VA · Official form

VA Form 21-8940: Veteran's Application for Increased Compensation Based on Unemployability

VA Form 21-8940 is the application for Individual Unemployability, the benefit that pays compensation at the 100 percent rate to veterans whose service-connected disabilities prevent them from keeping substantially gainful work.

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What is VA Form 21-8940?

VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, is the formal claim for a total disability rating based on individual unemployability, commonly called TDIU or IU. It asks which service-connected disabilities prevent work, medical care received for them, employment history for the five years before the veteran became too disabled to work and any work since, earnings, education, and any training before or after disability.

VA pairs the application with VA Form 21-4192, which it sends to the employers listed so they can verify the employment facts. The current edition of the 21-8940 is dated July 2024. Answering the work history and income questions completely and consistently with the rest of the record is the most important part of the form.

Who files VA Form 21-8940?

Veterans whose service-connected disabilities prevent them from keeping substantially gainful employment
Veterans meeting the schedular TDIU thresholds: one disability rated 60 percent or more, or a combined 70 percent with one rated at least 40
Veterans who fall below those thresholds but claim entitlement on an extraschedular basis
Veterans already receiving TDIU who are asked to update employment information

How to fill out VA Form 21-8940

Complete the identification section and list the service-connected disabilities that prevent you from working.
Report the medical care you have received for those conditions, including doctors and hospital dates.
List your employment for the five years before you became too disabled to work, plus any work since, with hours, earnings, and time lost.
Describe your education and any training before or after you became too disabled to work, then sign and date the certification.
Submit the form through va.gov or mail it to the VA Claims Intake Center address in the instructions. VA will send VA Form 21-4192 to the employers you listed.

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Page 1 53 fields

Read Important information and Social Security Benefits above. SECTION 1. VETERAN IDENTIFICATION INFORMATION. Read Note above. 1. VETERAN'S

1. VETERAN'S NAME. Middle Initial. 1 character max.

1. VETERAN'S NAME. Last Name. 18 characters max.

2. SOCIAL SECURITY NUMBER. Enter First Three Digits.

2. SOCIAL SECURITY NUMBER. Enter Middle Two Digits.

2. SOCIAL SECURITY NUMBER. Enter Last Four Digits.

3. V. A.FILE NUMBER. Enter 9 digit file number.

4. DATE OF BIRTH. Enter 2 digit Month.

4. DATE OF BIRTH. Enter 2 digit day.

4. DATE OF BIRTH. Enter 4 digit year.

5. MAILING ADDRESS (Number and street or rural route, city or P.O. Box, State, ZIP Code and Country). Number and Street. 30 characters max.

5. MAILING ADDRESS. Apartment or Unit Number. 5 characters max.

5. MAILING ADDRESS. City. 18 characters max.

5. MAILING ADDRESS. State or Province. 2 characters max.

5. MAILING ADDRESS. Country. 2 characters max.

5. MAILING ADDRESS. ZIP or Postal Code. First 5 digits.

5. MAILING ADDRESS. ZIP or Postal Code. Last 4 digits.

6. I agree to receive electronic correspondence from V. A. in regards to my claim.

6. EMAIL ADDRESS (if applicable). 17 characters max. Line 1 of 2.

6. EMAIL ADDRESS (if applicable). 17 characters max. Line 2 of 2.

7. TELEPHONE NUMBER (Include Area Code). Enter three digits of Area Code.

7. TELEPHONE NUMBER (Include Area Code). Enter middle three digits.

7. TELEPHONE NUMBER (Include Area Code). Enter last four digits.

7. Enter International Phone Number (If applicable).

SECTION 2 - DISABILITY AND MEDICAL TREATMENT. 8. WHAT SERVICE-CONNECTED DISABILITY(IES) PREVENT(S) YOU FROM SECURING OR FOLLOWING ANY

