The Department of Veterans Affairs (VA) provides two (2) types of monetary benefit programs for veterans. These monetary benefit programs are separated into benefits for (1) service-connected disabilities and (2) non-service-connected disabilities. The primary benefit for service-connected disabilities is the VA “compensation” benefit; the primary benefit for non-service- connected disabilities is the VA “pension” benefit.

Eligibility for the VA pension benefit to compensate veterans for non-service-connected is based upon disability, as well as income and financial need.  The veteran’s disability must be total and permanent (but need not be “service-connected”). There are three (3) types of VA pension benefits: (1) the basic pension, (2) “Housebound” benefits and (3) “Aid and Attendance” benefits (A&A).

If the veteran is living independently, the veteran must be receiving assistance with at least two (2) Activities of Daily Living (ADLs) in order to be eligible for VA pension benefits. Activities of Daily Living are defined by the VA in agency regulations, as follows:

V.iii.1.G.3.f.  ADLs and IADLs ADLs are basic self-care activities, consisting of

  • bathing or showering
  • dressing
  • eating
  • getting in or out of bed or a chair, and
  • using the toilet.

ADLs do not include Instrumental Activities of Daily Living (IADLs).  IADLs are activities other than basic self-care that are needed for independent living.  Examples of IADLs include

  • shopping
  • food preparation
  • housekeeping
  • laundering
  • handling medication, and
  • using the telephone.

Note:  Pull cords, 24-hour staffing, and locked exterior doors are not considered either ADLs or IADLs, although they may be indicative of a protected environment.

Examples of the assistance which must be provided with various ADLs follows:

Bathing:  assistance would include actual hands-on care, being in the room with the veteran for high-fall risk claimants, setting up the bath and water temperature, having to prompt the veteran because he/she would not bathe otherwise…as in the case of a dementia

Dressing:  assistance would include full dressing, having to pick out and lay out clothing, putting on shoes/socks, helping with pull-over clothing because the veteran cannot raise his/her arms above their head, application and removal of anti-embolism stockings

Eating:  assistance would include actually feeding the person, helping the veteran hold a cup due to tremors, instructing a blind veteran with the positioning of utensils and food, having to clean up after a veteran who spills food  (it would not include just reminding the veteran to eat or the preparation of food), and having to be with the veteran due to high choking risk.

If the veteran is living in an assisted living facility, however, the veteran does not have to be receiving assistance with any ADLs, provided that a doctor certifies that the veteran needs a “protective environment.”  Once it is established that the veteran needs a “protective environment,” then all unreimbursed fees paid to the assisted living facility for room-and-board, custodial care, and medical or nursing care may be deducted from the veterans income and other assets to establish eligibility. See the M21-1 policy manual below:

V.iii.1.G.3.l.  Medical Expense Deduction for ALF Fees If a claimant or relative is maintained in an ALF because the person needs to live in a protected environment, all unreimbursed fees paid to the ALF for room-and-board, custodial care, and medical or nursing care are deductible expenses, as long as

  • a licensed physician certifies that the person has a medical condition that makes such a level of care necessary, or
  • VA has determined the person is entitled to the A&A or housebound allowance.

If ALF fees are allowed, then, all reasonable fees paid to the facility for personal care of the disabled person and maintenance of the disabled person’s immediate environment may be allowed.  This includes such services as cooking for the disabled person, housecleaning for the disabled person, and other IADLs.

It is not necessary to distinguish between medical and non-medical services.  However, services that are beyond the scope of personal care of the disabled person and maintenance of the disabled person’s immediate environment, may not be allowed.

The claims processor must review VA Form 27-0820b, to confirm claimed medical expenses.

Exception:  Provider proof verification is not required if VA Form 21-0779, is of record and was received within one year of the date of claim.


  • Verification from other care facilities is not required unless the adjudicator finds reason to question a claim based on care facilities.
  • If it is established that a claimant or relative in a governmental institution is participating in a program of therapy or rehabilitation supervised by a physician, or a physician has certified that the claimant or relative has a medical condition that makes such a level of care necessary, allow the entire amount paid as a deductible expense.
  • A physician’s statement specifically addressing the issue of whether an individual who is not entitled to A&A or housebound needs to be in a protected environment must be of record, even if the individual’s diagnosis is known.

Reference:  For more information on provider proof verification, see M21-1, Part V,Subpart iii, 1.G.5.a.

For additional information concerning VA compensation and pension benefits, visit:

VA Compensation and Pension Benefits