Unreimbursed Medical Expenses and Veterans Pension Claims

The VA will reimburse for assistance with Instrumental Activities of Daily Living (IADL) as unreimbursed medical expense (UME) only in very particular circumstances. As a general rule, charges for assistance with IADLs are not UMEs for pension purposes because such assistance is not a medical or nursing service. However, VA will deduct the cost of assistance with IADLs from the individual’s income when: the individual is entitled to pension at the Aid & Attendance or housebound rate, or a physician has certified that the claimant has a need to be in a protected environment AND the facility provides medical services or assistance with ADLs to the individual. 
 
The VA does not consider emergency pull cords, 24-hour staffing, and locked exterior doors as a medical or nursing service. The cost of room and board at a residential facility is a UME if the facility provides custodial care to the individual or the individual’s physician states in writing that the claimant must reside in that facility to separately contract for custodial care with a third-party provider. A facility provides custodial care if it assists the individual with two or more ADLs. If the facility does not provide the claimant custodial care, or the claimant’s physician does not prescribe care by a third-party provider in that facility, VA will not deduct room and board paid to the facility but will deduct the cost of any medical or nursing services obtained from a third-party provider.
 
For additional reading on this topic refer to 38 C.F.R. § 3.272(g) and M21-1MR, Part V, Subpart iii, Chapter 1, Section G, 43, 44.

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