VA Form 21P-8416
- Form name:Medical Expense Report
- Form revision date: October 2023
- Related to: Disability, Family member and caregiver benefits, Health care, Pension
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
Online tool
You can submit your request online instead of filling out and sending us the paper form.