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, you should contact a qualified elder law attorney to see if you qualify for the Veterans Aid & Attendance Special Pension Benefit or the Veterans Housebound Special Pension Benefit. The Farr Law Firm helps our clients who are Veterans, and their spouses, obtain this financial assistance when they are entitled.

What Is the Aid & Attendance Benefit Amount?

In 2008, a Veterans Aid & Attendance Pension can provide up to $1,554 per month to a qualified veteran; $1,842 per month if the veteran is married; and $998 per month for a surviving spouse of a qualified veteran.

Who Is Eligible for the Aid & 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 during a period of war.

Periods of War:

- World War II: December 7, 1941 – December 31, 1946
- Korean Conflict: June 27, 1950 – January 31, 1955
- Vietnam Era: August 5, 1964 – May 7, 1975; for veterans who served “in country” before August 5, 1964: February 28, 1961 – May 7, 1975
- Gulf War: August 2, 1990 through a date to be set by law or Presidential Proclamation

The veteran must have been honorably discharged. 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 to adjust 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 a normal person 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.

Determination of need does not require that all of the disabling conditions in the list above exist, nor that there is a need for care 24/7. It is only necessary that the evidence establish that the veteran or spouse needs “regular” (scheduled and ongoing) aid and attendance from someone else.

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

Is Aid & Attendance Only For Low Income Veterans?

No, but this assumption is why this benefit is so widely misunderstood. If you speak to Veterans Service Representatives in most regional VA offices and ask them about the Veterans Aid & Attendance benefit, typically they will ask the amount of your household income. They will usually refer to a chart and will 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 that “income” for Veterans Administration purposes is actually your household income minus your unreimbursed medical and long-term care expenses (sometimes called IVAP or “adjusted income”).

To be eligible to receive the Veterans Aid & Attendance monthly benefit, the veteran’s household cannot have adjusted income exceeding the Maximum Allowable Pension Rate — MAPR — for that veteran’s Pension income category. If the adjusted income exceeds MAPR, no benefit can be paid. However, if adjusted income is less than the MAPR, the veteran receives a Pension income equal to the difference between MAPR and the adjusted income.

Medical Costs and Long-Term Care Expenses

A special provision for calculating pension income reduces household income by 12 months worth of future, recurring medical expenses. These allowable, annualized medical expenses include items such 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 with income exceeding the annual MAPR to qualify for the Aid & Attendance Benefit. For example, a veteran household with income of $6,000 a month could still qualify for the Aid & Attendance Benefit if the veteran is paying $4,500 to $6,000 a month for nursing home costs. The claimant must submit appropriate medical evidence and evidence of 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.

This firm will provide its clients, at no charge, with a special Certification Report which will allow our clients 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 & Attendance Benefit Calculated?

The monthly award is based on VA calculations: 12 months of estimated future income, minus 12 months of estimated future, recurring and predictable medical expenses. Allowable medical expenses are further 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 figure 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.

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 requires knowledge and skill. 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 includes: obtaining evidence of prospective, recurring medical expenses; and obtaining appointments for VA powers of attorney and fiduciaries. Often, qualification for this benefit involves the reallocation of assets and the shifting of income in order to qualify, and these reallocations may have significant impact on Medicaid eligibility.

Because many veterans who need the Aid and Attendance Benefit will eventually also need 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 effects each program has on the other.

The Asset Test

Ownership of certain assets or investments, particularly one which easily could be converted into income, might disqualify the claimant. An asset ceiling of $80,000 is often cited in the media as being the test, but this figure reflects VA internal filing requirements and is not an actual asset “ceiling.” In reality, because there is no dollar amount, 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 exempt by Medicaid (e.g., life estates) are considered 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, and there are no look-back periods or penalties assessed 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.

The Farr Law Firm can help you avoid both Aid and Attendance rejection and Medicaid penalties associated with reallocating assets.

Long-term care costs can add up quickly. Our firm can assist veterans and surviving spouses of veterans obtain valuable help when they need in-home care, or are in an assisted living facility or nursing home.

The Veterans Administration (VA) has an underused pension benefit called Aid and Attendance that provides money to those who need assistance performing everyday tasks. Even veterans whose income is above the legal limit for a VA pension may qualify for the Aid and Attendance benefit if they have large medical expenses for which they do not receive reimbursement.

Aid and Attendance is a pension benefit, which means it is available to veterans who served at least 90 days, with at least one day during war time. The veteran does not have to have service-related disabilities to qualify. Veterans or surviving spouses are eligible if they require the aid of another person to perform an everyday action, such as bathing, feeding, dressing, or going to the bathroom. This includes individuals who are bedridden, blind, or residing in a nursing home.

To qualify the veteran or spouse must have less than $80,000 in assets, excluding the home and vehicle. In addition, the veteran’s income must be less than the Maximum Annual Pension Rate (MAPR). Following are the MAPRs for 2007:

Single veteran $18,234
Veteran with one dependent  $21,615
Single surviving spouse $11,715
Surviving spouse with one dependent  $13,976

Income does not include Medicaid benefits or Supplemental Security Income. It also does not include unreimbursed medical expenses actually paid by the veteran or a member of his or her family. This can include Medicare, Medigap, and long-term care insurance premiums; over-the-counter medications taken at a doctor’s recommendation; long-term care costs, such as nursing home fees; the cost of an in-home attendant that provides some medical or nursing services; and the cost of an assisted living facility. These expenses must be unreimbursed (in other words, insurance must not pay the expenses). The expenses should also be recurring, meaning that they should recur every month.

How it works: The amount a person receives depends on his or her income. The VA pays the difference between the veteran’s income and the MAPR.

Example:   John, a single veteran, has income from Social Security of $16,500 a year and a pension of $12,000 a year, so his total income is $28,500 a year. He pays $20,000 a year for home health care, $1,122 a year for Medicare, and $1,788 a year for supplemental insurance, so his total medical expenses are $24,910. Subtracting his medical expenses from his income ($28,500 – $24,910), John’s countable income is $3,590. John could qualify for $14,644 ($18,234 – $3,590) in Aid and Attendance benefits.