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NOTICE TO VETERAN/SERVICE MEMBER OF EVIDENCE NECESSARY TO SUBSTANTIATE A CLAIM FORVETERANS DISABILITY COMPENSATION AND RELATED COMPENSATION BENEFITSThis notice provides information regarding the evidence necessary to substantiate a claim for:Disability Service ConnectionCompensation Claims Submitted Prior to DischargeCompensation under 38 U.S.C. 1151Automobile Allowance/Adaptive EquipmentSecondary Service CompensationTemporary Total Disability RatingSpecial Monthly CompensationBenefits Based on a Veteran's Seriously Disabled ChildIncreased Disability CompensationIndividual UnemployabilitySpecially Adapted Housing/Special Home AdaptationWhen to Use this FormUse this notice and the attached application to submit a claim for veterans' disability compensation and related compensation benefits. Thisnotice informs you of the evidence necessary to decide your claim. After you submit your claim on the attached application you will not receivean initial letter regarding your claim. You do not need to submit another application.If you are filing a claim for increased disabilitycompensation or disagree with an evaluation decidedmore than one year ago .If you disagree with an evaluation decided within thepast year and have new and relevant evidence ORIf you are filing a supplemental claim (a claim after aninitial claim for the same or similar benefit on the sameor similar basis was previously decided) .please complete and submit VA Form 21-526EZ,Application for Disability Compensation and RelatedCompensation Benefits.please complete and submit VA Form 20-0995, DecisionReview Request: Supplemental Claim**** You may also file a request for higher-level review or appeal to the Board of Veterans' Appeals. For additional information on all of thesedifferent options, please visit https://benefits.va.gov/benefits/appeals.asp.Want to apply electronically? You can apply online at www.va.gov. If you sign in or create an account at www.va.gov, we can prefill parts of yourapplication and save your work in progress. You can also upload all your supporting documents with your claim, and submit it through the FullyDeveloped Claims (FDC) program, then track claim status online. Get Started at OTE: You may wish to contact an accredited veterans service officer (VSO) to assist you with your application. For a list of accredited veteransservice organizations go to https://www.va.gov/vso/. You may also contact your state office of veterans affairs at https://www.va.gov/statedva.htm,should you need further assistance with the application process.Want your claim processed faster? The FDC Program is the fastest way to get your claim processed without any risk to participate! To participate inmaking a claim for veterans disability compensation or related compensation benefits, submit your claim in accordance with the "FDC Program" shownon the following information pages 2 through 7. If you are making a claim for veterans non service-connected pension benefits, use VA Form21P-527EZ, Application for Pension. If you are making a claim for survivor benefits, use VA Form 21P-534EZ, Application for DIC, Death Pension,and/or Accrued Benefits. VA forms are available at www.va.gov/vaforms. A separate expedited claims processing program available for current activeduty Servicemembers is explained on page 5 under Compensation Claims Submitted Prior to Discharge.NOTE: Participation in the FDC Program is optional and will not affect the benefits to which you are entitled. If you file a claim in the FDC Programand it is determined that other records exist and VA needs the records to decide your claim, then VA will simply remove the claim from the FDCProgram and process it in the Standard Claim Process. If you wish to file your claim in the FDC Program, see FDC Program (Optional ExpeditedProcess) on page 2 . If you wish to file your claim under the process in which VA traditionally processes claims, see Standard Claim Process on page 2.SUBMITTING A CLAIMWhen submitting a claim(s) for Veterans Disability Compensation and Related Compensation Benefits the following information tells you what youneed to do and what VA will do during the FDC Program (Optional Expedited Process) or the Standard Claim Process:1. HOW TO SUBMIT A CLAIMSubmit your claim on a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits (Attached). Make sureyou complete and sign your application.2. WHAT YOU NEED TO DOThe table on page 2 describes the information and evidence you need to submit based on whether you wish to have your claim considered in the FDCProgram (Optional Expedited Process) or in the Standard Claim Process. You will need to indicate how you want your claim to be processed bychecking the appropriate box in Item 1, on page 8 of this form.VA FORMSEP 201921-526EZSUPERSEDES VA FORM 21-526EZ, MAR 2018.Page 1

