VA values the contributions of caregivers and Veterans in our community. We’ve recently published a Notice of Proposed Rulemaking in the Federal Register, proposing updates to expand access to the Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Please note that these changes are not yet in effect, and your feedback is important in shaping the final rule.
Key highlights of the proposed changes
Although these changes are not yet in effect, the proposed updates aim to improve the PCAFC and provide more families with the support they need.
The proposed rule would:
- Expand eligibility: A broader definition of serious injury could allow more Veterans and caregivers to qualify for support.
- Add telehealth flexibility: VA seeks to offer telehealth home visits during certain types of emergencies.
- Extend delay in discharges based on reassessments: This proposed rule would delay discharges based on eligibility reassessments for legacy participants, legacy applicants and their family caregivers for an additional 18 months after the effective date of a final rule. The delay in discharges is currently slated to expire in September 2025. VA’s suspension of required annual reassessments, including legacy reassessments remains in place at this time.
- Require fewer reassessments: Under the proposed rule, VA would reassess eligibility less frequently, lowering the burden for Veterans and their families.
- Clarify eligibility: New criteria would expand and clarify the basis on which a Veteran may be determined in need of personal care services for six continuous months.
How you can get involved
The 60-day public comment period begins tomorrow, offering you the opportunity to share your thoughts and experiences. We encourage Veterans, caregivers and everyone involved in their care to review the proposed changes and provide feedback.
Your input is crucial. Every comment will be carefully reviewed to inform the final rulemaking. Remember, these are only proposed changes, and your voice can help shape the final rule. Get more information about PCAFC and check out our Frequently Asked Questions document for more information about the proposed rule.
“We are listening closely to Veterans, caregivers, Veterans Service Organizations and other stakeholders as we consider changes to PCAFC, including changes to eligibility. Your feedback is essential in refining these updates and improving the Program of Comprehensive Assistance for Family Caregivers,” said Dr. Colleen Richardson, executive director of the Caregiver Support Program.
About the Caregiver Support Program (CSP)
The Caregiver Support Program (CSP) enhances the health and well-being of caregivers of Veterans through education, resources and services. Every VA facility has a CSP team that offers vital information to keep caregivers informed and supported. Visit CSP’s website or contact your local CSP team to learn more. Discover CSP’s 2023 Highlights in last year’s Annual Report.
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Have being in this program for quite a few years now, I remember the stress we had to go through to make sure we we’re doing everything right, the rudeness of customer service the lack of any help and being treated like we we were looking for a hand out and like garbage at the Mather VA so much horrible treatment caused a stressed induced seizure in the behavioral health building at Mather VA ,where the VA did nothing for me I seized for approx 9 1/2 minutes waiting for a ambulance , the ED was no more than 600 ft away and NOT ONE NEUROLOGIST or ER DR came over to help… 9 1/2 min. That was the day I lost all hope for the VA health care if they couldn’t run 600 ft to help a (me spouse) with CHAMPVA or veteran I knew we were in for an uphill battle with the lack of compassion, care, and to do no harm. Feel free to ask for the video of that day and you will see the lack of consideration, the rudeness from workers and the lack of compassion . One this is where the breakdown begins between patient ,caregiver and Dr. The lack of training for these people who make the appointments for our Veterans kills, when you have a vet come into the ER screaming for help don’t put them in a broom closet or make these men and women wait out in the waiting room for 8 hours check the video tapes. I have witnessed this on several occasions and witnessed this through trying to get help for my husband . Sometimes a Valium can do enough to get them thinking straight ,I’ve been told there is a Pysicatrc dr on call at all times in the facility to find out it’s a lie. As a legacy caregiver I have had to pay out of pocket for care for my husband thank goodness for the stipend or we would not have been able to pay the bill.
The lack of mental health is so absurd for a person who went to a foreign country to see and kill young children , men, and women. The VA drops the ball and thinks every 90 days for 45 min is acceptable, this is not .
Also I have several concerns about how someone who never saw war never thought they wouldn’t see their family again can get a 100% and then get the highest Tier in this program. I have heard people laughing about how they really don’t need the program but the money is free. I have overheard and have had conversations with people who said no I really don’t need it but I went ahead and applied for it saying they were told what to say and how to act.
