VA Form 21-526EZ Example: Filling Out the January 2026 Form, Step by Step

Short answer: VA Form 21-526EZ is VA's application for disability compensation, for a first claim, a new condition, or an increase for a condition that got worse. The current edition is dated January 2026. Get the official PDF from VA or apply online. Below are two fictional, filled-in examples in form order.

This is a fictional, completed example of the current VA Form 21-526EZ, the January 2026 edition, taken in form order from Item 1 to the signature. Most of the form is identification and service history. The part that decides what VA will consider is Section V, Item 16, where you list each condition, the event or exposure behind it, how it relates to service, and when it began. The example shows three Item 16 rows: a direct injury, a secondary condition and an exposure-related condition.

The veteran below, Alex Morgan, is invented. Never copy invented facts onto your application. The form itself says that if this is not your original claim, only Section I, Section IV if it applies, Section V and a signature are required. You can also file the same application online at VA's how to file page; the online version asks the same questions.

Use this form for disability compensation, including a new condition or a rating increase. If you disagree with a decision VA already made, use a decision review form instead; the form itself points you to VA Form 20-0995 for Supplemental Claims.

21-526EZ or 20-0995: which form fits your claim

An initial claim, including a new claim for service connection or a claim for increase because a condition got worse, goes on 21-526EZ (38 C.F.R. 3.1(p)(1)). A supplemental claim, for the same or similar benefit on the same or similar basis that VA already decided, goes on VA Form 20-0995, May 2024 edition (38 C.F.R. 3.1(p)(2)).

The 21-526EZ instructions draw the same line: 21-526EZ for a new claim or an increase on an evaluation decided more than one year ago; 20-0995 if you disagree with an evaluation decided within the past year and have new and relevant evidence, or if VA already decided the same or a similar benefit. So a previously denied condition belongs on a Supplemental Claim, not as a fresh row on 21-526EZ. The 20-0995 walkthrough shows that form filled in, and the comparison of the three review options explains the other lanes.

Item 1: Choose the claim process

Fully Developed Claim or standard claim: the current rules

For a Fully Developed Claim, the form's instructions say you must send, with the claim, all relevant private treatment records, and identify relevant federal records (such as a VA medical center's) and, if they apply, where to find National Guard and Reserve records. VA's Fully Developed Claims page adds that you certify there is no more evidence VA might need and attend any exams VA schedules. If you send more evidence later, or VA finds it needs other records, the claim moves to the standard process. The form says choosing FDC is optional and does not affect your benefits.

For the standard claim process, you complete Forms 21-4142 and 21-4142a for private records you want VA to request, and you have up to one year from the date VA receives the claim to send evidence. The form warns that if you do not respond within 30 days to a request for evidence or information, VA may decide sooner, and you keep the rest of the year to send more. The 21-4142 walkthrough shows both release forms filled in and what VA says about uploading records yourself instead.

Section I: Veteran's identification (Items 2 to 12)

Sections II and III: Address change and homeless information

Section II (Items 13A to 13C) is only for a temporary or permanent address change, with the dates it takes effect. Section III (Items 14A to 14F) is only for veterans who are homeless or at risk of homelessness, with a point of contact VA can reach. Alex skips both.

Section IV: Exposure information (Items 15A to 15E)

Item 15A asks whether you are claiming any condition related to toxic exposure. If yes, complete 15B to 15E:

Answer Section IV only for conditions you believe relate to an exposure. It does not replace listing the condition in Item 16.

What the exposure section does, and the law behind it

Item 15A points you to VA's PACT Act page and to VA's public health exposures site. The PACT Act is Public Law 117-168, signed August 10, 2022. The Section IV questions line up with three parts of the law it added to title 38:

• Presumed exposure by location. 38 U.S.C. 1119 tells VA to presume that a "covered veteran" was exposed to the hazards on VA's list unless there is affirmative evidence otherwise. Covered veterans served at duty stations in listed countries, such as Iraq or Kuwait on or after August 2, 1990, or Afghanistan or Syria on or after September 11, 2001. That is why 15B asks for locations and month-and-year dates.
• Presumed diseases. 38 U.S.C. 1120 lists diseases presumed service connected for covered veterans, including asthma diagnosed after service, chronic sinusitis, chronic rhinitis, chronic obstructive pulmonary disease, and several types of cancer. VA's regulation for fine particulate matter, 38 C.F.R. 3.320, covers asthma, rhinitis, sinusitis and certain rare cancers.
• Exams for exposure claims. 38 U.S.C. 1168 says that when you claim a disability with evidence of the disability and of a toxic exposure risk activity during service, and that evidence is not enough to grant the claim, VA must give you a medical exam and get a medical opinion on whether a link is at least as likely as not. The exception is when VA determines there is no indication of an association between the disability and the exposure.

