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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: February 2019

1.2. VA Form 10182- Decision Review Request: Board Appeal

If you have received a decision from a local VA office or a higher-level adjudicator with which you disagree, and you would like one or more issues to be decided by a Veterans Law Judge, you must fill out and submit a Notice of Disagreement. You can choose to appeal all or only some of the issues previously decided, however, ONLY those issues that you list on your Notice of Disagreement will be considered on appeal.

Effective: February 2019

1.3. VA Form- 20-0995- Supplemental Claim

Use this form to request a SUPPLEMENTAL CLAIM of the decision you received that you disagree with. A SUPPLEMENTAL CLAIM is a new review of an issue(s) previously decided by the Department of Veterans Affairs (VA) based on submission of new and relevant evidence. 

Effective: February 2019

1.4. VA Forn 20-0996- Higher Level Review

Use this form to request a HIGHER-LEVEL REVIEW of the decision you received. A HIGHER-LEVEL REVIEW is a new review of an issue(s) previously decided by the Department of Veterans Affairs (VA) based on the evidence of record at the time VA issued notice of the prior decision. 

Effective: February 2019

1.5. VA Form 20-10206- Freedom of Information Act (FOIA) or Privacy Act Request

This form is used to submit a Freedom on Information Act (FOIA) or Privacy Act Request.  It must be signed by the requester or third-party authorized to act on behalf of the requester.

A FOIA request provides the public the right to request access to records from Federal agencies, except those protected by the nine FOIA exemptions.  For additional information please visit https://www.va.gov/FOIA/Requests.asp.

A Privacy Act Request can be submitted by a citizen of the United States or an alien lawfully admitted for permanent residence may request access to or amendment of records on herself/himself from a System of Records (SORs).

Examples of Privacy Act records are personal Claims Files (C-File), educational loan, and beneficiary records. For additional information please visit https://www.oprm.va.gov/privacy/.


Effective:  October 2020

1.6. VA Form 20-10207- Priority Processing Request

Use this form to request priority processing of a claim due to certain status or circumstances.


Effective:  October 2020

1.7. VA Form 20-10208- Document Evidence Submission

This form is used for the submission of additional documentation or evidence in support of a VA claim. 


Effective:  October 2020

1.8. 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: September 2019

1.9. 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

1.10. VA Form 21P-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: October 2018

1.11. VA Form 21P-530- Application for Burial Benefits

VA will pay a burial allowance up to $2000 if a veteran's death is service related.  VA will also pay a burial and funeral allowance for nonservice-connected injuries. The person who paid the Veteran's burial expenses may apply for reimbursement from VA.

Effective: April 2017

1.12. VA Form 21P-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: October 2018

1.13. VA Form 21P-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: September 2019

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

Declaration of Status of Dependents used to add eligible family members to a veteran's VA running award.

Effective date: September 2018

1.15. VA Form 21-0958 - Notice of Disagreement

This Notice of Disagreement is used to initiate an appeal from a VA decision for disability benefits you receive.

Effective: September 2018

 

 

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

This Form Is Used to Notify VA of Your Intent to File for the Compensation, Pension, Survivors Pension, and DIC 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- August 2018

1.17. 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: September 2018 

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

Statement in support of claim.

Effective date: Jan 2018

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

Authorization for Release of Information

Effective date: Mar 2018

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

Veteran's Application for Increased Compensation Based on Unemployability

Effective date: October 2017

1.21. VA Form 21-10210- Lay /Witness Statement

This form is used by the veteran/claimant or someone writing on your behalf to gather lay or witness statements that support an existing claim for benefits or service


Effective:  August 2020

2. Veteran Readiness and Employment (VR&E), formerly called VA Vocational Rehabilitation and Employment 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 Veteran Readiness and Employment (VR&E), formerly called VA 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: August 31, 2020












 






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 Veteran Readiness and Employment (VR&E), formerly called VA Vocational Rehabilitation and Employment benefits (chapter 31).

To apply for Veterans' Education Assistance based on your own service, use VA Form 22-1990.

To apply for Veteran Readiness and Employment (VR&E) 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: August 31, 2020

2.3. VA Form 28-1900 - Disabled Veterans Application for Veteran Readiness and Employment

Used to apply for Veteran Readiness and Employment (VR&E) benefits, formerly called VA Vocational Rehabilitation and Employment.

Veteran Readiness and Employment (VR&E) 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:  August 31, 2020

2.4. VA Form 28-10212- Chapter 31 Request for Assistance

Use this form to submit a request for assistance with your Chapter 31 benefits.


Effective:  August 2020

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.  VA physicians use DBQs when performing C&P exams for VA disability.

The purpose of a DBQ is to ensure that the physician performing the exam records all the information needed for VA to properly rate a disabled veteran’s conditions.

On 4/2/2020, VA sent a bulletin stating the Discontinuance of Publicly Available Disability Benefits Questionnaires (DBQs).  VA states they are "modernized"; whereby they are currently more than half-way through the process of updating all body systems in the VASRD (VA Schedule for Rating Disabilities), since the last update in 1945. As each body system is updated, so are the corresponding DBQs.

Citing abuse of the system, VA has removed DBQs from its public websites.  The VA says that DBQs will still be available to medical practitioners, who can use them in performing their official duties, but that they will no longer be available to the general public; as VA feel they have expanded its own capacity to conduct these examinations.

VA’s policy regarding accepting these forms directly from veterans’ providers has not changed. Therefore, we have provided links/pdf to a number of DBQs used by the VA, but no longer provided to the public.

Lastly, VA will continue to accept any evidence that veterans or their accredited representatives wish to submit in support of disability compensation or pension claims. 


Cardiovascular 

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

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

21-0960F-1 Scars-Disfigurement
21-0960F-2 Skin Diseases

Ear, Nose, and Throat

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

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

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

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

21-0960K-1 Breast Conditions and Disorders
21-0960K-2 Gynecological Conditions

Hematologic and Lymphatic

21-0960B-1 Hairy Cell and Other B-Cell Leukemias
21-0960B-2 Hematologic and Lymphatic Conditions, including Leukemia

Infectious Diseases

21-0960I-1 Persian-Gulf-and-Afghanistan-Infectious-Diseases

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

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 Miscellaneous (other than Flatfoot and 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

21-0960C-1 Parkinson’s Disease
21-0960C-2 Amyotrophic Lateral Selerosis (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 Selerosis (MS)
21-0960C-10 Peripheral Nerve Conditions (Not Including Diabetic Sensory-Motor Peripheral Neuropathy)
21-0960C-11 Seizure Disorders

Ophthalmological

21-0960N-2 Eye Conditions

Psychological

21-0960P-1 Eating Disorders
21-0960P-2 Mental Disorders (other than PTSD)
21-0960P-3 Review Post Traumatic Stress Disorder (PTSD)

Respiratory

21-0960L-1 Respiratory Conditions (other than Tuberculosis and Sleep Apnea)
21-0960L-2 Sleep Apnea

Rheumatological

21-0960Q-1 Chronic Fatigue Syndrome

General Surgery

21-0960H-1 Hernias (including Abdominal, Inguinal, and Femoral Hernias)
21-0960H-2 Rectum and Anus Conditions (including Hemorrhoids)


4. Military Separation/National Archives Forms

4.1. DD Form 149- Correction of Military Records

Used to correct an error or injustice which affects your military record.

4.2. DD Form 293- Review of Discharge from the Armed Forces.

 Used to request an upgrade of a military discharge from the appropriate discharge review board.

4.3. SF Form 180- Request Pertaining to Military Records

Used to request information from military records, such as DD 214, service treatment records, personnel records, medals, etc.