The VA does not take the family's word for how much help a veteran needs. It asks a clinician to record that need on VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance.1 That split is the whole decision. The family can carry most of the paperwork and the record of daily life. The medical findings have to come from someone who examines him and signs. What you need to decide is which of the rest you do yourself, and whether you pay someone to produce the medical part outside his regular doctor.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

What the family can do without paying anyone

Start a plain log of the tasks he needs help with. For each one, write what he can still do alone, what needs a second person or a reminder, and how often it happens on a typical day. Note nights as well as days. Keep it factual and specific. A log written as things happen is more useful to the clinician than a summary written from memory on the day of the visit.

Gather the identifying details the claim will ask for: his full legal name, service information, current address, and any VA file number already on record. Keep copies of everything you send. Nothing on this list needs a fee.

What only the clinician can complete

The 21-2680 asks the examining clinician to record diagnoses, findings, and the level of assistance he needs. The clinician has to sign it. A family member cannot complete those lines, and a note from someone who has not examined him will not stand in for them.

Before you book, call the treating office and ask four things. Will they complete the 21-2680 at a regular visit or only at a separate appointment? Is there a charge for the form, and if so, what does it cover? Will they review your log before the visit? Who sends the completed form, and will you receive a copy?

When paying for a separate medical opinion is worth comparing

Some families decide to pay a private clinician to examine him and complete the form, usually because the regular doctor is booked, does not do this paperwork, or cannot arrange an in-person visit. That can be reasonable. It is also where a family is most likely to overpay for a letter that adds little. Before you agree to anything, get these in writing:

  • The clinician's license, the exact form they will complete, and the VA criteria they have been given to check against.
  • Whether they will examine him in person and review his existing medical records, and what they expect those records to show.
  • A fee fixed before the exam, with what it covers and what it does not, including any second appointment.
  • Who receives the completed form, and whether you get a copy.

Be cautious of any arrangement that promises approval or ties the fee to the size of an award. A clinician's opinion supports a claim, and the VA decides the claim. If the person offering help also offers to file the claim for a fee, check their accreditation before you sign anything. VA publishes a search of accredited representatives on VA.gov.2

Where the free help sits

Veterans Service Organizations and county or state veterans service officers help families gather evidence, review a clinician's form, and file the claim at no charge. Bring your log and the form to them before you pay for a second opinion. St. Louis offices are listed on the Local Help page.

Whatever you choose, care does not have to wait for the claim. Families often start private pay while a claim is pending, and any award is decided by the VA on the record it holds. A clinician's letter is one piece of that record, not a substitute for the VA form.

Notes

1 VA.gov, Veterans pension benefits, and the VA Form 21-2680 listing. 2 VA.gov, accredited representatives search. Each footnote is also listed on the Sources page.