VA Form 21-526B Veteran's Supplemental Claim for Compensation

What Is VA Form 21-526b?

VA Form 21-526b, Veteran's Supplemental Claim for Compensation is a multi-purpose form used for providing information to the Department of Veteran Affairs (VA).

The latest version of the form was released by the VA in June 2014 with all previous editions obsolete. A VA Form 21-526b fillable version is available for download below or can be found through the VA website.

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OMB Control No. 2900-0001
Respondent Burden: 15 minutes
Expiration Date: 6/30/2017
VA DATE STAMP
DO NOT WRITE IN THIS SPACE
VETERAN'S SUPPLEMENTAL CLAIM FOR COMPENSATION
IMPORTANT: PLEASE READ THE PRIVACY ACT NOTICE AND RESPONDENT BURDEN INFORMATION
BELOW BEFORE COMPLETING THIS FORM.
PART I - VETERAN'S IDENTIFYING INFORMATION
1. NAME OF VETERAN (First, Middle, Last)
2. VETERAN'S SOCIAL SECURITY NUMBER
3. VA FILE NUMBER
4. VETERAN'S ADDRESS (Number, street or rural route, City or P.O., State and ZIP Code)
5. TELEPHONE NUMBER(S)
6. E-MAIL ADDRESS (If applicable)
A. DAYTIME (Include Area Code)
B. EVENING (Include Area Code)
PART II - INFORMATION ABOUT CLAIM
7. I WOULD LIKE TO FILE A CLAIM FOR: (Check all that apply)
INCREASED EVALUATION OF THE DISABILITY(IES) FOR WHICH I AM ALREADY SERVICE CONNECTED (Provide the name of the disability(ies))
SERVICE CONNECTION FOR NEW DISABILITY(IES) (List your new disability(ies))
REOPENING OF PREVIOUSLY DENIED DISABILITY(IES) (List your previously denied disability(ies))
DISABILITY(IES) SECONDARY TO MY EXISTING SERVICE CONNECTED DISABILITY(IES)
(Provide the name of the disability(ies) and your service connected condition(s))
8A. NAME AND LOCATION OF VA MEDICAL CENTER THAT HAS MY
8B. NAME AND ADDRESS OF MILITARY FACILITY THAT HAS MY RELEVANT
RELEVANT TREATMENT RECORDS
TREATMENT RECORDS
8C. DO YOU HAVE PRIVATE TREATMENT RECORDS?
YES
NO
(If "Yes," please attach the treatment records to this form. If you would like to have VA request your private treatment records, please attach a
VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, for each private treatment provider.
The form is available at www.va.gov/vaforms.)
9. I WOULD LIKE TO FILE A CLAIM FOR OTHER VA BENEFITS (Check appropriate box)
OTHER (Specify benefit)
AID AND ATTENDANCE
AUTOMOBILE ALLOWANCE
IMPORTANT - 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/.
A. SPOUSE'S NAME
B. SPOUSE'S SOCIAL SECURITY NO.
10. I WOULD LIKE TO FILE A CLAIM FOR ADDITIONAL BENEFITS BECAUSE MY
SPOUSE IS SERIOUSLY DISABLED (Please provide spouse's name and social
security number in Items 10A & 10B)
11A. VETERAN'S SIGNATURE (Do NOT print)
11B. DATE SIGNED
PRIVACY ACT NOTICE: 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 required to obtain or retain benefits. Giving us your SSN account information is
mandatory. Applicants are required to provide their SSN 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
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. The responses you submit are considered
confidential (38 U.S.C. 5701). Information that you furnish may be utilized in computer matching programs with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to
collect any amount owed to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.
RESPONDENT BURDEN: We need this information to make an eligibility determination for veterans' filing supplemental compensation claims (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 15 minutes 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.
21-526b
VA FORM
SUPERSEDES VA FORM 21-526b, MAY 2010,
JUN 2014
WHICH WILL NOT BE USED.
OMB Control No. 2900-0001
Respondent Burden: 15 minutes
Expiration Date: 6/30/2017
VA DATE STAMP
DO NOT WRITE IN THIS SPACE
VETERAN'S SUPPLEMENTAL CLAIM FOR COMPENSATION
IMPORTANT: PLEASE READ THE PRIVACY ACT NOTICE AND RESPONDENT BURDEN INFORMATION
BELOW BEFORE COMPLETING THIS FORM.
PART I - VETERAN'S IDENTIFYING INFORMATION
1. NAME OF VETERAN (First, Middle, Last)
2. VETERAN'S SOCIAL SECURITY NUMBER
3. VA FILE NUMBER
4. VETERAN'S ADDRESS (Number, street or rural route, City or P.O., State and ZIP Code)
5. TELEPHONE NUMBER(S)
6. E-MAIL ADDRESS (If applicable)
A. DAYTIME (Include Area Code)
B. EVENING (Include Area Code)
PART II - INFORMATION ABOUT CLAIM
7. I WOULD LIKE TO FILE A CLAIM FOR: (Check all that apply)
INCREASED EVALUATION OF THE DISABILITY(IES) FOR WHICH I AM ALREADY SERVICE CONNECTED (Provide the name of the disability(ies))
SERVICE CONNECTION FOR NEW DISABILITY(IES) (List your new disability(ies))
REOPENING OF PREVIOUSLY DENIED DISABILITY(IES) (List your previously denied disability(ies))
DISABILITY(IES) SECONDARY TO MY EXISTING SERVICE CONNECTED DISABILITY(IES)
(Provide the name of the disability(ies) and your service connected condition(s))
8A. NAME AND LOCATION OF VA MEDICAL CENTER THAT HAS MY
8B. NAME AND ADDRESS OF MILITARY FACILITY THAT HAS MY RELEVANT
RELEVANT TREATMENT RECORDS
TREATMENT RECORDS
8C. DO YOU HAVE PRIVATE TREATMENT RECORDS?
YES
NO
(If "Yes," please attach the treatment records to this form. If you would like to have VA request your private treatment records, please attach a
VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, for each private treatment provider.
The form is available at www.va.gov/vaforms.)
9. I WOULD LIKE TO FILE A CLAIM FOR OTHER VA BENEFITS (Check appropriate box)
OTHER (Specify benefit)
AID AND ATTENDANCE
AUTOMOBILE ALLOWANCE
IMPORTANT - 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/.
A. SPOUSE'S NAME
B. SPOUSE'S SOCIAL SECURITY NO.
10. I WOULD LIKE TO FILE A CLAIM FOR ADDITIONAL BENEFITS BECAUSE MY
SPOUSE IS SERIOUSLY DISABLED (Please provide spouse's name and social
security number in Items 10A & 10B)
11A. VETERAN'S SIGNATURE (Do NOT print)
11B. DATE SIGNED
PRIVACY ACT NOTICE: 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 required to obtain or retain benefits. Giving us your SSN account information is
mandatory. Applicants are required to provide their SSN 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
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. The responses you submit are considered
confidential (38 U.S.C. 5701). Information that you furnish may be utilized in computer matching programs with other Federal or state agencies for the purpose of determining your eligibility to receive VA benefits, as well as to
collect any amount owed to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.
RESPONDENT BURDEN: We need this information to make an eligibility determination for veterans' filing supplemental compensation claims (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 15 minutes 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.
21-526b
VA FORM
SUPERSEDES VA FORM 21-526b, MAY 2010,
JUN 2014
WHICH WILL NOT BE USED.

