Va Form 21 526

A Veteran’s Application for Disability Compensation and Related Compensation Benefits is a document used by the Department of Veterans Affairs and is formally known as VA Form 21-526EZ. This document is used by a veteran who previously served for a branch of the military and is now either retired and disabled and wishes to receive benefits. This document collects extensive information for compensation, including various pieces of personal information, medical history, military service, income, net worth, family information, and other expenses. Though this form can be quite invasive, it is important that the Department has all the necessary information so that the veteran’s claim can be properly processed.

What is a VA Form 21 526?

A VA Form 21-526EZ is used by the United States Department of Veterans Affairs. This form is known as a Veteran’s Application for Disability Compensation and Related Compensation Benefits. This form will be completed by someone who was a member of the military but is now either retired or disabled. 
The U.S. Department of Veterans Affairs requires a lot of information on its application for compensation, including personal information, medical history, military service, family information, income, net worth, and expenses. In order to ensure your application is processed quickly, include as much information as possible. Avoid leaving any sections blank. If you need assistance filling out the application, you can consult an attorney or a VA representative.

Most Common Uses

The VA Form 21-526EZ is commonly used by veterans who would like to file a claim for disability compensation benefits or pension benefits.  You can fill out a paper form, or fill out an electronic form on www.ebenefits.va.gov by selecting the option "Apply for Veterans Benefits via VONAPP."

Components of a VA Form 21 526

A VA Form 21-526EZ contains the following sections:

  • Identification and Claim Information
  • Change of Address
  • Homeless Information
  • Claim Information
  • Service Information
  • Service Pay (Retired Pay, Separation Pay, and Disability Severance Pay)
  • Direct Deposit Information
  • Claim Certification and Signature
  • Witnesses to Signature
  • Alternate Signer Certification and Signature
  • Power of Attorney (POA) Signature
  • Direct Deposit Information
    • Certification if you do not have an account with a financial institution or certified payment agent
    • Account number
    • Type of account
    • Name of financial institution
    • Routing or transit number
  • Claim Certification and Signature
    • Veteran/service member signature
    • Date signed
  • Witnesses to Signature
    • Signature
    • Printed name and address
  • Alternate Signer Certification and Signature
    • Indication that signer is a court-appointed representative, attorney-in-fact, agent authorized to act on behalf of a claimant under a durable power of attorney, person responsible for care of claimant, or manager or principal officer acting on behalf of an institution responsible for caring for an individual and that the individual is a minor, mentally incompetent, or physically unable to sign form (may be asked to provide proof in form of health care power of attorney, affidavit or notarized document showing authorization)
    • Signature
    • Date signed
  • Power of Attorney (POA) Signature
    • POA/Authorized representative signature
    • Date signed

You may be asked to provide specific evidence to support your claim.  For example, if you are claiming a disability that was caused or aggravated by VA medical treatment, vocational rehabilitation, or compensated work therapy, you must provide evidence that shows that as the result of VA hospitalization, medical or surgical treatment, examination, or training, you have: an additional disability or disabilities, an aggravation of an existing injury or disease; and the disability was the direct result of VA fault such as carelessness, negligence, lack of proper skill, or error in judgment, or not a reasonably expected result or complication of the VA care or treatment; or the direct result of participation in a VA Vocational Rehabilitation and Employment or compensated work therapy program.
 

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Sample Va Form 21 526

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Sample Va Form 21 526

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