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U.S. DOD Form dod-va-21-2545 OMB Approved No. 2900-0052 Respondent Burden 15 minutes 1A. FILE NO. REPORT OF MEDICAL EXAMINATION FOR DISABILITY EVALUATION 1B. 18. DATE SIGNED 19. SIGNATURE OF PERSON EXAMINED Do not print PENALTY - The law provides severe penalties which include fine or imprisonment or both for the willful submission of any statement or evidence of a material fact knowing it to be false or for the fraudulent acceptance of any payme.

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How to fill out the VA 21 2545 online

Filling out the VA 21 2545 form online is an important step in ensuring that your medical examination for disability evaluation is properly documented. This guide will walk you through each section of the form, providing clear and supportive instructions to help you complete it accurately.

Follow the steps to complete the VA 21 2545 form online.

  1. Click ‘Get Form’ button to retrieve the form and open it for editing.
  2. Begin by entering your file number in the designated field at the top of the form. This number is important for your identification purposes during the evaluation process.
  3. Provide your Social Security number in the appropriate section. This information is used to verify your identity.
  4. If applicable, fill in your insurance file number. This may include numbers related to V, H, or K categories.
  5. In section 4, specify the purpose of your examination clearly.
  6. Indicate the date of your examination in section 5.
  7. Enter your full name as it appears on official documents in section 3.
  8. Provide your home address completely in section 6, including street address, city, state, and ZIP code.
  9. Fill out the place of examination in section 7.
  10. Input your age in section 8 to complete the personal information section.
  11. Move on to section A and detail your occupational history since your last military discharge. This includes the name and address of your employer, type of work, monthly wages, and dates of employment.
  12. Record any time lost in the past 12 months in section 13, along with the reason for that lost time in section 14.
  13. In section B, recount your medical history since your latest VA examination in section 15, including the name and address of any doctor or hospital you have visited.
  14. Document your present complaint in section 17. Focus on symptoms rather than diagnoses.
  15. Sign and date the form in sections 18 and 19 to certify that all entries are accurate.
  16. Ensure that the examining physician completes section C, documenting the findings of their examination.
  17. Finally, make sure to save any changes, download or print the completed form, ensuring you have a copy for your records.

Take the next step by completing your VA 21 2545 form online today.

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