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Get Va Form 21 8416

Do not include any expense for which you have been reimbursed. Mileage Log Supplement to VA Form 21-8416 This form is not fillable print and give to client to keep track of their mileage. List of Possible Medical Expenses For 21-8416 Examples of different types of medical expenses are listed below. This list is not all-inclusive. You should report any unreimbursed expenses which you have paid and which may be reasonably related to medical care. The VA will determine which are allowable expenses under the law. Ask your representative if you are unsure if an expense is covered* You must have income other than just VA pension payments to qualify for these expenses. Abdominal Supports Acupuncture Ambulance Anesthetist Arch Supports Artificial Limbs and Teeth Back Supports Braces Cardiographs Chiropodist Convalescent Home Medical Treatment Only Crutches Dental Services Dentures Dermatologist Eyeglasses and Eye Care Food or Beverages Prescribed h Gynecologist Hearing Aids and Batteries Home Health Services Hospital Expenses and Diabetic Supplies Invalid Chair Wheelchairs Walkers Lab Tests Lip Reading Sign Language Classes Deaf Neurologist Nursing Services and Nurse s Board Occupational Physical Therapy Ophthalmologist Optician Optometrist Oral Surgery Osteopath Pediatrician Physical Examinations Physical Therapist Podiatrist Prescription Drugs Psychiatrist Psychoanalyst Psychologist Psychotherapy Radiation Therapy Sacroiliac Belt Seeing-eye Dog and Maintenance Speech Therapy Telephone or Special Communications Equipment Vaccines Vitamins Prescribed Whirlpool Baths Medical Purposes X-Rays Transportation Expenses for Medical Purposes at 0. 20 per mile plus parking tolls or actual other fees e*g* taxi busses etc* YOU MUST KEEP A LOG* Doctor s statement or prescription is needed* Medical insurance premiums and co-pay charges including Medicare Part B are covered* Over-the-counter drugs and items must have a doctor s statement or prescription* You must have paid medical expenses during the reporting period and you have not been reimbursed by insurance or otherwise. You should report the total unreimbursed amount you paid for medical expenses for yourself and family member you are under an obligation to support. You may include premiums paid for health sickness or hospitalization insurance. In computing your countable income the VA will exclude the amounts you paid for medical expenses if they qualify under the formula set by law. Medical legal or other expenses incurred because of a disability disease or injury for which civilian disability benefits have been awarded are deductible from the payments received for the year in which the expenses are paid in computing annual income for VA purposes. Date To For Mileage Date you went to doctor etc* Doctor lab pharmacy x-ray hospital etc* Illness you were treated for or pick up medications etc* Miles to and from appointment etc* Total Miles for this page SBVA Supplement to 21-8416. List of Possible Medical Expenses For 21-8416 Examples of different types of medical expenses are listed below. This list is not all-inclusive. You should report any unreimbursed expenses which you have paid and which may be reasonably related to medical care.

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