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About VA Form 21P-8416

Form name: Medical Expense Report
Related to: Disability, Family member benefits, Health care, Pension
Form last updated: April 21, 2022

When to use this form

Use VA Form 21p-8416 to report medical or dental expenses that you have paid for yourself or for a family member living in your household. These must be expenses you weren’t reimbursed for and don’t expect to be reimbursed for.

Downloadable PDF

Download VA Form 21P-8416 (PDF)