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Get VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. Use this VA form to apply for Aid and Attendance benefits that will be added to your monthly compensation or pension benefits.
Use this form to determine eligibility for aid and attendance or housebound benefits. For more. information, you can contact us online through Ask VA: https://ask.va.gov/. Ask us a question online or call us toll-free at 1-800-827-1000 (TTY: 711). VA forms are available at www.va.gov/vaforms.
Fill out VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), You can have your doctor fill out the examination information section. Get VA Form 21-2680 to download
VA Form 21-2680 can help support your claim for VA aid and attendance benefits to either disability compensation or non-service-connected pension claims.
Evidence, like a doctor’s report, that shows you need Aid and Attendance or Housebound care, along with VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), which your doctor can fill out Download VA Form 21-2680 (PDF)
Get VA Form 21-2680 to download or If you’re in a nursing home, a Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA Form 21-0779)
The purpose of this examination is to record manifestations and findings pertinent to the question of whether the claimant is housebound or in need of the regular aid and attendance of another person. Findings should be recorded to show whether the claimant is blind or bedridden.
VA FORM 21-2680, SEP 2018.
VA FORM 21-2680, JUN 2008 RESPONDENT BURDEN: We need this information to determine your eligibility for aid and attendance or housebound benefits. Title 38, United States Code 1521 (d) and (e), 1115 (1)(e), 1311(c) and (d), 1315 (h), 1122, 1541 (d) (e), and 1502(b) and (c) allows us to ask for this information.
VA FORM 21-2680, MAY 2015. PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research