Starting a claim for veterans disability compensation from the United States Department of Veterans Affairs (VA) can be confusing. Fortunately, understanding the process and filling out VA Form 21-526EZ doesn’t have to be an overwhelming experience. On pdfFiller, you will access the printable VA form 21-526EZ, as well as other VA forms that may need to be submitted to support the benefits claim.
In this blog post, we’ll cover all you need to know about VA form 21-526EZ – the who, what, when and where of submitting this form, plus provide details on the Toxic Exposure Update. Let’s get started!
Table of contents
- Who needs VA Form 21-526EZ?
- What is the VA Form 21-526EZ for?
- Is VA 21-526EZ accompanied by other forms?
- When is the VA Form 21-526EZ due?
- What information should be provided in Form VA Form 21-526EZ?
- How to fill out VA Form 21-526EZ?
- VA Form 21-526EZ: Toxic Exposure Update
- Where do I send VA Form 21-526EZ?
Who needs VA Form 21-526EZ?
A VA Form 21-526EZ is needed by veterans who want to apply for compensation and/or pension benefits from the Department of Veterans Affairs (VA). This form is used to initiate a claim for disability benefits and should be completed by the veteran or their representative. It is important to provide accurate and detailed information on the form to ensure that the claim is processed correctly and the benefits are received.
What is the VA Form 21-526EZ for?
The VA form is used to initiate a claim for benefits based on injuries or illnesses incurred during military service, as well as injuries or illnesses that may have been worsened by military service. Some examples of benefits that may be covered by this form include:
- disability compensation
- dependency and indemnity compensation
- survivor’s pension, etc.
Is VA 21-526EZ accompanied by other forms?
Yes, VA Form 21-526EZ may need to be accompanied by additional forms or supporting documents, depending on the specific circumstances of the veteran’s claim. For example, veterans may need to submit medical records, military service records, and other relevant documents and forms to support their claim for benefits.
Additionally, veterans may need to submit other VA forms, such as:
- VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC
- VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA)
- VA Form 21-686c, Declaration of Status of Dependents
- VA Form 21-4138, Statement in Support of Claim
The VA will review the veteran’s application and determine which additional forms and documents are required. It is important for veterans to carefully review the instructions for the VA Form 21-526EZ and ensure that any required supporting documents are included with their application.
When is the VA Form 21-526EZ due?
It is generally recommended to file a complete claim for either: Compensation (VA Form 21-526EZ), Pension (VA Form 21P-527EZ), and Survivor’s DIC/Death Pension/Accrued Benefits (VA Form 21P-534EZ) within one year after submitting VA Form 21 0966, Intent To File A Claim For Compensation and/or Pension, or Survivors Pension and/or DIC.
The effective date of benefits eligibility may be tied to the date that the VA receives a complete and valid application from the veteran. Therefore, it is important for veterans to submit their application with all required forms and supporting documents as soon as possible. This will help to ensure that the VA can process their claim in a timely manner and that the veteran receives the maximum benefits available to them.
What information should be provided in Form VA Form 21-526EZ?
The VA Form 21-526EZ is a comprehensive form that requires detailed information from veterans to determine their eligibility for compensation and/or pension benefits from the Department of Veterans Affairs (VA). Here are some of the types of information that should be provided in the form:
- Personal information: The form requires the veteran to provide their name, address, Social Security number, and military service information.
- Benefit types: The veteran should indicate the types of benefits they are applying for, such as disability compensation or pension benefits.
- Medical history: The veteran should provide information about any injuries or illnesses they incurred during military service, as well as any injuries or illnesses that may have been worsened by military service. This section of the form requires the veteran to provide a detailed medical history, including the name of each condition, the date they were first treated for it, and how it relates to their military service.
- Disability information: If the veteran is applying for disability compensation, they should provide information about the extent of their disability, including how it affects their daily life and ability to work.
- Dependent information: If the veteran has any dependents, they should provide information about their dependents, including their names, birthdates, and relationship to the veteran.
- Military service information: The veteran should provide information about their military service, including their branch of service, service dates, and highest rank achieved.
- Surviving spouse or child information: If the veteran is a surviving spouse or child of a deceased veteran, they should provide information about their loved one’s military service and date of death.
How to fill out VA Form 21-526EZ?
The VA Form 21-526EZ can be completed via pdfFiller, or on paper. The 2023 version of the form contains Sections I – XII. Here are the instructions for completing the form:
- Section I: Veteran’s Identification Information
In this initial section, provide essential details that identify you to the Department of Defense. Indicate your full name, date of birth, VA file number, social security number, and current mailing address.
- Section II: Change of Address
If you’re planning a temporary or permanent change in your mailing address, complete Items 14A through 14C in Section II.
- Section III: Homeless Information
This section, specifically Items 15A to 15F, should only be completed if you are presently homeless or at risk of homelessness. If this does not apply to you, you can skip Sections II and III.