Also how can a Veteran get a 100% be able to work 40+ hours a week qualify for this program. My Veteran Marine can not work. He is unemployable. We rely on his checks while I have to find a job so we eat and have a little extra money. The way things are being evaluated is absurd, more research into the people asking for this program would be who we all are. I get called manic , crazy , rude , someone who will holler at someone when lacking in their job. I have gotten to a point that when I need help I have to call a senator or a congressman. This program has been abused by a lot of younger veterans who never went to an immediate danger zone or war and some of our other Veterans. The lack of investigating such as going through the veterans medical record is appalling. How can someone just say they have this and that but their medical record has no record of it.
The program wants to expand so they’re going to cut off the legacies. That’s ridiculous talk, you need to look a little closer at that . Most of the things you want to do have been done and have been unsuccessful. It’s time to start talking to those who actually use and need this program.This program is blinded by the sight that people would rather have people feel sorry for them and get free money and welfare instead of working.
We have busted our butts working your program with little change except the fact more people are signing up for this program and we’re being left behind. Sounds like a Vietnam Veteran all over again. We are still waiting on his claim about burning toxic waste human feces , I have pictures of this. I have pictures of my husband standing within feet of biological warfare. And yet here we are legacies and you guys are dumping us, without the VA doing its job. And you guys want to expand and drop. Makes no sense to me or a lot of other people.
I have a lot of ideas and thoughts about this program that I’am truly grateful for. Any contact you would like to have would be nice but very unlikely it will happen.
ok holds up you want to cut legacy caregivers and their service members off, am I understanding that right? I have way ro many things to ask and comment on. Like the lack of care at the VA for mental health you have a 0.4% success in preventing suicide and now you want to cut off legacy how many more are you willing to put on welfare, just how many people fooled the VA and this program to have to have these cuts and less care. Feel free to call or make a appointment with you I ll give it to straight . Maybe hearing in person what the real people who struggle are needing. Rual area help, mental health …
Veterans also should continue to be paid during appeals until all appeals have been exhausted. Reviewers ignore medical physicians, they cherry pick one sentence and alter the meaning behind it. If those at 100% disability P&T could be fixed in a week at a hospital, they would be, but this is not the case for any of them, and that is why they re rated 100% P&T, and in many cases, they have had a second adjudication and upholding of that rating at the 10 year mark, which only upholds the reasoning that they need the caregiver program, and why. However, the boards ignore that information, and they make decisions outside of it. This needs to stop. Especially for those on the program for supervision and protection needs. Veterans need protections, families need protections, caregivers need protections, and Legacy definitely needs protections because they have been very much harmed over and over with denials and attempted removals despite still qualifying and no change in the veteran from when they first started on the program, and if changes occurred, they are only worse in their condition. We need to do better by our veterans and their families. And this is a first step in doing so.
Veterans on Legacy should be allowed to stay on permanently, especially if they are 100% P&T rated and their disability they are rated for is why they are on the caregiver program. Families are too often “kicked out” for unethical reasons upon reassessment, ones that would absolutely need to be appealed and which would cause undue harm to the veteran and their families. These put the veteran at risk of harm or death in the meantime as well, and this is a very large concern. Our veteran caregivers for these families already receive far lower amounts of pay than they were making before however, they take this pay reduction in order to stay home and care for their loved one 24/7 in order to make sure that they are safe/healthy/alive/and that they have the least restrictive environment possible that still allows them to be with their loved ones. Reassessments put stress and strain, ignore medical advice from VA physicians, outside physicians, disability reports, and many other documents; in the end stating things that put the veteran at great risk and bodily harm just to remove them from a program that they desperately need in order to make sure that they stay alive. This is integral for our veterans, caregivers, and would greatly reduce the burden on the CSP team as well. I truly believe that those on Legacy should be grandfathered in to this program, or at least those on Legacy who are 100% P&T and on the caregiver program for their specific disability as it is not expected to change and they are expected to need the same level of care or higher for the remainder of their lives; again, understanding that this program is meant to help the veteran, it is also meant to make sure to reduce outside costs such as facilities, hospitalizations, care costs, and more, because a caregiver is far less expensive than any of those costs. So, when a veteran would need a higher level of care if they did not have their caregiver with them 24/7, they would cost the VA much more in those fees, so the VA is spending far less in paying the caregiver in order to help these veteran families, and it is actually a cost savings as opposed to spending more. That is why I propose that Legacy stay on grandfathered in for no further re-assessments, or like I stated, Legacy that are 100% P&T at a minimum.
