How to Fill Out VA Form 21-526EZ with Examples (Plus 2023 Toxic Exposure Update)

Before you can proceed with filing VA form 21-526EZ for disability benefits, one of the following three scenarios must be true:

• You sustained an illness or injury during active military service and can provide medical evidence linking your current disability to the duties you completed in the military. The VA refers to this as an in-service disability claim.
• You had a diagnosed illness or injury before you entered military service and completing your duties made the condition worse. You will hear the VA refer to this as a pre-service disability claim.
• You have a current disability related to active duty, but you did not develop any complications from it after your honorable discharge. The VA refers to this as a post-service disability claim.

Some of the key purposes of Form 21-526EZ include:

1. Applying for disability compensation: Veterans use Form 21-526EZ to formally request disability compensation from the VA for disabilities that are connected to their military service. This form collects information about the veteran’s medical conditions, symptoms, and how they impact their daily life.
2. Providing evidence of service-connected disabilities: Form 21-526EZ requires veterans to provide evidence supporting their claim for service-connected disabilities. This may include medical records, military service records, and other relevant documents.
3. Requesting related benefits: Veterans can also use Form 21-526EZ to request other related benefits, such as dependents’ compensation, special monthly compensation, and other benefits that may be available based on their disability rating and circumstances.
4. Updating information: If a veteran has previously filed a disability claim with the VA and needs to update or correct information, they can use Form 21-526EZ to provide the updated information or request a review of their claim.

Section I: Identification and claim information

This section requires you to list the information that identifies you to the department of defense, such as your full name, date of birth, VA file number, social security number, and current mailing address. 

Section II: Change of address

If you know that you will be changing your address temporarily or permanently from what you list as your current mailing address, complete lines 14A through 14C of Section II. 

Section III: Homeless information

You should only complete Section III if you are currently homeless or in danger of becoming homeless. Section III starts at question 15A and ends at question 15F. You can skip this section and/or Section II if they do not pertain to you.

Section IV: Claim information

The second section of VA form 21-526EZ is where you provide the most information. You should be prepared to describe your current disability in full, including when it started or got worse. 

Establishing a service connection is extremely important, so be sure to take your time and provide significant details when completing this part of the VA disability form. You can include an addendum, but it is the respondent burden to indicate when completing VA form 21-526EZ, that you have attached additional information at the end of your disability claim.

Section V: Service information

Here you will provide details about your military service, including your branch of service and whether you served in the Army, National Guard, Navy, or Marines. Be sure to include your service number, enlistment date, and date of honorable discharge along with the total number of years you served. 

Section VI: Service pay

If you are currently receiving military service pay, you will need to complete Section VI. The VA considers military service pay as military retired pay, separation pay, and disability severance pay. 

Section VII: Direct deposit information

The VA gives you the option of receiving your disability benefit payment via direct deposit. You will need to include the name of your bank, its routing number, your account number, and the type of bank account accepting a direct deposit, such as a checking or savings account.

Section VIII: Claim certification and signature

You are ready to sign and date your application for health care and disability benefits once you have completed each of the above sections. Keep in mind that your signature means you have provided true and accurate information and that you understand the questions asked of you. 

Section IX: Witness to Signature

Completion of this section is only necessary if you are unable to sign the application and mark it with an X instead. You will need to find two people to witness you marking an X in the signature box to sign and date the application in this section.

Section X: Alternate signer certification and signature

The Department of Veterans Affairs only requires completion of this section if you leave Item 33A blank, which is the veteran’s signature line. You need to use VA form 21-0972 titled Alternate Signer Certification and have it on file with the VA already before anyone can sign this section. Persons eligible to sign on your behalf include:

• Court-appointed representative
• Attorney authorized to act on your behalf under a durable power of attorney arrangement
• The person responsible for your care, including a spouse or other relative
• Manager or principal acting on behalf of an institution where you reside
• Persons over the age of 18

Section XI: Durable Power of Attorney Signature

This section only pertains if you have legal representation assisting you in completing the VA claim. The VA only considers veteran service officers (VSO), VA accredited attorneys, and VA accredited service organization agents eligible to sign this section. 

Step 1: Choose a claims process to file VA form 21-526EZ.

Your first option is to choose the fully developed claim program, which is optional and expedited. The fully developed claim program requires you to submit all required evidence to prove your current disability, including the following:

• All private treatment records, including hospital records and previous VA medical center, medical records related to your current disability. The medical evidence should prove a service-connected disability and must relate to your new disability or a pre-existing rated disability that worsened with your most recent military service. 
• Treatment records from a federal facility.
• Identify the location and sufficient information to obtain records from National Guard and Reserve personnel and service treatment records.
• Statements of support from family, friends, co-workers, law enforcement personnel, or veterans who completed military service at the same time as you did. If you choose to include one or more statements of support, ask the person filling it out to describe what they have witnessed related to your VA disability. People closest to you can also talk about when your current disability began and compare it to your physical and/or mental condition before your illness or injury.

The biggest benefit of choosing the fully developed claim program is that it enables the VA to make a decision more quickly. However, the VA can move you to the standard claim process if you discover additional information you would like to include, or the VA asks you to submit additional information. 

With the standard claim process, the VA takes on more responsibility for obtaining your medical records and other information needed to support your disability claim. You can submit additional medical evidence for up to 12 months after starting the standard claim process.

You will need to include a completed form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, with VA form 21-526EZ. 

The VA will notify you if any service provider from which it requests medical evidence requires a fee. If so, you can switch to a fully developed claim and submit the medical records yourself if you wish.

You should check the box under Item 1 on VA form 21-526EZ if you want to opt into the standard claim process. Pay close attention to the special circumstances section and follow instructions if any of the special circumstances apply to you.

Step 2: Choose how to file 

The VA provides multiple options for filing VA form 21-526EZ to initiate a disability claim or request an increase in existing disability benefits. The first is to complete the application on the VA’s eBenefits platform and submit it via www.va.gov. You can also complete a direct upload at access.va.gov.  

If you prefer to mail your application for disability benefits, send it to the Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville WI 53547-4444. You can also drop the completed application off at your local VA regional office. Just click this link to locate the regional office nearest you. 

The final option for submitting your application for VA benefits is to access a legal representative through a veteran’s services organization, VA accredited agent, or VA accredited attorney. You will need to sign paperwork giving this person authorization to submit disability eligibility documents on your behalf. 

Section IV: Exposure Information – VA Form 21-526EZ

Updated December 29th, 2022: A new section of the VA Form 21-526EZ has been added that includes PACT ACT details, including toxic exposures.

• 15A: Are you claiming any conditions related to toxic exposures?
• 15B: Did you serve in any of the following Gulf War hazard locations?
• 15C: Did you serve in any of the following Herbicide (e.g. Agent Orange) locations?
• Have you been exposed to any of the following?
• If you were exposed multiple times, please provide all additional dates and locations of potential exposure.

The VA uses this form to determine eligibility for the following benefits and programs:

• Automobile Allowance and Adaptive Equipment
• Benefits Based on a Veteran’s Seriously Disabled Child
• Compensation Claims Submitted Prior to Discharge
• Disability Service Connection
• Increased Disability Compensation
• Individual Unemployability (common way to reach 100% disability compensation)
• Secondary Service Compensation
• Special Monthly Compensation 
• Specially Adapted Housing and Special Home Adaptation
• Temporary Total Disability Rating