Section I: Veteran identification
Items 1 to 7 ask for the Veteran's name, Social Security number, VA file number, date of birth, mailing address, an optional email address with consent to electronic correspondence, and telephone number.
21-8940
Veteran’s Application for Increased Compensation Based on Unemployability
- Agency
- VA
- Revision
- July 2024
- Fillable fields
- 176
- Pages
- 4
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 21-8940: Veteran's Application for Increased Compensation Based on Unemployability
VA Form 21-8940 is the U.S. Department of Veterans Affairs Veteran's Application for Increased Compensation Based on Unemployability. VA's form page says to use it to apply for Individual Unemployability disability benefits for a service-connected condition that prevents you from keeping a steady job. The form itself says that completing it claims total disability because of a service-connected disability or disabilities that have prevented securing or following any substantially gainful occupation.
The form is four pages. Section I identifies the Veteran, Section II covers disability and medical treatment, Section III is the employment statement, Section IV covers schooling and other training, Section V holds remarks, Section VI is the authorization, certification and signature, and Section VII gives the mailing address. VA's page says the form can also be filled out online 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 21-8940
Section II: disability and medical treatment
Items 8 to 13 ask which service-connected disabilities prevent substantially gainful work, whether you were under a doctor's care or hospitalized in the past 12 months, and the names, addresses and dates of doctors and hospitals.
Section III: key employment dates
Items 14 to 17 ask when the disability affected full-time employment, when you last worked full time, when you became too disabled to work, and the most you ever earned in one year, with the year and occupation.
Item 18: five years of work history
A list of all employment, including self-employment and military duty, for the last five years you worked, with type of work, hours per week, dates, time lost from illness and highest gross earnings per month.
Items 19 to 22: income and job search
Earned income for the past 12 months and current monthly income, whether you left your last job because of your disability, disability retirement and workers compensation benefits, and employers you applied to since becoming too disabled to work.
Sections IV to VI: training, remarks and signature
The highest year of school completed, other education and training before and since becoming too disabled to work, a remarks space, the release authorization and certification, and the claimant's signature and date.
How to file VA Form 21-8940
- 1
Fill in Section I
The form says it can be completed online or by hand. By hand, it asks for ink, neat and legible printing, one letter per box and fully filled checkboxes.
- 2
Describe your disability and treatment
Answer Items 8 to 13. The form points to Item 26, Remarks, for additional treatment and hospitalization dates.
- 3
List your employment
Enter the dates in Items 14 to 17 and each job from the last five years you worked in Item 18. The form says to use Section V, Remarks, for additional employment information.
- 4
Answer the income and training questions
Complete Items 19 to 25. If you left your last job because of your disability, the form asks you to explain in Item 26.
- 5
Read the certification and sign
Section VI says that if service-connected total disability benefits based on unemployability are granted, the claimant will immediately inform VA of a return to work. Sign Item 27, marked required, and date Item 28.
- 6
Mail it or file online
Mail it to the Evidence Intake Center in Janesville, Wisconsin, listed in Section VII, or fill out the form online through VA's page.
Why fill Form 21-8940 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 getting help
By mail
Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.
Online
VA's page says you can fill out this form online instead of filling out and sending the paper form.
Employer information
VA's page lists VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, which the Veteran's most recent employer completes and submits.
Social Security benefits
The form notes that people with a disability who meet medical criteria may qualify for Social Security or Supplemental Security Income disability benefits, and lists the Social Security Administration at 1-800-772-1213 (Hearing Impaired TDD line 1-800-325-0778).
Edition
The JUL 2024 edition supersedes the JUN 2021 edition. It carries OMB Approved No. 2900-0404, which expires 07/31/2027, and a respondent burden of 45 minutes.
Related forms
21-4192
Request for Employment Information in Connection with Claim for Disability Benefits
61 fields, 2 pages
21-526EZ
Application for Disability Compensation and Related Compensation Benefits
345 fields, 15 pages
21-4138
Statement in Support of Claim (VA Form 21-4138)
33 fields, 2 pages
21-4142
Authorization to Disclose Information to the Department of Veterans Affairs (VA) (VA Form 21-4142)
140 fields, 5 pages
21-0966
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
21-4140
Employment Questionnaire
59 fields, 2 pages
Who uses VA Form 21-8940?
VA's page and the form describe who fills in which parts.
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Questions about Form 21-8940
What is VA Form 21-8940 used for?
VA's page says to use it to apply for Individual Unemployability disability benefits for a service-connected condition that prevents you from keeping a steady job.
Can I file VA Form 21-8940 online?
Yes. VA's page says you can fill out this form online instead of filling out and sending the paper form.
Does my employer need to fill out a form?
VA's page lists VA Form 21-4192 for employers and says the Veteran's most recent employer completes and submits it.
How much work history does the form ask for?
Item 18 asks for all employment, including self-employment and military duty such as inactive duty for training, for the last five years you worked.
What does the form say about returning to work?
The certification says a claimant granted total disability benefits based on unemployability will immediately inform VA on returning to work, and that benefits paid after work begins may be considered an overpayment requiring repayment to VA.
Where do I mail VA Form 21-8940?
Section VII lists Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.