VA Caregiver Veteran Functional Assessment Preparation Tool
Prepare for the Veteran Functional Assessment by documenting typical performance, each-time assistance,
supervision, protection, instruction, safety risks, and the caregiver's role in daily function.
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VA claim numbers, dates of birth, addresses, or other identifying information.
Preparation tool, not an official VA assessment.
The clinical assessor assigns the official response levels and VA determines PCAFC eligibility. This tool helps organize truthful, complete descriptions of daily function and supervision needs.
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Before you begin
Describe typical, safe performance
The assessment is intended to reflect how activities are performed under usual conditions—not isolated ability on a best day.
For every activity, identify what help is required, how often it is required, and what risk exists without that support.
Separate setup, supervision, touching assistance, and hands-on physical effort.
Describe whether assistance is required each time the activity is performed.
Include cueing, protection, monitoring, and intervention—not only physical help.
Compare the final summary with the medical record and caregiver statements.
Part A
Daily Activities and Device Management
Document eating, hygiene, bathing, dressing, toileting, and prosthetic or orthopedic device management.
Part A
Positioning, Transfers, and Mobility
Document bed mobility, transfers, walking, surfaces, stairs, endurance, and community mobility under typical conditions.
Part B
Supervision, Protection, and Instruction
Document the non-physical support required to maintain medication safety, judgment, protection, behavior, task completion, and self-direction.
Evidence consistency
Medical Record and Caregiver Alignment
Identify where the daily functional picture is clearly documented, partially documented, or missing from the record.
Preparation summary
Review and Print
Review the functional picture, possible inconsistencies, and record gaps before the formal assessment.
Functional Assessment Preparation Summary
This independent educational tool is not affiliated with or endorsed by the U.S. Department of Veterans Affairs. It does not determine PCAFC eligibility, an official response level, a stipend level, or a final decision.