Mom is in an Independent Living Facility receiving help from a third party provider to help with showers and meds. VA did count the fees paid to the Private Care provider as a medical expense, but not the room and board. The denial was because without the room and board deduction she is $1,123.00 over per year in income. In the Dept. of Veterans Affairs "Fast Letter" of Oct. 26, 2012 that went out from the Director of VA regional offices and Center to all pension management center and veterans service center personnel it states "If the facility does not provide the claimant custodial care, or the claimant's physician does not prescribe care by a third-party provider in that facility, VA will not deduct room and board paid to the facility but will deduct the cost of any medical or nursing services obtained from a third-party provider." So I can assume that since the showers and med help are provided through a private care company and not the ILF , room and board is not counted against income. (The company does have an office, etc. in the ILF and all residents use this company). On that note, the claimaint's doctor did fill out the VA form in very much detail stating that she needs assistance with self care, etc. as she is not able to stand for any length of time due to severe arthritis,pain, balance and depth perception (no vision in one eye..included optometrist's report) and also mild cognitive impairment due to age (90)...I thought this would fulfil the requirement of "physician prescribing", but evidently not?? actually what would the dr. have to write or do to fulfill this requirement? The denial letter states "You claimed special monthly pension (aid and attendance or housebound allowance) because of your health conditions. A formal rating is required to determine your eligibility for special monthly pension. No rating has been done at this time, because your income exceeds the income limit. We used the aid and attendance income limit when denying your pension, because it is higher than the income limit without special monthly pension. However, this does not guarentee that you would have been granted Aid and Attendance if a rating had been done" WHAT IS MEANT BY "RATING'.... DOES THIS MEAN THEY DID NOT TAKE THE DOCTORS LETTER INTO CONSIDERATION AND PERHAPS IF THEY HAD THEY WOULD HAVE SEEN THAT THE DR. STATED THE NEED FOR HER TO LIVE IN THE FACILITY WITH HELP WITH MEDICAL ADL'S? What does the dr. need to provide to meet the quote of the VA regarding that the claimant must live in that facility to separately contract for custodial care with a third - party provider? Sorry this is so long....but I would so like to help my mom get this as she is truly in need. Thank you in advance for anyone who can help me .