Under the proposal, veterans and caregivers may be eligible for the program if the veteran needs hands-on help or extensive assistance to complete at least one activity of daily living, such as dressing, bathing, eating, grooming or going to the bathroom, or has a frequent need for supervision or protection as a result of neurological impairment.

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To qualify for the highest tier of compensation and benefits, veterans would typically require help with three or more different activities of daily living -- either hands-on assistance or extensive instruction -- or need continuous supervision or protection as a result of a neurological disorder, mental health or other medical condition.

When the Mission Act of 2018 expanded the VA caregiver program to include not only post-9/11 veterans but those from previous wars, it established eligibility criteria that focused on a veteran's inability to perform activities of daily living every time they tried to do something.

The change also did not fully consider the need for supervision or protection of veterans who have ongoing effects of traumatic brain injury like forgetfulness, lapses in thought or uncontrolled seizures, or mental health conditions that can cause aggression or hallucinations, according to the VA.

The new criteria don't specifically list symptoms or conditions that will be considered for program eligibility for supervision or protection, saying that listing them could prevent the department from accepting a vet into the program.

But they do say that veterans with conditions such as brain injury, mental health disorders, Parkinson's disease, dementia, and neuromuscular disorders may qualify, depending on the abilities of the veteran, their symptoms, and level of need for around-the-clock attention.

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The PCAFC was established in 2010 to provide benefits such as a monthly stipend, respite care, health care and counseling to eligible caregivers of severely injured post-9/11 veterans. By law, the VA was to determine eligibility based on level of injury, to include brain injury, psychological trauma or other mental health disorder, and the need for assistance based on their inability to perform one or more activities of daily living or the need for supervision or protection.

With the expansion under the Mission Act, the VA issued new eligibility criteria that included serious injury but also focused primarily on a veteran's need for physical help, eliminating a middle level of compensation and scoring stipends based on the amount of time it took to provide care, with those in the lowest tier needing 10 hours of care a week and those in the highest tier at least 40 hours a week.

The change, which also included reevaluation of the 19,700 veterans enrolled in the program before the new criteria went into effect in 2020, caused many to lose eligibility. The VA originally estimated that most in the lowest tier would lose eligibility, as would some in the middle tier, or roughly 6,000 veterans.

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In 2022, however, after thousands of veterans faced discharge from the program, the VA suspended assessments and dismissals for legacy participants, finding that, under the new criteria, about 90% faced discharges.

A lawsuit was filed in 2020 by Navy veteran Andrew Sheets, his wife Kristie and the advocacy group Veteran Warriors Inc., saying the new criteria conflicted with the law that created the program.

While the plaintiffs did not win the case, the U.S. Federal Circuit Court of Appeals invalidated some of the VA's policies in its decision, many of which needed to be addressed in the proposed rule.

Under the proposal, the VA says it will delay discharges from the program. Discharges were set to begin again in September 2025 but now will resume after eligibility reassessments that are expected to begin 18 months after the new rule and eligibility criteria are finalized.

When exactly that will occur is not known. Under the federal rulemaking process, the public has 60 days to comment on the proposed rule and then the department analyzes the comments and decides whether to tweak the proposal to accommodate the input, a review that could take months.

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Also, the Trump administration, set to take office Jan. 20, could keep the proposal, alter it, or scrap it altogether, adding to the uncertainty.

VA officials said Monday that the department hopes the rulemaking process will be complete by roughly March 2026.

"The exact extension remains to be seen because we don't know how many comments we are going to get," explained VA Under Secretary for Health Dr. Shereef Elnahal. "The complexity of those comments, how they might change the proposed rule to the final, all that is variable on public comment.”

The proposed rule expands eligibility for the program, adding veterans who have an individual unemployability designation from the VA. Previously, only those with a 70% disability rating or higher were eligible for the program; veterans who are considered by the VA to not be employable because of service-connected disabilities may not necessarily have a disability ratings criteria that met the 70% or higher threshold.

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The VA estimates that the change could add between 1,717 and 3,124 veterans into the program in the next five years.

Under the proposal, the VA also aims to make the required home assessments for the program less intrusive. The proposal would reassess eligibility not more than every two years with some exceptions, rather than the current one-year requirement.

And it would allow the VA to conduct home visits by telehealth in the event of a local, state or national emergency.

It also would allow veterans and their caregivers who live in assisted living facilities to be eligible for or continue the program. Given that many senior housing arrangements offer apartments or condominiums and don't provide personal care assistance, the VA decided these facilities should not be equated with hospitals, rehabilitation facilities or nursing homes.

The new rule also would provide up to three months' stipend and benefits for caregivers who request removal from the program as a result of domestic violence from their caregiver or are compassionately removed from the program by the VA -- because of domestic violence in most cases.

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The public will be able to begin commenting on the proposal Friday once the proposal posts on the Federal Register website.

It is estimated the program will cost $5.3 billion in the first 5 years after the changes and $13.9 billion for 10 years.

"These proposed changes would expand the program to tens of thousands of veterans and their family caregivers -- ensuring we can provide these caregivers with the respite care, education, support and resources they need to care for their veteran," VA Secretary Denis McDonough said in a statement Thursday.