FDC Program (Optional Expedited Process)You must: Submit all relevant private treatment records, if they exist Identify any relevant treatment records available at a FederalFacility, such as a VA medical center Identify the location and sufficient information to obtain yourNational Guard and Reserve personnel and service treatmentrecords (if applicable)If your claim involves a disability that you had before entering serviceand that was made worse by service, please provide any information orevidence in your possession regarding the health condition that existedbefore your entry into service.NOTE: If you decide to submit your claim through the FDC Program,please indicate FDC in Item 1 of the application on page 8.Standard Claim ProcessIf you know of evidence not in your possession and want VA to try to getit for you;You must: Complete and sign VA Form 21-4142, Authorization to DiscloseInformation to the Department of Veterans Affairs (VA) and VA Form21-4142a, General Release for Medical Provider Information to theDepartment of Veterans Affairs (VA), identifying any private medicalrecords you wish VA to request for you Give VA enough information about other relevant evidence so that wecan request it from the person or agency that has itIf the holder of the evidence declines to give it to VA, asks for a fee toprovide it, or otherwise cannot get the evidence, VA will notify you andprovide you with an opportunity to submit the information or evidence. Itis your responsibility to make sure we receive all requested records thatare not in the possession of a Federal department or agency.If your claim involves a disability that you had before entering service andthat was made worse by service, please provide any information orevidence in your possession regarding the health condition that existedbefore your entry into service.You must:You are strongly encouraged to: Send the information and evidence along with your claim Send any information or evidence as soon as you canIf you submit additional information or evidence after you submit your"fully developed" claim, then VA will remove the claim from the FDCProgram (Optional Expedited Process) and process it in the StandardClaim Process. If we decide your claim before one year from the datewe receive the claim, you will still have the remainder of the one-yearperiod to submit additional information or evidence necessary tosupport the claim.You have up to one year from the date we receive the claim to submit theinformation and evidence necessary to support your claim. If within 30days, you do not provide any evidence or do not provide us with theinformation needed to assist you with obtaining evidence, we may decideyour claim prior to the expiration of the one year period. If we decide theclaim before one year from the date we receive the claim, you will stillhave the remainder of the one year period to submit additional informationor evidence necessary to support the claim.If any of the special circumstances in the table below titled "SpecialCircumstances" applies to you;If any of the special circumstances in the table below titled "SpecialCircumstances" applies to you;You must:You are strongly encouraged to: Send the information and evidence identified in the "SpecialCircumstances" table below at the same time as your claim Send the information and evidence identified in the "SpecialCircumstances" table below at the same time as your claim. If you donot submit the needed information or evidence with your claim but it isneeded to make a decision, VA will request it from you.SPECIAL CIRCUMSTANCESUnder the special circumstances shown below, you must also submit along with your claim the following: If you were treated at a Veterans Center, submit a completed VA Form 21-4142, Authorization to Disclose Information to theDepartment of Veterans Affairs (VA) If claiming dependents, submit a completed VA Form 21-686c, Application Request to Add and/or Remove Dependents. If claiming achild in school between the ages of 18 and 23; also submit a completed VA Form 21-674, Request for Approval of School Attendance. Ifclaiming benefits for a seriously disabled (helpless) child, also submit all, relevant, private medical treatment records pertaining to thechild's pertinent disabilities If claiming Individual Unemployability, submit a completed VA Form 21-8940, Veteran's Application for Increased CompensationBased on Unemployability If claiming Post-Traumatic Stress Disorder (PTSD), submit a completed VA Form 21-0781, Statement in Support of Claim for ServiceConnection for Post-Traumatic Stress Disorder, or if claiming PTSD based on personal assault, submit a completed VA Form 21-0781a,Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder Secondary to Personal AssaultVA FORM 21-526EZ, SEP 2019Page 2

