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The VA Form 21-526B is a crucial document for veterans seeking to file supplemental claims for compensation. It provides veterans with an avenue to increase their evaluations for disabilities already recognized by the VA, claim service connection for new disabilities, or reopen previously denied claims. In addition, the form supports requests for benefits related to disabilities that are secondary to existing service-connected conditions. Completing this form requires specific personal information, including the veteran’s name, Social Security number, and details about their disabilities and medical treatment history. The form also prompts veterans to provide information on their spouse's disability status if applicable. Care should be taken to read the accompanying privacy notice and to follow the instructions carefully, as the information collected is essential for the VA to determine eligibility and calculate the appropriate benefits. Understanding the nuances of the form can greatly aid in navigating the complexities of the VA benefits system and securing the compensation deserved for service-related conditions.

Va 21 526B Example

OMB Control No. 2900-0001 Respondent Burden: 15 minutes Expiration Date: 6/30/2017

VETERAN'S SUPPLEMENTAL CLAIM FOR COMPENSATION

IMPORTANT: PLEASE READ THE PRIVACY ACT NOTICE AND RESPONDENT BURDEN INFORMATION BELOW BEFORE COMPLETING THIS FORM.

VA DATE STAMP

DO NOT WRITE IN THIS SPACE

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)

A. DAYTIME (Include Area Code)

B. EVENING (Include Area Code)

 

 

6.E-MAIL ADDRESS (If applicable)

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 RELEVANT TREATMENT RECORDS

8B. NAME AND ADDRESS OF MILITARY FACILITY THAT HAS MY RELEVANT 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)

AID AND ATTENDANCE

AUTOMOBILE ALLOWANCE

OTHER (Specify benefit)

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/.

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)

A. SPOUSE'S NAME

B. SPOUSE'S SOCIAL SECURITY NO.

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.

VA FORM

21-526B

SUPERSEDES VA FORM 21-526B, MAY 2010,

JUN 2014

 

WHICH WILL NOT BE USED.
Get Va 21 526B PDF Form

Form Characteristics

Fact Name Description
Form Purpose The VA Form 21-526B is used by veterans to file a supplemental claim for compensation for service-related disabilities.
Estimated Response Time Completing the form is expected to take an average of 15 minutes.
OMB Control Number The form is registered under OMB Control No. 2900-0001.
Privacy Act Notice The information collected on this form is protected under the Privacy Act of 1974 and may only be disclosed as authorized.
Expiration Date This version of the form expired on June 30, 2017.
Required Information Veterans must provide personal details, including their name, social security number, and information related to their claims.
State-Specific Law This form is governed by Title 38, United States Code, particularly for benefits eligibility and claims procedures.

Guidelines on Utilizing Va 21 526B

Filling out the VA 21-526B form is an important step in submitting your supplemental claim for compensation. After completing the form, you will need to gather your relevant documentation and either mail it or submit it online to the appropriate VA office. It’s crucial to be thorough and accurate to ensure that your claim is processed efficiently.

  1. Veteran's Identifying Information: Provide your full name (First, Middle, Last).
  2. Enter your Social Security Number.
  3. If known, fill in your VA File Number.
  4. Write your complete address, including street address, city, state, and ZIP code.
  5. List your daytime and evening telephone numbers, including area codes.
  6. If applicable, provide your email address.
  1. Information About Claim: Indicate what type of claim you want to file by checking all relevant options (Increased Evaluation, New Disability, Reopening Previous Claims, Secondary Disability).
  2. Provide the name and location of the VA Medical Center with your treatment records.
  3. If applicable, indicate the name and address of any military facility that has your treatment records.
  4. Answer whether you have private treatment records. If yes, attach those records or a VA Form 21-4142 for each provider.
  5. Specify any additional VA benefits you are filing for (Aid and Attendance, Automobile Allowance, Other).
  6. If claiming additional benefits due to a seriously disabled spouse, provide their name and Social Security number.
  1. Sign and Date: Sign the form where indicated and write the date you signed it.

What You Should Know About This Form

What is the VA Form 21-526B and what is its purpose?

The VA Form 21-526B is a document used by veterans to submit a supplemental claim for compensation. This form is crucial for veterans seeking increased benefits based on disabilities for which they are already recognized as service-connected, or for new disabilities. It's an essential tool for ensuring that veterans receive the benefits they deserve based on their service and health conditions.

Who should complete this form?

This form should be completed by veterans who wish to file a claim for various forms of compensation. This includes those looking to increase the evaluation of existing disabilities, establish service connection for new disabilities, or reopen previously denied claims. If a veteran has developed health issues that are related to their existing service-connected conditions, they should also use this form to file claims for secondary disabilities.

What information do I need to provide on the form?