1. Huntington, WV VSMC has very un-informed employees that are not trained or smart enough to know how to make informed decisions about caregiver claims. They do not know anything about due process. I don’t think they know anything about claimant’s rights with VA claims. For example, I was told my caregiver claim was approved and I was told about all of the benefits I would receive under this program. When my husband and I reported to an in person interview, and after seeing a white veteran with black spouse caregiver, the Huntington wv Vamc sent a letter that said “status of my claim changed to denied”. Their letter implied that my claim was once approved. They also didn’t take into account that I am a licensed nurse practitioner reporting that I take care of my husband’s physical and mental needs. Help tie his shoes, cut his toe nails, manage his medication, manage his safety, supervise his life.
2. The Huntington wv vamc and the VISN above them know nothing about this program regarding the mental health aspect like supervision, safety, management of veteran’s life
3. The direct appeals process to DC is horrible. Other than claim update status on VA’s website, there is no way to be informed of my claim. The appeals process is also extremely slow. My original date of claim is October 2020 with my appeal November 2021. Why does this process take so long?
4. Please clarify with examples of mental health conditions that qualify someone for caregiver claim. Clarify the standards about getting approved based on the mental health aspect of law.
5. Train VAMC employees on standards for va claims. For example, if VAMC employee is going to promulgate a claim, then they need to know what a VSR at a regional office knows about processing claims. It actually might be a good idea to stop letting VAMC employees work these claims.
6. Train VAMC employees to understand the VA regulation that states the weight of evidence in a VA claim favors the veteran.
7. What is the standard or specifically how does the VA determine if a caregiver is level 1 or 2 stipend. Their decision seems to be subjective and left up to the racist and often times biased employees
For example, I work during the day but I also work at night and weekends supervising and managing my husbands health. How would the VAMC rate my time taking care of my husband?
8. There should be some type of bias testing with employees making decisions on caregiver claims. For example, when I reported that I am a nurse practitioner, some employees attitude to me changed like they were jealous of my situation. I know the VA has employees that think va compensation is free money and I know there are Huntington wv vamc who intentionally (mental health employees Linda Pennington Denise Harris director Brian Nimmo, patient advocates conspired to harm and or arrest my husband after he spoke up to them about his concerns about my caregiver claim. The VAMC should not retaliate against anyone for calling them out for being wrong and should not exacerbating my husband’s mental health.
9. I’m still waiting on my appeal that’s over 3 years old. I’m assuming if my claim is granted or remanded that this will take several more months for a VAMC employee to finish my claim. This is what I’ve heard from others who have applied.
Why would this be? How can you streamline these claims to get fast decisions? Considering the Huntington wv vamc only had 800 employees a few years ago and now has about 1600, va should hire and train people just to streamline these claims
As a participant of the PCAFC program I was notified I no longer qualified though the decision was to not take me off until Sept. 2025 when final decisions were made. I have to say that I was insulted when my letter said anything a loved one or friend would do for the veteran didn’t count. I would take care of my husband in any way possible regardless of a stipend. As a veteran who served his country this is a benefit we deserve, and I feel I served as well. My husband has many health issues including short term memory-hand trimmers to name a few. There is no way he could make it alone. As far as friends his depression has isolated us from just about everyone as he doesn’t like to be around people. I was in the hospital for 3 days and my daughter and granddaughter had to take off work to be with him. Neither of them could afford to quit their job if something happened to me.I can tell you if something happened to me, he wouldn’t make it. I hope you consider all these things when making your final decision
I think that this would be a good thing to do. My husband is a gulf war veteran and I am the main caregiver for him, I applied and was denied due to the incompetent social workers who did not know what they were looking at. I think this needs to reevaluated and made more accessible to caregivers that need it.
How will the proposed changes to the PCAFC address the systemic gaps in understanding Gulf War Illness—a condition treated like an uncharted island by much of the VA? Despite affecting thousands of Veterans, Gulf War Illness remains largely ignored, as if the system only has a map for well-trodden territories like PTSD or physical combat injuries but no compass for navigating the complex symptoms of this condition.
