DIC to report back to VA on a regular basis to notify of the need for aid and attendance or housebound. We believe – and it is a sad commentary – that those who would be eligible have no clue that they can get this extra money to help them in with their needs.

Criteria for the Need for Aid and Attendance

The criteria for a need for aid and attendance is found in the following:

38 CFR § 3.352 Criteria for determining need for aid and attendance and "permanently bedridden."

(a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance (§3.351(c)(3):

• inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable;
• frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.);
• inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness;
• inability to attend to the wants of nature;
• or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment.
• "Bedridden" will be a proper basis for the determination (need for aid and attendance). For the purpose of this paragraph "bedridden" will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice.

It is not required that all of the disabling conditions enumerated in this previous paragraph be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need.

Determinations that the veteran is so helpless, as to be in need of regular aid and attendance will not be based solely upon an opinion that the claimant's condition is such as would require him or her to be in bed. They must be based on the actual requirement of personal assistance.

(Regular Aid and Attendance Provided by Relative (not the higher level)) (c) Attendance by relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance."

Almost without exception, ratings received in conjunction with long term care services in the home or in a care facility are ratings for aid and attendance. This must be obvious because these are the type of services that these care providers offer. They provide professional help with activities of daily living and incidental activities of daily living. Or they provide supervision for individuals who are cognitively impaired or have severe physical disabilities and could injure themselves without supervision.

Assistance with Activities of Daily Living (ADLs) and Incidental Activities of Daily Living (IADLs) involves the services of a person to provide the regular aid and attendance to a resident or a client receiving this care. It may be possible that a claimant residing in one of these care settings is housebound and does not need any assistance. This would then generate a rating for housebound which is always a lesser amount of allowance. It is more likely that a rating for housebound would be considered for someone who is living in his or her own home.

Definition of Housebound

The definition of housebound from 38 CFR § 3.350(i) (1)(2) is the following:

(1) Has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems,

OR

(2) Is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime.

Most veterans are going to qualify for being "housebound" under the second option above. Not very many veterans are going to qualify by being 100% rated disabled and then having VA say that they have an equivalent combined rating of 60% from other disabilities. Please note that any veteran in this situation would not have a final rating of 160%. The most available is 100%. What this is saying is that VA has determined there are additional disabilities that could be rated at 60% independently without actually paying the veteran for those disabilities since the veteran is already being paid at 100%.

A number of appeals in the past have addressed what "substantially confined" means. Previous board decisions had determined that substantially confines means that the claimant is restricted to his or her house and even restricted to leaving for medical treatment purposes. The Court of Appeals for Veterans Claims overturned those previous BVA decisions.

Howell versus Nicholson, March 23, 2006 number 04-0624 CAVC "The term "substantially confined" is not defined by statute or regulation. See id. Because the meaning of the term "substantially confined" is ambiguous and there is no regulatory interpretation, "the Court must determine the meaning" of the term "and the Board's obligation" thereunder. Thompson v. Brown, 8 Vet. App. 169, 175 (1995); see also Jackson and Cropper, both supra. The Secretary submits that the clear implication of this term is that the requirement that one be "substantially confined" is met when the claimant is restricted to his house except for medical treatment purposes. The Secretary, citing to Senate Report No. 1745 (June 27, 1960), notes that in passing section 1114(s) Congress intended to provide additional Compensation for veterans who were unable to overcome their particular disabilities and leave the house in order to earn an income as opposed to an inability to leave the house at all. Mr. Howell does not contest this interpretation.

To the extent substantial confinement does not include departures for medical purposes, we agree that the interpretation that the Secretary presents in his supplemental briefing is reasonable and consistent with statute and regulations. See Jackson, Thompson, and Cropper, all supra.

Accordingly, we hold that leaving one's house for medical purposes cannot, by itself, serve as the basis for finding that one is not substantially confined for purposes of SMC-HB benefits, and the Board's interpretation of section 1114(s) to preclude the grant of SMC benefits on the basis of Mr. Howell's leaving his house in order to attend VA medical appointments was erroneous as a matter of law.

