VA Form 21-2680: Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
VA Form 21-2680 is the medical examination form used to support a claim for Aid and Attendance or Housebound benefits, which can add money to a monthly VA compensation or pension payment.
This is the genuine VA PDF, unmodified. Source: VA official page.
What is VA Form 21-2680?
VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, documents that a veteran or eligible dependent needs another person's help with daily activities, or is substantially confined to their home, because of disability. VA uses the findings to decide whether to add Aid and Attendance or Housebound amounts to compensation or pension benefits.
The claimant completes the identifying sections, but the heart of the form is the medical examination portion, which a licensed physician or other qualified clinician fills in. It covers diagnoses, the ability to bathe, dress, feed oneself, and attend to the needs of nature, gait and balance, and how often and how far the patient can leave home. The current edition is dated February 2023.
Who files VA Form 21-2680?
- Veterans claiming Aid and Attendance or Housebound benefits on top of compensation or pension
- Surviving spouses or parents seeking the same allowances with a survivors benefit
- Family members or caregivers helping a claimant document the need for daily assistance
- Physicians and clinicians completing the examination findings for a patient
How to fill out VA Form 21-2680
- Fill in the claimant's name, Social Security number, VA file number, and address in the identification section.
- Take the form to the claimant's physician or clinician, who completes the examination sections describing diagnoses and what the claimant can and cannot do without help.
- Make sure the clinician signs and dates the certification, since an unsigned exam cannot support the claim.
- Review the completed form and download your copy for your records.
- Submit it with the underlying claim, upload it through va.gov, or mail it to the VA Claims Intake Center address in the form instructions. Residents of a nursing home should also file VA Form 21-0779.
Quick fill VA Form 21-2680 on this page
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Frequently asked questions
Who has to complete the medical portion of VA Form 21-2680?
A licensed physician or other qualified clinician who has examined the claimant. The claimant fills in the identifying information, but VA relies on the clinician's findings and signature, so the examination sections cannot be self-completed.
What is the difference between Aid and Attendance and Housebound?
Aid and Attendance means the claimant needs another person's regular help with daily activities such as bathing, dressing, or eating. Housebound means the claimant is substantially confined to their home because of permanent disability. VA pays only one of the two allowances, whichever results in the higher rate.
Do I still need a VA exam if I submit this form?
Sometimes. VA can accept the private examination on this form as evidence, but it may still schedule its own examination if the findings are incomplete or unclear. Answering every question fully reduces the chance of a follow-up exam.