VA 21-22 · VA
Appointment of a Veterans Service Organization as the veteran's representative with power of attorney for VA claims.
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Mail to VA
Department of Veterans Affairs Evidence Intake Center PO Box 4444 Janesville, WI 53547-4444
In person at your local VA Regional Office or VSO office
https://www.va.gov/find-locations/?facilityType=benefits1-2 weeks for VA to process. The VSO can begin assisting you immediately after signing.
Your appointed VSO will have access to your VA claims file and can submit evidence, track claims, and represent you in appeals.
VA 10-10EZ · VA
Application for VA health benefits. Requires military service history, current insurance, income/assets, and toxic exposure history.
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 21-526EZ · VA
Application for disability compensation and related benefits for service-connected conditions. Requires linking conditions to military service.
VA 21-0966 · VA
Preserves the effective date for a VA benefits claim while gathering evidence. Provides 1 year to submit the formal claim.
VA 21-4142 · VA
Authorization and consent allowing VA to obtain private medical records from non-VA providers for disability claim adjudication.
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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