Form 21 8764A – Fill Out and Use This PDF

DISABILITY COMPENSATION AWARD UNDER 38 U.S.C. 1151

IMPORTANT INFORMATION

WHEN WILL YOU RECEIVE YOUR FUNDS?

Depending on whether you elect to receive your monthly compensation by check or direct deposit, you should receive your funds within 15 days. Thereafter, your payments will be made at the beginning of each month for the prior month.

HOW CAN YOU RECEIVE HOSPITALIZATION AND OUTPATIENT TREATMENT?

Veterans who have one or more service-connected disabilities as determined by the Department of Veterans Affairs are eligible for medical care through the VA health care system. If you are interested in obtaining VA medical care, you may contact your nearest VA health care facility or the VA Health Revenue Center at 1-877-222-8387.

HOW CAN YOU RECEIVE ADDITIONAL COMPENSATION FOR DEPENDENTS?

Veterans having a 30% or more service-connected evaluation compensated under 38 U.S.C. 1151 may be entitled to additional compensation for a spouse, dependent parents, unmarried children under age 18 (or under 23 if attending an approved school) or a child who became permanently incapable of self-support because of mental or physical defect prior to age 18. The additional benefit for a spouse is payable in a higher amount upon receipt of evidence establishing that the spouse is a patient in a nursing home or so disabled as to require the aid and attendance of another person.

HOW CAN YOU RECEIVE INDIVIDUAL UNEMPLOYABILITY?

If your service-connected disabilities and/or disabilities compensated under 38 U.S.C. 1151 are seriously disabling to the extent that you are unable to secure and hold steady work/employment, you may apply to receive benefits based on total disability. To apply for this benefit, you should contact the nearest VA office and complete VA Form 21-8940, "Veteran's Application for Increased Compensation Based on Unemployability," available on the VA forms website at www.va.gov/vaforms.

HOW CAN YOU RECEIVE A CLOTHING ALLOWANCE?

You may be eligible for a clothing allowance if, because of a service-connected disability or a disability compensated under 38 U.S.C. 1151, you wear or use a prosthetic device or orthopedic appliance which tends to wear or tear clothing. You may be eligible if a doctor has prescribed medication for a service-connected skin condition or a skin condition compensated under 38 U.S.C. 1151 and the medication causes irreparable damage to your outer garments. To apply for this benefit, contact the Prosthetic and Sensory Aids Service at your nearest VA medical center or outpatient clinic. The address of your closest VA medical center or facility is available on the VA internet website, http://www.va.gov/directory.

HOW CAN YOU RECEIVE EDUCATIONAL BENEFITS?

A monthly educational assistance allowance is payable to certain veterans. Each program has unique eligibility criteria specified by law, and only one program can be used at any given time. If you need help with your VA education benefits, you can call toll-free 1-888-442-4551 or visit the VA national education website at http://www.gibill.va.gov.

ARE YOUR BENEFITS EXEMPT FROM CLAIMS OF CREDITORS?

Compensation payments are exempt from claims of creditors. With certain exceptions, the payments are not assignable and are not subject to attachment, levy or seizure except as to claims of the United States.

HOW DO YOU REPORT A CHANGE OF ADDRESS OR DIRECT DEPOSIT?

Please notify us by calling our toll-free number at 1-877-838-2778.

VA FORM

21-8764a

SUPERSEDES VA FORM 21-8764a, APR 2005,

(SEE REVERSE)

MAY 2009

WHICH WILL NOT BE USED.

TO SEND ANY COMPLETED, SIGNED FORMS OR TO FURNISH ANY INFORMATION TO VA

You can obtain the address to mail VA information or completed forms by calling toll-free 1-800-827-1000 (for the hearing impaired 1-800-829-4833). You can also locate the address of the closest VA regional office on the Internet at http://www.va.gov/directory or in the Government pages of your telephone book under "United States Government, Veterans."

HOW DO I RECEIVE MORE INFORMATION?

If you have any questions, you may contact us electronically, by telephone, or in writing.

	If you ...	Here is what to do...
	Use the Internet	Visit the Veterans Benefits Administration (VBA) website at http://www.vba.va.gov
	Contact VA	Send electronic inquiries through the Internet at https://iris.va.gov
	electronically
	Telephone	Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD),
		the number is 1-800-829-4833.
	Write	Put your full name and VA file number on the letter. Please send all correspondence to
		the address at the top of this letter.

WHAT CONDITIONS AFFECT RIGHT TO PAYMENTS?

1.Your award of disability compensation is subject to future adjustment upon receipt of evidence showing any change in the degree of disability.

2.Your payments may also be affected by any of the following circumstances which you must promptly call to our attention.

a.Reentrance into active military or naval service.

b.Receipt of armed forces service retirement pay, unless your retirement pay has been reduced

because of award of disability compensation.

c. Receipt of benefits from the Office of Federal Employees Compensation.

d. Receipt of active duty or drill pay as a reservist or member of the Federally recognized National Guard.

3.If you have a disability rating of 30% or more, you must promptly advise us of any change in the status of your dependents.

4.If your award includes special monthly compensation due to the need for aid and attendance, this additional allowance is generally subject to reduction from the first day of the second calendar month of admission to hospitalization, nursing home or domiciliary care at VA expense.

5.Benefits will be reduced upon incarceration in a Federal, State or local penal institution in excess of 60 days for conviction of a felony. The amount not payable may be apportioned to a spouse, dependent children or parents.

6.Monthly payments of your award may be stopped if you fail to furnish evidence as requested, fail to cooperate or submit to a VA examination when requested, or if you furnish VA, or cause to be furnished, any false or fraudulent evidence.

7.Information submitted is subject to verification through computer matching programs with other agencies.

8.The law provides severe penalties, which include fine, imprisonment, or both, for the fraudulent acceptance of any payment to which you are not entitled.

IMPORTANT

Please notify VA immediately if there is a change in any condition affecting your right to continued payments. Failure to notify us of these changes immediately may result in a debt that you will have to repay.

VA FORM 8764a, MAY 2009