SMC-L Aid and Attendance Guide: 38 CFR 3.350(b) and 3.352 Criteria

38 CFR 3.350(b) names these conditions: (1) anatomical loss or loss of use of both feet; (2) anatomical loss or loss of use of one hand and one foot; (3) blindness in both eyes with visual acuity of 5/200 or less; (4) being permanently bedridden; or (5) being so helpless as to be in need of regular aid and attendance. Paragraph (b)(2) says 5/200 or less bilaterally "qualifies", that acuity better than 5/200 but less than 10/200 "does not qualify", and that "concentric contraction of the field of vision beyond 5 degrees in both eyes is the equivalent of 5/200 visual acuity."

38 CFR 3.352(a) says "It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there be a constant need." 38 CFR 3.352(a) lists these for consideration: inability of the claimant to dress or undress, or to keep 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; inability to feed oneself 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 or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment. 38 CFR 3.352(a) also says "It is not required that all of the disabling conditions enumerated in this paragraph be found to exist before a favorable rating may be made."

For 38 CFR 3.352(a), "bedridden" is "that condition which, through its essential character, actually requires that the claimant remain in bed." The text adds that the fact that a 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." 38 CFR 3.350(b)(4) says that, where possible, determinations "should be on the basis of permanently bedridden rather than for need of aid and attendance (except where 38 U.S.C. 1114(r) is involved) to avoid reduction during hospitalization where aid and attendance is provided in kind."

Certain aid-and-attendance allowances may be discontinued or reduced during qualifying government-funded hospitalization under the timing and exceptions in 38 CFR 3.552. The effect depends on the veteran's underlying SMC entitlement. 38 CFR 3.552(a)(1) says additional compensation for aid and attendance for a hospitalized veteran "shall be discontinued as provided in paragraph (b)" except for disabilities in (a)(2). Paragraph (b)(1) says discontinuance is effective "the last day of the month following the month in which the veteran is admitted for hospitalization at the expense of the Department of Veterans Affairs." Paragraph (a)(2) continues the allowance where the disability is paraplegia involving paralysis of both lower extremities together with loss of anal and bladder sphincter control, or Hansen's disease. 3.552(d) says that where entitlement by reason of need for regular aid and attendance is the basis of the monthly rate under 38 U.S.C. 1114(l), the award "will be reduced to the rate payable under 38 U.S.C. 1114(s)."

VA publishes VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance); va.gov says it is used "to apply for Aid and Attendance benefits". Records potentially relevant to 38 CFR 3.352(a) include examination reports and statements describing the personal assistance a person needs.