VA Form 21-526 Veteran's Application for Compensation and/Or Pension

What Is VA Form 21-526?

VA Form 21-526, Veterans Application for Compensation and/or Pension is a form filed by veterans who currently have a disability that was caused by an injury, disease, or an event in military service and wish to apply for compensation or pension benefits.

The latest edition of the application was released by the Department of Veterans Affairs (VA) in November 2014 with the June 2014 edition obsolete. An up-to-date VA Form 21-526 fillable version is available for digital filing and download below. Alternatively, it can be found through the VA website.

If you are a veteran, you may elect a county or national Veterans' Service Organization (VSO) representative to help you with your application. Depending on the type of designated representative, the VA will send you one of the following forms:

  • The VA Form 21-22 (Appointment of Veterans Service Organization as Claimant's Representative);
  • The VA Form 21-22A (Appointment of Individual as Claimant's Representative).
ADVERTISEMENT
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE
VETERAN'S APPLICATION FOR COMPENSATION AND/OR PENSION
IMPORTANT - Please read the information below carefully to help you complete this form more quickly and
accurately. Some parts of the form also contain notes or specific instructions for completing that part.
Frequently Asked Questions
What do I use VA Form 21-526 for?
Use VA Form 21-526 to apply for compensation and/or pension benefits.
Should I apply for compensation or pension benefits?
You should apply for compensation benefits if:
You currently have a disability that is the result of an injury, disease,
or an event in military service.
You should apply for pension benefits if all of the following are true:
You are age 65 or older or are permanently and totally disabled.
You served on active duty with at least one day during a period of war.
Your income and net worth does not exceed certain limits. Visit our web site
at
https://www.benefits.va.gov/pension/current_rates_veteran_pen.asp
for the
maximum yearly income we allow.
Note: Attach current medical evidence showing that you are permanently and totally disabled.
IMPORTANT: If you are a veteran who is age 65 or older, or determined to be disabled by the Social Security
Administration, you DO NOT have to submit medical evidence with your application unless you are filing for special
monthly pension. Special monthly pension is an allowance that may be paid to individuals who, due to mental or physical
disability, require the assistance of another person to perform the basic activities of daily living, or their ability to leave
home is very limited.
May I apply electronically?
You can apply for VA disability compensation and pension online through eBenefits at www.ebenefits.va.gov. For
disability compensation claims, you can also upload all supporting evidence you may have and make your claim a Fully
Developed Claim. To file a claim for VA disability compensation electronically, go to eBenefits, select Apply for Benefits
and then select Apply for Disability Compensation. You will need to create an eBenefits account to apply for disability
compensation online. To file a claim for VA pension electronically, go to eBenefits, select Apply for Benefits, and then
select Apply for Veterans Benefits via VONAPP. Once you submit your claim, you can track the status using eBenefits.
NOTE: You can contact an accredited Veterans Service Officer to assist you with your application.
What parts of the form should I complete?
You should complete only the parts related to the benefit for which you are applying:
If you are applying for compensation ONLY, skip parts VII, VIII, IX, X.
If you are applying for pension, complete the ENTIRE form.
If you need more space to answer a question or have a comment about a specific item on this
form, please place it in Part XIII, Item 45, "Remarks." Please identify your answer or
comment by the part and item number.
VA FORM
21-526
SUPERSEDES VA FORM 21-526, JUN 2014,
PAGE 1
NOV 2014
WHICH WILL NOT BE USED.
INFORMATION AND INSTRUCTIONS FOR COMPLETING THE
VETERAN'S APPLICATION FOR COMPENSATION AND/OR PENSION
IMPORTANT - Please read the information below carefully to help you complete this form more quickly and
accurately. Some parts of the form also contain notes or specific instructions for completing that part.
Frequently Asked Questions
What do I use VA Form 21-526 for?
Use VA Form 21-526 to apply for compensation and/or pension benefits.
Should I apply for compensation or pension benefits?
You should apply for compensation benefits if:
You currently have a disability that is the result of an injury, disease,
or an event in military service.
You should apply for pension benefits if all of the following are true:
You are age 65 or older or are permanently and totally disabled.
You served on active duty with at least one day during a period of war.
Your income and net worth does not exceed certain limits. Visit our web site
at
https://www.benefits.va.gov/pension/current_rates_veteran_pen.asp
for the
maximum yearly income we allow.
Note: Attach current medical evidence showing that you are permanently and totally disabled.
IMPORTANT: If you are a veteran who is age 65 or older, or determined to be disabled by the Social Security
