APPLICATION FOR HEALTH CARE

VA Form 10-10EZ

VA Form 10-10EZ allows Veterans to apply for enrollment in the VA health care system. 

The VA uses the information provided on the form to determine the Veteran’s eligibility for medical benefits. 

Veterans not receiving VA benefits may attach a copy of their military discharge or separation papers, such as a DD-214 with their signed application to help expedite their application processing. 

For Veterans already receiving benefits, the VA will cross-reference the information on the form with VA data. 

Military service information includes the following: 

• Last branch of service and last entry date. 

• Future discharge date or last discharge date, and discharge type. 

• Military service number. 

Yes or no military history questions, including: 

• Purple Heart Award Recipient? 

• Former Prisoner of War (POW)? 

• Served in combat after 11/11/1998? 

• Discharged or retired for a disability incurred in the line of duty? 

• Receiving disability retirement pay instead of compensation from the VA? 

• Served in Southwest Asia between 8/2/1990 and 11/11/1998? 

• Service-connected rating? If yes, percentage? 

• Served in Vietnam between 1/9/1962 and 5/7/1975? 

• Exposed to radiation while in the military? 

• Received nose and throat radium treatments while in the military? 

• Served on active duty at least 30 days at Camp Lejeune from 8/1/1953 through 12/31/1987? 

Veterans should include information for all health insurance sources from which they receive coverage, including insurance through a spouse. 

Once the form has been completed, the Veteran or their Power of Attorney must sign and date the form. 

For VA to accept the form, it must be appropriately signed and dated; otherwise, it will be returned to the Veteran for them to complete. 

The completed application (and any supporting materials) can either be submitted in person at the Veteran’s local VA clinic or medical center, or mailed to:  

Health Eligibility Center, 2957 Clairmont Road, Suite 200, Atlanta, GA 30329 

Click below to download a copy of VA Form 10-10EZ now. 

Schedule a Free Consultation!

Once We've Received Your Submission, Our Staff Will Reach Out To You. Thanks!

We Represent Veterans Nationwide. Here Are Reviews From Just a Few Of Our Satisfied Clients:

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Blessed King profile picture
Blessed King
April 19, 2024.
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Where do I begin since I've been with Savannah and Dawson I have really realized that my VA case could be settled in my favor. They were patient with me when I would get a little frustrated and they were able to explain things in a way that I understood. I cannot say enough good things about them, they have really taken me from point A to point B and now my case has been solved and I'm so grateful. I would and will recommend them to anyone. I have to add more the hits just keep coming!! Savannah and Dawson have been heaven sent.????????❤️????????????
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Rod Watson profile picture
Rod Watson
April 10, 2024.
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I could have pursued bodily injury damages alone from the motorcycle accident, but I'm so glad I didn't. Don Marcari was easy to work with, and both he and his team had my back through the entire process. Additionally, they communicated often with me to keep me posted on progress. Don knows BI law, and he put the other party's insurance company in check. Trust me, you will want Don in your corner if you or a loved ever find yourself in need of a bodily injury attorney. I am incredibly appreciative of Don Marcari and his entire team at MRSB!
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Michael Hall profile picture
Michael Hall
March 27, 2024.
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This has been an amazing experience. They were able to get me from 90% (where I was stagnated at for several years) to 100% P&T with the VA. I can not say enough about the whole MRSB team. Heather is amazing at her job and is great at communicating with her clients. Again awesome experience. Myself and my family can't thank you enough.
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Lori Stewart profile picture
Lori Stewart
March 13, 2024.
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Marcari, Tussotto, Spencer & Balaban really work hard at getting you the money you deserve! They are a dedicated staff & help you in anyway possible. I would definitely recommend this group!!
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Carolyn Croxton profile picture
Carolyn Croxton
March 12, 2024.
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In January 2022 my husband was in a head on collision in NC. We had no clue how to handle the legal end of this wreck when a good friend of ours suggested this law firm. I contacted them and they immediately sent a representative out to our home. David Spencer got the ball rolling kept us abreast of the procedures that was going on. His secretary Mrs. Cathy out of the Fayetteville office was always a phone call away. She answered any and all of my questions very professionally. Cathy was on top of my husbands case just as if it was her own. We are very pleased with this law firm and would not hesitate yo use them again. Mr Spencer and Mrs. Cathy {in the Fayetteville office} treated us as if we were their only clients! Thank you both for a job well done! Ed and Carolyn Croxton
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Ernest Sloan profile picture
Ernest Sloan
March 12, 2024.
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I was nearing the end of my rope of trying to get what I'm entitled to as a burn pit victim. However, literally, one really last minute simple engine search brought me to these fantastic veteran advocates! I was stuck at 90% disabled for close to 3 years but in 5 maybe 6 short months, I'm now at 100% with close to 20 months of back pay. Thank God for these truly honest people fighting for the little guy!!
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Patrick Hazlett profile picture
Patrick Hazlett
February 15, 2024.
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I was initially denied for my VA disability claim, but with the help of Savannah Gay and Dawson Rouse, they were able to get my claim approved with back pay going back several years. Savannah was very communicative throughout the process, updating me on my case and assisting when needed. I would recommend them for any VA disability claim issues, as they were accommodating in ensuring my case was addressed.
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Trinity Burton profile picture
Trinity Burton
February 15, 2024.
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I would like to personally shout out Cathy Baggett at the Fayetteville location! She was and have been very professional and fought to the very end for me. Cathy made everything a smooth and easy process by being so helpful, thank you for everything!
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Brittany Moorman profile picture
Brittany Moorman
February 13, 2024.
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If you're looking for some legal bulldogs look no further! They will have you informed every step of the way!! Thank you Miss.Brittany and Miss.Vicki!!✨️✨️