VA Form 21-2680 - Page 2

What is VA Form 21-2680?

VA Form 21-2680, also known as the Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, is a document used by the Department of Veterans Affairs (VA) to assess the eligibility of veterans for benefits related to housebound status or aid and attendance. This form provides valuable information about the veteran's medical condition and daily living activities.

What are the types of VA Form 21-2680?

There are two main types of VA Form 21-2680: one for housebound status and another for aid and attendance benefits. The Housebound Examination form is used to determine if a veteran qualifies for housebound benefits, which provide additional financial assistance to veterans who are confined to their homes due to disability. The Aid and Attendance Examination form, on the other hand, helps determine if a veteran is eligible for aid and attendance benefits, which provide financial assistance for veterans who require the regular aid and attendance of another person.

Housebound Examination form
Aid and Attendance Examination form

How to complete VA Form 21-2680

Completing VA Form 21-2680 is an important step to apply for housebound status or aid and attendance benefits. Here are the steps to fill out the form:

01
Start by providing your personal information, such as your name, social security number, and contact details.
02
Next, answer the questions related to your medical condition and daily living activities. Be thorough and provide accurate information.
03
If you are applying for housebound status, make sure to provide details about your inability to leave your home and the need for assistance with daily activities.
04
For aid and attendance benefits, describe your need for regular aid and attendance from another person, such as a caregiver or healthcare professional.
05
Review the completed form to ensure all the information is correct and complete.
06
Sign and date the form, certifying the accuracy of the provided information.
07
Submit the form to the Department of Veterans Affairs through the designated channels.

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Video Tutorial How to Fill Out VA Form 21-2680

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Questions & answers

Use this form to report to VA any change in the child's status, such as termination of school attendance or marriage.
0:24 1:53 Learn How to Fill the VA Form 21 4138 Statement In Support of Claim YouTube Start of suggested clip End of suggested clip Once you have a completed draft you can either handwrite your explanation in the box or print itMoreOnce you have a completed draft you can either handwrite your explanation in the box or print it from a computer and attach it you must also attach any supporting documents. You may require.
Once the VA confirms a veteran or their surviving spouse is eligible for Aid and Attendance, they'll receive retroactive payments covering the previous months when the application was pending. For a veteran to receive retroactive payments, they'll need to fill out an Intent to File form.
VA Aid & Attendance Documentation Checklist Original DD-214 military discharge form q Social Security card or number. Marriage certificate(s) Death certificate of Spouse. Death certificate of Veteran. Proof of in-home healthcare costs including care provider information (name and phone number)
21-2680, Examination for Housebound or Permanent Need for Regular Aid and Attendance, to the Pension Management Center (PMC) having jurisdiction over your claim. If you do not know which PMC has jurisdiction over your claim, you may submit your request to the VA Regional Office closest to your current residence.
Use VA Form 21-2680 to apply for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits.