How to Download VA Form 21-2680 (PDF)
If you are a veteran or a surviving spouse of a veteran who needs long-term care services, you may be eligible for VA benefits that can help cover the cost of your care. One of these benefits is the Aid and Attendance (A&A) or Housebound allowance, which is a supplement to the VA pension or compensation. To apply for this benefit, you need to fill out and submit VA Form 21-2680, also known as Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. In this article, we will explain what VA Form 21-2680 is, how to fill it out, how to submit it, and where to get help with it.
download va form 21-2680 (pdf)
What is VA Form 21-2680?
VA Form 21-2680 is a form that is used to determine your eligibility for A&A or Housebound benefits. These benefits are paid in addition to your monthly pension or compensation if you meet certain criteria. The form requires information about your identity, your claim, and your medical condition. You can download the form as a PDF file from the VA website or from other online sources. You can also request a copy of the form by calling the VA toll-free hotline at 1-800-827-1000.
Purpose and eligibility of the form
The purpose of VA Form 21-2680 is to provide evidence that you need regular aid and attendance from another person to perform personal functions required in everyday living, such as bathing, dressing, feeding, adjusting prosthetic devices, or protecting yourself from the hazards of your environment. Alternatively, you can also use the form to show that you are housebound, which means that you are substantially confined to your immediate premises because of a permanent disability.
To be eligible for A&A or Housebound benefits, you must meet all of the following requirements:
You are enrolled in VA health care.
You are eligible for VA pension or compensation.
You have a service-connected disability or a non-service-connected disability that is not due to willful misconduct.
You have a disability that causes you to need A&A or Housebound status.
You have income and assets below certain limits.
Types of benefits and services covered by the form
If you qualify for A&A or Housebound benefits, you can receive an increased monthly amount that can help pay for your long-term care needs. The amount varies depending on your type of benefit, your marital status, and your dependency status. As of December 2021, the maximum monthly amounts are as follows:
Type of benefitSingle veteranVeteran with spouse/dependentSurviving spouseSurviving spouse with dependent
A&A with pension$23,238/year ($1,936/month)$27,549/year ($2,296/month)$14,934/year ($1,244/month)$17,815/year ($1,484/month)
A&A with compensation$43,704/year ($3,642/month)$49,296/year ($4,108/month)$18,984/year ($1,582/month)$22,224/year ($1,852/month)
Housebound with pension$16,540/year ($1,378/month)$20,851/year ($1,738/month)$11,420/year ($952/month)$14,301/year ($1,192/month)
Housebound with compensation$21,230/year ($1,769/month)$26,822/year ($2,235/month)$11,420/year ($952/month)$14,301/year ($1,192/month)
In addition to the increased monthly amount, you may also be eligible for other benefits and services that can help you with your long-term care needs. These include:
VA health care services, such as home health care, hospice care, respite care, adult day health care, geriatric evaluation and management, and skilled nursing facility care.
VA home and community-based services, such as homemaker and home health aide services, home telehealth services, home-based primary care, veteran-directed care, and medical foster home care.
VA long-term care programs, such as the Program of Comprehensive Assistance for Family Caregivers (PCAFC), the Program of General Caregiver Support Services (PGCSS), and the Medical Benefits Package.
VA long-term care benefits and supports, such as the Veterans Independence Program (VIP), the Veterans Mortgage Life Insurance (VMLI), the Specially Adapted Housing (SAH) grant, the Special Home Adaptation (SHA) grant, and the Home Improvements and Structural Alterations (HISA) grant.
How to fill out VA Form 21-2680?
VA Form 21-2680 is a four-page form that consists of five sections. You can fill out the form by yourself or with the help of a VA social worker or representative. You can also ask your doctor or other health care provider to fill out some parts of the form. Here are the instructions for each section of the form:
Section I: Veteran's identification information
In this section, you need to provide your personal information as the veteran who is applying for A&A or Housebound benefits. You need to enter your name, Social Security number or VA file number, date of birth, address, phone number, email address (optional), and relationship status. You also need to indicate whether you are receiving VA pension or compensation.
Section II: Claimant's identification information
In this section, you need to provide the personal information of the person who is claiming A&A or Housebound benefits on your behalf. This could be yourself or someone else who is acting as your fiduciary or representative. You need to enter their name, Social Security number or VA file number (if applicable), address, phone number, email address (optional), and relationship to you. You also need to indicate whether they are receiving VA pension or compensation.
Section III: Claim information
In this section, you need to provide information about your claim for A&A or Housebound benefits. You need to check the box that corresponds to the type of benefit you are applying for: A&A or Housebound. You also need to check the box that indicates whether you are applying for an increase in your current benefit or a new benefit. If you are applying for an increase in your current benefit, you need to enter the date when your condition worsened. If you are applying for a new benefit, you need to enter the date when your condition began.
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Section IV: Examination information
In this section, you need to provide information about your medical condition that causes you to need A&A or Housebound status. This section must be completed by a licensed physician who has examined you within the last 90 days. The physician must enter their name, address, phone number, email address (optional), license number and specialty. The physician must also answer several questions about your diagnosis, prognosis, functional limitations, need for assistance, and level of care. The physician must provide detailed explanations and examples to support their answers. The physician must also sign and date the form at the end of this section.
Section V: Certification and signature
In this section, you need to certify and sign the form as the veteran or the claimant. You need to read the certification statement carefully and make sure that all the information you provided is true and complete. You need to sign and date the form in ink. You also need to provide your phone number and email address (optional) for contact purposes.