Download VA Form 21-526B Veteran's Supplemental Claim for Compensation

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What Is VA Form 21-526b Used for?

VA Form 21-526b is a one-page form, used in conjunction with other claim forms, the so-called original claims. These forms belong to the VA 21-526 series, which includes:

  1. VA Form 21-526, Veterans Application for Compensation and/or Pension, used for applying for compensation and pension benefits;
  2. VA Form 21-526c, Pre-Discharge Compensation Claim, used for filing a pre-discharged claim. Pre-discharged claims are filed in advance, while a service member is on active duty;
  3. VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, used for filing a rating-related original, secondary, or increased disability service-connected claim for life compensation.

Original claims are the first formal claims, after it is filed and the VA Rating Officer has made a decision on it, the claim should be referred to as reopened claim. All further claims should be filed using the VA Form 21-526b. This form can be used to reopen an original claim that was previously denied. The claim form can also be used to claim for aid and assistance, for one-time automobile allowance, and for new non-original claims.

VA Form 21-526b Instructions

Form VA 21-526b is distributed without the filling guidelines. The instructions for completing the form are below.

How to Fill out VA Form 21-526b?

The form consists of two parts:

Part I. Veteran's Identifying information.

  1. Enter your full name in Box 1.
  2. Indicate your social security number in Box 2.
  3. Type your VA file number in Box 3.
  4. Provide your full address including ZIP code in Box 4.
  5. Enter your daytime and evening phone numbers with area codes in Boxes 5a and 5b.
  6. Enter your e-mail address, if applicable, in Box 6.

Part II. Information about the Claim.

  1. The appropriate option should be checked and explained in the provided space in Box 7. Increased evaluation of the already service-connected disability requires the name of the disability. New service-connected disability option requires a brief description of the disability. Reopening of the previously denied disability should contain the list of the denied disabilities. The secondary to the service-connected disabilities option should contain the list of such disabilities and service connected conditions.
  2. Provide the name and location of the medical or medical military facility that holds your medical records the Boxes 8a and 8b. If you have the records, attach them to the form and indicate this in Box 8c.
  3. If you would like the VA to request your private medical records, file the VA form 21-4142, Authorization To Disclose Information to the Department of Veterans Affairs (VA) and attach it to the VA form 21-526b. If you would like to file a claim for aid and attendance, automobile allowance or other claims, indicate this in Box 9. This part should also contain the name and the location of the medical or military facility that keeps your medical records. If you have the records, attach them to the form. If you wish to file a secondary claim for your disabled spouse, indicated this in Box 10 and provide your spouse's name and social security number in Boxes 10a and 10b.
  4. Sign and date the form in Boxes 11a and 11b.

Where to Send VA Form 21-526b?

There are three options to submit the VA Form 21-526b. The claim can be filed online using the VA website. The form can be printed out, completed manually and mailed to the nearest claims intake center. The form can be also filed electronically and emailed to the VA with other necessary papers.

The claimant can also contact an accredited Veterans Service Organization and receive assistance in filing their claim. VSOs are private non-profit groups that advocate on behalf of veterans, service members, dependents, and survivors. Accredited representatives may also work for the state or county government entities. Recognized organizations and individuals, whether congressionally chartered VSOs or VA accredited claims agents or attorneys, can legally represent a Veteran before the VA.