- Section IV: Exposure Information
As of December 29th, 2022, an important update has been made to the VA Form 21-526EZ, specifically in Items 15A – 15E. This revised section now incorporates crucial information regarding the PACT ACT (Post-9/11 Veterans’ Toxic Exposure) and its associated toxic exposures. More on that in the next chapter.
- Section V: Claim Information
Provide a comprehensive description of your current disability, including its onset or worsening. Establishing a service connection is crucial, so take your time to describe the details. You may attach additional information at the end of your disability claim if needed, clearly indicating so on VA Form 21-526EZ.
|Supplemental Claims||VA Form 20-0995|
|Dependents||VA Form 21-686c and, if claiming a child aged 18-23 years and in school, VA Form 21-674|
|Individual Unemployability||VA Form 21-8940 and VA Form 21-4192|
|Post-Traumatic Stress Disorder||VA Form 21-0781 or VA Form 21-0781a|
|Specially Adapted Housing or Special Home Adaptation||VA Form 26-4555|
|Auto Allowance||VA Form 21-4502|
|Veteran/Spouse Aid and Attendance benefits||VA Form 21-2680 or, if based on nursing home attendance, VA Form 21-0779|
- Section VI: Service Information
In this section, you will provide specific details about your military service, including your branch (Army, National Guard, Navy, or Marines). Please include your service number, enlistment date, date of honorable discharge, and the total number of years you served.
- Section VII: Service Pay
If you are currently receiving military service pay, complete Section VI. The VA considers military service pay as military retired pay, separation pay, and disability severance pay.
- Section VIII: Direct Deposit Information
You have the option to receive your disability benefit payment via direct deposit. To facilitate this, provide the name of your bank, its routing number, your account number, and specify the type of account (checking or savings) for direct deposit.
- Section IX: Claim Certification and Signature
Once you have completed the preceding sections, sign and date your application for health care and disability benefits in this section. Your signature indicates that you have provided accurate information and understand the questions asked.
- Section X: Witness to Signature
If you are unable to sign the application and will mark it with an X instead, you will need two witnesses to observe your marking in the signature box. These witnesses should sign and date the application in this section.
- Section XI: Alternate Signer Certification and Signature
Completion of this section is only required if you leave Item 33A (veteran’s signature line) blank. To use this section, you must have VA Form 21-0972 titled Alternate Signer Certification on file with the VA. Eligible persons who can sign on your behalf include court-appointed representatives, attorneys acting under durable power of attorney, individuals responsible for your care (such as a spouse or relative), managers or principals from your residing institution, and any persons over the age of 18.
- Section XII: Power of Attorney (POA) Signature
This section is relevant if you have legal representation assisting you with your VA claim. Only veteran service officers (VSO), VA accredited attorneys, and VA accredited service organization agents are authorized to sign this section.
VA Form 21-526EZ: 2023 Toxic Exposure Update
As of December 29th, 2022, an important update has been made to the VA Form 21-526EZ, specifically in Item 15:
- Item 15A: Claiming Conditions Related to Toxic Exposures
In this section, please indicate whether you are claiming any conditions that are directly related to toxic exposures during your military service. This enables us to assess and address any potential health issues resulting from these exposures.
- Item 15B: Service in Gulf War Hazard Locations
Did you serve in any of the designated Gulf War hazard locations? This information helps us determine if there are specific risks or hazards associated with your service in those regions.
- Item 15C: Service in Herbicide (e.g., Agent Orange) Locations
Did you serve in any of the designated Herbicide (such as Agent Orange) locations? This question is crucial in identifying potential exposure to herbicides and their long-term effects on your health.
- Item 15D: Exposure to Other Substances
Provide details if you have been exposed to any of the following substances – asbestos, mustard gas, radiation, SHAD (Shipboard Hazard and Defense), Military Occupational Specialty (MOS) – related toxin, contaminated water at Camp Lejeune, and others.
- Item 15F: Multiple Exposures
If you have experienced multiple exposures, provide all additional dates and locations of potential exposure. By gathering this information, the impact of these exposures on your health and well-being can be comprehensively evaluated.
Fill out this updated section of the VA Form 21-526EZ diligently, as it will allow for better understanding of your circumstances and help provide you with the necessary support and compensation for any service-related health issues.
Where do I send VA Form 21-526EZ?
The address to which you should send your completed VA Form 21-526EZ depends on the state in which you reside and the type of benefit you are applying for. To determine the correct address, you can use the VA’s online facility locator tool or call the VA benefits hotline at 1-800-827-1000 Monday through Friday, 8:00 a.m. to 9:00 p.m. ET, for assistance.
Additionally, once you have completed the form, you can submit it in one of the following ways:
- Online: You can submit the form electronically on the VA’s website by uploading the form directly via AccessVA.
- Mail: You can mail the form to the following address –
Department of Veterans Affairs Evidence Intake Center
PO Box 4444 Janesville, WI 53547-4444
- In Person: You can submit the form in person at your local VA regional office.
It is important to ensure that all required supporting documents are included with your application and that you keep a copy of the completed form for your records.
Originally published September 2016, updated June, 2023.