What Is VA Form 21-0788?-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with PART A, where you can nominate a representative if desired. Fill in their name, organization, and contact details.
3. Move to PART B to provide your personal details. Include your DVA file number, name, postal address, and the reason for your loss of earnings.
4. In PART C, your employer will need to confirm your absence from work and detail the wages lost during that period.
5. Finally, complete PART D by having your treating doctor report on the treatment provided and how it affected your ability to work.

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