How to submit VA Form 21-2680?
Once you have completed VA Form 21-2680, you need to submit it to the VA along with any supporting documents, such as medical records, receipts, or statements. You can submit the form by one of the following methods:
Online submission
You can submit VA Form 21-2680 online through the VA website or through the eBenefits portal. You need to create an account or log in with your existing account. You need to upload a scanned copy of the form and any supporting documents. You need to follow the instructions on the website to complete the submission process.
Mail submission
You can submit VA Form 21-2680 by mail to the VA regional office that serves your area. You can find the address of your regional office on the VA website or by calling the VA toll-free hotline at 1-800-827-1000. You need to print a copy of the form and any supporting documents. You need to put them in an envelope and write "Attention: Pension Management Center" on the front. You need to mail the envelope with sufficient postage.
In-person submission
You can submit VA Form 21-2680 in person at any VA regional office, medical center, or benefit office. You can find the location of your nearest office on the VA website or by calling the VA toll-free hotline at 1-800-827-1000. You need to bring a copy of the form and any supporting documents with you. You need to present them to a VA staff member who will assist you with the submission process.
Where to get help with VA Form 21-2680?
If you have any questions or difficulties with VA Form 21-2680, you can get help from various sources. Here are some of the options you can use:
VA toll-free hotline
You can call the VA toll-free hotline at 1-800-827-1000 to speak with a VA representative who can answer your questions and guide you through the process of filling out and submitting VA Form 21-2680. The hotline is available Monday through Friday, from 8:00 a.m. to 9:00 p.m. ET.
VA website and online tools
You can visit the VA website to access various online tools and resources that can help you with VA Form 21-2680. These include:
The online application for pension benefits, which allows you to apply for A&A or Housebound benefits online.
The eBenefits portal, which allows you to manage your benefits, upload documents, check your status, and communicate with the VA online.
The Pension Benefits Calculator, which allows you to estimate your potential pension amount based on your income, assets, and expenses.
The Aid and Attendance and Housebound Benefits page, which provides more information about these benefits, including eligibility criteria, application process, and payment rates.
The Frequently Asked Questions page, which provides answers to common questions about pension benefits and related topics.
VA social worker or representative
You can also get help from a VA social worker or representative who can assist you with filling out and submitting VA Form 21-2680. A VA social worker is a professional who can provide counseling, care coordination, advocacy, and referral services for veterans and their families. A VA representative is a person who is authorized by the VA or by law to act on behalf of veterans in matters related to their benefits. You can find a VA social worker or representative at any VA regional office, medical center, or benefit office. You can also contact a Veterans Service Organization (VSO), such as the American Legion, Disabled American Veterans, Veterans of Foreign Wars, or Paralyzed Veterans of America, to get help from a VSO representative who can assist you with your claim and represent you before the VA.
Conclusion
VA Form 21-2680 is a form that is used to apply for A&A or Housebound benefits, which are supplements to the VA pension or compensation for veterans or surviving spouses who need long-term care services. The form requires information about your identity, your claim, and your medical condition. You can download the form as a PDF file from the VA website or other online sources. You can fill out the form by yourself or with the help of a VA social worker or representative. You can submit the form online, by mail, or in person. You can get help with the form from the VA toll-free hotline, the VA website and online tools, or a VA social worker or representative.
FAQs
Here are some frequently asked questions about VA Form 21-2680:
Q: How long does it take to process VA Form 21-2680?
A: The processing time for VA Form 21-2680 depends on several factors, such as the complexity of your claim, the completeness of your application, the availability of your supporting documents, and the workload of the VA office that handles your claim. Generally, it may take several months to receive a decision from the VA. You can check the status of your claim online through the eBenefits portal or by calling the VA toll-free hotline at 1-800-827-1000.
Q: What if I disagree with the decision on my VA Form 21-2680?
A: If you disagree with the decision on your VA Form 21-2680, you have the right to appeal it. You can file a Notice of Disagreement (NOD) within one year from the date of the decision letter. You can choose between two options for your appeal: the Higher-Level Review (HLR) option or the Supplemental Claim (SC) option. The HLR option allows you to request a review by a senior VA adjudicator who will look at the same evidence that was used to make the original decision. The SC option allows you to submit new and relevant evidence that was not previously considered by the VA. You can also request a hearing with a Veterans Law Judge (VLJ) at the Board of Veterans' Appeals (BVA) after you have completed either option. You can get help with your appeal from a VA social worker or representative or a VSO representative.
Q: Can I get A&A or Housebound benefits if I live in a nursing home or assisted living facility?
A: Yes, you can get A&A or Housebound benefits if you live in a nursing home or assisted living facility, as long as you meet the eligibility criteria for these benefits. However, if you are receiving Medicaid benefits to pay for your care, your A&A or Housebound benefits may be reduced or discontinued by the VA. This is because Medicaid is considered a third-party payer that offsets your need for VA benefits. You should report any changes in your living situation or income to the VA as soon as possible.
Q: Can I get A&A or Housebound benefits if I have a spouse or family member who provides care for me?
A: Yes, you can get A&A or Housebound benefits if you have a spouse or family member who provides care for you, as long as you meet the eligibility criteria for these benefits. However, your spouse or family member cannot receive any payment from the VA for providing care for you. If they do receive payment from another source, such as an insurance company or a state program, your A&A or Housebound benefits may be reduced by the amount of their payment. You should report any changes in your care situation or income to the VA as soon as possible.
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