VA Form 21-0304a

Application for Benefits for Children with Covered Birth Defects (Children of Women Vietnam Veterans)

Spina Bifida (Vietnam Children)Official VA form on VA.gov

Who fills it

dependent

Journey phase

Specialty Benefits

Estimated time

30-45 minutes.

When to file

Anytime.

You are the child of a woman who served in Vietnam and you have a birth defect listed in 38 CFR 3.814 (other than spina bifida).

Gather before you start

—Mother's DD-214 showing women's service in Vietnam

—Medical documentation of the covered birth defect

—Birth certificate proving mother-child relationship

—Confirmation the birth defect is on the covered list (38 CFR 3.814)

Attach with the form

—Mother's DD-214 (Vietnam service)

—Birth certificate

—Medical records documenting the covered birth defect

Section I - Applicant Identification

1 field

Blocks 1-5Child's name, SSN, DOB, addressPII

The child with the birth defect files (or their guardian). Note: this program applies only to children of WOMEN veterans who served in Vietnam. Children of male Vietnam veterans with birth defects other than spina bifida generally do not qualify under this program.

Example

(child's legal name, SSN, DOB)

Common mistakes

Children of male Vietnam veterans applying under this form - use 21-0304 for spina bifida; children of male veterans with other birth defects generally do not qualify under VA law.
Not knowing about the distinction between this form (women veterans' children) and 21-0304 (all Vietnam veterans' children with spina bifida).

Section II - Veteran Mother Information

1 field · 1 citation

Blocks 6-10Mother veteran's name, SSN, VA File Number, Vietnam servicePII

The mother who served in Vietnam. She must have served in the Republic of Vietnam between February 28, 1961 and May 7, 1975.

Example

(mother's name, VA file number, service in Vietnam)

Common mistakes

Not confirming the mother served in-country Vietnam (not just the region or on a ship offshore).

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

Section III - Covered Birth Defect

1 field · 2 citations

Blocks 11-15Specific birth defect and medical documentation

Identify the specific birth defect from the covered list at 38 CFR 3.814. The list includes: cleft lip/palate, club foot, congenital heart disease, achondroplasia, defects of the upper and lower limbs, hypospadias, neural tube defects (other than spina bifida), undescended testicle, esophageal and intestinal atresia, and others. Attach medical records confirming the diagnosis.

Example

e.g., Congenital heart disease (ventricular septal defect), diagnosed at birth 1975, surgically repaired 1976; records attached.

Common mistakes

Applying for a birth defect not on the covered list - only specific defects qualify under 38 CFR 3.814.
Not attaching medical records - diagnosis must be documented.

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

Section IV - Certification

1 field

Blocks 16-17Applicant or guardian signature and datePII

Sign and date. By signing you certify the information is accurate under penalty of perjury.

Example

(signature/date)

Common mistakes

Not knowing this is a separate program from the Women Veterans health benefits - different eligibility, different application.

Statutory & regulatory authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

VA Form 21-0304a

Application for Benefits for Children with Covered Birth Defects (Children of Women Vietnam Veterans)

Spina Bifida (Vietnam Children)Official VA form on VA.gov

Who fills it

dependent

Journey phase

Specialty Benefits

Estimated time

30-45 minutes.

When to file

Anytime.

You are the child of a woman who served in Vietnam and you have a birth defect listed in 38 CFR 3.814 (other than spina bifida).

Gather before you start

—Mother's DD-214 showing women's service in Vietnam

—Medical documentation of the covered birth defect

—Birth certificate proving mother-child relationship

—Confirmation the birth defect is on the covered list (38 CFR 3.814)

Attach with the form

—Mother's DD-214 (Vietnam service)

—Birth certificate

—Medical records documenting the covered birth defect

Section I - Applicant Identification

1 field

Blocks 1-5Child's name, SSN, DOB, addressPII

Example

(child's legal name, SSN, DOB)

Common mistakes

Children of male Vietnam veterans applying under this form - use 21-0304 for spina bifida; children of male veterans with other birth defects generally do not qualify under VA law.
Not knowing about the distinction between this form (women veterans' children) and 21-0304 (all Vietnam veterans' children with spina bifida).

Section II - Veteran Mother Information

1 field · 1 citation

Blocks 6-10Mother veteran's name, SSN, VA File Number, Vietnam servicePII

The mother who served in Vietnam. She must have served in the Republic of Vietnam between February 28, 1961 and May 7, 1975.

Example

(mother's name, VA file number, service in Vietnam)

Common mistakes

Not confirming the mother served in-country Vietnam (not just the region or on a ship offshore).

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

Section III - Covered Birth Defect

1 field · 2 citations

Blocks 11-15Specific birth defect and medical documentation

Example

e.g., Congenital heart disease (ventricular septal defect), diagnosed at birth 1975, surgically repaired 1976; records attached.

Common mistakes

Applying for a birth defect not on the covered list - only specific defects qualify under 38 CFR 3.814.
Not attaching medical records - diagnosis must be documented.

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

Section IV - Certification

1 field

Blocks 16-17Applicant or guardian signature and datePII

Sign and date. By signing you certify the information is accurate under penalty of perjury.