For Gulf War Veterans like me, living with this illness is like being stranded on that uncharted island. The symptoms—chronic pain, fatigue, neurological issues—are real, but the VA’s response often feels like being handed a boat with no oars. Beyond the War Related Illness and Injury Study Center (WRIISC), which serves as a lighthouse in a sea of misunderstanding, the VA lacks skilled personnel to recognize, assess, and treat Gulf War Illness. This lack of expertise has led to misdiagnoses and denials of critical support, including caregiver assistance.
My wife, who is my caregiver, has been the lifeline keeping me afloat. She manages everything I can no longer handle, yet her application for caregiver support through PCAFC was denied because Gulf War Illness doesn’t fit neatly into the VA’s limited definitions. It’s as if the VA has a keychain of pre-cut keys but refuses to forge a new one for conditions like mine, leaving caregivers and Veterans locked out of essential programs.
Will the proposed updates serve as the new compass for Gulf War Veterans, ensuring that the VA maps out clearer pathways for support? Specifically, how will the changes expand eligibility criteria to account for overlooked conditions like Gulf War Illness and address the glaring lack of expertise among VA staff, which has left too many Veterans and caregivers adrift?
I hope the VA recognizes that ignoring these systemic gaps is like building a bridge with missing planks—it leaves too many of us and our families falling through the cracks.
All those seem like great ideas.
CSP program has big flaws. Veterans live in different parts of the world after serving, part due to family support, or returning to their countries of origin. Any veteran living outside of the United States is not qaulified for this program. I reside in my birth country in West Africa because I did not have family support in the United States to cope with my mental health. I was denied the program and I told that to qualify for CSP, I must return to live in the US. This is unjust. The program must cover veterans no matter where they live in the world.
I’ve commented
We as veteran think about all our comrades. It’s called selfless service. A doctrine that was ingrained in us from basic training. Your husband should tell you not to only think about one person. No one is left behind. The program must benefit all veteran regardless.
This program has helped me to keep my husband home & not going to a nursing home. My CSP team has saved my life too. The stress & physical toll on me has been great. CSP is saving my life. My husband has Lewy body dementia, vascular dementia, Parkinson’s & severe ptsd. He’s a Vietnam combat Vet, 80 yrs old. I’d like to see more of a stipend for cases like my husband. He is terminal & requires 24/7 care & supervision. The VA is saving allot of dollars by keeping these severe Vets at home.
yes———would/could avoid being told to go to emergency
I am a 71 yr old woman veteran. Because I cannot afford dental care I used my jewelry pliers and pulled my own molar. I haven’t been to a dentist in years. I’m hoping you give us some help with this problem. Even if it’s once a year.
As a 70 year old Vietnam Nam Service related disabled veteran (72 to 76) I wish to be a part of this ruling by contributing if I can. Stephen E Lawrence UNITED STATES SUBMARINE SERVICE (SS-568 USS HARDER. Veterans all over need to be taken care of instead of illegals looking to vote to stay her getting benefits up to $4,000 a month better than what I get from being asked to serve my country and I did. TIME has come to change things to get veterans their due.
I am a Vietnam War Veteran, with a 100 percent disability based on wounds received in combat and a severe case of PTSD. Yet, my caregiver, who’s essential to my care, was rejected for the program. Frankly, I was surprised and disappointed with this decision.
I DO agree that the VA should not have to reevaluate the veteran/caregiver as often as they have in the past. That is a lot of paperwork and meeting time for the case workers to accomplish. We just completed the last “meeting” by video chat, and that was pretty easy. I was a little worried that I would not be able to figure out how to get connected, but it was so easy!!!
Yes, the outside services that give your caregivers a really not that good they I’ve had them twice and twice. I asked them to leave and I had a family member come down to stay with me to help me and she could not pay because she was not on the rolls. It’s really difficult when they have family members are good friends taking care of a three or four hours a day they should get compensated yeah OK, thank you very much
Outside care givers are not relatives with connections to disabled veterans. This program must allow veterans to choose their caregivers. Families and friends will care much for their disabled veterans than some random person who is just doing this as any regular job.