Health Benefits Renewal Form


I have questions concerning, DA form 10-10EZR (Health Benefits Renewal Form)? I'm a veteran (TDIU) 100% sc 90% with multiple injuries. My back, hypertension, pelvic injury, migrane headaches, ect. I receive some of my care at the VAMC Atlanta, Ga. I also have a private doctor too. Every year around about this time, I usually receive a questionnaire to sign? (30 Aug) So far, I have only received the DA form 10-10EZR. Could you please, explain for me, what this form means? I have problems with the VA, right now as does every veteran who has served! I have just put in a HUD complaint, against the apartment management that renting from? The VA is involved, with the preps who are harassing and stalking me! I believe that this maybe retaliation on their part? They have also been stalling on dental work needed on two teeth! They act like don't want to do the work! I believe that this form is a catch 22? What are your thoughts? Thank you!


Each year at about the time of your original award, you should get a VA Form 21-4140. That's an employment questionnaire to confirm that you didn't have gainful employment during the last year. TDIU restricts your ability to work and earn a living.

All the various Regional Offices are sloppy about sending out the form. Some do, some don't, most send it late if at all.

The problem arises when they don't send you the form and then months or even years later they notice that you didn't return the form they didn't send you and they try to suspend your benefits because you made the mistake.

I can only guess that some dummy sent you the wrong form. That would be typical of the sloppy work that we've come to know and love from our Regional Offices. Somebody deep in the bowels of your RO just grabbed whatever was handy and mailed it to you.

I don't think there was anything sinister to it. I almost wish that there was a plot...that would be better than knowing that their work product is that bad. If these errors only happened rarely, we could look past an occasional mistake. But...we've learned that this is what to expect and that is really sad.

Download the 4140 form

Print it out and mail it using certified mail, return receipt requested. Don't hand deliver or fax, please. You want that receipt to prove you mailed it.