How to Fill Out and Submit VA Form 10-10EZR: Filing and Appeals

VA Form 10-10EZR is the Health Benefits Update Form that veterans already enrolled in VA health care use to report changes to their personal, financial, insurance, or military service information. To fill out VA Form 10-10EZR, complete Sections I, II, VII, and VIII (required for every filer) plus any of Sections III through VI that apply to the change you are reporting, then submit online at VA.gov, by mail to the Health Eligibility Center in Janesville, Wisconsin, or in person at any VA medical facility.¹

When to File

There is no annual deadline. You file when something in your life changes that affects how the VA calculates your priority group, your copays, or how it bills your other insurance. Common triggers:

A household income shift from a raise, job loss, retirement, or new Social Security payments.
Marriage, divorce, or the death of a spouse.
A new dependent by birth or adoption, or a child aging out of dependent status.
Gaining, dropping, or switching private health insurance, or enrolling in Medicare.
A new mailing address, phone number, or emergency contact.
A toxic exposure, radiation incident, or other service-related hazard you want added to your record.

The current version of the form is dated February 2025 and can be downloaded as a PDF from the VA forms page or completed through the online portal after signing in to VA.gov.¹

What to Have Ready Before You Start

Pull these together first. Missing one item is the most common reason a form gets returned or has to be resubmitted.

Your Social Security number and date of birth.
Social Security numbers and dates of birth for your spouse and each dependent child.
Insurance cards for every plan that covers you, including any plan through a spouse. If you have Medicare or Medicaid, have those cards ready to copy.
Previous calendar year income figures for you, your spouse, and any dependent children with reportable income. A recent tax return or W-2s work well.
Records of deductible expenses: non-reimbursed medical costs, insurance premiums (including Medicare premiums), and any burial expenses you paid for a spouse or dependent.
DD-214 or discharge papers if you are not currently receiving VA benefits. Veterans already receiving benefits can skip this; the VA will cross-reference its own records.²

Section-by-Section Instructions

Sections I, II, VII, and VIII are required for every veteran. Sections III through VI are conditional, based on what you are updating.²

Section I: General Information

Full legal name, preferred name, Social Security number, sex, date of birth, mailing address, phone numbers, and marital status. You also list next of kin and an emergency contact. Answer every field. An incomplete Section I will get the form returned.

Section II: Insurance Information

List every health insurance plan that covers you, including coverage through a spouse or partner. For each plan, enter the insurance company name, the policyholder’s name, the policy number, and the group code. If you carry more than one plan, attach the extra information on a separate sheet. Attach photocopies of your insurance cards, Medicare card, and Medicaid card if you have access to a copier.² The VA uses this to bill your private insurer for non-service-connected care. It does not bill Medicare or Medicaid directly, though it may bill Medicare supplemental insurance.³

Section III: Military Service Information

Last branch of service, entry and discharge dates, discharge type, and military service number. Yes-or-no questions cover whether you are a Purple Heart recipient, former prisoner of war, combat veteran who served after November 11, 1998, or were discharged for a disability incurred in the line of duty. A separate block covers toxic exposure history: ionizing radiation, Gulf War hazard locations, herbicide exposure (such as Agent Orange), Camp Lejeune contaminated water, asbestos, and other occupational hazards. If you are claiming an exposure, you can attach a written statement or witness statements to support it.²

If you already receive VA benefits, the VA will pull your service data from its own records. Section III matters most for veterans documenting a new exposure or a change in service-connected status.

Section IV: Dependent Information

Complete this section only if you are also filling out Section V. For your spouse, provide name, Social Security number, date of birth, sex, marriage date, and address if different from yours. You may count your spouse as a dependent even if you did not live together, as long as you contributed financial support during the previous calendar year.

For each dependent child, provide the child’s name, date of birth, Social Security number, the date they became your dependent, and their relationship to you. Children qualify as dependents if they are unmarried and under 18; between 18 and 23 and attending school at least part-time; or permanently disabled before age 18. The form also asks whether you paid educational expenses for any dependent child with reportable income.²

Section V: Previous Calendar Year Gross Annual Income

Report income for yourself, your spouse, and any dependent children with reportable income. The form breaks income into three categories:

Employment income: wages, bonuses, tips, and severance pay, but not income from a farm, ranch, property, or business.
Net income from a farm, ranch, property, or business, reported as revenue minus expenses.
Other income: Social Security payments, compensation, pension, interest, dividends, and similar sources. Welfare is excluded.²

For dependent children, include any income that could have been used to pay household expenses. Figures come from the previous calendar year, so a form filed in 2026 reports 2025 income. Your most recent tax return is the easiest reference.