Section 1168 is the exam rule, not the source of the presumptions; those come from sections 1119 and 1120. VA decides whether a presumption fits your service and diagnosis. Your job on the form is accurate locations, dates and exposures.

Section V: Item 16, the claimed conditions

Item 16 has four columns: the current disability or symptom; the exposure, event or injury, if any; how the disability relates to that in-service event, exposure or injury; and the approximate date it began or got worse. The form prints three examples of its own: hearing loss from noise as a heavy equipment operator (July 1968), diabetes from Agent Orange during Vietnam service (December 1972), and "left knee, secondary to right knee," injured when a brace on the right knee failed (6/11/2008). The third shows how to write a secondary condition: name it, then add "secondary to" and the condition that caused it.

Alex's three fictional rows:

Each row names one condition. A record uploaded under the knee does not claim the hip; the hip needs its own row. Write "approximate" when you are not sure of a date, and describe a symptom as a symptom if you have no diagnosis yet. If you run out of the 15 rows, use Section XIII.

Item 16's columns line up with three common reasons the Board gives for denials. In Claim Raven's analysis of 2024 to 2025 Board decisions, among denied condition records with a classified main reason, no link between the condition and service (no nexus) was 22.9%, service connection not shown was 17.0%, and no current diagnosis was 16.3%. These are appeals of claims already in dispute, so the shares describe patterns, not your odds; Claim Raven's analysis of classified Board denials explains the method.

Wording a primary condition versus a secondary condition

A primary (direct) condition is one you say began in, or was caused by, service, like Alex's right knee. Fill all four columns: the condition, the in-service event or exposure, one plain sentence linking them, and the approximate date.

A secondary condition is caused or made worse by a service-connected condition. Under 38 C.F.R. 3.310, a disability proximately due to a service-connected condition is service connected, and so is a worsening beyond natural progress that a service-connected condition caused. Follow VA's example 3: in column 1, name the new condition, then "secondary to" and the cause. The form's example leaves column 2 blank; "None (secondary)" is also clear. In column 3, say in one sentence how the first condition caused or worsened the second.

A secondary grant depends on the first condition being service connected. If it is not yet, claim it in its own row on the same form, as Alex does with the right knee. The secondary service connection guide explains caused-by versus aggravated-by claims and the evidence each one needs.

Section V: Item 17, VA and military treatment after discharge

Item 17 asks for VA medical centers and DoD military treatment facilities where you were treated for the Item 16 conditions after discharge. Column A is the disability treated and the facility name and location; column B is the approximate start date (month and year); column C is a box to check if you do not have dates. The form says you do not need dates if treatment began in 2005 or later.

Private doctors do not go here. Alex lists the private orthopedic clinic on Forms 21-4142 and 21-4142a so VA can request those records.

Two cases need care. The form's special circumstances list says that if you were treated at a Vet Center, you submit a completed VA Form 21-4142. And VA's duty-to-assist rule groups records from non-VA facilities that treated you at VA expense with federal records (38 C.F.R. 3.159(c)(2)), but the form does not say where to list that care. If you had it, ask VA at 800-827-1000 or an accredited representative rather than leaving it off.

Below Item 17, the form lists extra forms for certain claims, including VA Form 21-0781 for a mental health condition, Forms 21-8940 and 21-4192 for individual unemployability, and Form 21-686c for dependents.

Section VI: Service information (Items 18A to 23B)

Section VII: Service pay (Items 24A to 28)

This section asks about military retired pay (24A to 25), separation pay, disability severance pay or other lump sums (27A to 27D), and training pay. Alex receives none and answers No. Items 26 and 28 are boxes that say "Do NOT pay me VA compensation." Leave them blank unless you have decided to keep retired pay or training pay instead of VA compensation, because the form warns that checking them means you will not receive VA compensation.

