VA Form 21-8940: Veteran's Application for Increased Compensation Based on Unemployability

What VA Form 21-8940 is for

Form 21-8940 is the application for Total Disability based on Individual Unemployability (TDIU). With it you claim that your service-connected disabilities have kept you from getting or keeping any substantially gainful job.

Parts someone else completes

VA sends Form 21-4192 to the employers you worked for in your last year of work. The employer completes that form, not you. If you serve in the Reserve or National Guard, VA may also send Form 21-4192 to your unit commander.

What you fill in by hand

The filler never asks for your Social Security number, VA file number, date of birth or signature. You write those in by hand. Leave these boxes for yourself:

• Item 2: Social Security number (and the SSN line at the top of pages 2, 3 and 4)
• Item 3: VA file number
• Item 4: date of birth
• Item 7: international phone number
• Item 19: Reserve or National Guard
• Items 27 and 28: signature and date
• Items 29 and 30: witnesses

Where to send it

• By mail, the address printed on the form: Department of Veterans Affairs, Evidence Intake Center, PO Box 4444, Janesville, WI 53547-4444.
• VA's form page also offers an online version of this form.
• Check every date and amount against your pay, tax and training records before you sign.
• Keep a copy of what you send, with any confirmation you get.
• An accredited Veterans Service Organization representative can review the form with you at no charge.

Claim Raven does not submit forms to VA. You review the filled PDF, sign and date it, and send it to VA yourself. Claim Raven is independent and is not affiliated with VA.

Official form and guide

• VA's page for Form 21-8940 on VA.gov
• VA Form 21-8940 example and how to fill it out

This filler uses the July 2024 edition of the form.