Section VI: Previous Calendar Year Deductible Expenses

Deductible expenses reduce the income figure the VA uses to determine your priority group and copay level. Report non-reimbursed amounts paid by you or your spouse during the previous calendar year, including:

Medical and dental care costs.
Prescription medications.
Eyeglasses and vision care.
Medicare premiums and other health insurance premiums.
Expenses you paid on behalf of dependents or anyone you have a legal or moral obligation to support.
Last illness and burial expenses, including prepaid burial costs, paid for a spouse or dependent.²

Many veterans undercount here. Out-of-pocket dental work, hearing aids, and transportation to medical appointments generally qualify, and totaling them carefully can move you into a more favorable priority group.

Section VII: Consent to Copays and Communications

By signing, you agree to pay applicable VA copayments as required by law, including copays for urgent care. Mandatory for all filers.

Section VIII: Signature

Sign and date. If Section VIII is incomplete, the VA returns the entire form for correction rather than processing the rest.²

How to Submit

You have three options, and there is no filing fee for any of them.

Online at VA.gov. Sign in and go to the health benefits update page. This is the fastest route and generates an immediate confirmation.⁴
By mail. Print the completed PDF and send it to: Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.⁴
In person at any VA medical facility. Staff can review the form for completeness before accepting it, which reduces the chance of a return.

What Happens After You Submit

The VA sends a letter by mail confirming your updated information and any changes to your priority group or copay rates. There is no online tracking tool for 10-10EZR submissions; the VA’s claim status tracker covers disability compensation and pension claims, not health benefits updates. To check on a submission, call the VA health benefits hotline at 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.⁵

Behind the scenes, the VA cross-references the income you reported against IRS and Social Security Administration records through computer matching agreements.⁶⁷ If verified income exceeds what you reported, or exceeds the national income limits for your area, your copay responsibility and priority group can change, sometimes retroactively. The income thresholds are adjusted each year and vary by ZIP code; the VA posts current figures at its income limits page.⁸ Placement is most sensitive for veterans in priority groups 5, 7, and 8, where eligibility and copay rates hinge on whether household income falls below or above the geographically adjusted limit.⁹

If You Disagree With the Result

If the VA changes your priority group after processing your update and you believe the decision is wrong, the administrative decision review process applies (not the clinical appeals process, which covers medical treatment decisions).¹⁰ Your options are a Supplemental Claim with new evidence, a Higher-Level Review by a senior reviewer, or an appeal to the Board of Veterans’ Appeals. The decision letter you receive explains which review options apply and how to start one.

Why Accuracy Matters

Federal law makes it a crime to fraudulently obtain VA benefits. Under 38 U.S.C. § 6102, anyone who obtains money or payments under VA-administered programs without being entitled to them, and with intent to defraud, faces a fine under Title 18 or up to one year in prison, or both.¹¹ The far more common consequence of a misreported income figure is a retroactive billing adjustment, but the statute is on the books, and Sections V and VI are worth the extra time to get right.

1
Veterans Affairs. About VA Form 10-10EZR
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U.S. Department of Veterans Affairs. VA Form 10-10EZR Health Benefits Update Form
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Veterans Affairs. VA Health Care and Other Insurance
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Veterans Affairs. How to Update Your VA Health Benefits Information
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Veterans Affairs. Check Your VA Claim, Decision Review, or Appeal Status
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Department of Veterans Affairs. Income Verification Frequently Asked Questions
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Department of Veterans Affairs. Computer Matching Agreement Between Social Security Administration and Department of Veterans Affairs Veterans Health Administration
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Veterans Affairs. Income Limits and Your VA Health Care
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Veterans Affairs. VA Priority Groups
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Veterans Affairs. VA Decision Reviews and Appeals
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Office of the Law Revision Counsel. 38 USC 6102 – Fraudulent Acceptance of Payments