Section VIII: Direct deposit (Items 29 to 32)

If you already have direct deposit set up with VA, skip this section. Otherwise enter the account number and type, the bank name and the routing number, or check Item 29 if you have no bank account. Alex enters account details.

Section IX: Certification and signature (Items 33A and 33B)

By signing, you certify that the statements are true, authorize others to give VA information about you, and confirm you received VA's notice about the evidence needed. You also certify one of three things: that you enclosed all the information or evidence that supports your claim (including identifying relevant records at a federal facility such as a VA medical center), that you have no information or evidence to give VA, or that you checked the standard claim process in Item 1 because you plan to send more evidence. Alex signs and dates the form.

That is why Item 1 matters: a Fully Developed Claim fits the first statement, and a plan to send more evidence fits the standard process.

Sections X to XII apply only in special signing situations: two witnesses if you sign with an "X," an alternate signer with VA Form 21-0972, or a representative with power of attorney on file. The form notes that a representative cannot sign an original claim under Section XII. Section XIII is the addendum page for more Item 16 rows.

Second fictional example: An increase, a new secondary condition, and a denied condition

Jordan Reyes is invented, and so is every fact below. Jordan already has a 10% rating for a low back strain, decided in 2023. The back has gotten worse, and a new nerve problem in the right leg started after it. Separately, VA denied a tinnitus claim in 2025, and Jordan now has a statement from a fellow service member about the noise exposure.

Which form for which issue:

• Low back strain, worse: a claim for increase, so 21-526EZ.
• Right leg radiculopathy: a new condition caused by a service-connected condition, so 21-526EZ, worded as secondary.
• Tinnitus, previously denied: a supplemental claim with new evidence, so VA Form 20-0995, not a row on 21-526EZ.

Because this is not Jordan's original claim, the form requires only Section I, Section IV if it applies, Section V and a signature. In Item 1, Jordan checks the Standard Claim Process to have VA request a private physical therapist's records. In Section I, Item 4 is Yes and Item 5 is Jordan's VA file number. Item 15A is No, so Jordan skips to Item 16:

Jordan's Item 17 entry is "Low back and right leg; VA clinic, [city and state]," with no date needed because Jordan's VA treatment began in 2023. Jordan sends Forms 21-4142 and 21-4142a for the physical therapist, files the tinnitus issue on 20-0995 with the buddy statement as new evidence, and keeps a copy of each submission.

VA's evidence page says an increase needs current medical or lay evidence that the condition got worse, and a secondary claim usually needs medical records or opinions showing the link. If Jordan filed on paper and needed time to gather that evidence, an intent to file on VA Form 21-0966 would come first; see the 21-0966 walkthrough and the intent to file tracker.

Submit it and keep proof

VA's instructions on the form say you can apply online and upload your supporting documents with the claim, or mail the paper form to Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444. VA's filing page also lists in-person filing at a regional office, fax, and help from an accredited representative; it now calls the mailing address the Claims Intake Center, at the same PO Box. Starting the online application sets your intent to file automatically; on paper, VA suggests submitting an intent to file first. Keep a complete copy of what you sent and the confirmation or delivery proof. After filing, you have up to one year to send more evidence, but the form says VA may decide sooner if it asks for information and you do not respond within 30 days.

Before you send it, Claim Raven's free document review explains one letter, DBQ, statement or medical record with source references. After filing, the VA claim status guide explains each step.

For the full filing sequence, including whether to work with a representative, see the guide to filing a VA disability claim. Claim Raven's help center also has a final package check for Form 21-526EZ.

Claim Raven sells claim-preparation tools, including the one linked on this page, and has a commercial interest in them.

Sources and scope

Checked November 8, 2026: VA Form 21-526EZ (VA's form page lists the January 2026 revision and was last updated November 2, 2026; the PDF supersedes the November 2022 edition) and its printed instructions, VA's how to file page, the Fully Developed Claims page, the evidence needed page, the Supplemental Claim page, VA's 20-0995 and 21-0966 form pages, 38 C.F.R. 3.1, 3.155, 3.159, 3.310, 3.320 and 3.2501 on eCFR, and 38 U.S.C. 1119, 1120 and 1168. First checked September 23, 2026. Board figures come from Claim Raven's analysis of 2024 to 2025 decisions and count condition records. Alex Morgan, Jordan Reyes and every entry above are fictional.

VA Form 21-526EZ questions