For spouses who provide daily, hands-on care to wounded, ill, or injured Veterans, the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) is more than a benefit; it’s financial stability, training, and recognition of the essential work of caregiving.

In late 2025, the Department of Veterans Affairs finalized updates to PCAFC to increase fairness and consistency. These revisions directly affect how caregivers are evaluated, how appeals are handled, and what evidence is required during reassessments.

What’s Changing in the Caregiver Evaluation Process

The new rules fall into three major areas: evaluation consistency, appeals structure, and documentation requirements.

1. More Consistent Clinical Evaluations

VA has standardized how clinicians assess whether a Veteran needs:

• Hands-on physical assistance

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• Supervision or cueing
• Ongoing safety monitoring
• Support for daily living
• Cognitive or behavioral oversight

The goal is to ensure evaluations follow the same clinical expectations across the country.

2. A Formal Two-Level Appeals System

VA created a clearer, two-stage appeals pathway:

• Reconsideration – A new clinical review conducted by a different evaluation team.
• Higher-Level Review – A senior adjudicator reviews whether the decision followed proper procedure.

This structure aligns PCAFC with broader VA disability claims processes.

3. Strengthened Evidence Requirements

VA clarified which documents carry weight during assessments. Caregivers should maintain:

• Daily care logs
• Medication management notes
• Behavior tracking for PTSD, TBI, or cognitive injuries
• Transfer and mobility assistance notes
• Updated clinical summaries from providers
• Treatment plans outlining ongoing needs
• Statements identifying supervision or safety concerns

Thorough documentation is now key for eligibility.

How Caregivers Should Prepare Before a Reassessment

Keep Detailed Daily Records

Document each task you support, including:

• Mobility and transfers
• Bathing, dressing, toileting, or feeding assistance
• Medication timing and management
• Behavioral episodes
• Cognitive support or cueing
• Safety interventions

Coordinate With Providers

Ask providers to update notes and treatment plans to reflect:

• Functional changes
• Cognitive symptoms
• Behavioral health needs
• Changes in medical conditions
• Recommendations for assistance or supervision

Anticipate What Reviewers Will Ask

Reviewers now prioritize:

• Safety risks
• Frequency of hands-on care
• Need for cognitive or behavioral supervision
• The Veteran’s ability to perform daily tasks independently

Insight From the Elizabeth Dole Foundation

The Elizabeth Dole Foundation, a leading national organization supporting military and Veteran caregivers, has worked closely with the VA throughout PCAFC reforms.

Steve Schwab, CEO of the Elizabeth Dole Foundation, shared the significance of clearer standards,

“Caregivers deserve a system that reflects the true demands of their daily work. These changes are a step toward greater transparency and fairness for those who support our nation’s Veterans.”

The individual experience of a caregiver can be wildly different from another. It is critical to clearly articulate your own experience, what it’s like, what it entails, and what support you need. The only way to accomplish this is by keeping detailed documentation and records that support your needs, goals, and responsibilities as a caregiver.

The Foundation’s Director of Caregiver and Family Support, Kristin Ellis, highlighted the importance of maintaining proper evidence.

“Your records matter. If you’re helping with medications, transfers, or safety, document it. Those details help reviewers understand what daily care actually involves.”

What to Do If You Disagree With a VA Decision

If your eligibility is reduced or denied:

1. File for Reconsideration

Submit the request in writing before the deadline. A different clinical team reviews the case.

2. Submit Additional Documentation

Provide updated care logs, treatment notes, or clinician statements.

3. Request a Higher-Level Review

A senior adjudicator evaluates whether VA followed proper procedure.

4. Seek Support

Caregiver advocates and veteran service organizations can help identify missing evidence or clarify the next step.

Reassessment Checklist For Caregivers

1. Daily Care Documentation

☐ One month (minimum) of daily care logs

☐ Notes describing assistance with bathing, dressing, feeding, toileting, or mobility

☐ Medication administration records (timing, doses, supervision)

☐ Safety intervention notes (falls, wandering, disorientation, panic episodes)

☐ Behavioral health symptom tracking (PTSD, TBI, anxiety, memory lapses)

2. Clinical & Medical Records

☐ Updated provider visit summaries

☐ Current treatment plans and recommendations

☐ Statements from primary care, behavioral health, neurology, rehab, or TBI specialists

☐ Notes describing cognitive or functional changes

☐ Any ER visits, crisis events, or safety concerns from clinicians

3. Personal Statements

☐ Your description of a typical day of care

☐ Specific examples showing frequency of hands-on support

☐ Examples of safety risks requiring your supervision

☐ How care needs impact daily family routines or employment

4. Evidence to Bring to the Review

☐ Printed or digital copies of all logs

☐ Updated medical documentation

☐ Any clinician letters supporting eligibility

☐ Your own written statement summarizing the veteran’s needs

5. Be Prepared to Explain

☐ How often do you provide hands-on assistance

☐ What happens if you step away

☐ Instances where supervision prevented harm

☐ Cognitive, behavioral, or memory-related challenges

☐ How symptoms fluctuate day-to-day

6. Practical Tips

☐ Answer clearly and factually (avoid minimizing care)

☐ Provide real examples — not generalities

☐ Bring your notes in case you get overwhelmed or forget details

7. Review the Decision Carefully

☐ Check for accuracy in the assessment summary

☐ Identify any missing or incorrect information

☐ Compare findings to your documentation

8. If You Disagree With the Decision

☐ Submit a written Reconsideration request

☐ Include any documents not reviewed initially

☐ If needed, request a Higher-Level Review

☐ Contact a caregiver advocate or VSO for guidance

What These Changes Mean for Military Families

Military spouses already balance medical care, household responsibilities, employment, and frequent moves. PCAFC reassessments add another layer of administrative complexity. The updated rules bring more structure, clearer expectations, and defined avenues for appeal, making it easier to understand what VA needs and how to prepare for it.

Being organized, keeping records, and staying informed are key to protecting caregiver benefits and ensuring Veterans’ needs are represented.

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