Fill out VA Form 21-526EZ online

Who uses VA Form 21-526EZ

• Veterans claiming disability compensation for a condition linked to their service
• Veterans asking for a higher rating on a service-connected condition that has worsened
• Service members 90 to 180 days from separation who file under the Benefits Delivery at Discharge (BDD) program
• Veterans claiming conditions related to toxic exposures, including those that may now qualify under the PACT Act

Before you start

• Your Social Security number, and your VA file number if you have filed a claim with VA before
• Your branch, component, service dates and service number or DoD ID number
• A list of each condition you are claiming, with the event, exposure or injury in service and the approximate date it began or got worse
• Names and locations of VA medical centers or military treatment facilities where you were treated after discharge
• Details of any military retired pay, separation pay or disability severance pay
• Your bank's routing number and your account number, if you want direct deposit and have not signed up already

How to fill out VA Form 21-526EZ

1. 1

   Item 1: Select how VA processes your claim

   Select the claim program or process that applies to you: the Fully Developed Claim (FDC) Program, the Standard Claim Process, IDES, or a BDD Program claim. Select IDES only if your military service department referred you to the IDES Program, and BDD only if you meet the BDD criteria in the notice. The notice before the application explains what you and VA each do under FDC and the standard process.

2. 2

   Sections I to III: Identification, change of address and homeless information (Items 2 to 14F)

   Section I asks for your name, Social Security number, whether you have filed a claim with VA before, your VA file number, date of birth, service number or DoD ID number, phone, mailing address and email, and whether you are a VA employee. Item 8 is for BDD claims only: the date or expected date of your release from active duty. Complete Section II (Items 13A to 13C) only if your address is changing, and Section III (Items 14A to 14F) only if you are homeless or at risk of becoming homeless. If your claim is not an original claim, the form says only Section I, Section IV (if it applies), Section V and a signature are required.

3. 3

   Section IV: Exposure information (Items 15A to 15E)

   Item 15A asks whether you are claiming conditions related to toxic exposures; if not, skip to Item 16. If yes, say whether you served in the listed Gulf War hazard locations (15B) or herbicide locations, such as Agent Orange locations (15C), and give approximate month and year dates. Item 15D asks about other exposures, such as asbestos, mustard gas, radiation or contaminated water at Camp Lejeune. Use 15E for additional dates and locations if you were exposed more than once.

4. 4

   Section V: Claim information (Items 16 and 17)

   In Item 16, list each current disability or symptom, the exposure, event or injury it is due to, how it relates to your service, and the approximate date it began or got worse. The form shows three examples. Item 16 has 15 rows; Section XIII on the last page has 20 more, and you can copy that page if you need more space. In Item 17, list VA medical centers and DoD military treatment facilities where you were treated after discharge for these conditions, with the approximate month and year treatment began; you do not need dates if treatment began in 2005 or later.

5. 5

   Section VI: Service information (Items 18A to 23B)

   Give any other names you served under, your branch and component, your most recent entry and exit dates, and the place of your last or expected separation. Item 20C asks if you served in a combat zone since September 11, 2001, and 20D is for other periods of service. Items 21A to 22C cover Reserve or National Guard service and federal activation. Items 23A and 23B ask whether you were ever a prisoner of war and the dates of confinement.

6. 6

   Sections VII and VIII: Service pay and direct deposit (Items 24A to 32)

   Section VII asks about military retired pay (Items 24A to 25) and any separation pay, disability severance pay or other lump sum payment from your branch (Items 27A to 27D). Read the form's notes on retired pay and training pay before Items 26 and 28. In Section VIII, give your account number and type, the name of your bank and its routing number. Skip Section VIII if you have already signed up for direct deposit, or check Item 29 if you do not have a bank account.

7. 7

   Sections IX to XII: Certification and signature (Items 33A to 37B)

   Read the certification in Section IX, then sign Item 33A and date Item 33B. If you sign with an X, two witnesses sign and give their printed names and addresses in Section X. Section XI is only for an alternate signer when Item 33A is blank, and VA accepts that signature only if a valid VA Form 21-0972 is on record or attached. Section XII is for a power of attorney or authorized representative, whose signature VA accepts only if a valid VA Form 21-22 or 21-22a is on record when the claim is submitted.

After you fill it out

Send the signed application and any evidence you have to VA by mail, by fax, or in person at a VA regional office. Check the current mailing address and fax numbers on VA's How to file a VA disability claim page before you send it. The form's notice says you will not get an initial letter about your claim after you submit it, and you do not need to submit another application. VA may send you a letter asking for more information or schedule a claim exam.

Signing: The veteran or service member must sign Item 33A and date Item 33B; if you sign with an X, two witnesses sign Items 34A and 35A. The paper form does not say whether a digital signature is accepted, so follow VA's instructions for the way you submit it.

Questions about VA Form 21-526EZ

Official information

• About VA Form 21-526EZ
• How to file a VA disability claim
• Additional forms for your disability claim
• Your intent to file a VA claim

Page text last reviewed November 7, 2026.

Related forms

• VA Form 21-0966Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or DIC
• VA Form 21-4138Statement in Support of Claim
• VA Form 21-10210Lay/Witness Statement
• SF 180Request Pertaining to Military Records