Download VA Form 21-2680 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
What Is VA Form 21-2680 Used for?
The VA 21-2680 is used to outline the health problems veteran or beneficiary suffers from, their physical state, and their ability to make basic movements. It allows them to request aid and assistance or extra money payments in addition to their pension. The decision about the amount of financial assistance or necessary aid is made according to the information provided.
Veterans or beneficiaries will be provided with aid and assistance if they need the help of another person in order to perform basic daily actions, such as bathing, dressing, feeding themselves, etc. A need to stay in bed due to a disability, or being in a nursing facility due to a mental or physical condition is also considered serious enough for receiving aid.
VA Form 21-2680 Instructions
There are no specific instructions provided on this form. All necessary filing guidelines can be found inside the form.
How To Fill out VA Form 21-2680?
- Section I. Identification of the veteran. Box 1. Full name of the veteran. Box 2. Social security number. Box 4. Date of birth. Box 5. Service number. Box 6. Gender. Boxes 7-9. Phone number, email, and post addressed.
- Section II. Information about the claimant. The veteran and the claimant can be the same person. Boxes 10 and 11 should contain the name and the claimant's social security number. In Box 12 the relationship to the veteran or beneficiary should be mentioned. In Box 13 the claimant must choose between two options for which benefit they apply. The options are Special Monthly Compensation (SMC) and Special Monthly Pension (SMP). SMC is required for veterans or their relatives who are housebound, while SMP is paid only to veterans or claimants with other diseases.
- Section III. Information on physical tests and the physical state of the person in need of help. Box 14. The date of the examination. Box 15. Home address of the veteran or beneficiary. Box 16 requires specification, whether the claimant is in a hospital or not. A positive answer requires the date of admission to the hospital, its name and the location in Boxes 16B and 16C. If the answer is negative, these Boxes should be left blank.
- Box 17. Information about the claimant's diagnosis. Information in Box 17 must not contradict the data provided in Boxes 25-39. In Boxes 18A-18C physical characteristics of the claimant are recorded, including weight, both actual and estimated, and height in feet and inches. In Boxes 19-20 information about the nutrition is given. Boxes 21-23 will contain the results of the examination: blood pressure, pulse and respiratory rates. In Box 24 the disabilities preventing the claimant from doing activities listed in questions 26-28 should be listed.
- If the claimant has to stay in bed, the hours in bed should be given in Box 25. Boxes 26-28 require basic information on activities, such as feeding, preparing meals, bathing and whether the claimant is able to perform them. If Boxes 26 and 27 contain negative answers and Box 28 is answered positively, an explanation is needed. This can be done on a separate sheet of paper. Boxes 29A and 29B are for providing information about the claimant's sight and whether they are blind or not.
- The kind of help the claimant needs and whether they would be able to manage the payments is specified in Boxes 30-32. The answers should be supported by arguments. The posture and appearance of the claimant are described in Box 33. Boxes 34-36 are describing the restrictions to basic actions and movements. All pathologies preventing the claimant from doing these actions are listed in Box 37.
- When and under which circumstances the claimant is able to leave home is entered in Box 38. Box 39 is for providing information about whether the claimant requires locomotion assistance. Boxes 40-41 must be completed by the examining physician, providing their name and signature.
Where to Send VA Form 21-2680?
The completed forms should be sent to a local VA regional office.
The Los Angeles Regional Office is responsible for the following regions:
Inyo, Kern, Los Angeles, San Luis Obispo, Santa Barbara, San Bernardino, and Ventura.
Los Angeles Regional Office, Federal Building, 11000 Wilshire Boulevard, Los Angeles, CA 90024
The San Diego Regional Office covers the following counties: Imperial, Orange, Riverside and San Diego.
San Diego Regional Office, 8810 Rio San Diego Drive San Diego, CA 92108
The Reno Regional Office is responsible for the following regions: Alpine, Lassen, Modoc, and Mono.
Reno Regional Office: 5460 Reno Corporate Drive Reno, NV 89511
The Oakland Regional Office covers all remaining counties.
Oakland Regional Office: 1301 Clay Street, Room 1400 North, Oakland, CA 94612