An Evaluation of the Veterans Administration Housebound and Aid and Attendance Allowance Program. An Evaluation of the Veterans Administration Housebound and Aid and Attendance Allowance Program : Table 23


: Table 23

    Complete the enclosed income statement.
On the Statement In Support Of Claim, (VA Form 21-4138), include the following statement: “I elect to receive benefits under the Improved Pension Program, Public Law 95-588, if it is to my financial advantage. I understand that once the election is made, and the first check is cashed, it cannot be changed.” Any other information you wish to provide in support of your claim may also be included on this form.
If you are a nursing home patient, supply a certification from the administrator of the nursing home affirming your patient status and the level of nursing care you receive.
If you are a nursing home patient and have a constant high level of monthly unreimbursed medical expenses, furnish an itemized statement of these recurring, unreimbursed expenses. Unreimbursed expenses are those not covered by insurance, medicare, and medicaid.
If you are not a nursing home patient, furnish a medical statement covering the findings, diagnosis and prognosis of any recent medical treatment or examination. The doctor’s statement or hospital report should include the number of hours in bed; posture and general appearance; restriction of use of lower and upper extremities; restrictive use of spine, trunk and neck; effects of advancing age (such as loss of memory and or balance, which affects ability to perform self care, ambulate or travel beyond home or ward); and what is done during a typical day if that information is a part of the record. However, you are not required to incur the expense of the physical examination by a private physician in order to receive consideration. If the detailed medical information about your ability to care for yourself is not available from the doctor’s or hospital’s current records, the VA can arrange for a physical examination. You may also furnish any other information which will help determine that you are unable to care for yourself or that you are unable to walk or travel beyond your home because of your condition.