Va Form 21 8940 PDF Details

The VA Form 21-8940, titled "Veteran's Application for Increased Compensation Based on Unemployability," serves as a critical tool for veterans seeking to establish their eligibility for higher benefits due to service-connected disabilities that inhibit their ability to secure or follow substantially gainful employment. This document meticulously gathers information regarding the veteran's personal identification, medical history, employment details, and educational background, aiming to paint a comprehensive picture of the individual's current situation and limitations. With sections dedicated to outlining the veteran's service-connected disabilities, recent treatments, employment history—including any attempts to find work despite their disabilities—and educational training before and after becoming substantially unemployable, the form encapsulates a broad spectrum of data necessary for evaluating a claim for increased compensation. The explicit instructions emphasize the importance of providing accurate and thorough responses, given that the information submitted will heavily influence the determination of eligibility for benefits. Alongside the procedural aspects, the form also addresses potential overlaps with Social Security benefits and includes directives for authorization and certification of the information provided, underscoring the legal and ethical responsibilities of the claimant. A designated section for remarks offers applicants the opportunity to furnish additional details that could be pivotal to their application, ensuring that evaluators have access to all pertinent information. Furthermore, it underscores the legal implications of submitting false statements, reflecting the seriousness with which these claims are treated and the rigorous verification processes in place. By completing VA Form 21-8940, veterans take a significant step toward receiving the support and recognition they deserve, amidst acknowledging the potential for their circumstances to evolve, as indicated by the requirement to notify the VA of any return to employment, signifying a change in their unemployability status.

QuestionAnswer
Form NameVa Form 21 8940
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesva form 21 8940, unemployability claiming, how to file unemployability, how to unemployability

Form Preview Example

OMB Approved No. 2900-0404 Respondent Burden: 45 minutes Expiration Date: 06/30/2024

VETERAN'S APPLICATION FOR INCREASED

COMPENSATION BASED ON UNEMPLOYABILITY

IMPORTANT: This is a claim for compensation benefits based on unemployability. When you complete this form you are claiming total disability because of a service-connected disability(ies) which has/have prevented you from securing or following any substantially gainful occupation. Answer all questions fully and accurately. See mailing information on page 4 of this form.

Social Security Benefits: Individuals who have a disability and meet medical criteria may qualify for Social Security or Supplemental Security Income disability benefits. If you would like more information about Social Security benefits, contact your nearest Social Security Administration (SSA) office. You can locate the address of the nearest SSA office in your telephone book blue pages under "United States Government, Social Security Administration" or call 1-800-772-1213 (Hearing Impaired TDD line 1-800-325-0778). You may also contact SSA by Internet at http://www.ssa.gov/.

SECTION I - VETERAN IDENTIFICATION INFORMATION

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

NOTE: You may complete the form online or by hand. If completed by hand print the information requested in ink, neatly, and legibly, insert one letter per box, and completely fill each applicable circle to help expedite processing of the form.

1.VETERAN'S NAME (First, Middle Initial, Last)

2. SOCIAL SECURITY NUMBER

3. VA FILE NUMBER

4. DATE OF BIRTH

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.MAILING ADDRESS (No. and street or rural route, city or P.O., State, ZIP Code and Country)

No. &

Street

Apt./Unit Number

State/Province

Country

City

ZIP Code/Postal Code

6. EMAIL ADDRESS (If applicable)

I agree to receive electronic correspondence

from VA in regards to my claim.

7.TELEPHONE NUMBER (Include Area Code)

Enter International Phone Number (If applicable)

SECTION II - DISABILITY AND MEDICAL TREATMENT

8. WHAT SERVICE-CONNECTED DISABILITY PREVENTS

9. HAVE YOU BEEN UNDER A DOCTOR'S CARE

10. DATE(S) OF TREATMENT BY DOCTOR(S)

YOU FROM SECURING OR FOLLOWING ANY

AND/OR HOSPITALIZED WITHIN THE PAST 12

 

(Go to Item 26 - Remarks - for additional dates)

SUBSTANTIALLY GAINFUL OCCUPATION?

MONTHS?

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. NAME AND ADDRESS OF DOCTOR(S)

12. NAME AND ADDRESS OF HOSPITAL

13. DATE(S) OF HOSPITALIZATION

 

(Go to Item 26 - Remarks - for additional dates)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION III - EMPLOYMENT STATEMENT

14.DATE YOUR DISABILITY AFFECTED FULL-TIME EMPLOYMENT

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. DATE YOU LAST WORKED FULL-TIME

16. DATE YOU BECAME TOO DISABLED TO WORK

Month

 

 

Day

 

 

 

Year

 

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17A. WHAT IS THE MOST YOU EVER EARNED IN ONE YEAR?

17B. WHAT YEAR?

17C. OCCUPATION DURING THAT YEAR?

$

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JUN 2021

21-8940

 

 

 

 

 

 

 

 

 

Page 1

VA FORM

 

 

 

 

 

 

SUPERSEDES VA FORM 21-8940, OCT 2017.

