Applying for VA’s Caregiver Program, Requirements, and Benefits Offered

CCK Law: Our Vital Role in Veterans Law

What Is the VA Caregiver Support Program?

The VA Caregiver Support Program was initially established in 2011 to provide benefits to caregivers of post-9/11 disabled veterans. In 2018, the VA Mission Act expanded the program, which now includes two primary programs: the Program of Comprehensive Assistance for Family Caregivers (PCAFC), and the Program of General Caregiver Support Services (PGCSS)

These programs are designed to support individuals who provide care to veterans with disabilities, but they offer different levels of benefits and have different eligibility requirements:

• The Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides benefits to eligible caregivers of veterans with serious service-connected disabilities. To qualify, the veteran must require personal care services for at least six continuous months due to functional impairment, such as difficulty performing activities of daily living (ADLs) or the need for supervision. Caregivers in PCAFC may receive a monthly stipend, access to health care coverage, mental health services, respite care, and training.
• The Program of General Caregiver Support Services (PGCSS) is available to caregivers of veterans from all service eras, regardless of disability rating or service connection. While it does not provide a monthly stipend, PGCSS offers valuable support, including education and training, peer support, and access to VA Caregiver Support Coordinators.

Together, these programs recognize the important role caregivers play in supporting veterans, while providing varying levels of assistance based on the veteran’s needs and eligibility. For the purposes of this article, however, we will primarily be covering the PCAFC, as it is the more comprehensive of the two programs.

What Are Personal Care Services?

Personal care services refer to the services a caregiver may provide to a veteran to assist with their Activities of Daily Living, or ADLs. VA outlines that caregivers should assist veterans with personal care services when the veteran is unable to perform these tasks themselves. This may include assisting with any of the following:

• Bathing or personal grooming
• Dressing and undressing
• Eating and preparing food
• Adjusting a prosthetic or orthopedic device or assisting the veteran with their mobility
• Supporting the veteran’s safety, which can occur in instances where the veteran may harm themselves without assistance
• Aiding the veteran through instruction regarding their daily living environment
• Supporting the veteran’s day to day life

Common Disabilities That Can Require Full-Time Care:

• TBI, or traumatic brain injury
• PTSD, or post-traumatic stress disorder
• Amputation or loss of limbs
• Paralysis
• Blindness or impairment in vision
• Deafness

What Benefits Does the PCAFC Offer to Caregivers and Secondary Caregivers?

The PCAFC offers several prominent benefits to caregivers depending on whether they are the primary caregiver or one of two secondary caregivers who support the primary caregiver when needed. The benefits for a primary caregiver include:

• Monthly stipend
• Travel expenses (including lodging and per diem while accompanying the veterans undergoing care)
• Access to health care insurance (if the caregiver is not already entitled to care or services under a health care plan)
• Mental health services and counseling
• Comprehensive VA Caregiver training
• Respite care (not less than 30 days per year)

Secondary caregivers, on the other hand, may instead only gain access to mental health counseling and certain travel benefits.

Who Is Eligible for the PCAFC?

Though the Caregiver Support Program was initially intended to support only the caregivers of veterans who served post-9/11, the VA Mission Act of 2018 expanded eligibility for the PCAFC beyond post-9/11 veterans through a phased rollout that concluded in October 2022. As a result, eligible veterans from all service eras may now qualify for the program.

VA has also reassessed certain legacy participants—those who were enrolled in the program prior to the expansion—under updated eligibility criteria. In some cases, VA has provided extension periods or transitional protections for caregivers who no longer meet the revised standards.

For instance, per a VA decision, certain legacy participants in the PCAFC may have their benefits extended through to September 30, 2028. This preserves the benefits of these participants as VA evaluates how to incorporate them into the newer framework.

Eligibility for Caregivers:

In order to qualify for the program, the caregiver assisting the veteran must meet the following qualifications:

1. Be at least 18 years old;
2. Be the spouse, child, parent, stepparent, step-child, or extended family member of the veteran; OR
3. Live with the veteran full time or be willing to if designated as the family caregiver.

Additionally, the caregiver candidate will be assessed by VA as to whether they are competent enough to undergo caregiver training and education. They must then successfully complete the training and demonstrate their ability to carry out the duties of a caregiver.

Veteran Eligibility for Caregiver Assistance:

In order for the veteran to qualify for the caregiver program, the veteran must:

1. Be a veteran, or member of the armed forces, undergoing a medical discharge
2. Have an individual or combined VA disability rating of 70 percent or higher, due to service-connected disabilities which were caused or aggravated by active duty service
3. Need at least six months of continuous, in-person personal care services

Play

Scenarios That Indicate the Veteran Needs Personal Care Services

VA has three scenarios which can indicate that the veteran is in need of personal care services. In order for VA to determine that the veteran requires these services, the veteran only needs to identify with one of the following scenarios:

• The veteran is unable to perform one or more of the Activities of Daily Living (ADLs). Examples of these could include brushing one’s teeth, bathing, eating, cooking or cleaning.
• The veteran demonstrates a need for supervision, protection, or assistance based on the symptoms or residuals of a disability. This could include neurological impairments or other impairments or injuries. Specifically, these impairments, injuries, or residuals could stem from a traumatic brain injury, PTSD, or a mental disorder.
• The veteran requires personal care services due to a serious service-connected disability without which their ability to function would be significantly impaired. Importantly, this eligibility is based on functional need, not necessarily whether the veteran is rated 100% disabled or receiving Special Monthly Compensation for aid and attendance.

