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VAU.S. Department of Veterans Affairs
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VA Form 21-2680 ยท v3.1

Aid and Attendance or Housebound examination

Veteran completes Section I. Section II is routed to a physician on a single-use link and returns automatically.

Published
warning

1 field has no downstream target

Those answers are captured on the intake record but are not sent anywhere yet. A person has to choose the mapping before they can flow downstream.

7 fields in v3.1

Each field records where it came from on the paper form, so a reviewer can always trace a digital answer back to the box it replaced.

Field schema for VA Form 21-2680

  • Field
    veteran_full_nameVeteran's full name
    Type
    Text
    Required
    Yes
    On the paper form
    Page 1, Section I, box 1
    Maps to
    claimant.fullName
  • Field
    va_file_numberVA file number
    Type
    Text
    Required
    Yes
    On the paper form
    Page 1, Section I, box 2
    Maps to
    claimant.fileNumber
  • Field
    care_settingCurrent care setting
    Type
    Choice
    Required
    Yes
    On the paper form
    Page 1, Section I, box 6
    Maps to
    pension.careSetting
  • Field
    examining_physicianExamining physician
    Type
    Text
    Required
    Yes
    On the paper form
    Page 2, Section II, box 1
    Maps to
    exam.providerName
  • Field
    requires_assistance_bathingRequires assistance bathing
    Type
    Yes/No
    Required
    Yes
    On the paper form
    Page 2, Section II, box 9a
    Maps to
    exam.adl.bathing
  • Field
    physician_signature_datePhysician signature date
    Type
    Date
    Required
    Yes
    On the paper form
    Page 3, Section II, box 21
    Maps to
    exam.signedOn
  • Field
    additional_remarksAdditional remarks
    Type
    Text
    Required
    No
    On the paper form
    Page 3, Section II, box 20
    Maps to
    Unmapped