Administration, you DO NOT have to submit medical evidence with your application unless you are filing for special
monthly pension. Special monthly pension is an allowance that may be paid to individuals who, due to mental or physical
disability, require the assistance of another person to perform the basic activities of daily living, or their ability to leave
home is very limited.
May I apply electronically?
You can apply for VA disability compensation and pension online through eBenefits at www.ebenefits.va.gov. For
disability compensation claims, you can also upload all supporting evidence you may have and make your claim a Fully
Developed Claim. To file a claim for VA disability compensation electronically, go to eBenefits, select Apply for Benefits
and then select Apply for Disability Compensation. You will need to create an eBenefits account to apply for disability
compensation online. To file a claim for VA pension electronically, go to eBenefits, select Apply for Benefits, and then
select Apply for Veterans Benefits via VONAPP. Once you submit your claim, you can track the status using eBenefits.
NOTE: You can contact an accredited Veterans Service Officer to assist you with your application.
What parts of the form should I complete?
You should complete only the parts related to the benefit for which you are applying:
If you are applying for compensation ONLY, skip parts VII, VIII, IX, X.
If you are applying for pension, complete the ENTIRE form.
If you need more space to answer a question or have a comment about a specific item on this
form, please place it in Part XIII, Item 45, "Remarks." Please identify your answer or
comment by the part and item number.
VA FORM
21-526
SUPERSEDES VA FORM 21-526, JUN 2014,
PAGE 1
NOV 2014
WHICH WILL NOT BE USED.
Where can I get help?
You can ask VA to help you fill out the form by contacting a regional office or call center. Before you contact us, make
sure you gather the necessary materials and complete as much of the form as you can. You can contact VA in the
following ways:
By internet:
https://iris.va.gov
In person: You can locate the address of the closest regional office at
http://www.va.gov/directory
or in your telephone book blue pages under
"United States Government, Veterans"
By telephone: Please call one of the following telephone numbers:
1-800-827-1000
Relay Number 711 (Hearing Impaired TDD line)
1-412-395-6272 (If living outside the U.S.)
You can also contact a county or national veterans' service organization (VSO) representative to help you with your claim.
If you want to use a representative to help you, consult your local telephone book to contact a particular VSO or
contact the closest VA office. Depending on the type of representative you want to designate, we will send you one of the
following forms:
VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative
VA Form 21-22A, Appointment of Individual as Claimant's Representative
What should I do when I have finished my application?
You should provide your signature in Part XII, Item 42A. Be sure to sign every form you fill out
before you send it to us. If you don't sign the form, VA will return it for you to sign, and it will
take longer for us to process.
Attach any materials that support and explain your claim.
Mail or take your application to the closest VA regional office. VA regional office addresses are
available on the internet at
http://www.va.gov/directory
Do I need to keep a copy of my application?
It is important that you keep a copy of all completed forms and materials you give to VA.
Social Security and Supplemental Security Income Benefits
Social Security and Supplemental Security Income are two Federal programs that help people with disabilities. While
these programs are different in many ways, the Social Security Administration (SSA) administers both programs. If you
think you have a disabling condition, you may qualify for benefits under one or both of these programs and should contact
Social Security.
How can I contact SSA if I have questions?
You can find answers to most questions and file a claim online at www.socialsecurity.gov. Specific information is
available for active duty military, veterans, and their families at www.socialsecurity.gov/woundedwarriors.
You can also contact SSA in the following ways:
By phone: (Monday-Friday, 7 a.m. - 7 p.m. EST) at one of the following toll-free numbers:
1-800-772-1213
Relay Number 711 (TDD if you are deaf or hard of hearing)
By mail or in person: You can locate the address of the Social Security office nearest to you in your
telephone book blue pages under "United States Government, Social Security Administration".
PAGE 2
SPECIFIC INSTRUCTIONS FOR VA FORM 21-526
Part II - Nature and History of Service-Related Disability(ies)
What disabilities should I list?
List the disease(s) or medical condition(s) that form the basis of your claim for service connected compensation. Be as
specific as you can. Indicate the approximate date the disability began and the place of treatment.
Do I have to include any records with this claim form?
If you have records that support your claim, you should attach them to this form. VA will help you obtain records by
requesting them from the person, company, or agency that has them. On this form you must tell us the name and address
