The Aid and Attendance claim turns on need, not on bookkeeping. But the money side of the file, the part where unreimbursed medical expenses can lower countable income, rests on a stack of quotes, contracts, invoices and receipts, and VA reads that stack line by line.[1] A figure that cannot be tied back to a signed document is one you should not expect VA to accept.

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.

Set the signed paper beside the invoice

Lay the agency's signed rate sheet or contract next to the most recent invoice. Compare three things: the hourly or daily rate, the number of hours or shifts billed, and the service description. If the invoice bills a rate higher than the one you signed, or a shift the contract never listed, stop there. Ask the agency for a corrected invoice before anything is copied into the folder. Do not fix the discrepancy yourself by editing the figures on your own copy.

Match the hours to the daily log

The invoice says how many hours were billed. The daily log says when the care was given. Check that the billed dates appear in the log and that the hours roughly agree. Gaps are not automatically a problem, since a missed week can be explained, but an invoice that bills for days with no record at all will draw questions. Keep the log and the invoice for the same months together so a reviewer can follow the trail without guessing.

Separate care lines from everything else

Many home care invoices mix personal care, housekeeping, errands and meal preparation on one page. Do not assume every line counts the same way. Ask which lines fall under medical expenses and which do not, and record them in separate columns before you total anything. VA's medical expense report asks for specific detail, so the sorting has to happen before the form is filled in.[2]

Show the payment, not just the bill

An invoice shows what was owed. VA also wants to see what was paid, when, and from which account. Keep the cancelled check, bank transfer record or card statement that matches each invoice. Show credits, refunds and any amount reimbursed by insurance or another source, because those reduce what can be claimed. If a relative paid part of the bill, record that payment as the relative's, and do not count it again as the veteran's expense.

Questions to put to the agency before you file

  • Can you issue a single invoice that shows the rate, hours and service type exactly as written in the signed contract?
  • Which of your service lines do you classify as medical care, and which as household or companion work?
  • What credit or refund appears on the statement if the care schedule changed mid-month?
  • Will you provide a year-end statement that lists every payment received, with dates and method?

What this step does not decide

Checking the invoices does not decide whether the veteran meets the service, need or income tests for the pension. It only controls whether the expense side of the file can be supported. For the wider picture, start with the order of reading on this site, and if the paperwork feels beyond you, the St. Louis offices on the local help page can look over the folder before it goes in.[3]

Start Here: The Order to Read and Local Help: St. Louis Offices cover the next steps. The Sources page lists the VA.gov pages behind each claim in this piece.

Footnotes

[1] VA.gov, Aid and Attendance and Housebound benefit page, section on eligibility and income.

[2] VA.gov, forms library, Medical Expense Report (VA Form 21P-8416).

[3] VA.gov, Pension eligibility and income rules page, section on unreimbursed medical expenses.