Compensation and Pension Exams (C&P) for the VA Caregiver Program

When applying for the VA Caregiver program, VA might schedule the veteran for an exam to determine if the veteran is eligible for the program and how much assistance they may need. It is important to follow through with attending this exam, as VA may deny veterans if they do not attend the exam or do not follow through with scheduling it.

The exam will go over the aspects of eligibility, as mentioned above. In addition to the requirements for both the veteran and the caregiver, VA stipulates that:

• The veteran must receive the care at home.
• The veteran will receive ongoing care from a Patient Aligned Care Team or other VA health care team.
• Personal care services provided by the caregiver to the veteran may also not be provided by any other individual, entity, or program simultaneously.

How Does VA Rate Veterans’ Eligibility for the Caregiver Program?

An exam will also rate the veteran based on how able they are to perform Actions of Daily Living (ADLs), as well as how much supervision or protection they may need. The VA examiner will typically assess whether the veteran needs supervision or assistance in the following instances:

• Safety Concerns
  • The veteran may have difficulty assessing risks, experience frequent falls, or have memory difficulties which could lead to dangers such as forgetting to turn off a stove or oven. The veteran could also experience suicidal ideation.
• Prone to Seizures
  • The veteran may experience seizures, or blackouts, or lapses in mental awareness.
• Difficulty with Life Planning
  • The veteran may be unable to manage their medication schedule on their own, unable to manage their finances, or unable to manage their household affairs.
• Difficulties with Mental Disorders or Conditions
  • The veteran may experience hallucinations or delusions as a result of a mental condition or disorder.
• Difficulties with Mood Disorders or Conditions
  • The veteran may have trouble regulating their mood, experience mood swings, or feel frequent agitation and aggression.
• Sleep Irregularity
  • The veteran may have difficulty maintaining a sleep schedule or getting adequate amounts of sleep.

Rather than assigning a fixed numerical score or set number of weekly care hours, VA places eligible veterans into one of two stipend tiers based on the level and frequency of personal care services required:

• Level One is for veterans with less intensive needs, and generally provides a lower stipend to their primary caregiver.
• Level Two is for veterans whom VA has judged to be “unable to self-sustain in the community”, and comes with a higher stipend for the primary caregiver.

Play

How Do I Apply for the PCAFC?

To apply for the caregiver program, the veteran should submit VA Form 10-10CG, or Application for the Program of Comprehensive Assistance for Family Caregivers. The form has sections to provide the veteran’s identification information, the caregiver’s identification information, and information regarding a secondary family caregiver, if applicable.

Secondary family caregivers may be designated when a veteran requires assistance from more than one person. However, unlike primary caregivers, secondary caregivers are not eligible for a monthly stipend or health care benefits. They may still receive training, education, and certain support services through VA.

Tips for Getting Approved for the Caregiver Program

While the application and process for becoming approved for the VA Caregiver Program may seem daunting, there are a few things veterans and their caretakers may do to help boost their chances of success.

For Veterans:

• Be Prepared for the Home Visit—After applying to the program, VA will schedule a home visit with a VA clinician. The clinician will assess the veteran’s need for a caregiver. It is important to be honest about the veteran’s condition(s) and need for assistance. The veteran will want to talk about specific Activities of Daily Living (ADLs) with which they require assistance.
• Follow Through with Any C&P Exams—Much like all other C&P exams, it is important to follow through with scheduling and attending the exam. If the veteran fails to attend or does not follow up with scheduling, VA could deny the claim. If the veteran is unable to attend the appointment, they should be sure to inform VA.

For Caregivers:

• Complete All Caregiver Training—The applying caregiver will need to complete the caregiver training once they have submitted the caregiver application. The goal of the training is to guarantee that the caretaker will be equipped to support the veteran and assist them with their daily life.
• Be Honest—During the home visit and any conversations with VA clinicians, it is important to be honest about the role the caregiver plays in the veteran’s life. The caregiver will want to include details regarding the type of tasks the caregiver assists the veteran with, the veteran’s care schedule, and any other specific details regarding the veteran’s care.
• Contact the Caregiver Support Coordinator—The Caregiver Support Coordinator (CSC) can assist with any questions the caregiver might have during the application process, home visit, or caregiver training. If the caregiver has any concerns about missing scheduled appointments or exams, they should be sure to inform the CSC. Caregivers can find more information about their CSC through their local VA medical center.