Attorneys and claims agents may charge fees — review the fee agreement carefully before signing

Most VA disability attorneys are paid from back-pay (typically 20-33%), not upfront

This form replaces any existing power of attorney — your previous VSO will lose access

Veterans Affairseasy

Appointment of Individual as Representative

VA 21-22a · VA

Designates an accredited attorney or claims agent as the veteran's representative in VA proceedings.

Form Details

Total fields: 18
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Filled by: patient
Frequency: one time

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Where to Submit This Form

🌐

VA.gov

https://www.va.gov/get-help-from-accredited-representative/appoint-rep/

Appoint an individual representative online.

📬

Mail to VA

Department of Veterans Affairs Evidence Intake Center PO Box 4444 Janesville, WI 53547-4444

🏢

In person at a VA Regional Office

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

Required Attachments

📎 Signed by both the veteran (or claimant) and the individual attorney or claims agent
📎 Fee agreement (if the representative charges fees)

Processing Time

1-2 weeks for VA to process the appointment.

What Happens Next

Your appointed attorney or claims agent will have access to your VA file and can represent you in claims and appeals proceedings.

Tips for This Form

✓ Attorneys and claims agents may charge fees — review the fee agreement carefully before signing
✓ Most VA disability attorneys are paid from back-pay (typically 20-33%), not upfront
✓ This form replaces any existing power of attorney — your previous VSO will lose access

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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.

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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.