VA Form 21-526EZ is the Department of Veterans Affairs formal Application for Disability Compensation and Related Compensation Benefits. Under most circumstances, the submission of Form 21-526EZ initiates a disability-related claim and is the first step in receiving benefits for a service-related disability, disease, or disorder.
Assessing Your Eligibility for Compensation
The Department of Veterans Affairs only offers disability-related benefits to former servicemen and women who were injured in the military. A disability could be physical, psychological, or emotional. However, before filing a claim, Veterans must ensure that they meet one of the following three criteria:
- You sustained an injury or illness during active military duty and can provide documentation linking your current disability to a task you performed in the military. The Department of Veterans Affairs refers to these injuries as in-service disabilities.
- You were diagnosed with an injury or illness before beginning military service, but serving in the armed forces exacerbated or otherwise worsened your condition. The Department of Veterans Affairs refers to these injuries as pre-service disabilities.
- You have a disability that is related to your former military service, but never developed any complications after receiving an honorable discharge. The Department of Veterans Affairs refers to these injuries as post-service disabilities.
If you meet any of the above criteria, then you may use Form 21-526EZ to petition the Department of Veterans Affairs for disability-related compensation and other benefits.
The Base Components of Form 21-526EZ
The Department of Veterans Affairs provides benefits to former service people and their family members. However, Form 21-526EZ is intended for use by Veterans who have suffered, or are suffering, service-related disabilities.
While Form 21-526EZ may appear complicated, it serves several basic purposes:
- Apply for disability compensation. Filing Form 21-526EZ is the first step in every request for service-related disability compensation. When completing this form, you must provide information about your medical condition and symptoms, which the department uses to determine your disability code and rating.
- Provide evidence of a disability. The Department of Veterans Affairs will only process and approve Form 21-526EZ if it contains evidence supporting the applicant’s claim of a service-related disability or disabilities. Evidence could include medical records, official diagnoses, and your service history.
- Request related benefits. If you already have an approved disability claim, Form 21-526EZ can be used to request dependents’ compensation, special monthly compensation, and any other relevant benefits.
- Update information. Form 21-526EZ can also be used to update personal information, including your address, phone number, and bank details.
How to Fill Out Form 21-526EZ
VA Form 21-526EZ contains 13 separate sections, each of which serves a different purpose:
Section I: Veteran’s Identification Information
The first section of Form 21-526EZ asks for your basic identifying information, including your full name, date of birth, and Social Security number. While the Department of Veterans Affairs will sometimes overlook omissions, try to complete every item.
Section II: Change of Address
If you have changed or will change, your current mailing address, completing items 14A through 14C will inform the department of your updated address.
Section III: Homeless Information
You should only complete Section III: Homeless Information if you are homeless or believe that you may soon be homeless. Do not complete Section III if you are not homeless or at risk for homelessness.
Section IV: Exposure Information
The fourth section of VA Form 21-526EZ has been updated to reflect recent legislation expanding Veterans’ eligibility for toxic chemicals-related exposures. Refer to your service records to determine whether you have served in locations or theaters with known toxins exposures.
If you affirm any of the items in Section IV: Exposure Information, you should have service records detailing your dates and locations of deployment.
Section V: Claim Information
While completing Section V: Claim Information, you must be prepared to:
- Describe your current disability
- Establish a service connection, or a connection between your current disability and past military service
- Provide the dates on which exposure or occurred, and the approximate dates on which the disability began
If you have received treatment for any of the listed disabilities, you must enter the name and the location of the facility at which you received treatment on Lines 17A-B. If you have not yet received treatment, check Line 17C.
Section VI: Service Information
You must provide information about your military service, including your branch of service, service number, enlistment date, and the date of your honorable discharge. Only complete line 23A if you have ever been a prisoner of war.
Section VII: Service Pay
You should only complete Section VII if you are currently receiving any military service pay, such as:
- Military retired pay
- Separation pay
- Severance pay
Section VIII: Direct Deposit Information
If you have not already signed up for direct deposit and wish to receive benefits to your bank account, complete:
- Line 30, which asks for your account number, or the number of the account to which you would like funds deposited.
- Line 31, the name of your bank or other financial institution.
- Line 32, your bank’s routing number, which can be found on a personal check or your bank’s website.
Section IX: Claim Certification and Signature
Your claim is only valid if it signed, certifying that you have provided true and accurate information. Signatures should be made in ink.
Section X: Witness to Signature
If you cannot complete the application by hand or without assistance, you must find two witnesses to affirm that you have signed an “X” in place of a conventional written signature.
Section XI: Alternate Signer Certification and Signature
The Department of Veterans Affairs requires the completion of Section XI only if you have left the Veteran’s signature line incomplete. If you need an alternate signer, you must submit VA Form 21-0972, Alternate Signer Certification, and send a copy to the department before initiating your claim for disability benefits. An authorized alternate signer could be:
- A court-appointed representative
- An attorney
- A guardian
- A manager or principal
- Any authorized person over the age of 18
Section XII: Power of Attorney (POA) Signature
Your attorney, or attorney-in-fact, will complete Section XII if you are receiving legal assistance to complete Form 21-526EZ.
Section XIII: Claim Information (Addendum)
You may use Section XIII to add additional information about disabilities not already listed in Section V: Claim Information.
Contact a Veteran Affairs Disability Attorney Today
Navigating the Department of Veteran Affairs’ bureaucracy can be time-consuming and difficult, even for Veterans who have experience completing legal paperwork. While you do not need a lawyer to claim disability benefits, Sean K. Kendall, Attorney at Law, has found that Veterans with competent legal representation are more likely to receive compensation than Veterans without an advocate.
If you, or a loved one, have questions about completing Form 21-526EZ or another Department of Veteran Affairs request, please send Sean K. Kendall, Attorney at Law, a message online or call us toll-free at 877-629-1712 to schedule your free, no-obligation consultation as soon as possible.