SPECIAL CIRCUMSTANCES (Continued)Under the special circumstances shown below, you must also submit along with your claim the following: If claiming Specially Adapted Housing or Special Home Adaptation, submit a completed VA Form 26-4555, Application in AcquiringSpecially Adapted Housing or Special Home Adaptation Grant If claiming Auto Allowance, submit a completed VA Form 21-4502, Application for Automobile or Other Conveyance and Adaptive Equipment If claiming additional benefits because you or your spouse require Aid and Attendance, submit a completed VA Form 21-2680, Examinationfor Housebound Status or Permanent Need for Regular Aid and Attendance; or if claiming Aid and Attendance based on nursing homeattendance, a VA Form 21-0779, Request for Nursing Home Information in Connection with Claim for Aid and AttendanceNOTE: VA forms are available online at www.va.gov/vaforms.3. HOW VA WILL HELP YOU OBTAIN EVIDENCE FOR YOUR CLAIMThe table below describes the information and evidence VA will assist you in obtaining based on whether you wish to have your claim considered inthe FDC Program (Optional Expedited Process) or in the Standard Claim Process.FDC Program (Optional Expedited Process)VA will:Standard Claim ProcessVA will: Retrieve relevant records from a Federal facility, such as a VAmedical center, that you adequately identify and authorized VA toobtain Provide a medical examination for you, or get a medical opinion, ifwe determine it is necessary to decide your claim Retrieve relevant records from a Federal facility, such as a VA medicalcenter, that you adequately identify and authorized VA to obtain Provide a medical examination for you, or get a medical opinion, if wedetermine it is necessary to decide your claim Make every reasonable effort to obtain relevant records not held by aFederal facility that you adequately identify and authorize VA toobtain. These may include records from State or local governments andprivately held evidence and information you tell us about, such as aprivate doctor or hospital records from current or former employers4. WHERE TO SEND INFORMATION AND EVIDENCEYou may send your application and any evidence in support of your claim by using the following methods shown in the table below.MAIL TODepartment of Veterans AffairsEvidence Intake CenterPO Box 4444Janesville, WI 53547-4444SUBMIT ONLINEVA gov: www.va.govDirect Upload via access.va.gov5. WHAT THE EVIDENCE MUST SHOW TO SUPPORT YOUR CLAIMThe table below provides a guide to the evidence tables showing what evidence you must provide to support your claim.If you are claiming.See the evidence table titled.You have a disability that was caused or aggravated by your serviceYour service connected disability caused or aggravated an additionaldisabilityYour service connected disability has worsenedCompensation and you are a service person who is about to be dischargedYour service connected disability caused you to be hospitalized or toundergo surgery or other treatmentYour service connected disability(ies) prevents you from getting orkeeping substantial employmentYou have a disability caused or aggravated by VA medical treatment,vocational rehabilitation, or compensated work therapyYour service connected disability (ies) causes you to be in need of aid andattendance or to be confined to your residenceAdapting and/or purchasing a residenceAdapting and/or purchasing a vehicleA Severely Disabled SpouseA Severely Disabled ChildDisability Service ConnectionVA FORM 21-526EZ, SEP 2019Secondary Service ConnectionIncreased Disability CompensationCompensation Claims Submitted Prior to DischargeTemporary Total Disability RatingIndividual UnemployabilityCompensation Under 38 U.S.C. 1151Special Monthly CompensationSpecial Adapted Housing or Special Home AdaptationAuto AllowanceSpecial Monthly CompensationHelpless ChildPage 3

EVIDENCE TABLESDisability Service ConnectionTo support a claim for service connection, the evidence must show: You had an injury in service, or a disease that began in or was made permanently worse during service, or there was an event in service thatcaused an injury or disease; AND You have a current physical or mental disability. This may be shown by medical evidence or by lay evidence of persistent and recurrentsymptoms of disability that are visible or observable; AND A relationship exists between your current disability and an injury, disease, symptoms, or event in service. This may be shown by medicalrecords or medical opinions or, in certain cases, by lay evidence.However, under certain circumstances, VA may presume that certain current disabilities were caused by service, even if there is no specificevidence proving this in your particular claim. The cause of a disability is presumed for the following veterans who have certain diseases: Former prisoners of war; Veterans who have certain chronic or tropical diseases that become evident within a specific period of time after discharge from service; Veterans who were exposed to ionizing radiation, mustard gas, or Lewisite while in service; Veterans who were exposed to certain herbicides, such as by serving in Vietnam; or Veterans who served at Camp Lejeune for no less than 