VA disability claims · Aid & Attendance · Housebound · SMC

VA Form 21-2680: The Exam That Makes or Breaks A&A and Housebound

VA Form 21-2680 is not a claim form. It is an examination report. The official title is Examination for Housebound Status or Permanent Need for Regular Aid and Attendance (revision February 2023). A medical examiner completes the clinical portion. VA uses it to decide whether the veteran (or, in some files, a spouse or other claimant) needs regular personal help, or is housebound, for purposes of Aid & Attendance or housebound benefits added to compensation or pension.

That last sentence is doing a lot of work. The same form shows up in two different benefit systems. Compensation Special Monthly Compensation (SMC-L for regular Aid & Attendance; SMC-S for housebound) is function-based and is not means-tested. Pension Aid & Attendance is a needs-based add-on to wartime pension. The form does not know which program you meant. The rest of the claim has to say so, and the evidence has to match that program’s rules.

A complete 21-2680 can make an SMC file readable. An incomplete one — checkboxes with no typical day, a signature with no exam, “needs some help” with no task — can stall the same file for months. The form is also not the whole claim. You still need the disability application (usually VA Form 21-526EZ), current ratings or a pending claim, and a record of who actually helps, with what, and how often.

Veterans Promise is a veteran-led team based in Nashville. We work with veterans nationwide on rating increases and SMC, including Aid & Attendance and housebound when the facts support them. We do not complete the examiner’s portion of a 21-2680. A clinician does. We do help you see whether the form, the ratings, and daily life are telling the same story.

This page is general information about what the form is, who fills it out, how it supports SMC-L and SMC-S, what “regular aid and attendance” looks like on the page, and the incomplete-exam problems we see. It is not legal or medical advice. Veterans Promise is not affiliated with the U.S. Department of Veterans Affairs. VA decides every claim. No one can honestly guarantee a result.

Request a complimentary consult or call (877) 778-0385.

What VA Form 21-2680 is (and what it is not)

VA publishes the form here: https://www.va.gov/find-forms/about-form-21-2680/. The downloadable PDF is VBA-21-2680. VA’s forms page states the name as Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, last revised February 2023, and says to use it to apply for Aid and Attendance benefits that will be added to monthly compensation or pension.

The instructions on the PDF are more precise than the marketing sentence. The purpose of the examination is to record findings on whether the claimant is housebound (confined to the home or immediate premises) or in need of the regular aid and attendance of another person. The examiner is asked to describe how well the person ambulates, where they go, and what they are able to do during a typical day. Findings should show whether the claimant is blind or bedridden. That narrative is the point of the form. The checkboxes are a map. They are not the report.

VA’s evidence-needed page lists the 21-2680 as one of two documents for Aid and Attendance and Housebound: this exam, or, if the person is in a nursing home, VA Form 21-0779 (Request for Nursing Home Information in Connection with Claim for Aid and Attendance). Official evidence page: Evidence needed for your disability claim.

What the form is not

• Not VA Form 21-526EZ. 21-526EZ is the application for disability compensation and related benefits. The 21-2680 does not start a claim by itself if VA has nothing pending and no application in the file.
• Not a rating decision. An examiner can describe total dependence. VA still assigns the SMC letter, or does not.
• Not a pension application. Wartime pension has its own forms (including VA Form 21P-527EZ) and income/net-worth rules. A 21-2680 can support pension A&A. It does not replace the pension application, and it does not convert pension facts into compensation SMC.
• Not a substitute for treating records. A one-visit snapshot that contradicts years of notes will be read against those notes. A snapshot that matches them is strong.
• Not something Veterans Promise fills out as the examiner. We are not your doctor. We do not practice medicine. We do not complete the clinical portion.

If the household need is daily personal care because of service-connected disability, read VA Aid & Attendance first, then come back to this page for the exam. If the need is confinement to the home, or a 100 + 60 ratings combination, read VA housebound benefits. The form can speak to both. The legal tests are not the same.

Tell us what a typical day looks like. We will sort whether a 21-2680 even belongs in the next filing. Call (877) 778-0385.

Who completes it

The form has claimant identification and an examination section. VA’s Aid and Attendance (pension) page says a medical examiner must fill out the examination information section. That matches the PDF: the examination is a clinical report, not a veteran worksheet.

