Item 1: claim program
Boxes for the Fully Developed Claim (FDC) program or the standard claim process, plus IDES and BDD options. The notice describes the evidence each path asks for.
21-526EZ
Application for Disability Compensation and Related Compensation Benefits
- Agency
- VA
- Revision
- January 2026
- Fillable fields
- 345
- Pages
- 15
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21-526EZ: Application for Disability Compensation and Related Benefits
VA Form 21-526EZ is the U.S. Department of Veterans Affairs Application for Disability Compensation and Related Compensation Benefits. VA's form page says to use it when you want to apply for VA disability compensation (pay) and related benefits. The PDF opens with an eight-page notice that explains the evidence needed for each kind of claim, followed by the application itself.
The notice covers claim types such as disability service connection, presumptive and secondary service connection, increased disability compensation, claims submitted before discharge, individual unemployability, special monthly compensation, temporary total disability ratings, and automobile and specially adapted housing benefits. It points to other forms for other needs: VA Form 20-0995 for a supplemental claim, VA Form 21P-527EZ for Veterans pension and VA Form 21P-534EZ for survivor benefits.
VA's page says you can also apply online at va.gov instead of sending the paper form. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 21-526EZ
Sections I to III: you, your address and housing
Name, Social Security number, VA file number, date of birth, service number, contact details and whether you work for VA. Section II records an address change and Section III asks about homelessness or the risk of it.
Section IV: toxic exposures
Whether you claim conditions related to toxic exposures, service in listed Gulf War hazard or herbicide locations, and exposures such as asbestos, radiation or contaminated water at Camp Lejeune, with approximate dates.
Section V: claimed conditions
Up to 15 current disabilities or symptoms, each with how it relates to service, any exposure, event or injury, and an approximate start date. Item 17 lists VA and military treatment facilities.
Sections VI and VII: service and service pay
Branch, component, service dates, combat zone service since 9-11-2001, Reserve or National Guard details, prisoner of war dates, and military retired, separation, severance and training pay.
Sections VIII to XIII: deposit, signatures, addendum
Direct deposit details, your certification and signature, witnesses if you sign with an X, places for an alternate signer or a power of attorney, and an addendum page with 20 more condition lines.
How to file VA Form 21-526EZ
- 1
Read the evidence notice
The first eight pages explain what evidence supports each claim type and how VA helps get records. The certification in Section IX says you received this notice.
- 2
Choose FDC or the standard process
Under the FDC program, the form says to send relevant private treatment records and other evidence with the claim. Under the standard process, VA Form 21-4142 and VA Form 21-4142a let VA request private records.
- 3
Attach any extra forms the claim needs
The form lists extra forms for some claims, such as VA Form 21-686c for dependents, VA Form 21-8940 and VA Form 21-4192 for individual unemployability, and VA Form 21-0781 for mental health conditions.
- 4
List each condition
Fill in Section V for each claimed disability or symptom. The Section XIII addendum page adds lines, and the form says to copy that page if more space is needed.
- 5
Sign and date it
Sign Item 33A and date Item 33B. If you sign with an X, two witnesses sign Section X. An alternate signer is accepted only with a valid VA Form 21-0972 on record or attached.
- 6
Mail it or submit online
Mail it to the Evidence Intake Center in Janesville, Wisconsin, or submit it online at va.gov or by direct upload through AccessVA, the two online options the form lists.
Why fill Form 21-526EZ on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it and what happens next
By mail
Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.
Online
VA's form page says you can apply online instead of sending the paper form. The notice says signing in lets VA prefill parts of the application, save work in progress and accept uploaded supporting documents.
Time to send evidence
Under the standard process, the notice says you have up to one year from the date VA receives the claim to send information and evidence. Under FDC, evidence sent after the claim moves it to the standard process.
Retired and separation pay
The form says filing waives military retired pay in an amount equal to any VA compensation awarded, if you are entitled to both, unless concurrent receipt applies. VA compensation may also be withheld to recoup separation or severance pay.
Help with the form
The form points to accredited veterans service officers, state offices of veterans affairs, Ask VA at ask.va.gov and the toll-free number 1-800-827-1000 (TTY: 711).
Related forms
21-0966
Intent to File a Claim for Compensation and/or Pension, or Survivors Pension and/or D.I.C. (VA Form 21-0966)
49 fields, 2 pages
21-4142
Authorization to Disclose Information to the Department of Veterans Affairs (VA) (VA Form 21-4142)
140 fields, 5 pages
21-0781
Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s)
124 fields, 7 pages
21-686c
Application Request to Add and/or Remove Dependents
625 fields, 15 pages
20-0995
Decision Review Request: Supplemental Claim
136 fields, 7 pages
21-22
Appointment of Veterans Service Organization as Claimant’s Representative
63 fields, 4 pages
Who uses VA Form 21-526EZ?
The notice at the front of the form describes these claimants and claim types.
Official sources and the blank
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Questions about Form 21-526EZ
Can I file VA Form 21-526EZ online?
Yes. VA's form page says you can apply online at va.gov instead of filling out and sending the paper form. You can also fill out the PDF here free and print or download it.
What is the difference between FDC and the standard claim process?
Under the Fully Developed Claim (FDC) program, the form says to send all relevant evidence with the claim. If more evidence is sent later or VA needs other records, the claim moves to the standard process. The form says FDC is optional and does not affect the benefits you are entitled to.
Can I file before I leave active duty?
The form describes the Benefits Delivery at Discharge (BDD) program, which accepts a claim 90 to 180 days before the anticipated separation date. Its listed criteria include being available for examinations for 45 days after filing and sending service treatment records for the current period of service.
What if I have more than 15 conditions to list?
Section XIII, the Claim Information (Addendum) page, has 20 more lines. The form says to make additional copies of that page if more space is needed.
Does this form add dependents to my claim?
Not on its own. The form says to attach VA Form 21-686c when claiming dependents, and VA Form 21-674 when claiming a child aged 18 to 23 who is in school.
Can someone else sign VA Form 21-526EZ for me?
Section XI is for an alternate signer, such as a court-appointed representative or a person responsible for your care, and is accepted only with a valid VA Form 21-0972 on record or attached. A power of attorney signature needs a valid VA Form 21-22 or VA Form 21-22a on record.
Which form is for a decision I disagree with?
The notice points to VA Form 20-0995 for a supplemental claim with new and relevant evidence, VA Form 20-0996 for a higher-level review and VA Form 10182 for an appeal to the Board of Veterans' Appeals.
Where do I mail VA Form 21-526EZ?
The form lists Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.