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VA Health Benefits Update Form: Health Benefits Update Form
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VA Form 10-10EZR in short
VA Form 10-10EZR is for veterans already enrolled in VA health care who need to update their personal, insurance, financial or military service details. VA uses the updates to decide copays, travel pay eligibility and priority group. It is not an application for VA health care; new applicants use VA Form 10-10EZ.
| Issued by | U.S. Department of Veterans Affairs (VA), Veterans Health Administration |
|---|---|
| Current version | Rev. February 2025 (checked 2026-10-25) |
| Who fills it in | Veterans already enrolled in VA health care. The veteran signs, or someone the veteran has given power of attorney. If the veteran signs with an X, two people must witness it and sign. |
| Who receives it | VA's Health Eligibility Center in Janesville, Wisconsin. |
| Where to send it | By mail, the form and VA's page say to send it with any supporting documents to Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207. VA's page also lists online (signed in to VA.gov), by phone with the Health Eligibility Center, and in person at a VA health facility. |
| Deadline | No fixed deadline. Use it when your details change. Income questions cover the previous calendar year. |
| Fee | No fee to file. By submitting it you agree to pay any VA copays that apply, as the form explains in Section VII. |
| Official links | Official page · Official PDF |
What changed
The printed edition is FEB 2025. The form says previous editions are not to be used. VA did not publish a list of changes.
How to fill out VA Form 10-10EZR, line by line
| Section I | General information Name, preferred name, Social Security number, sex, date of birth, phone numbers, mailing and home address, email, marital status, next of kin and emergency contact. |
| Section II | Insurance information Every health insurer that covers you, including through a spouse. Add Medicaid eligibility and Medicare Part A details. The instructions suggest attaching copies of your insurance and Medicare or Medicaid cards. |
| Section III | Military service and exposure Last branch, entry and discharge dates, discharge type, Purple Heart, POW, combat service and exposure questions such as Gulf War locations, Agent Orange locations, burn pits or Camp Lejeune water, with approximate dates. |
| Section IV | Dependents Spouse and child details, including Social Security numbers. The instructions say to complete it only if you complete the income section. |
| Section V | Previous calendar year income Gross employment income, net farm or business income, and other income for you, your spouse and a child. The instructions list income you should not report, such as SSI and welfare payments. |
| Section VI | Deductible expenses Non-reimbursed medical expenses, funeral and burial costs for a spouse or child, and your own education costs from last year. |
| Section VIII | Signature and date Sign in ink and date. The form says VA will return it if it is not signed and dated. |
Common mistakes to avoid
- Using it to apply for VA health care for the first time. VA says it is only for people already enrolled; new applicants use VA Form 10-10EZ.
- Leaving out insurance that comes through a spouse. The instructions ask for all insurers that cover you.
- Reporting income the instructions say to leave out, such as SSI, welfare or tax refunds.
- Filling in financial sections you do not need. The instructions say veterans rated 50 to 100 percent service-connected and veterans getting VA pension do not have to give a financial assessment.
- Signing with an X without two witnesses who sign and print their names.
- Forgetting to sign and date the last page. VA says it will return an unsigned form.
- Updating military exposure details online. VA's page says those updates can only be made on the PDF form at this time.
Questions about VA Form 10-10EZR
Can I use VA Form 10-10EZR to apply for VA health care?
No. VA says you can use it only after you are enrolled. To apply, use the health care application, VA Form 10-10EZ.
Where do I mail VA Form 10-10EZR?
Mail it to Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207.
Can I update my information online or by phone?
Yes. VA lists online, phone, mail and in person. VA's page notes that military exposure history can only be updated with the PDF at this time.
Why does the form ask about my private insurance?
VA says it has to bill private health insurance for care of non-service-connected conditions. It says it does not bill Medicare or Medicaid.
Do I need to send documents about toxic exposure?
VA says supporting documents are not required, but items like a DD214, service records, orders or a buddy statement may help confirm details and speed processing.
Do I have to fill in the income section?
Not always. The instructions say veterans rated 50 to 100 percent service-connected and veterans receiving VA pension are not required to give financial information.
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Sources
Checked against the official sources on 2026-10-25. PDF Editor Hub is not affiliated with the U.S. Department of Veterans Affairs or any government agency. This page is general information, not legal or tax advice.