In practice:

• The veteran or a helper can complete name, file number, and similar identifying items so the examiner is not guessing the claim number.
• A medical examiner — a physician or other clinician acting as examiner — completes the findings: diagnoses, function, assistance needed, ambulation, typical day, vision, and the aid-and-attendance / housebound opinions the form asks for.
• The examiner signs, dates, and lists credentials and contact information. An unsigned exam is a draft.

The examiner can be a VA clinician or a private treating provider. VA may also schedule its own claim exam on the same issues. A private 21-2680 does not bar VA from ordering another exam. It also does not guarantee VA will adopt the private findings. What it does is put a structured functional report in the file instead of a one-line primary-care note that says “lives with spouse.”

Relatives who provide the care do not complete the examination. They can — and often should — complete a lay statement (VA Form 21-10210 or 21-4138) that says who helps, with what, how often, and what happens when they do not. 38 C.F.R. § 3.352(c) is explicit that aid and attendance provided by a relative or other household member still counts. The caregiver’s statement and the examiner’s 21-2680 are different documents. One is lay evidence of the actual help. The other is a medical description of why that help is needed.

We will not fill in range of motion, check the bathing box, or draft a medical opinion on your behalf. If a consult shows the file needs a 21-2680, the next step is a clinician who actually examines you, not a form we ghostwrite.

How it supports SMC-L Aid & Attendance and SMC-S housebound

For disability compensation, the 21-2680 is usually evidence for Special Monthly Compensation, not for a higher 10% step on an old diagnostic code. SMC is extra or higher tax-free compensation for specific functional and anatomical situations. Overview: Special Monthly Compensation.

SMC-L — regular Aid & Attendance

Regular A&A under 38 U.S.C. § 1114(l) and 38 C.F.R. § 3.350(b) is payable when service-connected disability leaves the veteran so helpless as to need the regular aid and attendance of another person (or when listed L criteria such as loss of use of both feet, qualifying blindness, or being permanently bedridden are met). The detailed A&A factors live in 38 C.F.R. § 3.352(a):

• Inability to dress or undress, or to keep ordinarily clean and presentable
• Frequent need of adjustment of a special prosthetic or orthopedic appliance that the veteran cannot manage without help (not ordinary belts and laces)
• Inability to feed oneself through loss of coordination of the upper extremities or extreme weakness
• Inability to attend to the wants of nature
• Physical or mental incapacity that requires regular care or assistance to protect the veteran from hazards of the daily environment

Not all of those must be present. Constant, round-the-clock nursing is not the test. Regular need is. The determination has to rest on the actual requirement of personal assistance from others, not on a theory that the veteran “should be in bed.”

A 21-2680 that tracks those functions — bathing, dressing, feeding, toileting, transferring, medication, safety — is useful because it is the same vocabulary the regulation uses. A 21-2680 that only lists diagnoses is not.

SMC-L is a basic SMC rate. For 2026 (effective December 1, 2025), the veteran-alone SMC-L rate is $4,900.83 a month, compared with $3,938.58 at schedular 100%. Dependents change both numbers. Those figures are VA’s published rates, not a quote. See our 2026 disability rates page and VA’s SMC rate tables.

SMC-S — housebound

Housebound under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i) is a different test. One path is ratings math: a single 100% service-connected disability plus additional disability independently ratable at 60% or more, in a different system. That path may not need a 21-2680 at all. The codesheet may already contain it. The other path is factual housebound: substantially confined to the dwelling and immediate premises by service-connected disability, reasonably certain to continue throughout life. Leaving for medical care does not, by itself, defeat that. A social life outside the property usually does.

The 21-2680 asks the examiner about confinement, ambulation, where the veteran goes, and a typical day. That is the factual-housebound conversation. It is not the 100 + 60 conversation. Mixing them is how a veteran with a clean 100 + 60 combination spends a year collecting an exam they did not need, and how a veteran who never leaves the property files only for another 10% on a knee.

For 2026, veteran-alone SMC-S is $4,408.53 a month. That is more than schedular 100% and less than SMC-L. Families who already have S should still ask whether the facts now look like Aid & Attendance. Details: VA housebound benefits and 100% and SMC.

Compensation SMC vs pension A&A, on the same form

Because VA uses 21-2680 for both programs, a file can get lost in the wrong folder. Pension A&A has income and net worth tests. Compensation SMC does not. If you already receive disability compensation at a high rate, pension is usually the wrong conversation. If someone in the house is helping with the shower because of service-connected disability, SMC-L is the conversation. Say which program you mean when you file. Do not assume the examiner’s checkbox picks the statute for you.

