VA Form 21-526EZ

Use VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.

You can use this form for any of these reasons:

• You’re applying for disability compensation for a new condition or an increased rating on an existing condition
• You’re applying for disability compensation under the Benefits Delivery at Discharge (BDD) program
• You’re applying for disability compensation for conditions that may now qualify under the PACT Act

Note: This isn’t the right form if you want us to review a decision you already received on a claim. You should instead request a decision review.

Learn about choosing a decision review option

What to know if you’re filing your claim online

When you start filling out the form online, we’ll check to find out if you already have an intent to file. If you don’t, we’ll automatically record your intent to file. If we approve your claim, you may receive back pay from the date we recorded your intent to file.

If either of these describes your situation, you can provide the information we need as part of your claim for disability compensation:

• If you’re submitting a claim for a new mental health condition, we’ll ask about your condition
• If you want us to gather evidence for you from non-VA sources like a private doctor or hospital, we’ll ask if you’ll give us permission to get your personal information from those providers or facilities

If you provide this information during the process of filling out your form online, you don’t need to submit separate supporting forms.

If you don’t provide this information during the process of filling out your form online, you may need to submit these additional forms:

• Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s) (VA Form 21-0781)
  Get VA Form 21-0781 to download
• Authorization to Disclose Information to the Department of Veterans Affairs (VA) (VA Form 21-4142)
  Get VA Form 21-4142 to download