What Is the Amount of the Aid and Attendance Benefit?
Who Is Eligible for the Aid and Attendance Pension Benefit?
Is Aid and Attendance Only for Low Income Veterans?
Medical Costs and Long-Term Care Expenses
How is the Aid and Attendance Benefit Calculated?
Filing a Claim
The Asset Test

The Farr Law Firm is an Elder Law and Estate Planning Firm that also specializes in helping Veterans and their spouses obtain the financial assistance to which they are entitled. If you are a Veteran or spouse of a Veteran and you need assistance in your home, or are living in or considering moving into an Assisted Living Facility or Continuing Care Retirement Community, please contact us to see if you might qualify for the Veterans Aid and Attendance Special Pension Benefit or the Veterans Housebound Special Pension Benefit.

What Is the Amount of the Aid and Attendance Benefit?

In 2008, the Veterans A&A Pension can provide up to $1,644 per month to a qualified veteran; $1,949 per month if the veteran is married; $1,056 per month for a surviving spouse of a qualified veteran; $2,540 per month if both spouses are veterans.

Who Is Eligible for the Aid and Attendance Pension Benefit?

To receive the Aid & Attendance Special Pension Benefit or Housebound Special Pension Benefit, a veteran must have served on active duty, at least 90 days, at least one day of which occurred during a period designated as wartime.

Periods Designated As Wartime:

World War II -- December 7, 1941 through December 31, 1946

Korean Conflict -- June 27, 1950 through January 31, 1955

Vietnam Era -- August 5, 1964 through May 7, 1975; for veterans who served "in country" before August 5, 1964, February 28, 1961 through May 7, 1975

Gulf War -- August 2, 1990 through a date to be set by law or Presidential Proclamation

There must have been an honorable discharge. Single surviving spouses of such veterans are also eligible.

If younger than 65, the veteran must be totally disabled.

If age 65 and older, there is no requirement to prove disability.  However, the veteran or spouse must be in need of regular aid and attendance due to: 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 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. 

Not all of the disabling conditions in the list above are required to exist.  It is only necessary that the evidence establish that the veteran or spouse needs "regular" (scheduled and ongoing) aid and attendance from someone else, not that there be a 24-hour need.

Determinations of a need for the aid and attendance or housebound benefit is based on medical reports and findings by private physicians or from hospital facilities. Authorization of aid and attendance or housebound benefits is automatic if evidence establishes the claimant is a patient in a nursing home or that the claimant is blind or nearly blind or having severe visual problems.

Is Aid and Attendance Only For Low Income Veterans?

No, and this is the primary reason that this benefit is so widely misunderstood. If you speak to a Veterans Service Representative in a regional VA office and ask them about the Veterans Aid and Attendance benefit, they will typically ask for your household income.  When you tell them your household income, they will compare it to a chart and most often tell you that you earn too much income to receive the benefit.  While the information they provide may be technically accurate, what they typically don't explain is the "income" for Veterans Administration purposes (sometimes called IVAP or "adjusted income") is actually your household income minus your unreimbursed medical and long-term care expenses.

To be able to receive the Veterans Aid and Attendance benefit, the veteran household cannot have adjusted income (i.e., household income minus unreimbursed medical expenses) exceeding the Maximum Allowable Pension Rate-- MAPR -- for that veteran's Pension income category. If the adjusted income exceeds MAPR, there is no benefit. If adjusted income is less than the MAPR, the veteran receives a Pension income that is equal to the difference between MAPR and the household income adjusted for unreimbursed medical expenses. The Pension income is calculated based on 12 months of future household income, but paid monthly.

Medical Costs and Long-Term Care Expenses

A special provision for calculating Pension income allows household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application. These allowable, annualized medical expenses are such things as health insurance premiums, home care expenses, the cost of paying a family member or other person to provide care, the cost of adult day care, the cost of an assisted living facility, or the cost of a nursing home.

This special provision is what allows veteran households earning more than the annual MAPR to qualify for the Aid and Attendance Benefit. As an example, a veteran household earning $6,000 a month could still qualify for the Aid and Attendance Benefit if the veteran is paying $4,500 to $6,000 a month for nursing home costs. The applicant must submit appropriate evidence for a rating and for recurring costs in order to qualify for this special provision. VA typically does not tell applicants about this special treatment of medical expenses or how to qualify for it. 

For clients of our firm, we will provide you, at no charge, a special Certification Report which will allow you to verify actual out-of-pocket and recurring medical expenses and long-term care expenses. We will also provide our clients with a Care Provider Report form to be completed by your care provider (assisted living facility, residential care provider, adult day care facility, home care provider, or similar provider). You will then include both of these reports with your application.

How is the Aid and Attendance Benefit Calculated?

The monthly award is based on VA totaling 12 months of estimated future income and subtracting from that 12 months of estimated future, recurring and predictable medical expenses. Allowable medical expenses are reduced by a deductible to produce an adjusted medical expense which in turn is subtracted from the estimated 12 months of future income.

The new income derived from subtracting adjusted medical expenses from income is called "countable" income or IVAP (Income for Veterans Affairs Purposes). This countable income is then subtracted from the Maximum Allowable Pension Rate -- MAPR -- and that result is divided by 12 to determine the monthly income Pension award. This award is paid in addition to the family income that already exists.

Filing a Claim

Filing a claim for the Veterans Aid and Attendance Pension Benefit is complex and time-consuming. If you want to do it correctly, it's important to get qualified assistance. Just knowing which form to fill out and how to complete it is a complex endeavor in itself. Even if the proper form is completed, failure to check a single box may result in a complete denial of your claim.

The application process involves: getting a rating; obtaining evidence of prospective, recurring medical expenses; appointments for VA powers of attorney and fiduciaries; and a thorough understanding of the application process.  Often, qualification for this benefit involves reallocation of assets and shifting of income in order to qualify, and these reallocations may have significant impact on Medicaid eligibility.

Given that many veterans who need the Aid and Attendance Benefit will eventually wind up also needing Medicaid, this process should not be attempted without the help of a qualified elder law attorney who thoroughly understands both the Veterans Aid and Attendance Benefit and the Medicaid program, as well as the interaction between these two benefit programs.

We assist clients of our firm, at no charge, in completing the required paperwork.

The Asset Test

There is an asset test to qualify for the Aid & Attendance Pension Benefit.  Any asset or investment that could be easily converted into income might disqualify the claimant. An asset ceiling of $80,000 is often cited in the media as being the test. However, the $80,000 has to do with VA internal filing requirements and is not an actual test. In reality, there is no dollar amount for the test and any level of assets could block the award.

Asset Exemptions:

A primary residence, vehicles, and difficult-to-sell property are generally excluded from the asset test. However, some assets that are considered to be exempt by Medicaid (e.g., life estates) are considered to be countable by the Veterans Administration.

Asset Transfers:

VA will allow assets to be transferred or converted to income in order to meet the asset test. There is no look-back penalty for transferring assets as there is with Medicaid. However, because the veteran or the surviving spouse might need to apply for Medicaid in the future, it is extremely important to consider future Medicaid eligibility when transferring assets or converting assets to income in order to obtain eligibility for Veterans Aid & Attendance.

Evan H. Farr is an Accredited Attorney with the U.S. Dept. of Veterans Affairs.  The Farr Law Firm can help you avoid both Aid and Attendance rejection and Medicaid penalties associated with reallocating assets.