Masthead header

Veterans with ALS: Aid & Attendance

Caregiver setting up weekly medications

Note: the following discussion is in no way related to receiving home health care, unskilled or skilled, by VHA, Veterans Health Administration. This is a discussion on Aid and Attendance as it relates to benefits, VBA, Veterans Benefits Administration.

There is not a VA disability benefit that is specifically aid and attendance. Aid and attendance are part of additional ratings above 100 per cent compensation. Ratings above 100 per cent compensation are known as Special Monthly Compensation, SMC. The amount of aid and attendance awarded in SMC depends on the documented need of the veteran.

The SMC schedule has 11 different levels, all the levels are letters, such as L, L1/2, M, M1/2, N, N1/2, O/P, R.1, R.2, S, and T. The compensation goes up accordingly. The highest compensation rating is R2. To be rated R2 the veteran must be in need of regular aid and attendance and, additionally, in the need of personal health-care services provided on a daily basis in the veteran’s home by a person who is licensed to provide such services or who provides services under the regular supervision of a licensed health-care professional. The difference between R1 and R2: R1 the veteran requires, unskilled, regular aid and attendance. R2 the veteran requires the R1 criteria and skilled care in the home without otherwise the veteran would need to be in a long-term care facility.

Aid and Attendance is a medical rating and additional amounts of money available with all VA disability income benefit levels to help individuals receiving these benefits cope with the added burden of helplessness. The additional amounts of money require a Rating Veterans Service Officer in the Regional Office to establish the need and issue a rating. A Rating Veterans Service Officer is an employee with the Veterans Benefits Administration.

Criteria for the Need for Aid and Attendance

38 CFR 3.352 Criteria for determining need for aid and attendance and “permanently bedridden”.  

(a) Basic criteria for regular aid and attendance and permanently bedridden. The following will be accorded consideration in determining the need for regular aid and attendance, 3.351(c)(3)

  • inability of veteran to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable
  • frequent need of adjustment of any 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 normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc)
  • inability of veteran 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 and assistance on a regular basis to protect the veteran from hazards or dangers incident to his or her daily environment
  • “Bedridden” will be a proper basis for the determination (need for aid and attendance). For the purpose of this paragraph “bedridden” will be that condition which, through its essential character, actually requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice.

A veteran does not need to require all of the above for a favorable rating for SMC. The veterans condition, along with the functions the veteran is unable to perform, are all taken in to consideration. The bar to meet is that the veteran is experiencing a level of helplessness to need regular aid and attendance. The need does not have to be a constant one but must need regular assistance.

(c) Attendance by a relative. The performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his or her household will not prevent the granting of the additional allowance.

The following are regulations broken down in common language:

  • Assistance with bathing or showering
  • Assistance with toileting
  • Assistance with feeding (having a need to be fed by someone else)
  • Assistance with dressing or undressing
  • Assistance with transferring in or out of a bed or chair
  • Assistance with incontinence
  • Assistance with walking
  • Assistance with keeping oneself ordinarily clean and presentable, including hygiene issues
  • Assistance with frequent need of adjustment of special prosthetic or orthopedic devices which cannot be done without the aid of another person
  • Having an incapacity (physical or psychological/psychiatric) requiring care or assistance on a regular basis to protect the patient from hazards or dangers to his or her daily environment.

Again, the veteran does not need to meet all of the above criteria to be rated for aid and attendance. For a veteran with ALS meeting any of the above criteria is generally not difficult though it must be documented by a physician.

VA does not require a relative, or caregiver, be paid for services in order to receive aid and attendance compensation in the form of a SMC rating.