FDC: you send all evidence with the claim. IDES: only if your service referred you. BDD: file 180 to 90 days before separation.
VA Disability Claim Prep Worksheet (VA Form 21-526EZ)
Prepare the 21-526EZ before you file: claim type, toxic exposures, each claimed condition with its in-service link, treatment, service history, and the evidence you have.
What this worksheet covers
Name, rank, and unit prefill from your service profile.
Claim program
- 1Type of claim program / process
Section i: veteran's identification information
- 2Veteran/Servicemember's Name (First, Middle Initial, Last)
- 4Have you ever filed a claim with VA?
- 8BDD claims only: date or anticipated date of release from active duty
Section iv: exposure information
- 15AAre you claiming any conditions related to toxic exposures?
If yes, complete 15B through 15E. PACT Act presumptions may apply.
- 15BDid you serve in any Gulf War hazard locations? If yes, when (MM-YYYY to MM-YYYY)
Includes Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the UAE, Oman, Yemen, Lebanon, Somalia, Afghanistan, Israel, Egypt, Turkey, Syria, Jordan, Djibouti, Uzbekistan, and the surrounding gulfs and seas (full list on the form).
- 15CDid you serve in any herbicide (e.g., Agent Orange) locations? If yes, where and when
Includes the Republic of Vietnam, Thailand bases, Laos, parts of Cambodia, Guam or American Samoa, Johnston Atoll, the Korean DMZ, and C-123 aircraft (full list on the form).
- 15DHave you been exposed to any of the following? (Check all that apply)
- 15EIf exposed multiple times, all additional dates and locations of potential exposure
Section v: claim information
- 16Current disability(ies) or symptoms claimed
One condition per row, the way item 16 is laid out. Form examples: "Hearing loss — Noise — Heavy equipment operator in service — July 1968" and "Left knee, secondary to right knee — Injured left knee when brace on right knee failed — 6/11/2008".
- 17VA medical centers and DoD military treatment facilities where treated after discharge
The disability treated and the facility name and location, with the month and year treatment began. If treatment began in 2005 or later, dates are not required.
Section vi: service information
- 19ABranch of service
- 19BComponent
- 20AMost recent active service dates (entry / exit)
- 20BPlace of last or anticipated separation
- 20CDid you serve in a combat zone since 9-11-2001? (dates)
- 21A–21FReserve / National Guard service (component, obligation dates, unit)
Section vii: service pay
- 24–26Receiving or will receive military retired pay, separation pay, or disability severance pay? (type, amount)
VA offsets some of these payments against compensation, so the form asks for them.
Claim prep (NOT ON THE FORM)
- Evidence for each condition
What proves each link: service treatment record entries (date and page), private records (VA 21-4142 authorizes VA to request them), buddy or spouse statements (VA 21-10210), deployment orders, profiles, line-of-duty determinations.
- Current symptoms and effect on work and daily life
For each condition: frequency, severity, what you can no longer do, medication, and missed work. This is what a C&P examiner and a rater look for.
- Supporting forms to attach
- Intent to File date (if filed)
- VSO / accredited representative and appointment
- Questions for the VSO
Draft / worksheet aid. Prepare it here, then transcribe into VA.gov online claim (or the paper 21-526EZ), usually with an accredited VSO. This is not an official submission. Check it against the current official Worksheet (VA Form 21-526EZ, JAN 2026) before use.
How to fill out the Worksheet (VA Form 21-526EZ, JAN 2026)
The 21-526EZ asks for each condition, how it connects to service, and when it started or got worse. This worksheet follows the form's own sections (I, IV, V, VI, VII) so your answers and evidence are ready before you sit down with a VSO or open VA.gov. When: Start 180 days before separation. The BDD program accepts claims 180 to 90 days before your separation date if you can attend exams for 45 days after filing. After separation, file an Intent to File (VA 21-0966) first; it protects your effective date for one year.
Step by step
- Decide the claim process: FDC (you submit all evidence now), Standard, IDES (only if referred), or BDD (180–90 days before separation).
- Answer Section IV if any condition is tied to a toxic exposure: Gulf War hazard locations, herbicide locations, or other exposures, with month and year.
- List each claimed condition in Section V with the event, exposure, or injury, how it relates to service, and when it began or worsened. One condition per line.
- List where you were treated after discharge (VA medical centers and military treatment facilities).
- Fill in Section VI service history from your DD 214 or current orders, and Section VII if you receive retired, separation, or severance pay.
- Gather the evidence for each condition, pick the supporting forms you need, and describe how each condition affects work and daily life.
What a strong one looks like
- Name the current diagnosis or symptom, not just the event: "tinnitus, both ears" rather than "loud noise".
- For a secondary condition, say what it is secondary to, like the form's own example: "left knee, secondary to right knee".
- Get copies of your service treatment records before you separate, and get sick-call visits documented while you are still in.
- Use an accredited VSO (for example, from the DAV, VFW, American Legion, or your state veterans office). Their help is free.
Common mistakes
- Claiming a condition with no current diagnosis or symptoms.
- Missing C&P exams. BDD requires you to be available for exams for 45 days after filing.
- Overstating or understating symptoms. Describe your worst days and typical days honestly.
- Putting your SSN in shared worksheets. This draft leaves it off; enter it only on the real form.
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