21-651

Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation from Department of Veterans Affairs (38 U.S.C. 5304(a)-5305)

Agency
VA
Revision
June 2015
Fillable fields
7
Pages
1
Official source
VA form page
Checked
October 20, 2026
Fill 21-651 online
Page 1 of form 21-651

VA Form 21-651: Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay

VA Form 21-651 is the U.S. Department of Veterans Affairs Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation from Department of Veterans Affairs, under 38 U.S.C. 5304(a)-5305. It is a one page form in two sections.

The form says Section I is to be completed by VA, with the address of the VA office and the Veteran's identification. Section II is to be completed by the Veteran. In it the Veteran elects to receive compensation from VA in lieu of the total amount of retired pay, or waives the portion of retired pay equal in amount to the compensation VA may award, then signs and dates the form and returns it to the VA office shown in Item 1.

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Top of page 1 of VA Form 21-651: Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay, as printed by VA

What's on VA Form 21-651

Item 1: address of VA office

The VA office the form goes back to, filled in by VA as part of Section I.

Items 2 to 5: Veteran identification

Name of Veteran, VA file number, service number and Social Security number, also part of Section I.

Section II: instructions and election

Instructions to sign, date and return the form, a phone number for questions, and the statement electing VA compensation in lieu of retired pay or waiving the matching portion of retired pay.

Items 6 and 7: signature and date

The Veteran's signature in Item 6 and the date in Item 7, at the bottom of the page.

How to complete VA Form 21-651

  1. 1

    Check Section I

    Section I is completed by VA. Items 1 to 5 hold the VA office address and the Veteran's name, VA file number, service number and Social Security number.

  2. 2

    Read the election

    The Section II statement elects VA compensation in lieu of the total amount of retired pay, or waives the portion of retired pay equal in amount to the compensation VA may award.

  3. 3

    Sign and date it

    The Veteran signs Item 6 and enters the date in Item 7.

  4. 4

    Return it to the VA office

    The instructions say to return the form to the VA office shown in Item 1.

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Where to send it and getting help

Return address

The form says to return it to the VA office shown in Item 1, which VA fills in.

Questions

The form says to call VA toll-free at 1-800-827-1000 (Hearing Impaired TDD federal relay number is 711) with questions about completing it.

Edition

The JUN 2015 edition supersedes VA Form 21-651, MAR 2005, which the form says will not be used.

Related forms

Who completes VA Form 21-651?

  • VA, for Section I

    The form says Section I is to be completed by VA: the address of the VA office in Item 1, then the Veteran's name, VA file number, service number and Social Security number.

  • The Veteran, for Section II

    The form says Section II is to be completed by the Veteran, who signs Item 6 and dates Item 7.

  • Veterans with retired pay

    The Section II statement concerns the Veteran's retired pay: it elects VA compensation in lieu of the total amount of retired pay, or waives the portion of retired pay equal to the compensation VA may award.

  • The VA office in Item 1

    The instructions say to sign and date the form and return it to the VA office shown in Item 1.

The form splits the work between VA and the Veteran.

Official sources and the blank

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Questions about Form 21-651

What is VA Form 21-651?

It is VA's Election of Compensation in Lieu of Retired Pay or Waiver of Retired Pay to Secure Compensation from Department of Veterans Affairs, under 38 U.S.C. 5304(a)-5305.

Who fills in Section I?

The form says Section I is to be completed by VA. It holds the VA office address and the Veteran's name, VA file number, service number and Social Security number.

What does the Veteran sign?

In Section II the Veteran elects to receive compensation from VA in lieu of the total amount of retired pay, or waives the portion of retired pay equal in amount to the compensation VA may award, and signs Item 6 and dates Item 7.

Where do I return VA Form 21-651?

The instructions say to return it to the VA office shown in Item 1.

Can the March 2005 edition still be used?

No. The June 2015 edition says it supersedes VA Form 21-651, MAR 2005, which will not be used.