When filling out the VA Form 21-526B, you'll need to provide personal information such as your name, Social Security number, VA file number, address, and contact numbers. Additionally, you’ll have to specify the nature of your claim—whether it’s for increased evaluation, new disabilities, previously denied claims, or secondary disabilities. Information regarding any relevant treatment records, both from VA medical centers and other healthcare providers, is also necessary.

How long will it take to complete the form?

The VA estimates that veterans will need about 15 minutes to review the instructions and complete the VA Form 21-526B. It is advisable to gather all necessary personal information and documentation beforehand to streamline the process. If you have private treatment records, gathering them prior to filling out the form can be particularly helpful.

What happens after I submit the form?

Once the VA receives the completed form, they will review the submitted information and any attached documentation. The VA will then make a determination regarding the claim. You will be notified of the decision, and if necessary, additional information may be requested. It's important to keep an eye on your communication channels for updates regarding your claim status.

Do I need to include my spouse's information?

You should include your spouse's information if you are filing for additional benefits based on their serious disability. This might influence the level of benefits you are eligible to receive. Make sure to provide their name and Social Security number where required on the form to ensure accurate processing of your claim.

Where can I find assistance if I have questions about the form?

If you have any questions regarding the VA Form 21-526B, you can reach out to the VA's toll-free number at 1-800-827-1000. This line is helpful for inquiries about the form itself, the claims process, or if you need guidance on gathering the required documentation. Additionally, there may be local veterans' service organizations that can provide support and assistance with your claim submission.

Common mistakes

Filling out the VA Form 21-526B can be an overwhelming task. One common mistake is not providing complete identifying information. Ensure all fields, such as the veteran's name, Social Security number, and VA file number, are accurately filled out. Missing data may result in delays in processing the claim.

Another frequent error involves incorrectly checking the boxes that specify the type of claim being filed. Each option requires careful consideration. For instance, if an increased evaluation is desired, the applicant must provide exact names of the disabilities involved. Incomplete selections can complicate the claim review process.

Failing to include treatment records is a significant oversight. If there are private medical records relevant to your claim, make sure to attach them. If assistance from the VA is requested to obtain these records, attaching the necessary VA Form 21-4142 is essential. Neglecting this step often leads to a lack of supporting documentation.

Improperly certifying marital status can also create issues. If claiming benefits based on a spouse's disability, ensure that the marriage meets the necessary legal criteria. Inconsistencies in information may result in complications or denials of benefits.

Leaving out the veteran's signature or the date signed is often seen as a trivial mistake, but it is crucial. This signature holds legal weight, affirming the validity of the claims submitted. Without it, the form is incomplete and cannot be processed.

Many applicants also overlook the importance of reviewing the Privacy Act notice and respondent burden information before submitting the form. Understanding the implications of providing personal information helps maintain informed consent. Ignoring these sections can lead to confusion down the line.

Lastly, not seeking help when necessary can hinder the process. Veterans may benefit from reaching out to veteran service organizations or legal assistance if there are uncertainties. Utilizing available resources ensures that the form is completed correctly and thoroughly, ultimately aiding in a smoother claims process.

Documents used along the form

The VA Form 21-526B, known as the Veteran's Supplemental Claim for Compensation, is often accompanied by several other forms and documents during the claims process. Below is a list of key forms that veterans may need to submit or reference alongside the 21-526B. Each document serves a specific purpose in ensuring that the claims process is thorough and accurate.

  • VA Form 21-4142: This form is used to authorize the Department of Veterans Affairs (VA) to obtain private medical records from healthcare providers. It is necessary for supporting claims with additional medical evidence.
  • VA Form 21-526EZ: The Fully Developed Claim form allows veterans to submit a claim with additional evidence already gathered. By using this form, the VA can process claims more quickly.
  • VA Form 21-530: Known as the Application for Burial Benefits, this form is required if the veteran is seeking benefits related to burial expenses. It helps the VA determine eligibility for such benefits.
  • VA Form 21-534: The Dependency and Indemnity Compensation (DIC) form is used by survivors of veterans to apply for benefits after a veteran's death. It helps ensure dependents receive the support they deserve.
  • VA Form 10182: The Decision Review Request form is used to appeal a decision made by the VA. This is essential when a veteran disagrees with the outcome of their claim.
  • VA Form 21-0781: This statement in support of a claim for service connection for PTSD is necessary when the veteran is claiming benefits based on post-traumatic stress disorder. It collects detailed information about the traumatic events experienced during service.
  • VA Form 21-8940: This form is used to apply for a total disability based on individual unemployability (TDIU). It is essential for veterans who are unable to secure or follow substantial employment due to service-connected conditions.
  • VA Form 21-2828: This form, known as the Application for Government Life Insurance, is essential for veterans who wish to apply for insurance benefits. It provides details necessary to establish eligibility and coverage options.