30 days (consecutive or nonconsecutive) between August 1, 1953 and December 31,1987; or Veterans who served in the Southwest Asia theater of operations during the Gulf War.To support a claim for service connection based upon a period of active duty for training, the evidence must show: You were disabled during active duty for training due to disease or injury incurred or aggravated in the line of duty; AND You have a current physical or mental disability. This may be shown by medical evidence or by lay evidence of persistent and recurrentsymptoms of disability that are visible or observable; AND There is a relationship between your current disability and the disease or injury incurred or aggravated during active duty for training. Thismay be shown by medical records or medical opinions or, in certain cases, by lay evidence.To support a claim for service connection based upon a period of inactive duty training, the evidence must show: You were disabled during inactive duty training due to an injury incurred or aggravated in the line of duty or an acute myocardial infarction,cardiac arrest, or cerebrovascular accident during inactive duty training; AND You have a current physical or mental disability. This may be shown by medical evidence or by lay evidence of persistent and recurrentsymptoms of disability that are visible or observable; AND There is a relationship between your current disability and your inactive duty training. This may be shown by medical records or medicalopinions or, in certain cases, by lay evidence.In order to file a supplemental claim, you must submit or identify new and relevant evidence. To qualify as new, the evidence must not have been part of the evidentiary record at the time of the prior decision. In order to be considered relevant, the additional evidence must tend to prove or disprove a matter at issue in the claim.Secondary Service ConnectionTo support a claim for compensation based upon an additional disability that was caused or aggravated by a service-connected disability, theevidence must show: You currently have a physical or mental disability shown by medical evidence or by lay evidence of persistent and recurrent symptoms ofdisability that are visible or observable, in addition to your service-connected disability; AND Your service-connected disability either caused or aggravated your additional disability. This may be shown by medical records or medicalopinions or, in certain cases, by lay evidence. However, VA may presume service-connection for cardiovascular disease developing in aclaimant with certain service-connected amputation(s) of one or both lower extremities.Increased Disability CompensationIf VA previously granted service connection for your disability and you are seeking an increased evaluation of your service-connected disability, weneed medical or lay evidence to show a worsening or increase in severity and the effect that worsening or increase has on your ability to work.VA FORM 21-526EZ, SEP 2019Page 4

EVIDENCE TABLES (Continued)Compensation Claims Submitted Prior to DischargeUnder the Benefits Delivery at Discharge (BDD) program you can submit a disability claim 90 to 180 days prior to your anticipated separation datefrom active duty. Claims are accepted from active duty Servicemembers, including reservists serving on active duty in an Active Guard Reserve(AGR) role under 10 U.S.C. and full-time National Guard members serving in an AGR role under 32 U.S.C.BDD program participants can have their VA medical examinations conducted while they are still on active duty. You are encouraged to file yourclaim as close to the 180 day mark as possible to ensure your examinations can be scheduled and completed prior to your discharge from active duty.The BDD program requires that Servicemembers be available to report for examinations for 45 days following submission of a disability claim.Claims and additional contentions received with less than 90 days remaining on active duty, claim types that are excluded from the BDD program, orwhere the Servicemember is unable to report for an examination within the BDD required time frame will be processed under the standard VAclaims process, the Fully Developed Claim (FDC) program or any other qualifying program.BDD Program Criteria for Claim(s) for Disability Compensation and Related Compensation Benefits Submitted Prior to Separation fromActive Duty: be within 90 to 180 days of discharge; be available to report for examinations for 45 days following the submission of a disability claim; submit copies of service treatment records for the current period of service with the BDD claim; provide an anticipated release from active duty date, and complete a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation BenefitsTemporary Total Disability RatingIn order to support a claim for a temporary total disability rating due to hospitalization, the evidence must show: You were treated for more than 