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VA Commonly Used Forms

The Knowledge Book contains the most commonly used forms for obtaining various types of veterans benefits or services.

1. VA Compensation and Pension Forms

1.1. VA Form 9 - Appeal to Board of Veterans Appeals

Effective date: July 2015

1.2. VA Form 21-526EZ- Application for Disability Compensation Benefits

Veterans and Service Member should use this form to submit a claim for veterans disability compensation and related compensation benefits.  

Use this form to expedite the process under the Fully Developed Claim Program (FDC)

Effective date:  Feb 2016

1.3. VA Form 21-526c- Pre-Discharge Compensation Claim

Service Members with 6 months or less remaining on active duty can file a claim with the Department of Veterans Affairs

 

Form effective June 2016

1.4. VA Form 21-527EZ - Application for Pension

Want your pension claim processed faster?  Use this form to expedite the process under the Fully Developed Claim Program (FDC)

 

Date effective; June 2014

1.5. VA Form 21-534EZ- Application for DIC, Death Pension, and/or Accrued Benefits

Application used for surviving spouses and children to submit a claim for DIC. Death Pension, and/or Accrued benefits under the Fully Developed Claim Program (FDC)

 

Form effective: June 2014

1.6. VA Form 21-601- Application For Accrued Amounts Due A Deceased Beneficiary

To apply for accrued benefits due the beneficiary but not paid prior to death

 

Effective date: June 2014

1.7. VA Form 21-686c - Declaration of Status of Dependents

Declaration of Status OF Dependents

Effective date: June 2014

1.8. VA Form 21-0958 - Notice of Disagreement

1.9. VA Form 21-0966-Intent To File a VA Claim

This Form Is Used to Notify VA of Your Intent to File for the General Benefit(s). The Intent to File a claim process allows applicants additional time to gather all of the information and evidence needed to support their claim(s).  

Intent to File replaces an informal claim.

38 CFR §3.155

Effective- July 2015

1.10. VA Form 21-2680 Request for Aid and Attendance/Housebound Status

Veterans and Spouses would require assistance in performing their daily activities of living (ADLs), must have their primary care physician complete this form indicating the need for either Aid and Attendance (A&A) or Housebound status.  

 

Effective May 2015

1.11. VA Form 21-4138 - Statement in Support of Claim

Statement in support of claim.

Effective date: Jan 2015

1.12. VA Form 21-4142 - Authorization for Release of Information

Authorization for Release of Information

Effective date: June 2014

1.13. VA Form 21-8940 -Application for Increased Compensation due Unemployability

Veteran's Application for Increased Compensation Based on Unemployability

Effective date: Feb 2016

2. VA Vocational Rehabilitation and Education Forms

2.1. VA Form 22-1990- Application for VA Education Benefits

Use this form to apply for educational assistance under the following benefit programs:


- Post- 9/11 GI Bill chapter 33 of title 38, U.S. Code


- Montgomery GI Bill (MGIB) chapter 30 of title 38, U.S.Code


- Montgomery GI Bill - Selected Reserve (MGIB-SR) chapter 1606 of title 10, U.S. Code


- Reserve Educational Assistance Program (REAP) chapter 1607 of title 10, U.S. Code


- Post-Vietnam Era Veterans' Educational Assistance Program (VEAP) chapter 32 of title 38, U.S. Code, or section 901 or section 903 of Public Law 96-342


Do not use this form to apply for Vocational Rehabilitation and Employment benefits (chapter 31 of title 38, U.S. Code), Dependents Educational Assistance benefits (chapter 35 of title 38, U.S. Code), Transfer of Entitlement, or National Call to Service (section 510 of title 10, U.S. Code). These benefits require different application forms.   


 


Effective: December 2016


 

2.2. VA Form 22-5490 - Dependent's Application for VA Education Benefits

Do not use this form to apply for Veterans' education assistance based on your own service (chapters 30, 32, 33, 1606, or 1607) or vocational rehabilitation benefits (chapter 31). To apply for veterans' education assistance based on your own service, use VA Form 22-1990. To apply for vocational rehabilitation benefits, use VA Form 28-1900.

To qualify for Survivors' and Dependents' Educational Assistance (DEA) you must be either:

(1) The spouse or child of a veteran who is permanently and totally disabled as a result of a service-connected disability.

(2) The spouse or child of an individual on active duty who has been listed as missing in action, captured in the line of duty by hostile force, forcibly detained or interned in the line of duty by hostile force, or forcibly detained or interned in the line of duty by foreign government or power for more than 90 days.

(3) The surviving spouse or child of a veteran who died of a service-connected disability or who dies while a service-connected disability was rated permanent and total in nature.

(4) The surviving spouse or child of an individual on active duty for which the evidence shows that the individual is hospitalized for receiving outpatient medical care services or treatment; has a total disability permanent in nature incurred or aggravated in the line of duty in the active military, naval, or air service; and the serviceperson is likely to be discharged or released from such service for such disability.

 

Effective date: December 2016

2.3. VA Form 28-1900 - Disabled Veterans Application for Vocational Rehabilitation

Used to apply for vocational rehabilitation benefits.  Vocational Rehabilitation provides services and assistance to certain veterans with disabilities to get and keep a suitable job. If employment is not reasonably feasible, vocational rehabilitation may be able to provide services to support veterans with disabilities to achieve maximum independence in their daily living activities. 