 

VETERAN'S SOCIAL SECURITY NUMBER

SECTION III - EMPLOYMENT STATEMENT (Continued)

18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED

(Include any military duty including inactive duty for training) (Note: For additional employment information use Section V, Remarks)

NAME AND ADDRESS OF EMPLOYER (OR UNIT)

TYPE OF WORK

HOURS

PER WEEK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. DATES OF EMPLOYMENT

 

TIME LOST

HIGHEST GROSS EARNINGS

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

FROM ILLNESS

 

 

PER MONTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF EMPLOYER (OR UNIT)

 

 

TYPE OF WORK

 

 

 

HOURS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PER WEEK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATES OF EMPLOYMENT

 

TIME LOST

 

 

HIGHEST GROSS EARNINGS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

FROM ILLNESS

 

 

 

 

PER MONTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF EMPLOYER (OR UNIT)

 

 

TYPE OF WORK

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PER WEEK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATES OF EMPLOYMENT

 

 

 

 

 

 

 

TIME LOST

HIGHEST GROSS EARNINGS

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

FROM ILLNESS

 

 

PER MONTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF EMPLOYER (OR UNIT)

 

 

 

 

 

 

 

 

TYPE OF WORK

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PER WEEK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATES OF EMPLOYMENT

 

 

 

 

 

 

 

 

 

 

 

 

TIME LOST

 

FROM

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

 

FROM ILLNESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

HIGHEST GROSS EARNINGS

PER MONTH

,

NAME AND ADDRESS OF EMPLOYER (OR UNIT)

TYPE OF WORK

HOURS

PER WEEK

 

 

 

 

 

 

 

 

 

 

 

 

 

DATES OF EMPLOYMENT

 

 

 

 

 

 

 

TIME LOST

 

HIGHEST GROSS EARNINGS

 

 

 

 

 

 

 

FROM

 

 

 

 

 

 

 

 

 

 

 

 

 

TO

 

 

 

 

 

 

FROM ILLNESS

 

 

PER MONTH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

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VA FORM 21-8940, JUN 2021

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2

How to Edit Va Form 21 8940 Online for Free

This PDF editor makes it simple to manage the how to file unemployability file. You should be able to create the file effortlessly through these basic steps.

Step 1: First, select the orange button "Get Form Now".

Step 2: The form editing page is currently available. It's possible to add text or update present details.

The next segments are included in the PDF form you will be completing.

what is unemployability for va fields to fill in

Type in the required particulars in YES, NAME AND ADDRESS OF DOCTORS, NAME AND ADDRESS OF HOSPITAL, DATES OF HOSPITALIZATION Go to, FROM, DATE YOUR DISABILITY AFFECTED, DATE YOU LAST WORKED FULLTIME, DATE YOU BECAME TOO DISABLED TO, Month, Day, Year, Month, Day, Year, and Month segment.

Finishing what is unemployability for va stage 2

You could be asked for some valuable details to be able to fill up the VETERANS SOCIAL SECURITY NUMBER, LIST ALL YOUR EMPLOYMENT, SECTION III EMPLOYMENT STATEMENT, NAME AND ADDRESS OF EMPLOYER OR, TYPE OF WORK, HOURS PER WEEK, D DATES OF EMPLOYMENT, FROM, NAME AND ADDRESS OF EMPLOYER OR, TIME LOST FROM ILLNESS, HIGHEST GROSS EARNINGS PER MONTH, TYPE OF WORK, HOURS PER WEEK, DATES OF EMPLOYMENT, and TIME LOST FROM ILLNESS section.

part 3 to finishing what is unemployability for va

Within the field FROM, TIME LOST FROM ILLNESS, HIGHEST GROSS EARNINGS PER MONTH, NAME AND ADDRESS OF EMPLOYER OR, TYPE OF WORK, HOURS PER WEEK, DATES OF EMPLOYMENT, FROM, TIME LOST FROM ILLNESS, HIGHEST GROSS EARNINGS PER MONTH, NAME AND ADDRESS OF EMPLOYER OR, TYPE OF WORK, HOURS PER WEEK, DATES OF EMPLOYMENT, and FROM, identify the rights and responsibilities of the sides.

Filling in what is unemployability for va part 4

Complete the file by looking at these sections: NAME AND ADDRESS OF EMPLOYER OR, TYPE OF WORK, HOURS PER WEEK, DATES OF EMPLOYMENT, FROM, TIME LOST FROM ILLNESS, HIGHEST GROSS EARNINGS PER MONTH, VA FORM JUN, and Page.

what is unemployability for va NAME AND ADDRESS OF EMPLOYER OR, TYPE OF WORK, HOURS PER WEEK, DATES OF EMPLOYMENT, FROM, TIME LOST FROM ILLNESS, HIGHEST GROSS EARNINGS PER MONTH, VA FORM  JUN, and Page fields to insert

Step 3: Hit the "Done" button. Now you can upload your PDF form to your gadget. Additionally, you can deliver it through email.

Step 4: It may be simpler to have copies of the document. There is no doubt that we are not going to reveal or view your particulars.

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