9. HAVE YOU BEEN UNDER A DOCTOR'S CARE AND / OR HOSPITALIZED WITHIN THE PAST 12 MONTHS? YES.

10. DATE(S) OF TREATMENT BY DOCTOR(S) (Go to Item 26 - Remarks - for additional dates). FROM. Enter 2 digit Month.

10. DATE(S) OF TREATMENT BY DOCTOR(S). FROM. Enter 2 digit day.

10. DATE(S) OF TREATMENT BY DOCTOR(S). FROM. Enter 4 digit year.

10. DATE(S) OF TREATMENT BY DOCTOR(S) (Go to Item 26 - Remarks - for additional dates). TO. Enter 2 digit Month.

10. DATE(S) OF TREATMENT BY DOCTOR(S). TO. Enter 2 digit day.

10. DATE(S) OF TREATMENT BY DOCTOR(S). TO. Enter 4 digit year.

11. NAME AND ADDRESS OF DOCTOR(S).

12. NAME AND ADDRESS OF HOSPITAL.

13. DATE(S) OF HOSPITALIZATION (Go to Item 26 - Remarks - for additional dates). FROM. Enter 2 digit Month.

13. DATE(S) OF HOSPITALIZATION. FROM. Enter 2 digit day.

13. DATE(S) OF HOSPITALIZATION. FROM. Enter 4 digit year.

13. DATE(S) OF HOSPITALIZATION (Go to Item 26 - Remarks - for additional dates). TO. Enter 2 digit Month.

13. DATE(S) OF HOSPITALIZATION. TO. Enter 2 digit day.

13. DATE(S) OF HOSPITALIZATION. TO. Enter 4 digit year.

SECTION 3 - EMPLOYMENT STATEMENT. 14. DATE YOUR DISABILITY AFFECTED FULL-TIME EMPLOYMENT. Enter 2 digit Month.

14. DATE YOUR DISABILITY AFFECTED FULL-TIME EMPLOYMENT. Enter 2 digit day.

14. DATE YOUR DISABILITY AFFECTED FULL-TIME EMPLOYMENT. Enter 4 digit year.

15. DATE YOU LAST WORKED FULL-TIME. Enter 2 digit Month.

15. DATE YOU LAST WORKED FULL-TIME. Enter 2 digit day.

15. DATE YOU LAST WORKED FULL-TIME. Enter 4 digit year.

16. DATE YOU BECAME TOO DISABLED TO WORK. Enter 2 digit Month.

16. DATE YOU BECAME TOO DISABLED TO WORK. Enter 2 digit day.

16. DATE YOU BECAME TOO DISABLED TO WORK. Enter 4 digit year.

17. A. WHAT IS THE MOST YOU EVER EARNED IN ONE YEAR? Enter dollar amount. First 3 digits.

17. A. WHAT IS THE MOST YOU EVER EARNED IN ONE YEAR? Enter dollar amount. Last 3 digits.

17. B. WHAT YEAR? Enter 4 digit year.

17. C. OCCUPATION DURING THAT YEAR?

Page 2 60 fields

18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED (Include any military duty including inactive

18. TYPE OF WORK. 1 of 5.

18. HOURS PER WEEK. 3 digits max. 1 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit Month. 1 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit day. 1 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 4 digit year. 1 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit Month. 1 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit day. 1 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 4 digit year. 1 of 5.

18. TIME LOST FROM ILLNESS. 3 digits max. 1 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. First 3 digits. 1 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. Last 3 digits. 1 of 5.

18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED (Include any military duty including inactive

18. TYPE OF WORK. 2 of 5.

18. HOURS PER WEEK. 3 digits max. 2 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit Month. 2 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit day. 2 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 4 digit year. 2 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit Month. 2 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit day. 2 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 4 digit year. 2 of 5.

18. TIME LOST FROM ILLNESS. 3 digits max. 2 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. First 3 digits. 2 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. Last 3 digits. 2 of 5.

18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED (Include any military duty including inactive

18. TYPE OF WORK. 3 of 5.

18. HOURS PER WEEK. 3 digits max. 3 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit Month. 3 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit day. 3 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 4 digit year. 3 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit Month. 3 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit day. 3 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 4 digit year. 3 of 5.

