Request an expedited review if the issue poses a risk to your health or safety

Contact the Patient Advocate at your VA facility first — they can often resolve issues informally

Keep copies of all correspondence and document dates and details of incidents

Veterans Affairsmoderate

VA Advance Directive

VA 10-0137 · VA

VA advance directive and durable power of attorney for health care. Documents treatment preferences and designates a healthcare agent within the VA system.

Form Details

Total fields: 25
Auto-fillable: 12 (48%)
Time without BeneFill: 30 minutes
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Time saved: 20 minutes
Filled by: patient
Frequency: one time

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Where to Submit This Form

📬

Mail to the VA Medical Center Director

Address the form to the director of the VA facility where you were treated.

🏢

In person at the VA Medical Center Patient Advocate office

https://www.va.gov/find-locations/?facilityType=health

Processing Time

VA must acknowledge within 5 business days and provide a final decision within 30 days (standard) or 3 business days (expedited if health or safety risk).

What Happens Next

The VA facility director will review your complaint and issue a written response. If not satisfied, you can escalate to the VA's Office of the Inspector General or your congressional representative.

Tips for This Form

✓ Request an expedited review if the issue poses a risk to your health or safety
✓ Contact the Patient Advocate at your VA facility first — they can often resolve issues informally
✓ Keep copies of all correspondence and document dates and details of incidents

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VA 10-10EZ · VA

Application for VA health benefits. Requires military service history, current insurance, income/assets, and toxic exposure history.

VA Health Benefits Update

VA 10-10EZR · VA

Health Benefits Update Form for veterans already enrolled in VA health care who need to update personal, insurance, financial, or military service information.

VA Disability Compensation Application

VA 21-526EZ · VA

Application for disability compensation and related benefits for service-connected conditions. Requires linking conditions to military service.

Intent to File a Claim

VA 21-0966 · VA

Preserves the effective date for a VA benefits claim while gathering evidence. Provides 1 year to submit the formal claim.

Authorization to Release Information to VA

VA 21-4142 · VA

Authorization and consent allowing VA to obtain private medical records from non-VA providers for disability claim adjudication.

General Release for Medical Provider Information

VA 21-4142a · VA

Companion form to 21-4142 allowing specific medical professionals to release records to VA for claim processing.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the VA or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.