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VA Form 21-2680 is a form, filled out by a medical doctor, to support a claim for aid and attendance and/or housebound benefits filed with the Department of Veterans Affairs.
Veterans should provide a description of what occurred, the approximate date and geographic location, their unit and dates of assignment, and the full names and assignments of anyone who was killed or injured during the incident. VA requests veterans complete the form with as many specific details as possible.
Use VA Form 21-4142a to give us permission to get medical provider information from a non-VA source like a private doctor or hospital. This will allow us to gather information like the name and address of a facility and your medical treatment dates.
NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly, insert one letter per box, and completely fill in each applicable circle to help expedite processing of the form.
VA Forms 21-4142 and 21-4142a are used in conjunction with each other and both forms must be completed in order to obtain treatment records.
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How do you fill out and complete VA Form 21-2680? Frequency: describe how often a particular symptom affects the veterans ability to leave the house. Chronicity: describe the duration of the particular symptom, not just in the past, but into the future. Severity: describe how severe the symptom is.
VA Form 21, APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE.
0:38 2:10 How to Fill Out a 21-4138 VA Form - YouTube YouTube Start of suggested clip End of suggested clip And refusal to provide. It. Or any other person who knows about the veterans disability to proveMoreAnd refusal to provide. It. Or any other person who knows about the veterans disability to prove that the current conditions are connected with the military.
You may apply for Aid and Attendance or Housebound benefits by filling out, or have your doctor complete, VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) and mailing it to the Pension Management Center (PMC) that serves your state.
For most veterans, it is the same number as their social security number, just without the dashes. However, if the veteran filed the first claim a long time ago, the number will be a different number. Just below your file number will be your name.

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