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Question About Form 21-4192.(Employment Information)



I'm waiting on my decision for 100 I.U.My claim is in gathering of evidence.Recently i recieved a letter saying,we have sent the V.A form 21-4192 (Request for employment information in connection with claim for disabilty benefits) to your past employer.It was 10 years ago when i worked for this employer.And i'm concerned that they will not fill out the form and return it to the V.A.If this happens i think the V.A will request me to get this information.I don't think the company is even around anymore.Does anyone know what will happen if the V.A or me cannot get this information from my last employer? Thank you.

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M21-1MR, Part IV, Subpart ii, Chapter 2, Section F 25 e:

Request each employer for whom the Veteran worked during the 12-month period prior to the date the Veteran last worked complete and return VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits. At the same time, send a copy of VA Form 21-4192 to the Veteran.

If VA Form 21-4192 is not received from the Veteran’s employer(s) within 30 days

  • send a follow-up request to the employer(s) for VA Form 21-4192, allowing an additional 10 days for response, and

  • notify the Veteran that

  • the employer has failed to respond to VA’s request, and

  • it is ultimately his/her responsibility to obtain this information.

Exception: Do not send VA Form 21-4192 to the Veteran’s last employer if it has been more than five years since the Veteran last worked.


  • If the information on VA Form 21-4192 only states that the Veteran retired, then request additional information as to whether the Veteran’s retirement was by reason of disability. If so, ask the employer to identify the nature of the disability for which the Veteran was retired.

  • Do not deny an IU claim solely because an employer failed to return a completed VA Form 21-4192.

Edited by toddt (see edit history)
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Fast letter 13-13 is the update to that section above. Fast letters are modifications to m21-1 that haven't been updated yet. See pg 3 of the link I've attached). The end result is the same. They won't deny based on non return of 4192. (Our RO doesn't admin deny based on non return of 8940 also).


Note: Request VA Form(s) 21-4192 for the Veterans last year of employment even if the Veteran has not worked for five years or more.

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It should not hurt you, the VA sent that same letter to the State of Texas, when I was a Marshall and those ASS***** did not fill it out either, and no harm came of it. Just try to breathe, and please don't let this process drive you into the ground. We are all stressed, and it gets no easier. Good luck and we are here for you bud.

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Thanks for such great information,it took a load off me knowing it is possible that if this form is not submitted,it may not hurt my claim.This process is sure a roller coaster ride,but hopefully the end result will be worth the ride.Thank you.

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Oh man,more stress.Got another letter from evidence intake center about form 21-4192.It says,this is our second request for your past employment information from your last employer.They said that they have requested the information from my last employer.I am sure they are not going to bother sending this form back to the VA.If I send them the form they will not fill it out,why would they,if they are ignoring the VA.The VA is working on my claim they said,so they must be reviewing my C&P exam report.Now more stress,waiting longer for there determination.I just want this over with,a negative or positive determination,I don't care .Any feedback,thanks.

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Oh lord,called the VA about my claim today,still in gathering of evidence,mainly in regards to this form.She said if they don't get this form back from the employer,it could jeopardize my claim.Stressful.

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They told you some BS.They simply cannot deny you tdiu just because your former employer failed to respond to their letter. Relax usally that's the last step in adjudication of tdiu..They usually already have enough evidence to award without this letter. Relax.

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