What “regular aid and attendance” looks like on the form

The February 2023 PDF asks whether the patient requires assistance with activities that map closely onto § 3.352(a) and onto ordinary daily living:

• Bathing / showering
• Eating or self-feeding
• Dressing
• Ambulating within the home or living area
• Tending to hygiene needs
• Transferring in or out of bed or chair
• Toileting
• Medication management
• Additional activities such as housekeeping, laundering, and meal preparation (instrumental ADLs — useful context, not a substitute for the personal-care factors)

It also asks about legal blindness, use of a cane, crutches, wheelchair, or another person for locomotion, and how far the person can walk. Those items matter for housebound and for safety. They do not, standing alone, equal Aid & Attendance. Plenty of veterans use a cane and dress themselves. Plenty of veterans are dressed by a spouse and still walk to the mailbox.

What a useful exam actually sounds like, in plain language:

• “Spouse lays out clothes and helps with socks, shoes, and the shirt because the veteran cannot raise the arms or bend to the feet. This is daily, not occasional.”
• “Veteran cannot transfer from the shower chair without a person present. Unsteady; fell in the stall in [month].”
• “Cannot manage pill organizer. Wrong-day doses when left alone. Spouse administers medications twice daily.”
• “Does not leave the property except for medical appointments. Last non-medical outing was [date]. Service-connected [condition] is the reason, not preference.”
• “Needs another person in the home because of seizure risk / wandering / inability to respond to a fire alarm. Not companionship. Safety.”

Those sentences are examples of the level of detail. They are not a script. An examiner who copies a script is not examining. An examiner who writes “needs help with ADLs” and stops has not answered the form.

Regular need can exist even if some days are better. The regulation does not require constant helplessness. It does require that personal assistance is actually needed on a regular basis. A spouse who has been doing the work for years still counts. Hiring a licensed aide is not the test for regular A&A (it can matter for a higher-level-care letter, which is a different SMC question and a different part of § 3.352).

Common incomplete-exam problems

These are the patterns that make a 21-2680 weak or unusable. None of them are a moral failing. They are gaps. Gaps get filled or they show up in the denial.

1. Checkboxes without a typical day. The PDF tells the examiner to describe a typical day, where the person goes, and how they ambulate. A page of ticks with three words of narrative is what a rater cannot use when the lay evidence and the exam disagree.
2. “Needs some assistance” with no task, frequency, or person. Assistance with laundry is not assistance with toileting. Weekly help is not daily help. A neighbor who shops is not a spouse who bathes you.
3. Diagnoses instead of function. PTSD, lumbar degenerative disc disease, and diabetes can all be consistent with total independence or with needing two people to transfer. The rating codesheet already has the diagnoses. The 21-2680 has to say what the body still cannot do.
4. No exam. A form completed from a chart review, a phone call, or the veteran’s own handwriting in the clinical blocks. VA asked for an examination. If the clinician did not examine, say so in the consult; do not pretend the PDF is something it is not.
5. Unsigned, undated, or no credentials. Same problem as any medical opinion.
6. Stale. A 21-2680 from four years ago describes four years ago. SMC is about current need. An old exam can still show history. It does not show today.
7. Wrong program in the examiner’s head. Comments about income, “pension,” or “the veteran is not 65” on a compensation SMC claim. Age is not the SMC-L test. Income is not the SMC-L test.
8. Housebound and A&A collapsed into one sentence. “Veteran is homebound and needs A&A” without saying which personal functions fail, and without saying whether the veteran leaves for anything other than medical care. Those are two letters. The form can support both only if the facts for both are written down.
9. Contradicts the rest of the file with no explanation. Treatment notes that the veteran walks the dog twice a day, plus a 21-2680 that says the veteran never leaves the recliner. Sometimes the notes are wrong. Sometimes the exam is advocacy. Raters notice the collision. So do we. We will not build a claim on a collision we can already see.
10. Veteran completed the medical portion. Identification, yes. Clinical findings, no. If that is what you have, it is a statement, not an examination. Put it on a 21-4138 and get a clinician to do the 21-2680.

If you already have a 21-2680, bring it to the consult. Incomplete is fixable more often than people think. Fabricated is not a strategy we will touch.

The 21-2680 is not the whole claim

Think of the exam as one exhibit. The claim still needs a spine.