18. TIME LOST FROM ILLNESS. 3 digits max. 3 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. First 3 digits. 3 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. Last 3 digits. 3 of 5.

18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED (Include any military duty including inactive

18. TYPE OF WORK. 4 of 5.

18. HOURS PER WEEK. 3 digits max. 4 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit Month. 4 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit day. 4 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 4 digit year. 4 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit Month. 4 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit day. 4 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 4 digit year. 4 of 5.

18. TIME LOST FROM ILLNESS. 3 digits max. 4 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. First 3 digits. 4 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. Last 3 digits. 4 of 5.

18. LIST ALL YOUR EMPLOYMENT INCLUDING SELF-EMPLOYMENT FOR THE LAST FIVE YEARS YOU WORKED (Include any military duty including inactive

18. TYPE OF WORK. 5 of 5.

18. HOURS PER WEEK. 3 digits max. 5 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit Month. 5 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 2 digit day. 5 of 5.

18. DATES OF EMPLOYMENT. FROM. Enter 4 digit year. 5 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit Month. 5 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 2 digit day. 5 of 5.

18. DATES OF EMPLOYMENT. TO. Enter 4 digit year. 5 of 5.

18. TIME LOST FROM ILLNESS. 3 digits max. 5 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. First 3 digits. 5 of 5.

18. HIGHEST GROSS EARNINGS PER MONTH. Enter dollar amount. Last 3 digits. 5 of 5.

Page 3 43 fields

19. IF YOU ARE CURRENTLY SERVING IN THE RESERVE OR NATIONAL GUARD, DOES YOUR SERVICE CONNECTED DISABILITY PREVENT YOU FROM PERFORMING YOUR

20. A. INDICATE YOUR TOTAL EARNED INCOME FOR THE PAST 12 MONTHS. Enter dollar amount. First 3 digits.

20. A. INDICATE YOUR TOTAL EARNED INCOME FOR THE PAST 12 MONTHS. Enter dollar amount. Last 3 digits.

20. B. IF PRESENTLY EMPLOYED, INDICATE YOUR CURRENT MONTHLY EARNED INCOME. Enter dollar amount. First 3 digits.

20. B. IF PRESENTLY EMPLOYED, INDICATE YOUR CURRENT MONTHLY EARNED INCOME. Enter dollar amount. Last 3 digits.

21. A. DID YOU LEAVE YOUR LAST JOB / SELF-EMPLOYMENT BECAUSE OF YOUR DISABILITY? YES (If "Yes," explain in Item 26, "Remarks").

21. B. DO YOU RECEIVE / EXPECT TO RECEIVE DISABILITY RETIREMENT BENEFITS? YES.

21. C. DO YOU RECEIVE / EXPECT TO RECEIVE WORKERS COMPENSATION BENEFITS? YES.

22. HAVE YOU TRIED TO OBTAIN EMPLOYMENT SINCE YOU BECAME TOO DISABLED TO WORK? YES. If "Yes," complete Items 22. A., 22 B, and 22 C.

22. A. NAME AND ADDRESS OF EMPLOYER. Line 1 of 3.

22. B. TYPE OF WORK. Line 1 of 3.

22. C. DATE APPLIED. Enter 2 digit Month. Line 1 of 3.

22. C. DATE APPLIED. Enter 2 digit day. Line 1 of 3.

22. C. DATE APPLIED. Enter 4 digit year. Line 1 of 3.

22. A. NAME AND ADDRESS OF EMPLOYER. Line 2 of 3.

22. B. TYPE OF WORK. Line 2 of 3.

22. C. DATE APPLIED. Enter 2 digit Month. Line 2 of 3.

22. C. DATE APPLIED. Enter 2 digit day. Line 2 of 3.

22. C. DATE APPLIED. Enter 4 digit year. Line 2 of 3.

22. A. NAME AND ADDRESS OF EMPLOYER. Line 3 of 3.

22. B. TYPE OF WORK. Line 3 of 3.

22. C. DATE APPLIED. Enter 2 digit Month. Line 3 of 3.

22. C. DATE APPLIED. Enter 2 digit day. Line 3 of 3.

22. C. DATE APPLIED. Enter 4 digit year. Line 3 of 3.

SECTION 4 - SCHOOLING AND OTHER TRAINING. 23. EDUCATION (Check highest year completed). GRADE SCHOOL. FIRST GRADE. 1

