How to Fill Out and Submit VA Form 21-2680: Sections and Filing

VA Form 21-2680, the Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, is the medical evidence form you file when you’re asking the VA for an increased monthly benefit based on needing daily personal care or being confined to your home. You complete the identifying sections and sign it; a qualified medical examiner completes the clinical sections. You can submit the finished form online at VA.gov, through the QuickSubmit tool on AccessVA, or by mail to the VA Pension Intake Center in Janesville, Wisconsin.1Department of Veterans Affairs. VA Form 21-2680 – Examination for Housebound Status or Permanent Need for Regular Aid and Attendance

What the Form Supports

Section III of the form asks you to check which benefit you’re claiming. There are two:

  • Special Monthly Compensation (SMC), an increase for veterans and surviving spouses already receiving VA disability compensation who also need regular help from another person or are housebound.
  • Special Monthly Pension (SMP), an increase for veterans and survivors who qualify for the VA’s needs-based pension and need daily personal assistance or are confined to home. This is the more common reason people file this form.

The medical criteria are the same for both. What differs is the underlying eligibility: SMC requires a service-connected rating; SMP requires meeting the VA’s income and net worth limits for pension. The same form also covers the lower-tier Housebound benefit; the examiner’s clinical findings determine which level the VA awards.

What to Gather Before You Start

Form 21-2680 rarely stands alone. Depending on your situation, you’ll file it with one of the following:

  • VA Form 21P-527EZ if you’re a veteran applying for pension for the first time.
  • VA Form 21P-534EZ if you’re a surviving spouse applying for Survivors Pension with Aid and Attendance.2Veterans Affairs. Evidence To Support VA Pension, DIC, Or Accrued Benefits Claims
  • VA Form 21-0966 (Intent to File), which you can file first to lock in an earlier effective date for retroactive payments. You then have one year to submit the full claim.3Veterans Affairs. About VA Form 21-0966

If you already receive VA pension or compensation and are now adding an Aid and Attendance claim, Form 21-2680 may be the only additional document you need.

Before the medical appointment, write out every medication you take, every assistive device you use, and every daily task where you need help. The examiner has to document those specifics, and gaps in the clinical record are one of the main reasons claims get delayed.

How to Fill Out VA Form 21-2680

The form has eight sections. You complete the first five. A qualified medical examiner completes the last three.

Section I — Veteran’s Identification Information

Enter the veteran’s full legal name, Social Security number, VA file number (if one has been assigned), service number, and date of birth. Even when a surviving spouse is the claimant, this section identifies the veteran whose service established eligibility.

Section II — Claimant’s Identification Information

If the claimant is someone other than the veteran, typically a surviving spouse, enter the claimant’s name, Social Security number, relationship to the veteran, date of birth, mailing address, phone number, and email. If the veteran is filing for themselves, some of this overlaps with Section I but still has to be completed.

Section III — Claim Information

Check the box for Special Monthly Compensation or Special Monthly Pension. This tells the VA which benefit pathway to evaluate.

Section IV — Hospitalization

If you are currently in a hospital or nursing home, provide the facility name, address, and date of admission. If you live at home, leave this section blank.

Section V — Certification and Signature

Read the certification statement, sign, and date. Your signature is required. The VA will reject the form without it.

Section VI — Examination Information

This is the heart of the form, and the examiner fills it out. Acceptable examiners include a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), physician assistant, or advanced practice registered nurse. It does not have to be a VA doctor: your primary care provider, a specialist, or a doctor at an assisted living facility can all complete this portion.1Department of Veterans Affairs. VA Form 21-2680 – Examination for Housebound Status or Permanent Need for Regular Aid and Attendance

The examiner records:

  • Diagnoses and symptoms, and whether any of them are permanently and totally disabling.
  • Vitals: age, weight, height, nutritional status, gait, blood pressure, pulse, and respiratory rate.
  • Functional limitations in a checkbox grid covering bathing, toileting, transferring in and out of a chair or bed, eating, managing medications, personal hygiene, walking, and dressing.
  • Mobility restrictions in the upper extremities, lower extremities, spine, trunk, and neck, including range of motion, atrophy, and balance problems.
  • Cognitive and sensory issues, including legal blindness, memory loss, dizziness, and loss of bowel or bladder control.
  • Confinement: hours per day spent in bed, how often you leave the home, and whether you need aids like canes, braces, or crutches.
  • Mental capacity: whether you can manage your own benefit payments or need a fiduciary.

Specificity matters here. Vague entries like “needs help with daily activities” without elaboration are one of the most common reasons claims get delayed or denied. Ask the examiner to describe exactly what you cannot do, why, and how often you need assistance.

Section VII — Examiner’s Signature

The examiner signs and dates the completed form.

Section VIII — Examiner’s Information

The examiner provides their printed name, professional title, National Provider Identifier (NPI) number, and the name, address, and phone number of their medical facility. A form missing any of these details can be sent back for correction, adding weeks to your timeline.

Where and How to Submit

You have three options:

Online submission is faster and avoids the risk of lost mail. If you do mail it, send it by certified mail with a return receipt so you have proof of delivery. Keep a copy of everything you submit regardless of method.

What Happens After You Submit

Once the VA receives your form and any accompanying application, the claim enters the review pipeline. The VA may schedule a Compensation and Pension (C&P) exam with a VA-contracted physician to verify your examiner’s findings. Not every claim triggers a C&P exam. If your Form 21-2680 is thorough and the clinical evidence is clear, the VA may decide on the submitted records alone.

Processing times vary. The VA reported an average of 76.6 days to complete disability-related claims in February 2026, though pension claims with Aid and Attendance considerations can take longer depending on complexity and whether the VA requests additional evidence.7Veterans Affairs. The VA Claim Process After You File Your Claim You can check status at va.gov/claim-or-appeal-status/.

Veterans aged 85 or older may qualify for priority processing. If you meet that threshold, make sure your date of birth is clearly documented in your application.

The VA sends a decision letter explaining whether you were approved, the effective date, and your new monthly payment. If approved, the benefit is typically retroactive to the date the VA received your claim, or to your Intent to File date if you filed Form 21-0966 beforehand.3Veterans Affairs. About VA Form 21-0966

If Your Claim Is Denied

A denial is not the end of the process. The VA offers three review options, and you can choose one:

  • Supplemental Claim: submit new and relevant evidence the VA didn’t have the first time. This is the right choice when the original Form 21-2680 was incomplete or a more detailed medical opinion could change the outcome.
  • Higher-Level Review: a senior reviewer re-examines the existing evidence. You cannot submit new evidence through this lane, so it works best when you believe the original reviewer misapplied the criteria.
  • Board of Veterans’ Appeals: a Veterans Law Judge reviews your case. This takes the longest but allows a hearing where you or your representative can present the argument directly.8Veterans Affairs. VA Decision Reviews And Appeals

The most common reason for denial is insufficient medical evidence, meaning the examiner’s entries were too vague or critical sections were left blank. When that’s what happened, a Supplemental Claim with a more thoroughly completed form from a different examiner is usually the strongest move. A Veterans Service Organization such as DAV, VFW, or American Legion can help you identify where the original claim fell short and prepare a stronger resubmission at no cost.