VA Claim Preparation Checklist
Items In Red Not Correctly Completed Will Result in Your Form Being Returned for Correction
Form Completion Checklist
Completed
VA Form
21-526EZ
Completed
VA Form
21-686c
STRs
Private
Medical
Records
DD Form
214
SECTION I completed to include Full Name, SSN and Date of Birth
Applicable Homeless Block checked
Branch and Component of Service checked
Current Mailing Address and if Pre-Discharge claim, a forwarding address should you elect a final PCS away from your current location
Telephone and email information
Claimed Disabilities Listed
Listed the DoD and VA facilities where you received care after Discharge
Most recent Service Entry and Release Dates and combat zone deployments
Reserve or Guard Information to include your unit of assignment
Former Prisoner of War Information
Separation Severance Pay Information
Military Retirement instead of VA Disability (You probably DO NOT WANT TO CHECK THIS
Complete Bank or Credit Union account information
SIGNATURE
VSO Representative Information
Veteran Information Block
Marital History – Include Dates, Cities and States for each
Spouse’s Marital History - Include, Dates, Cities and States for each
Spouses Veteran Information and Residence
Child Information (all columns)
– Include SSNs, Full Name, City State and Dates of Birth information
Complete VA Form 674 for College Children Ages 18-23
Pre-
Discharge Claim: Obtained from Installation’s Medical Treatment Facility – Included
Pre-Discharge Claim: Not provided
– DoD will make Available within 45 days from Discharge Date
Veteran (Post-Discharge Claim: No STRs Available
– Please Obtain for my Claim
Copies Obtained and Submitted
VA Forms 21-4142 Completed for VA to Obtain my private health care provider(s) treatment records on my behalf
Not Applicable
– No Private Records to Submit
Copy Provided and Submitted
No Copies Provided Please Obtain on My Behalf
Copy provided for one or more periods of Service, but Need VA to Obtain DD 214 for period of Service for dates listed here:
Checklist Continued On Next Page
If you wish to claim any of the following, please complete these below noted forms and submit them with your claim:

To Claim
Dependents
Individual Unemployability
Complete, Sign and Submit
VA Form 21-686c
VA Forms 231-8940 and 21-4192
Post Traumatic Stress Disorder (PTSD)
Specially Adapted Housing or Special Home
Adaptation
Automobile Allowance
VA Forms 21-0781 and 21-0781a
VA Form 26-4555
VA Form 21-4502
Veteran/Spouse Aid and Attendance Benefits VA Form 21-2580 and if based on home attendance, VA Form 21-0779
AUTHOR’S NOTE: While I encourage you to use this checklist, I respectfully ask you not to freely distribute it. I have worked hard to ensure you are getting all the information you need on to help your claim flow smoothly through the VA system and am providing this information to anyone willing to pay the very modest price. All content herein is subject to copyright laws and more importantly, it just would not be cool for you to rip off a fellow Veteran that is trying to help you get more bucks for your VA bang.