Veteran’s Aid & Attendance | Begley Law Group

Has the Veteran or Spouse or Widow served in one of the following: Army, Navy, Air Force, Marines, Coast Guard, Merchant Marine during WWI, WWII, Korean War or Vietnam?

Yes
No

If yes, indicate which:

Army
Navy
Air Force
Marines
Coast Guard
Merchant Marine during WWII

Did the Veteran serve at least 90 days of consecutive active duty?

Yes
No

Did the Veteran serve at least 1 day during wartime?

Yes
No

If yes, indicate which wartime:

WWI
WWII – December 7, 1941 thru December 31, 1946
Korean War – June 27, 1950 thru January 31, 1955
Vietnam War – August 5, 1964 thru May 7, 1975
Gulf War – August 2, 1990 to date

Is the person who is ill one of the following: Veteran, Spouse of Veteran, Spouse of Deceased Veteran, Dependent Child of Veteran?

Yes
No

If yes, indicate which:

Veteran
Spouse of Veteran
Spouse of Deceased Veteran
Dependent Child of Veteran

Did the Veteran receive a discharge other than dishonorable?

Yes
No

Was the disability caused without willful misconduct by the claimant?

Yes
No

Is the Claimant one of the following: confined to home, in an assisted living facility, in a nursing home?

Yes
No

If the claimant is home bound, does the claimant meet one of the following conditions? (Listed below yes/no options)

Yes
No

» Claimant is blind
» Claimant is unable to dress/undress or keep self clean and presentable
» Claimant is unable to attend the wants of nature
» Claimant has a physical or mental incapacity that requires assistance on a regular basis to protect claimant from daily environmental hazards

Does the claimant need assistance with any of the Activities of Daily Living (A&A)?

Yes
No

If yes, which ADLs?

Bathing
Dressing
Feeding
Transferring from chair to bed or bed to chair
Toileting
Continence

Does the claimant have serious dementia making it difficult to remember to administer medications?

Yes
No

Name:

Email:

Phone:

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