How to Download VA Form 21-2680 (PDF) for Housebound Status or Permanent Need for Regular Aid and Attendance
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.
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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.
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 reg