When a Veteran can't manage their own benefits: dementia, competency, and VA fiduciaries

Why now

VA's Oct 30, 2026 Research Wrap Up highlighted a new Alzheimer's disease genetic risk score built partly with data from VA's Million Veteran Program. It looks at many genetic variants, not just APOE, and worked across several ancestry groups. It's research, not a VA benefit rule. But it's a good reminder for families: if memory loss is starting, plan now for who will handle VA money and care.

How VA decides a Veteran can't manage benefits

Under 38 CFR 3.353, a person is "mentally incompetent" for VA purposes when, because of injury or disease, they can't contract or manage their own affairs, including spending their money without limits.

• Proposed first, not final. When VA plans to rate someone incompetent, it must first send notice of the proposed action and the right to a hearing (38 CFR 3.103). If a hearing is requested, it has to happen before the decision. You can also send evidence, like a doctor's statement that the Veteran can handle money.
• Medical opinion needed. Unless the medical evidence is clear and leaves no doubt, VA needs a definite medical opinion on the question.
• Doubt favors the Veteran. Reasonable doubt about capacity is resolved in favor of competency.
• The notice isn't required if a court has already found the person incompetent or appointed a guardian.

VA says this finding doesn't affect non-VA finances or the right to vote or sign contracts. You can challenge it with a Supplemental Claim (20-0995), Higher-Level Review (20-0996) or Board Appeal (10182), and later ask VA to restore competency with a written request and medical evidence (VA fiduciary help).

How the VA Fiduciary Program works

• Field exam. After an incompetency rating, VA schedules a field examination. Have photo ID, a list of bills and income, all assets, and next-of-kin contact ready (VA Fiduciary Program).
• Who serves. VA first tries to qualify the person the Veteran wants. It may also look at a spouse or relative, the head of a care facility, or a professional fiduciary. Checks can include an interview, credit check and criminal background check.
• Accounting and oversight. Fiduciaries may have to file accountings and go through follow-up field exams. VA's Guide for VA Fiduciaries explains the duties.
• Change or report a fiduciary. The Veteran can ask for a different fiduciary (38 CFR 13.30). Using the money for anything other than the Veteran and dependents is misuse (38 CFR 13.400). Report it to the Fiduciary Contact Center at 888-407-0144 or VA at 800-827-1000. Written requests go to Fiduciary Intake Center, PO Box 5211, Janesville, WI 53547-5211.

Extra money when daily care is needed

• With compensation: special monthly compensation (SMC). SMC-L can apply when a service-connected condition means the Veteran needs regular aid and attendance. SMC-S (housebound) can apply with one condition rated 100% plus either more conditions rated 60% or higher, or being permanently housebound (38 CFR 3.350, criteria in 3.352).
• With pension: Aid and Attendance or Housebound payments are added to VA pension. You can't get both at once (VA.gov, 38 CFR 3.351).
• The form: VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance). A medical examiner fills out the exam section. If the Veteran is in a nursing home, also send VA Form 21-0779.

Nursing home and care costs can also lower countable income for pension. See VA pension and medical expenses.

Dementia as a service-connected condition

Under 38 CFR 3.310(d), if a Veteran has service-connected moderate or severe TBI, VA treats certain dementias (presenile dementia of the Alzheimer type, frontotemporal, Lewy body) as caused by it if they show up within 15 years. Parkinsonism, including Parkinson's disease, is also on that list. Dementia linked to a service-connected condition like Parkinson's may be claimed as secondary under 3.310(a) with a medical opinion. See Blast exposure, TBI, and your claim.

Support for caregivers

• PCAFC (Program of Comprehensive Assistance for Family Caregivers): the Veteran needs a 70% or higher rating, at least 6 months of continuous in-person personal care, and VA health care enrollment. Primary caregivers may get a monthly stipend, CHAMPVA and respite care. Apply together on VA Form 10-10CG.
• General caregiver support (PGCSS): for caregivers of Veterans enrolled in VA health care who don't qualify for PCAFC. Training, support and resources.
• Caregiver Support Line: 855-260-3274 (TTY 711), Mon–Fri 8 a.m.–8 p.m. ET.

If the Veteran dies, see our survivor checklist.

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