• An application that asks for the benefit. Usually VA Form 21-526EZ for compensation, including SMC. VA can infer SMC in some files from evidence already there. Relying on inference is how A&A stays off the award letter for years. If the facts are there, the claim should say Aid & Attendance, housebound, or both.
• A service-connected foundation. Compensation SMC is paid because of service-connected disability. A 21-2680 that attributes all the help to a non-service-connected problem does not carry L or S. If the rated conditions are not the reason someone helps you, the next conversation may be an increase, a secondary, or a different program — not a better checkbox on the 2680.
• Lay evidence from the person who actually helps. Specific, dated, and boring in the best way: mornings, evenings, which task, what happens if they leave overnight.
• Treating records that do not pretend you are fully independent if you are not. You do not need to perform for a primary-care visit. You do need the chart to stop saying “no assistance required” if that line is false.
• If you are in a nursing home, VA Form 21-0779 from the facility, in addition to or instead of a 21-2680, depending on the situation.

The 21-2680 also does not replace work on the underlying ratings. If you are at 70% and a rated condition has gotten worse, an increase can still be the first filing. If a new problem is caused by a rated condition, a secondary can still matter. SMC sits beside those filings. It is not a reason to skip them, and they are not a reason to skip SMC when someone is already dressing you. We look at the whole file. We do not sell one form as the product.

More on how the pieces fit: resources, SMC, Aid & Attendance, housebound.

Complimentary consult — we do not bill 5× the monthly VA increase

Start with a conversation, not a contract pitch.

Veterans Promise does not bill five times the amount of a VA rating increase. The first conversation is a complimentary consult. We will tell you whether the next work looks like a 21-2680 plus an SMC filing, an increase, a secondary, housebound on the 100 + 60 path that may not need this form, some combination, or none of those — and how we work if you want help after that.

We are veteran-led and based in Nashville. We assist veterans in every state. The work covers disability compensation and Special Monthly Compensation: new claims, rating increases, supplemental claims, appeals, Aid & Attendance, housebound, and other SMC letters when the facts reach them. If your need is a straightforward increase on a condition that has changed, say that. You will not be steered into a 21-2680 because it is the topic of this page. If your need is help at home that a percentage never priced, say that too.

What to bring

• The latest rating decision, including any SMC letter already assigned.
• Any 21-2680 you already have, complete or not.
• A medication list and an honest description of a typical day: who helps, with what, how often, whether you leave the home, and why.

If you have none of that yet, still call. “My spouse has to help me in the shower” is a starting point, not a finished exam.

When we take a case, we review the file, help develop the evidence the claim actually needs, and help prepare and submit the filing. We stay through VA requests and the decision. We do not guarantee SMC, a particular letter, an increase, or any dollar amount. We do not replace your doctor. We are not the VA.

Call (877) 778-0385 or request a complimentary consult online. Email support@veteranspromise.com.

FAQ

What is the official name of VA Form 21-2680?

Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. VA last revised the form in February 2023. Confirm the current title and file on VA’s Form 21-2680 page.

Can I fill out the 21-2680 myself?

You can complete identifying information. A medical examiner must complete the examination section. If you write the clinical findings yourself, you have a statement, not an exam. Use VA Form 21-4138 or 21-10210 for your account of a typical day, and have a clinician complete the 21-2680 after an actual examination. Veterans Promise does not complete the examiner’s portion.

Does a 21-2680 guarantee Aid & Attendance or housebound?

No. It is evidence. VA still decides whether the facts meet SMC-L, SMC-S, pension A&A, or none of those. An incomplete or stale exam can hurt. A thorough exam that matches treating records and lay statements is often the difference between a readable file and a guess. Nothing on this page is a promise of a grant.

Do I need this form if I already have a 100% rating plus another 60%?

Not necessarily for the ratings-combination path to SMC-S. That path is on the codesheet. You may still need a 21-2680 if the real issue is factual housebound or regular Aid & Attendance. A 100 + 60 combination and a spouse who dresses you are not the same claim. See housebound and Aid & Attendance.

Does Veterans Promise only handle Aid & Attendance exams?

No. The 21-2680 is one exhibit in SMC work. SMC is one part of the work. We also help veterans with new disability claims, rating increases, secondaries, supplemental claims, and appeals. If your issue is a rated condition that has worsened, say so. If your issue is help at home or confinement, say that. Both are core work.