Get Va 21-0819 2009

Filling out the VA 21-0819 form is essential for service members seeking to initiate a disability evaluation board claim. This guide provides clear, step-by-step instructions to help users easily complete the form online.

Follow the steps to complete the VA 21-0819 online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Review Section I, which must be completed by the Military Treatment Facility. Here, provide the service member's full name, grade, and component, along with the unit address and Social Security number.
3. In Section I, include the service member's sex, date of birth, and contact information for the assigned Physical Evaluation Board Liaison Officer (PEBLO), as well as the name of the referring Military Treatment Facility.
4. Detail the date of referral to the Medical Evaluation Board (MEB) and list the medical conditions to be considered as the basis for the fitness for duty determination.
5. Proceed to Section II, which asks for your personal contact information. Fill in your address with appropriate details, including phone numbers and email address if applicable.
6. Indicate whether you have previously filed a claim with the VA, and if so, provide your VA file number.
7. Complete Item 6 regarding any other names you may have served under, and then continue to provide your entry date for the current period of active service.
8. In Section III, provide information about your military service and fill out any relevant details about reserve duty or National Guard duty.
9. Confirm if you are currently assigned to an active reserve unit or National Guard unit, providing necessary details such as the name and mailing address of your current unit.
10. List any additional disabling conditions in Section III, if applicable, and denote if you have dependents.
11. Move to Section IV and make your choice regarding military retired pay versus VA compensation.
12. Complete Section V for direct deposit information, including your account number and financial institution's details. You may request a waiver if needed.
13. Sign the certifying statement in Section VI, ensuring that your signature is included and the date is provided.
14. If needed, complete Section VII regarding witnesses to your signature. Ensure witness details are correctly entered.
15. Finally, review all entered information for accuracy. Save the changes, download, print, or share the completed form as needed.

Complete your VA 21-0819 form online today to initiate your disability evaluation board claim.