VA Form 21-526b at a glance
What it is: VA Form 21-526b is the Veteran's Supplemental Claim for Compensation.
Who signs: The veteran signs in box 11A; do NOT print the signature.
A filled-in VA Form 21-526b example: a veteran claims service connection for a new disability
How to fill out VA Form 21-526b, box by box
Part I, the veteran's identifying information
In Part I, Veteran's Identifying Information, enter the name of the veteran (First, Middle, Last) in box 1, the veteran's social security number in box 2 and the VA file number in box 3.
Enter the veteran's address in box 4: number, street or rural route, City or P.O., State and ZIP Code.
Enter the telephone numbers in box 5: A, Daytime and B, Evening, each including the area code. Enter an e-mail address in box 6 if applicable.
Box 7, the claim
In Part II, Information About Claim, check all that apply in box 7. For an increased evaluation of the disability(ies) for which you are already service connected, provide the name of the disability(ies).
For service connection for new disability(ies), list your new disability(ies).
For reopening of previously denied disability(ies), list your previously denied disability(ies).
For disability(ies) secondary to your existing service connected disability(ies), provide the name of the disability(ies) and your service connected condition(s).
Box 8, treatment records
In box 8A, write the name and location of the VA medical center that has your relevant treatment records. In box 8B, write the name and address of the military facility that has them.
In box 8C, Do you have private treatment records? Yes or No. If Yes, attach the treatment records to the form. If you would like to have VA request your private treatment records, attach VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, for each private treatment provider.
Box 9, other VA benefits
In box 9, check the appropriate box to file a claim for other VA benefits: Aid and attendance, Other (specify the benefit) or Automobile allowance.
Box 10, spouse seriously disabled
Check box 10 to file a claim for additional benefits because your spouse is seriously disabled, and provide your spouse's name and social security no. in items 10A and 10B.
If you are certifying that you are married for the purpose of VA benefits, your marriage must be recognized by the place where you and/or your spouse resided at the time of marriage, or where you and/or your spouse resided when you filed your claim (or a later date when you became eligible for benefits) (38 U.S.C. § 103 (c)).
Box 11, signature and date
The veteran signs in box 11A; do NOT print the signature.
Enter the date signed in box 11B.
More rules for VA Form 21-526b
Do not write in the VA date stamp space.
Read the Privacy Act notice and the respondent burden information on the form before completing it.
Sources
[1] VA Form 21-526b (printed JUN 2014), Veteran's Supplemental Claim for Compensation, Department of Veterans Affairs (the Official source link on this page).
