Va form 21 4142a mar 2018-2025

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To receive TDIU benefits, the veteran must apply for disability compensation and fill out two additional forms: Veterans Application for Increased Compensation Based on Unemployability (Form 21-8940) Request for Employment Information in Connection with Claim for Disability Benefits (Form 21-4192)
An accredited attorney, claims agent, or Veterans Service Organization (VSO) representative can help you file a claim or request a decision review. Learn how to find and appoint one of these types of accredited representatives to help you.
If you decide to file a TDIU claim, youll need to submit a VA Form 21-8940. Based on the information you provide in Form 21-8940, the VA will automatically generate and send a VA Form 21-4192 to your most recent employer. The VA will send you a copy as well.
Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our
When to use this form. Use VA Form 21-4192 if youre a Veteran and you need your most recent employer to send us information so you can apply for Individual Unemployability disability benefits. Your most recent employer must complete and submit this form.
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The VA Form 21-4142 is valid for 12 months from the date signed. It is permissible to authorize release of, and disclose, information created after the consent is signed.
The VA cant deny your unemployability claim if your former employer fails to complete VA Form 21-4192. The form is not absolutely necessary to receive a favorable decision on your TDIU claim. Many veterans have succeeded with their TDIU claim without a 21-4192. However, without the form, the process could be delayed.

va form 21 4142a