of the person, company or agency that has these records, the approximate time frame covered by them, and the condition
for which you were treated. If you received treatment from a non VA health care provider complete and return
VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA Form
21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA), in order for VA
to obtain your treatment records. Additional VA Forms 21-4142a can be obtained from the VA forms web site at
www.va.gov/vaforms.
Part III - Active Duty Service Information
Do I need to include my active duty service information?
Please provide the information for each period of active duty (provide a copy of your DD214 or other separation
papers for all periods of active duty service).
Part IV - Reserve and National Guard Service Information
What If I have Reserve or National Guard Service?
This section tells us if you were a member of the Reserve or National Guard. Complete information for each period of
Reserve and National Guard service. Provide a copy of your DD214 or other separation papers for all periods of active
service.
Part V - Military Retired/Severance Pay
What If I have received or will receive military pay?
This section asks about your military severance or separation pay, the type, and the amount. If you currently receive
military retired pay, we may reduce your retired pay by the amount of any compensation that we award. It is to your
advantage because VA compensation is not taxable while retired pay is taxable. However, if you wish to receive military
retired pay rather than VA compensation, you must check the box in Item 25. Some veterans receive various readjustment,
separation, or severance pay from service departments which may be recouped in full or in part from VA benefit
payments.
Part VI - Marital and Dependency Information
Who can I count as a dependent spouse?
A spouse is a person who is married to the veteran (authority: 38 U.S.C. subsection 101(31)). If you are certifying that you
are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your spouse
resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when
you became eligible for benefits) (38 U.S.C. § 103(c)). Additional guidance on when VA recognizes marriages is
available at http://www.va.gov/opa/marriage/.
Note: It is important that you provide your marital history and that of your spouse.
Who can be recognized as a dependent child?
VA recognizes the veteran's biological child, adopted child, and stepchild. However, the child must be unmarried and:
under the age of 18, or
at least 18 but under 23 and pursuing an approved course of education, or
permanently incapable of self support before reaching the age of 18.
PAGE 3
SPECIFIC INSTRUCTIONS FOR VA FORM 21-526 (Continued)
Part VII - Non-Service Connected Pension
This section asks you to provide the disabilities that prevent you from working. We also ask you to tell us if you require
the regular assistance of another person, if you are housebound, if you are in a nursing home, if you are in
receipt of Social Security, or if you have applied for Medicaid.
Part VIII - Income Information
This section asks you to provide specific information about the monthly income you and your dependants receive from all
sources. Report the gross amount you receive monthly before deductions are taken out for taxes, health care, insurance,
etc. Do not leave any blank boxes in this section! Complete each box with either a dollar figure, "0", or "none." If you
expect to receive payment, but you don't know how much it will be, write "Unknown" in the space. If you are not sure
about a particular type of income, report it and provide a full explanation of its source. If you are receiving monthly
benefits from any source and have a copy of your most recent award letter, please include a copy of the letter with your
application.
Part IX - Net Worth
This section asks you to provide specific information about your net worth and that of your dependents. Do not leave any
blank boxes in this section! Complete each box with either a dollar figure, "0", or "none."
Net worth is the market value of all interest and rights in any kind of property, after subtracting any mortgages and
other claims against the property. List all assets except the house in which you live, any reasonable area of land on
which it sits, and those items you use everyday, such as your vehicle, clothing and furniture.
Clearly indicate if you and your spouse jointly share assets (such as money in a joint checking account). Report the value
of farms or buildings that you or a dependent owns as "real property."
You must disclose all financial transactions that involve a transfer of assets that occurred within the last three years, even
if the transaction occurred prior to the date of your application for VA pension. A gift of property or a sale below the
property's value to a relative residing in the same household does not reduce net worth. Likewise, a gift of property to
someone other than a relative residing in your household does not reduce net worth unless it is clear that you have
relinquished all rights of ownership, including the right to control the property. Send in a separate sheet of paper listing all
asset transfers, including the date and type of transfer.
Part X - Medical, Legal or Other Expenses