23. GRADE SCHOOL. SECOND GRADE. 2

23. GRADE SCHOOL. THIRD GRADE. 3

24. A. DID YOU HAVE ANY OTHER EDUCATION AND TRAINING BEFORE YOU WERE TOO DISABLED TO WORK? YES. If "Yes," complete Items 24 B and 24 C.

24. B. TYPE OF EDUCATION OR TRAINING. 15 characters max.

24. C. DATES OF TRAINING. BEGINNING. Enter 2 digit Month.

24. C. DATES OF TRAINING. BEGINNING. Enter 2 digit day.

24. C. DATES OF TRAINING. BEGINNING. Enter 4 digit year.

24. C. DATES OF TRAINING. COMPLETION. Enter 2 digit Month.

24. C. DATES OF TRAINING. COMPLETION. Enter 2 digit day.

24. C. DATES OF TRAINING. COMPLETION. Enter 4 digit year.

25. A. HAVE YOU HAD ANY EDUCATION AND TRAINING SINCE YOU BECAME TOO DISABLED TO WORK? YES. If "Yes," complete Items 25 B and 25 C.

25. B. TYPE OF EDUCATION OR TRAINING. 15 characters max.

25. C. DATES OF TRAINING. BEGINNING. Enter 2 digit Month.

25. C. DATES OF TRAINING. BEGINNING. Enter 2 digit day.

25. C. DATES OF TRAINING. BEGINNING. Enter 4 digit year.

25. C. DATES OF TRAINING. COMPLETION. Enter 2 digit Month.

25. C. DATES OF TRAINING. COMPLETION. Enter 2 digit day.

25. C. DATES OF TRAINING. COMPLETION. Enter 4 digit year.

Page 4 8 fields

SECTION 5 - REMARKS. NOTE: This section can be used for any additional information, if needed. 26. REMARKS.

28. DATE SIGNED. Enter 2 digit Month.

28. DATE SIGNED. Enter 2 digit day.

28. DATE SIGNED. Enter 4 digit year.

29. B. ADDRESS OF WITNESS. 17 characters max. Line 1 of 2.

29. B. ADDRESS OF WITNESS. 17 characters max. Line 2 of 2.

30. B. ADDRESS OF WITNESS. 17 characters max. Line 1 of 2.

30. B. ADDRESS OF WITNESS. 17 characters max. Line 2 of 2.

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Frequently asked questions

What rating do I need to qualify for TDIU?

The schedular thresholds are one service-connected disability rated 60 percent or higher, or two or more with a combined rating of 70 percent and at least one rated 40 percent. Veterans below those levels can still be considered on an extraschedular basis, but those claims get extra review.

Can I work at all while receiving TDIU?

Marginal employment, generally earnings below the poverty threshold for one person, does not by itself defeat TDIU. Substantially gainful employment does. Report all work honestly on the form; unreported work discovered later can create severe problems.

Do I also have to send VA Form 21-4192?

The 21-4192 is completed by your employers, not you. VA sends it to the employers you list, but giving a copy to your most recent employer yourself and asking them to return it promptly can shorten the wait.

VA Form 21-8940: Veteran's Application for Increased Compensation Based on Unemployability

What is VA Form 21-8940?

Who files VA Form 21-8940?

How to fill out VA Form 21-8940

Quick fill VA Form 21-8940 on this page

Frequently asked questions

Related forms

VA Form 21-4192: Request for Employment Information in Connection with Claim for Disability Benefits

VA Form 21-526EZ, Application for Disability Compensation

VA Form 21-4138: Statement in Support of Claim