Va Form 21-526ez (Aug 2013) - Notice To Veteran Service Member Template
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8NOTICE TO VETERAN/SERVICE MEMBER
OF EVIDENCE NECESSARY TO SUBSTANTIATE A CLAIM FOR VETERANS DISABILITY
COMPENSATION AND RELATED COMPENSATION BENEFITS
(This notice is applicable to claims for: Disability Service Connection • Secondary Service Connection • Increased Disability
Compensation • Temporary Total Disability Rating • Individual Unemployability • Compensation under 38 U.S.C. 1151 • Special
Monthly Compensation • Specially Adapted Housing/Special Home Adaptation • Automobile Allowance/Adaptive Equipment •
Benefits Based on a Veteran's Seriously Disabled Child)
Use this notice and the attached application to submit a claim for veterans disability compensation and related compensation benefits.
This notice informs you of the evidence necessary to substantiate your claim.
Want your claim processed faster? The Fully Developed Claim (FDC) Program is the fastest way to get your claim processed and
there is no risk to participate! To participate in the FDC Program, if you are making a claim for veterans disability compensation or
related compensation benefits, simply submit your claim in accordance with the "FDC Criteria" shown below. If you are making a
claim for veterans non service-connected pension benefits, use VA Form 21-527EZ, Application for Pension. If you are making a
claim for survivor benefits, use VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits.
VA forms are available at
FDC Criteria (Claim(s) for Veterans Disability Compensation and Related Compensation Benefits)
1. Submit your claim on a signed and completed VA Form 21-526EZ, Application for Disability Compensation and Related
Compensation Benefits (Attached).
2. Submit simultaneously with your claim:
. .
All, if any, relevant, private medical treatment records; AND
An identification of any relevant treatment records available at a Federal facility, such as a VA medical center.
Special Circumstances
Under the special circumstances shown below, you must also submit simultaneously with your claim:
• For Guard and Reserve members, any and all Service Treatment and Personnel Records in
the custody of your Unit(s)
• If claiming dependents, a completed VA Form 21-686c, Declaration of Status of Dependents. If
claiming a child in school between the ages of 18 and 23, you must also submit a completed
VA Form 21-674, Request for Approval of School Attendance. If claiming benefits for a seriously
disabled (helpless) child, you must also submit all, relevant, private medical treatment records
pertaining to the child's pertinent disabilities
• If claiming Post-Traumatic Stress Disorder (PTSD), a completed VA Form 21-0781,
Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder, or if claiming
PTSD based on personal assault, a completed VA Form 21-0781a, Statement in Support of Claim for
Service Connection for Post-Traumatic Stress Disorder Secondary to Personal Assault
• If claiming Individual Unemployability, a completed VA Form 21-8940, Veteran's Application
for Increased Compensation Based on Unemployability, and a completed VA Form 21-4192, Request
for Employment Information in Connection with Claim for Disability Benefits
• If claiming Specially Adapted Housing or Special Home Adaptation, a completed VA Form
26-4555, Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant
• If claiming Auto Allowance, a completed VA Form 21-4502, Application for Automobile or
Other Conveyance and Adaptive Equipment
• If claiming additional benefits because you or your spouse require Aid and Aid Attendance,
a completed VA Form 21-2680, Examination for Housebound Status or Permanent Need for
Regular Aid and Attendance, or if claiming Aid and Attendance based on nursing home attendance,
a VA Form 21-0779, Request for Nursing Home Information in Connection with Claim for Aid
and Attendance.
.
For current active duty Service Members, all service treatment records for your current period of service.
3. Report for any VA medical examinations that VA determines are necessary to decide your claim.
VA FORM
SUPERSEDES VA FORM 21-526EZ, JAN 2013,
21-526EZ
Page 1
AUG 2013
WHICH WILL NOT BE USED.
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