When determining your eligibility for pension, we may be able to deduct unreimbursed medical expenses from your
income for the year in which the expenses are paid. Report the amount of unreimbursed medical expenses, including the
Medicare deductions you paid (out-of-pocket) for yourself or relatives you are under an obligation to support. Also, show
medical, legal, or other expenses you paid because of a disability for which civilian disability benefits have been awarded.
Do not report any expenses you did not pay or expenses for which you were or will be reimbursed.
PRIVACY ACT INFORMATION: The VA will not disclose information collected on this form to any source other than what has been authorized
under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional
communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a
party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel
administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and
Employment Records - VA, published in the Federal Register. Your obligation to respond is voluntary; however, no allowance of compensation or
pension may be granted unless this form is completed fully as required by law. Giving us you and your dependents' Social Security numbers is
mandatory. Applicants are required to provide their SSN and the SSN of any dependents for whom benefits are claimed under Title 38 USC 5101 (c)
(1). The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by a Federal
Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is considered relevant and necessary to determine
maximum benefits under the law. Information submitted is subject to verification through computer matching programs with other Federal or state
agencies. Income and employment information furnished by you will be compared with information obtained by VA from the Secretary of Health
and Human Services or the Secretary of the Treasury under clause (viii) of section 6103(1)(7)(D) of the Internal Revenue Code of 1986.
RESPONDENT BURDEN: We need this information to determine your eligibility for compensation and/or pension (38 U.S.C. 5101). Title 38,
United States Code, allows us to ask for this information. We estimate that you will need an average of 1 hour to review the instructions, find the
information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You
are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB
Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or
suggestions about this form.
PAGE 4
OMB Control No. 2900-0001
Respondent Burden: 1 hour
Expiration Date: 8/31/2017
VETERAN'S APPLICATION FOR COMPENSATION AND/OR PENSION
IMPORTANT - Read information and instructions carefully before completing the form. Type, print, or write plainly.
(DO NOT WRITE IN THIS SPACE)
(VA DATE STAMP)
PART I - VETERAN'S INFORMATION
1. FOR WHAT BENEFIT ARE YOU APPLYING?
COMPENSATION
PENSION
BOTH COMPENSATION AND PENSION
(
2. HAVE YOU PREVIOUSLY APPLIED FOR ANY VA BENEFIT
S)? (Check applicable box)
(Specify)
PENSION
COMPENSATION
OTHER
3. FIRST, MIDDLE, LAST NAME OF VETERAN
4A. VETERAN'S SOCIAL SECURITY NO.
4B. VA FILE NUMBER (If applicable)
4C. SPOUSE'S SOCIAL SECURITY NO.
4D. IF YOU SERVED UNDER ANOTHER NAME, GIVE NAME AND PERIOD DURING WHICH YOU SERVED AND SERVICE NO.
.
5
MAILING ADDRESS (Number and street or rural route, city or P.O., State and ZIP Code)
(If applicable)
6. TELEPHONE NUMBER(S) (Include Area Code)
7. E-MAIL ADDRESS
A. DAYTIME
B. EVENING
C. CELL
8B. PLACE OF BIRTH
9. SEX
8A. DATE OF BIRTH (Month, day, year)
MALE
FEMALE
10B. WHEN WAS THE CLAIM FILED?
10C. FOR WHAT DISABILITY ARE YOU
10A. HAVE YOU EVER FILED A CLAIM FOR COMPENSATION FROM
(Mo., day, yr.)
RECEIVING BENEFITS?
THE OFFICE OF WORKERS' COMPENSATION PROGRAMS?
(Formerly the U.S. Bureau of Employees Compensation)
(If "Yes," complete Items 10B & 10C)
YES
NO
PART II - NATURE AND HISTORY OF SERVICE-RELATED DISABILITY(IES) (If you need more space please use Item 45, "Remarks")
11. PLEASE PROVIDE NATURE OF SICKNESS, DISEASE, OR INJURIES FOR WHICH THIS CLAIM IS MADE; DATE EACH BEGAN; AND PLACE OF TREATMENT
A. LIST DISABILITY(IES)
B. DATE BEGAN
C. PLACE OF TREATMENT
12B. DATES OF TREATMENT/CARE
12C. NAME AND ADDRESS OF VA MEDICAL FACILITY
12A. ARE YOU NOW OR HAVE YOU RECEIVED
(If you need more space use Item 45, "Remarks")
TREATMENT OR DOMICILIARY CARE AT A VA
Month
Day
Year
MEDICAL FACILITY?
(If "Yes,"complete Items 12B &12C)
YES
NO
13A. HAVE YOU EVER BEEN A PRISONER OF WAR?
13B. NAME OF COUNTRY
13C. DATES OF CONFINEMENT
FROM
TO
YES
NO
(If "Yes," complete Items 13B and 13C)
14. ARE YOU CLAIMING A DISABILITY RELATED TO AGENT ORANGE OR
15. ARE YOU CLAIMING A DISABILITY RELATED TO ASBESTOS
OTHER HERBICIDE EXPOSURE? (If "Yes," list disability(ies) below)
EXPOSURE? (If "Yes," list disability(ies) below)
YES
NO
YES
NO
17. ARE YOU CLAIMING A DISABILITY RELATED TO IONIZING RADIATION
16. ARE YOU CLAIMING A DISABILITY RELATED TO MUSTARD GAS EXPOSURE?
(If "Yes," list disability(ies) below)
EXPOSURE? (If 'Yes," list disability(ies) below)
YES
NO
YES
NO
18. ARE YOU CLAIMING A DISABILITY RELATED TO AN ENVIRONMENTAL HAZARD EXPOSURE DURING THE GULF WAR? (If "Yes," list disability(ies) below)
YES
NO
YOU MUST SIGN AND PRINT YOUR NAME AND DATE THIS FORM IN ITEMS 42A THRU 42C ON PAGE 10.
VA FORM
21-526
SUPERSEDES VA FORM 21-526, JUN 2014,
PAGE 5
NOV 2014
WHICH WILL NOT BE USED.