21 days for a service-connected disability at a VA or other approved hospital; OR You underwent hospital observation at VA expense for a service-connected disability for more than 21 days.In order to support a claim for a temporary total disability rating due to surgical or other treatment performed by a VA or other approvedhospital or outpatient facility, the evidence must show: The surgery or treatment was for a service-connected disability; AND The surgery required convalescence of at least one month; OR The surgery resulted in severe postoperative residuals, such as incompletely healed surgical wounds, stumps of recent amputations, therapeuticimmobilizations, house confinement, or the required use of a wheelchair or crutches; OR One major joint or more was immobilized by a cast without surgery.Individual UnemployabilityIn order to support a claim for a total disability rating based on individual unemployability, the evidence must show: That your service-connected disability or disabilities are sufficient, without regard to other factors, to prevent you from performing the mentaland/or physical tasks required to get or keep substantially gainful employment; AND Generally, you meet certain disability percentage requirements as specified in 38 Code of Federal Regulations 4.16 (i.e. one disability ratableat 60 percent or more, OR more than one disability with one disability ratable at 40 percent or more and a combined rating of 70 percent ormore).In order to support a claim for an extra-scheduler evaluation based on exceptional circumstances, the evidence must show: That your service-connected disability or disabilities present such an exceptional or unusual disability picture, due to such factors as markedinterference with employment or frequent periods of hospitalization, that application of the regular schedular standards is impractical.Compensation Under 38 U.S.C. 1151In order to support a claim for compensation under 38 U.S.C. 1151, the evidence must show that, as a result of VA hospitalization, medical orsurgical treatment, examination, or training, you have: An additional disability or disabilities; OR An aggravation of an existing injury or disease; AND The disability was the direct result of VA fault such as carelessness, negligence, lack of proper skill, or error in judgment, or not a reasonablyexpected result or complication of the VA care or treatment; OR The direct result of participation in a VA Vocational Rehabilitation and Employment or compensated work therapy program.VA FORM 21-526EZ, SEP 2019Page 5

EVIDENCE TABLES (Continued)Special Monthly CompensationIn order to support a claim for increased benefits based on the need for aid and attendance, the evidence must show that, due to your serviceconnected disability or disabilities: You require the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding, dressingyourself, attending to the wants of nature, adjusting prosthetic devices, or protecting yourself from the hazards of your daily environment (38Code of Federal Regulation 3.352(a)); OR You are bedridden, in that your disability or disabilities requires that you remain in bed apart from any prescribed course of convalescence ortreatment (38 Code of Federal Regulation 3.352(a)).In order to support a claim for increased benefits based on an additional disability or being housebound, the evidence must show: You have a single service-connected disability evaluated as 100 percent disabling AND an additional service-connected disability, ordisabilities, evaluated as 60 percent or more disabling; OR You have a single service-connected disability evaluated as 100 percent disabling AND, due solely to your service-connected disability ordisabilities, you are permanently and substantially confined to your immediate premises.In order to support a claim for increased benefits based on your spouse's need for aid and attendance, per the provisions of 38 C.F.R. § 3.351(c),the evidence must show: Your spouse is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visualfield to 5 degrees or less; OR Your spouse is a patient in a nursing home because of mental or physical incapacity; OR Your spouse requires the aid of another person in order to perform personal functions required in everyday living, such as bathing, feeding,dressing, attending to the wants of nature, adjusting prosthetic devices, or protecting him or her from the hazards of his or her daily environment(See 38 C.F.R. § 3.352(a) for complete explanation).IMPORTANT: For additional benefits to be payable for a spouse, the veteran must be entitled to compensation and evaluated as 30 percent or moredisabling.Specially Adapted Housing or Special Home AdaptationTo support your claim for specially adapted housing (SAH), the evidence must show you are a: Veteran entitled to compensation under 38 U.S.C. Chapter 11 for a permanent and totally disabling qualifying condition; OR Servicemember on active duty who has a permanent