Veteran Filling Out Form 21 4192The United States Department of Veteran Affairs provides benefits to former and active-duty servicepeople who have been injured in the armed forces. If a service-related condition becomes disabling, Veterans can apply for individual unemployability benefits. Individual unemployability benefits pay at a 100% rate, even for disabilities that have been accorded a lower rating.

However, these benefits can be difficult to obtain. Veterans may be expected to submit evidence of their ailment and ask previous employers to send information about their work history.

Individual Unemployability Benefits

Individual benefits provide significant compensation for Veterans whose service-related condition, or conditions, prevents them from seeking or maintaining regular employment.

Under most circumstances, claimants must satisfy both of the following requirements to receive individual unemployability benefits:

  1. Service-related disability. Applicants must have at least one service-related disability rated at 60% or two or more service-related disabilities. If a Veteran has two or more disabilities, at least one disability must be rated at 40% or more disabling, providing a combined rating of 70% or higher.
  2. Unemployability. A former serviceperson may only receive individual unemployability benefits if their service-related conditions preclude them from finding regular employment.

Some Veterans may qualify for individual unemployability benefits even if they do not meet the above requirements. For example, a claimant could receive compensation if they have a lower-rated disability that requires frequent hospital visits or medical examinations.

However, the application for individual unemployability benefits—Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability—must be supported by underlying evidence. After the Department of Veterans Affairs has received Form 21-8940, it may ask claimants to obtain a statement from their most recent employer.

Department of Veteran Affairs Form 21-4192

The Department of Veteran Affairs typically requires that individual unemployability applicants complete VA Form 21-4192, Request for Employment Benefits in Connection with Claim for Disability Benefits. Unlike most other disability-related forms, VA Form 21-4192 requests relatively little information from Veteran applicants.

Department of Veterans Affairs Form 21-4192 is comprised of the following four sections:

Section I – Identification Information

The first section must be completed by the Veteran applicant. You should provide your:

  • Full name and middle initial in Item 3.
  • Social Security number in Item 4.
  • Department of Veterans Affairs file number in Item 5, if you already have a VA file number.
  • Date of birth.

The Department of Veteran Affairs can usually adjudicate disability claims, even if “Section I – Identification” information is incomplete. However, since Form 21-4192 is primarily intended for employers’ use, Veterans should fill in every item to avoid unnecessary delays.

Section II – Employment Information

Section II – Employment Information should only be completed by the Veteran’s most recent employer. This section asks questions about the following:

  • The Veteran’s dates of employment.
  • The applicant’s pay rate and hours worked. 
  • The claimant’s disability, and any disability-related concessions offered to the employee.

The second section of Form 21-4192 provides an opportunity for the Department of Veterans Affairs to assess how, if at all, an applicant’s disability has affected their work performance.

Section III – Reserve or National Guard Duty Status

You should only complete Section III if you are serving in the Reserve or National Guard.

Section IV – Information on Benefit Entitlement or Payments

Your most recent employer is responsible for completing “Section IV – Information on Benefit Entitlement or Payments,” which elicits information relating to:

  • Any retirement or illness-related benefits you are currently receiving from your most recent employer.
  • The type of benefits you are receiving from your most recent employer.
  • The date that benefits began and the date that benefits are expected to end.

The fifth section of VA Form 21-4192 also includes space for “remarks,” in which an employer may offer any additional information that the Department of Veteran Affairs should consider when adjudicating the initial individual unemployability benefits application.