Benefits Application - Form 10-10EZ
The primary purpose of this form is to request enrollment in the VA Health Care System (Apply for Medical Benefits). Typically, veterans who have NOT previously enrolled or applied for VA health care benefits should use this form.
The 10-10EZ Form is available for download or printing. Once you complete the form, you can mail or fax the signed application and a copy of your DD-214 Discharge form to:
VA Appointment Center and Patient Services Center
910 West Oglethorpe Blvd.
Albany, Georgia 31701
For questions, please call the clinic nearest you ( click here for locations and phone numbers ) or email info@vacbocs.com
FREQUENTLY ASKED QUESTIONS
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What is VA Form 10-10EZ used for?
To apply for enrollment in the VA health care system, or for nursing home, domiciliary or dental benefits.
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Where can I get help filling out the form?
Call or visit the nearest
VA Clinic .
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How can I contact someone if I have questions?
1. Contact your Outreach Director from our
Contacts page.
2. For questions about eligibility, call or visit the clinic nearest you.
3. For an appointment, call or visit the clinic nearest you.
(Phone numbers and locations are available on our
Locations page.)
Definitions of terms used on this form
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SERVICE-CONNECTED (SC): A veteran with a VA determination that an illness or injury was incurred or aggravated in theline of duty, in the active military, naval or air service.
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COMPENSABLE: A determination by VA that a service-connected disability is severe enough to warrant monetarycompensation.
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NONCOMPENSABLE: A determination by VA that a service-connected disability is not severe enough to warrant monetarycompensation.
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NONSERVICE-CONNECTED (NSC): A veteran who does not have a VA determined service-related condition.
(click here for a free copy of Acrobat reader)
Mail the signed application and a copy of your DD-214 Discharge form to:
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VA Appointment Center and Patient Services Center
910 West Oglethorpe Blvd.
Albany, Georgia 31701
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