Download VA Form 21-526 Veteran's Application for Compensation and/Or Pension

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What Is VA Form 21-526 Used for?

The form is used as an application to request compensation or pension benefits from the VA.

All veterans with a service-related disability are eligible to apply for VA compensation benefits. A veteran is eligible to apply for a VA pension if they are 65 years of age or older, have a total and permanent disability and were on active duty for at least a single day during a period of war. The income of applicants must not exceed certain limits prescribed by the VA.

How to Fill Out VA Form 21-526?

The form is distributed with filing guidelines and FAQ provided on the first pages of the form. Step-by-step instructions for the VA Form 21-526 can be found below.

VA Form 21-526 Instructions

All sections of the form must be filled out in order to apply for a pension. When applying for compensation benefits parts VII, VIII, IX, X should be skipped.

  1. Part I requires information about the veteran and the type of benefit they are applying for. The required personal information includes the Veteran's full name, Social Security Number (SSN), VA file number, the date and place of birth, gender and their spouse's SSN - if applicable. This part should also contain the veteran's mailing address, phone number, and email address. If there were any VA 21-526 forms submitted previously, this should also be reflected in Part I;
  2. Part II is for information about the nature and history of the veteran's service-related disability. The required information includes when the disability has first manifested, the treatment received and the main cause of the condition;
  3. Part III, Information about Active Duty. This part requires information on the time period of service, service number, date of separation from the service, branch of service, organization, grade, and rank;
  4. Part IV, Reserve and National Guard service information. This part requires specifying whether the cause of disability occurred during active duty or training. If the applicant is a member of the Reserve or National Guard at the moment of filing the application, this should be reflected;
  5. Part V, Information about retired pay or severance pay. Enter the veteran's retired status and their desire to receive VA compensation in lieu of military retired pay;
  6. Part VI, Information about the veteran's spouse and dependents;
  7. Part VII, Information about a requested non-service connected pension;
  8. Part VIII, Income information. This part contains a table for income data and requires information about an income received from renting property or any business operation for the last 12 months, income from the operation of a farm for the last 12 months and the possibility of a change in income;
  9. Part IX, Veteran's net worth information. Part X, Information about any recurring medical, legal or other expenses. Part XI, Direct deposit data.
  10. Part XII, Certification, authorization, and signatures of the veteran and representative. Additional remarks must be provided in Part XIII.

VA 21-526 Related Forms

The VA 21-526 is a part of the VA 21-526 forms series. The other three forms in the series are the following:

  1. The VA Form 21-526b (Veteran's Supplemental Claim for Compensation), used to file a claim for increase of benefits, to reopen previously denied VA claims or to claim for secondary service connection.
  2. The VA Form 21-526c (Pre-Discharge Compensation Claim), used with Benefits Delivery at Discharge (BDD) or Quick Start Claims.
  3. The VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits), used for submitting claims for Veterans' disability compensation and related compensation benefits.
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