Each of these documents plays a critical role in the overall process, assisting veterans in obtaining the benefits they have earned. Properly completing and submitting these forms alongside VA Form 21-526B will significantly enhance the claim’s chances for approval. Understanding their purposes can streamline the process for veterans seeking assistance from the VA.

Similar forms

The VA Form 21-526B is used by veterans to file a supplemental claim for compensation. Several other documents serve similar purposes in helping veterans gain access to benefits. Here’s a list of those documents:

  • VA Form 21-526EZ: This is a simplified claim application for veterans seeking service-connected compensation. Unlike the 21-526B, it requires less documentation and is intended for first-time claims or those seeking to reopen a claim.
  • VA Form 21-4138: Known as the Statement in Support of Claim, this form allows veterans to provide additional information and evidence to support their claims. It can be submitted alongside the 21-526B to strengthen the case for benefits.
  • VA Form 21-4142: This form is an Authorization and Consent to Release Information. It is used to obtain medical records from private treatment providers. Veterans are encouraged to include this with the 21-526B if they have relevant private treatment records.
  • VA Form 21-22: This is the Appointment of Veterans Service Organization as Claimant’s Representative form. It allows veterans to designate an organization to assist them with their claims, ensuring they receive necessary support throughout the claims process.
  • VA Form 21-8779: This form is used for applying for aid and attendance benefits. Similar to the 21-526B, it addresses specific claims for additional support due to the veteran's disability level.
  • VA Form 21-534: This form is intended for survivors of veterans. While it has a different primary purpose, it shares similarities in terms of gathering information for claims related to veteran benefits connected with service-related disabilities.

Dos and Don'ts

Filling out the VA Form 21-526B can be a straightforward process if you follow certain guidelines. Below are six important dos and don'ts to consider when completing the form.

  • Do read the instructions carefully before starting the form.
  • Do provide your complete and accurate identifying information, including your name, Social Security number, and VA file number.
  • Do check all applicable boxes concerning your claim to ensure no relevant information is overlooked.
  • Do sign and date the form to validate your claim submission.
  • Don't leave any sections blank unless instructed otherwise; incomplete forms can lead to delays.
  • Don't forget to attach any necessary documents or treatment records, especially from private providers.

By following these guidelines, you can greatly improve the chances of a smooth application process and timely response from the VA.

Misconceptions

Understanding the VA Form 21-526B, the Veteran's Supplemental Claim for Compensation, can be confusing. Let's clear up some common misconceptions:

  • Misconception 1: I can’t file for new disability claims on this form.
    Many veterans think the 21-526B is solely for increased evaluations. In reality, it covers both new and reopened claims.
  • Misconception 2: My social security number is optional.
    It's essential to provide your social security number on this form. It's required for accurate processing and benefits determination.
  • Misconception 3: The form only applies to veterans who are already receiving benefits.
    The VA 21-526B is for any veteran seeking benefits, regardless of their current status.
  • Misconception 4: I don't need to include private treatment records.
    If you've received private medical treatment, it's crucial to attach those records if applicable. They support your claim effectively.
  • Misconception 5: The VA will process my claim as soon as I submit the form.
    While the VA strives to process claims quickly, several factors, including the complexity of your case and required evidence, can affect the timeline.
  • Misconception 6: This form is too complicated.
    Many veterans feel overwhelmed, but the 21-526B is designed with clear sections and instructions to help navigate the process.
  • Misconception 7: I can fill out the form in any way I want.
    It's essential to fill the form accurately and clearly. Any ambiguity can lead to delays or denials.
  • Misconception 8: Filing a claim will automatically lead to a benefits increase.
    Submitting this form does not guarantee an increase in benefits. Each claim is assessed based on its own merits.

By addressing these misconceptions, veterans can better navigate the claims process and enhance their chances of receiving the benefits they deserve.

Key takeaways

1. Understand the Purpose: The VA Form 21-526B is specifically for veterans seeking supplemental compensation for disabilities.

2. Fill Out Completely: Provide all required personal and claim-related information. Incomplete forms can lead to delays.

3. Identifying Information: Ensure accurate entry of your name, Social Security number, and VA file number in Part I.

4. Clarify Your Claim: In Part II, specify whether you are requesting an increase, reopening a claim, or filing for a new service-connected disability.

5. Include Treatment Records: If applicable, attach private treatment records or use VA Form 21-4142 to allow the VA to request them.

6. Significant Deadlines: Pay attention to the expiration date of the form and ensure submissions are made in a timely manner.

7. Check Your Spouse’s Eligibility: If claiming additional benefits due to a seriously disabled spouse, include their details accurately.

8. Signature Required: Make sure you sign and date the form where indicated; unsigned forms will be returned.

9. Privacy Matters: Familiarize yourself with the Privacy Act notice. Your information will only be used as specified.

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