and totally disabling qualifying condition incurred or aggravated in the line of duty.To support that you have a qualifying condition for SAH the evidence must show: Amyotrophic lateral sclerosis (ALS); OR Loss (amputation) or loss of use of: both lower extremities; OR one lower extremity and one upper extremity affecting balance or propulsion; OR one lower extremity plus residuals of organic disease or injury affecting balance or propulsion creating a need for regular, constant use of awheelchair, braces, crutches or canes as a normal mode of getting around (although getting around by other methods may occasionally bepossible); OR Loss or loss of use of both upper extremities precluding use of the arms at or above the elbow; OR Permanent but not total disability due to blindness in both eyes, (having central visual acuity of 20/200 or less in the better eye with the use ofa standard correcting lens); OR A severe burn injury, meaning full thickness or sub-dermal burns that have resulted in contractures with limitation of motion of: two or more extremities; OR at least one extremity and the trunk.To support your claim for SAH the evidence may alternatively show you are a: Veteran who served and became permanently disabled from a qualifying condition on or after September 11, 2001; OR Servicemember on active duty who was permanently disabled in the line of duty from a qualifying condition on or after the same date.To support that you have a qualifying condition under the alternative service criteria the evidence must show: Loss (amputation) or loss of use of: one or more lower extremities, severely affecting the functions of balance or propulsion and creating a need for regular, constant use of awheelchair, braces, crutches or canes as a normal mode of getting around (although getting around by other methods may occasionally bepossible).To support your claim for a special home adaptation (SHA) grant the evidence must show you are a: Veteran entitled to compensation under 38 U.S.C. Chapter 11 for a qualifying condition; OR Servicemember on active duty who has a qualifying condition incurred or aggravated in the line of duty.VA FORM 21-526EZ, SEP 2019Page 6

EVIDENCE TABLES (Continued)Specially Adapted Housing or Special Home Adaptation (Continued)To support that you have a qualifying condition for SHA the evidence must show: the loss, or permanent loss of use, of at least a foot or a hand; OR Permanent and total disability from loss, or loss of use, of both hands; OR Permanent and total disability from a severe burn injury meaning deep partial thickness burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremityand the trunk; OR full thickness or sub-dermal burns that have resulted in contracture(s) with limitation of motion of one or more extremities or the trunk; OR residuals of inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease).Auto AllowanceTo support a claim for automobile allowance or adaptive equipment, the evidence must show that you have a service-connected disability resulting in:(1) the loss, or permanent loss of use, of at least a foot or a hand; OR(2) permanent impairment of vision of both eyes, resulting in:(a) vision of 20/200 or less in the better eye with corrective glasses; OR(b) vision of 20/200 or better, if there is a severe defect in your peripheral vision; OR(3) deep partial thickness or full thickness burns resulting in scar formation that cause contractures and limit motion of one or more extremities ofthe trunk and preclude effective operation of an automobile; OR(4) amyotrophic lateral sclerosis (ALS).NOTE - You may be entitled to only adaptive equipment if you have ankylosis ("freezing") of at least one knee or one hip due to service-connecteddisability. Medical evidence, including a VA examination, will show these things. VA will provide an examination if it determines that one isnecessary.Helpless ChildTo support a claim for benefits based on a veteran's child being helpless, the evidence must show that the child, before his or her 18th birthday,became permanently incapable of self-support due to a mental or physical disability.IMPORTANT: For additional benefits to be payable for a child, the veteran must be entitled to compensation and evaluated as 30 percent or moredisabling.HOW VA DETERMINES THE EFFECTIVE DATE.If we grant your claim, the beginning date of your entitlement or increased entitlement to benefits will generally be based on the following factors: When we received your claim, OR When the evidence shows a level of disability that supports a certain rating under the rating scheduleIf VA received your claim prior to or within one year of your

If you file a claim in the FDC Program and it is determined that other records exist and VA needs the records to decide your claim, then VA will simply remove the claim from the FDC Program and process it in the Standard Claim Process. If you wish to file your claim in the FDC Program,