Example

(signature/date)

Common mistakes

Not knowing this is a separate program from the Women Veterans health benefits - different eligibility, different application.

Statutory & regulatory authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

VA Form 21-0304a

Application for Benefits for Children with Covered Birth Defects (Children of Women Vietnam Veterans)

Spina Bifida (Vietnam Children)Official VA form on VA.gov

Who fills it

dependent

Journey phase

Specialty Benefits

Estimated time

30-45 minutes.

When to file

Anytime.

You are the child of a woman who served in Vietnam and you have a birth defect listed in 38 CFR 3.814 (other than spina bifida).

Gather before you start

—Mother's DD-214 showing women's service in Vietnam

—Medical documentation of the covered birth defect

—Birth certificate proving mother-child relationship

—Confirmation the birth defect is on the covered list (38 CFR 3.814)

Attach with the form

—Mother's DD-214 (Vietnam service)

—Birth certificate

—Medical records documenting the covered birth defect

Section I - Applicant Identification

1 field

Blocks 1-5Child's name, SSN, DOB, addressPII

Example

(child's legal name, SSN, DOB)

Common mistakes

Children of male Vietnam veterans applying under this form - use 21-0304 for spina bifida; children of male veterans with other birth defects generally do not qualify under VA law.
Not knowing about the distinction between this form (women veterans' children) and 21-0304 (all Vietnam veterans' children with spina bifida).

Section II - Veteran Mother Information

1 field · 1 citation

Blocks 6-10Mother veteran's name, SSN, VA File Number, Vietnam servicePII

The mother who served in Vietnam. She must have served in the Republic of Vietnam between February 28, 1961 and May 7, 1975.

Example

(mother's name, VA file number, service in Vietnam)

Common mistakes

Not confirming the mother served in-country Vietnam (not just the region or on a ship offshore).

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

Section III - Covered Birth Defect

1 field · 2 citations

Blocks 11-15Specific birth defect and medical documentation

Example

e.g., Congenital heart disease (ventricular septal defect), diagnosed at birth 1975, surgically repaired 1976; records attached.

Common mistakes

Applying for a birth defect not on the covered list - only specific defects qualify under 38 CFR 3.814.
Not attaching medical records - diagnosis must be documented.

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

Section IV - Certification

1 field

Blocks 16-17Applicant or guardian signature and datePII

Sign and date. By signing you certify the information is accurate under penalty of perjury.

Example

(signature/date)

Common mistakes

Not knowing this is a separate program from the Women Veterans health benefits - different eligibility, different application.

Statutory & regulatory authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

VA Form 21-0304a

Application for Benefits for Children with Covered Birth Defects (Children of Women Vietnam Veterans)

Spina Bifida (Vietnam Children)Official VA form on VA.gov

Who fills it

dependent

Journey phase

Specialty Benefits

Estimated time

30-45 minutes.

When to file

Anytime.

You are the child of a woman who served in Vietnam and you have a birth defect listed in 38 CFR 3.814 (other than spina bifida).

Gather before you start

—Mother's DD-214 showing women's service in Vietnam

—Medical documentation of the covered birth defect

—Birth certificate proving mother-child relationship

—Confirmation the birth defect is on the covered list (38 CFR 3.814)

Attach with the form

—Mother's DD-214 (Vietnam service)

—Birth certificate

—Medical records documenting the covered birth defect

Section I - Applicant Identification

1 field

Blocks 1-5Child's name, SSN, DOB, addressPII

Example

(child's legal name, SSN, DOB)

Common mistakes

Children of male Vietnam veterans applying under this form - use 21-0304 for spina bifida; children of male veterans with other birth defects generally do not qualify under VA law.
Not knowing about the distinction between this form (women veterans' children) and 21-0304 (all Vietnam veterans' children with spina bifida).

Section II - Veteran Mother Information

1 field · 1 citation

Blocks 6-10Mother veteran's name, SSN, VA File Number, Vietnam servicePII

The mother who served in Vietnam. She must have served in the Republic of Vietnam between February 28, 1961 and May 7, 1975.

Example

(mother's name, VA file number, service in Vietnam)

Common mistakes

Not confirming the mother served in-country Vietnam (not just the region or on a ship offshore).

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

Section III - Covered Birth Defect

1 field · 2 citations

Blocks 11-15Specific birth defect and medical documentation

Example

e.g., Congenital heart disease (ventricular septal defect), diagnosed at birth 1975, surgically repaired 1976; records attached.

Common mistakes

Applying for a birth defect not on the covered list - only specific defects qualify under 38 CFR 3.814.
Not attaching medical records - diagnosis must be documented.

Authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.

Section IV - Certification

1 field

Blocks 16-17Applicant or guardian signature and datePII

Sign and date. By signing you certify the information is accurate under penalty of perjury.

Example

(signature/date)

Common mistakes

Not knowing this is a separate program from the Women Veterans health benefits - different eligibility, different application.

Statutory & regulatory authority

38 CFR 3.815 - Monetary allowance under 38 USC chapter 18 for a child with covered birth defects (other than spina bifida) whose biological mother is or was a Vietnam veteran.

38 USC 1822 - Monetary allowance for covered birth defects in children of women veterans who served in Vietnam.