It should be noted that there are no housebound allowances for regular Disability Compensation. The only allowances are for aid and attendance. There are 4 possibilities concerning Veterans Pension, Survivor's Pension, Disability Compensation or DIC for housebound allowances.

1. The first of these are housebound allowances for a veteran receiving Veterans Pension.
2. The second are housebound allowances for a surviving spouse receiving Survivor's Pension.
3. The third is an alternative higher level of payment under SMC Schedule S where a veteran who is totally disabled can get an additional monthly income if that veteran is considered housebound but is not in need of aid and attendance. Or
4. The fourth is an allowance for a surviving spouse receiving Dependency and Indemnity Compensation (DIC) who is rated housebound.

Interpreting the Regulation for the Requirement for Aid and Attendance

We have taken the rules from 38 CFR §3.352 and applied them to more modern terminology of providing assistance. Here is our list based on the regulation.

1. Assistance with bathing or showering
2. Assistance with toileting
3. Assistance with feeding (having a need to be fed by someone else)
4. Assistance with dressing or undressing
5. Assistance with transferring in or out of a bed or chair
6. Assistance with incontinence
7. Assistance with ambulating (walking)
8. Assistance with keeping oneself ordinarily clean and presentable, including hygiene
9. Assistance with frequent need of adjustment of special prosthetic or orthopedic devices which cannot be done without the aid of another person
10. Having an incapacity (physical or mental) requiring care or assistance on a regular basis to protect the patient from hazards or dangers incident to his or her daily environment
11. Is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less in both eyes
12. Is a patient in a nursing home because of mental or physical incapacity
13. Meets the criteria of being totally bedridden as defined in the regulation

As is mentioned in the regulation, there does not need to be a certain number of these incapacities in order to determine a rating for aid and attendance. The rating service representative simply must determine from the evidence whether the claimant is so helpless as to require the regular aid and attendance of another person based these conditions.

From our experience with the rating authority, the veteran who is applying or the spouse of the veteran who is applying should exhibit the need for and be receiving at least two or more of the services from #1 through #8 above and from #9 through #13, only one of these need apply. For purposes of Pension benefits, it is also important to note that a relative or a member of the household providing aid and attendance services is acceptable to VA for granting the additional regular – not the higher amount – allowance for aid and attendance. (The so-called higher amount is only available with SMC Schedule R.2.)

Since Compensation, DIC and SMC are not means tested programs – unlike Veterans Pension or Survivor's (Death) Pension – VA does not require a caregiver or relative or member of the household to be paid for services. For non-Pension benefits, VA would probably grant the allowance without evidence that anyone is providing services. The Regional Office would rely primarily on VA Form 21-2680 for granting the additional allowance.

We have found it useful to provide the Regional Office with evidence that care for aid and attendance is also being provided. This helps if there is a question on the 2680 whether or not the beneficiary actually meets the medical criteria to grant the rating. If a question is raised about the suitability for a rating, then submitting evidence of care being provided will help VSRs make the decision. Service Representatives will likely note the discrepancy between an inadequate 2680 and evidence of care and ask for more information, or for a 2680 that provides more detailed information for a rating decision

Dependency and Indemnity Compensation (DIC) for 2020
Basic Monthly Rate = $1,340.04, with 1 Child $1,672.14, with 2 Children $2,004.14, etc.
Allowances:  with A&A $1,672.14, with Housebound $1,495.67, with 8 Yrs Continuous Disabled $1,624.71
1. Add $284.57 for veteran's death, if veteran was in receipt of or entitled to receive Compensation for a service-connected disability rated totally disabling (including a rating based on individual unemployability) for a continuous period of at least 8 years immediately preceding death AND the surviving spouse was married to the veteran for those same 8 years. (38 U.S.C. 1311(a)(2))
2. Add the following allowance for each dependent child under age 18: Effective 12/1/14 $332.00 per child (38 U.S.C. 1311(b))
3. If the surviving spouse is entitled to Aid and Attendance, add $332.00. (38 U.S.C. 1311(c))
4. If the surviving spouse is entitled to Housebound, add $155.53 (38 U.S.C. 1311(d))
5. If the surviving spouse has one or more children under the age 18 on the award, add the 2-year transitional benefit of $296.00 effective, December 1, 2014 (38 U.S.C. 1311(f))

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