Effective date: September 2014

3. Disability Benefits Questionnaires (DBQ)

3.1. Disability Benefits Questionnaire (DBQ) Forms

Disability Benefits Questionnaires (DBQs) are medical examination forms used to obtain important information for evaluating disability compensation and/or pension claims.

 

The following DBQ can be obtained by visiting: http://www.benefits.va.gov/COMPENSATION/dbq_ListByDBQFormName.asp

 

Cardiovascular

Form #

Form Name

21-0960A-2

Artery and Vein Conditions (Vascular Diseases including Varicose Veins)

21-0960A-3

Hypertension

21-0960A-4

Heart Conditions (including IHD, Non-IHD, Arrhythmias, Valvular Disease and Cardiac Surgery)

 

Dental and Oral

Form #

Form Name

21-0960M-15

Temporomandibular Joint (TMJ) Conditions

21-0960D-1

Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)

 

Dermatological

Form #

Form Name

21-0960F-1

Scars/Disfigurement

21-0960F-2

Skin Diseases

 

Ear, Nose and Throat

Form #

Form Name

21-0960N-1

Ear Conditions (including Vestibular and Infectious Conditions)

21-0960N-3

Loss of Sense of Smell and/or Taste

21-0960N-4

Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx

 

Endocrinological

Form #

Form Name

21-0960E-1

Diabetes Mellitus

21-0960E-2

Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)

21-0960E-3

Thyroid and Parathyroid Conditions

 

Gastrointestinal

Form #

Form Name

21-0960G-1

Esophageal Conditions (Including GERD, Hiatal Hernia and Other Esophageal Disorders)

21-0960G-2

Gallbladder and Pancreas Conditions

21-0960G-3

Intestinal Conditions (other than Surgical or Infectious) Including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis and Diverticulitis

21-0960G-4

Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy)

21-0960G-5

Hepatitis, Cirrhosis, and other Liver Conditions

21-0960G-6

Peritoneal Adhesions

21-0960G-7

Stomach and Duodenal Conditions (not including GERD or Esophageal Disorders)

21-0960G-8

Infectious Intestinal Disorders (including Bacterial and Parasitic Infections)

 

Genitourinary

Form #

Form Name

21-0960J-1

Kidney Conditions (Nephrology)

21-0960J-2

Male Reproductive Organ Conditions

21-0960J-3

Prostate Cancer

21-0960J-4

Urinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)

 

Gynecological

Form #

Form Name

21-0960K-1

Breast Conditions and Disorders

21-0960K-2

Gynecological Conditions

 

Hematologic and Lymphatic

Form #

Form Name

21-0960B-1

Hairy Cell and Other B-Cell Leukemias

21-0960B-2

Hematologic and Lymphatic Conditions, including Leukemia

 

Infectious Diseases

Form #

Form Name

21-0960I-1

Persian Gulf and Afghanistan Infectious Diseases

21-0960I-2

HIV-Related Illnesses

21-0960I-3

Infectious Diseases (other than HIV-Related Illness, Chronic Fatigue Syndrome, or Tuberculosis)

21-0960I-4

Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases

21-0960I-5

Nutritional Deficiencies

21-0960I-6

Tuberculosis

 

Musculoskeletal

Form #

Form Name

21-0960M-1

Amputations

21-0960M-2

Ankle Conditions

21-0960M-3

Non-Degenerative Arthritis (including Inflammatory, Autoimmune, Crystalline and Infectious Arthritis) and Dysbaric Osteonecrosis

21-0960M-4

Elbow and Forearm Conditions

21-0960M-6

Foot Conditions, Including Flatfoot (Pes Planus)

21-0960M-7

Hand and Finger Conditions

21-0960M-8

Hip and Thigh Conditions

21-0960M-9

Knee and Lower Leg Conditions

21-0960M-10

Muscle Injuries

21-0960M-11

Osteomyelitis

21-0960M-12

Shoulder and Arm Conditions

21-0960M-13

Neck (Cervical Spine) Conditions

21-0960M-14

Back (Thoracolumbar Spine) Conditions

21-0960M-16

Wrist Conditions

 

Neurological

Form #

Form Name

21-0960C-1

Parkinson's Disease

21-0960C-2

Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)

21-0960C-3

Cranial Nerve Conditions

21-0960C-4

Diabetic Sensory-Motor Peripheral Neuropathy

21-0960C-5

Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)

21-0960C-6

Narcolepsy

21-0960C-7

Fibromyalgia

21-0960C-8

Headaches (Including Migraine Headaches)

21-0960C-9

Multiple Sclerosis (MS)

21-0960C-10

Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy)

21-0960C-11

Seizure Disorders

 

Ophthalmological

Form #

Form Name

21-0960N-2

Eye Conditions

 

Psychological

Form #

Form Name

21-0960P-1

Eating Disorders

21-0960P-2

Mental Disorders (other than PTSD)

21-0960P-3

Review Post Traumatic Stress Disorder (PTSD)

 

Respiratory

Form #

Form Name

21-0960L-1

Respiratory Conditions (other than Tuberculosis and Sleep Apnea)

21-0960L-2

Sleep Apnea

 

Rheumatological

Form #

Form Name

21-0960Q-1

Chronic Fatigue Syndrome

 

General Surgery

Form #

Form Name

21-0960H-1

Hernias (including Abdominal, Inguinal, and Femoral Hernias)

21-0960H-2

Rectum and Anus Conditions (including Hemorrhoids)