How to Fill Out a Winning VA Expense Report

By Kate Bluest

Using Veterans Administration medical facilities where veterans and their qualified family members can receive care without paying money up-front is the best way to handle your VA medical needs. However, if you do need to use medical facilities not run by the VA, you can submit a Medical Expense Report also known as form 21-8416 for reimbursement. Reimbursable expenses include, eye care, dental care, medical related transportation, hearing aids, home health aides and medications. To ensure that you will get you the maximum reimbursement, be sure to keep documentation of all expenses.

Download and open the medical expense report, which is Form 21-8416. This form is available from many sources including the U.S. Federal Government's hub for federal forms. The form is in a PDF format and can be filled in and saved to your computer.

Enter the "Name of Veteran" in field one. Tab to the next field.

Enter the "VA file number" if you have one in field two. The Veterans Affairs regional office might have asked you to fill out the medical expense report as part of an active claim. If the VA has started processing a claim for you in connection with this form, contact them to get your VA file number. If the VA has not started a claim for you, leave this field blank. Tab to the next field.

Enter the "Name and Address of Claimant" in field 3A. Tab to the next field. Click the square box in field 3B to put an "X" in it if the address in field 3A is a "Change of Address" from the address the VA office has on file. Tab to the next field.

Enter your "E-mail Address" in field 3C if you choose to. Tab to the next field.

Enter the "Veteran's Social Security Number" in field four.

Enter the dates the itemized expenses cover. If you have not received instructions about the time period, and are newly eligible for VA medical benefits, include all expenses incurred from your date of eligibility for which you have not been and will not be reimbursed for from another source. You can find this date on your Eligibility Verification Report. If you cannot find the information or you are unsure, call your regional VA office and ask.

Enter the purpose, amount you paid, date paid, name of provider, and the name of the person you paid the expenses for each item you list in field five, the "Itemization of Medical Expenses." If you received partial reimbursement from Medicare or private medical insurance, list the source and amount.

Add pages if you run out of room when itemizing your expenses. Use a word or spreadsheet program or write it out. Set up columns with all the column headers listed in the "Itemization of Medical Expense" section and continue itemizing your medical expenses.

Enter your telephone numbers in fields 6A and 6B. Save the form. Print the form.

Sign the printed form in field 7A to certify the information you have given is true and date the signature in field 7B.

Mail or take the completed printed form with copies of your documentation for the itemized list to your local regional VA office or to the entity that requested you fill out the information.

Keep receipts and invoices documenting itemized medical expense for three years from the date the VA processes your claim. Failure to do so can result in a retroactive reduction in benefits or termination of benefits.

Do not report expenses that you have or will be reimbursed for through another source.

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