Application for Benefits for Children with Spina Bifida (Vietnam Veterans' Children)
You are the adult child (or guardian) of a Vietnam veteran and have spina bifida. You are applying for the monthly monetary allowance.
Gather before you start
Attach with the form
Section I - Applicant (Child) Identification
Blocks 1-5Child's name, SSN, DOB, addressPII
The child with spina bifida files (or their guardian files on their behalf if they lack capacity). The child is the claimant, even if an adult.
(child's legal name, SSN, DOB, address)
- Not knowing there is no age limit for the monetary allowance - adults with spina bifida continue to qualify.
Section II - Veteran Parent Information
Blocks 6-10Veteran parent name, SSN, VA File Number, service in VietnamPII
The veteran parent who served in a qualifying location. For spina bifida: Vietnam (in-country), Thailand at a Royal Thai Air Force Base, Korean DMZ (Sept 1967 - Aug 1971). The veteran's service location must match one of the qualifying areas.
(veteran parent's name, VA file number, qualifying service location)
- Applying for a veteran parent who served in Vietnam during but NOT in-country - only veterans with boots-on-ground service in Vietnam qualify.
- Not knowing the Korean DMZ eligibility period (Sept 1967 - Aug 1971).
Section III - Spina Bifida Diagnosis and Level
Blocks 11-15Spina bifida diagnosis, type, and functional disability level
VA evaluates disability at three levels: Level I (no neurological deficit), Level II (moderate neurological deficit), Level III (severe neurological deficit requiring extensive assistance). The monthly allowance increases with level. Provide medical records supporting the level. Spina bifida occulta does NOT qualify.
e.g., Myelomeningocele spina bifida (diagnosed at birth); severe neurological deficit including paraplegia and urinary incontinence (Level III); requires assistance for all mobility and ADLs.
- Not documenting functional level in medical records - VA needs clinical evidence of neurological deficit level, not just the diagnosis.
- Spina bifida occulta applicants - this type does not qualify.
Section IV - Certification
Blocks 16-17Applicant/guardian signature and datePII
The adult child (or guardian if child lacks capacity) signs.
(applicant/guardian signature/date)
- Not also applying for the healthcare program (VA Form 10-7959e) which provides additional medical benefits.