What is the Application Process for Aid and Attendance Pension?

Understanding how VA applies income, medical expenses and assets in estimating and paying benefits for the 12-month prospective period for initial application is perhaps one of the most intimidating aspects of applying for Pension.

An initial or original application – often called a claim – for Pension is generally based on income estimates, asset estimates and medical expense estimates beginning the month of application and extending 12 months into the future. VA calls this the 12-month prospective period. Income, net-worth and medical expenses prior to application are not generally applicable and are usually disregarded by VA.

Many people make the mistake of listing medical expenses for previous months. Or they may list some sort of extraordinary income receipt prior to application. Additionally, they may list assets they no longer have that were in place prior to application. Providing this information just confuses the Pension Management Center and could result in a denial.

The application is an estimate of the three factors above for the future – 12 months starting from the month of application or date of the submitted Intent to File Form. Assets listed on the application are those that would apply to either of these same starting dates. Finally, medical care and health insurance expenses that can be applied to offset income are only those that can be certified by the applicant to recur each month for the future 12-month period from the date of the application going forward.

General Medical Costs Eligible for the 12 Month Look Ahead (Prospective) Deduction

Only certain recurring, out-of-pocket – UNREIMBURSED – medical expenses will be considered by VA for the initial application. Here are the ones most commonly used. Combined household medical expenses are used, not just those of the claimant.

  1. The monthly recurring out-of-pocket cost of long-term care services for home care provided by professionals or family, Independent Living, assisted living, adult day services and nursing home services when VA determines the services are deductible.
  2. The recurring out-of-pocket cost for health insurance premiums such as Medicare Part B, Medicare supplements, Medicare advantage plans, supplemental health insurance plans and long-term care insurance but not to include reimbursement policies such as AFLAC.
  3. The out-of-pocket cost for possible visits for medical treatment that can be proven that need to be performed on a regular basis. An example might be dialysis. Another example might be ongoing chiropractic treatments.
  4. The out-of-pocket cost for renting medical equipment on a monthly basis such as health monitoring equipment, hospital beds and so on.

If you can come up with any other recurring costs that are not reimbursed and are out-of-pocket – as long as you can prove that they will exist month to month – VA will probably accept them.

Medical Costs Eligible for Ongoing Receipt of Pension after Initial Application

After receiving the initial benefit, you may choose to submit evidence of medical expenses that are not recurring as well as actual evidence of all of the expenses that were used to estimate the benefit initially. This is important for several reasons.

  1. Often the recurring medical expenses that you estimated for the initial application were actually less than those you estimated. Unless you can come up with additional expenses that are allowable after the initial award, you may have a reduction in future benefits.
  2. Often the income that you estimate for the initial application may be less than your actual income for the period. Again, without offsetting medical expenses, you may see a reduction in future benefits.
  3. If your initial award is less than the maximum that was available, evidence of additional medical expenses will allow VA to give you a catch-up payment for those benefits that you missed.
  4. You apply for past benefits under the Liberalization Law. See below.

You should use VA Form 21P-8416 Medical Expense Report to provide VA a full accounting of your one-time and ongoing medical expenses after you are on claim. The 8416 form should be accompanied by VA Form 21-4138 - Statement in Support of Claim, which is the standard communication form used by all claimants, mainly as a cover letter. All of these forms are available on the Claim Support Disc with this book. Details on how to do this reporting are outlined in a section below.

The list below shows many of the common allowable medical expenses, but this list is not all-inclusive. Any expenses are allowable that are directly related to medical care. These must be unreimbursed expenses paid out-of-pocket by the beneficiary and/or spouse. Remember, claims based on long term care expenses like home care, assisted living, and nursing home care are the most likely to succeed as these expenses are ongoing and significantly reduce income and assets.


Please refer to the table of contents in the top right column of this page for more topics on Pension with Aid and Attendance.