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CHAMPVA claim form

Form name:CHAMPVA Claim Form (VA Form 10-7959a)
Form revision date: March 2025
Related to: Family member and caregiver benefits, Health care

When to use this form

If you’re currently enrolled in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), use VA Form 10-7959a to file a claim for reimbursement. Or if you need to submit more documents for a claim you already filed.

Downloadable PDF

Online tool

You can file a claim online instead of filling out and sending us the paper form.

Helpful links related to VA Form 10-7959A

  • Find out when and how to file a CHAMPVA claim, what supporting documents you need to submit, and what to expect after you file your claim.

  • Learn how eligible spouses and children of Veterans can get healthcare benefits through CHAMPVA.

  • Find out about VA benefits for spouses, dependents, survivors, and family caregivers.

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