VA Form 21-2507a

Separation Health Assessment - Part A

IDES (Active Duty Separation)Official VA form on VA.gov

Who fills it

service-member-active

Journey phase

Filing Your Claim

Estimated time

30-45 minutes.

When to file

During the BDD window (90-180 days before your discharge date) or as part of IDES.

You are separating from active duty and participating in the BDD program (90-180 days before separation) or IDES, and VA requires a separation health assessment.

Gather before you start

—Complete list of every health condition you have had during service

—Dates and locations of treatment for each condition

—Medications currently taking and reason for each

—Mental health treatment history

—All injuries sustained during service

Attach with the form

—Service treatment records for any conditions you are reporting

—Current medication list

Section I - Service Member Identification

1 field

Blocks 1-6Name, SSN, DOB, branch, rank, separation datePII

Your active-duty information. Include your expected separation date as this determines the BDD window.

Example

(legal name, SSN, branch, expected separation date)

Common mistakes

Filing outside the BDD window (less than 90 days from separation) - BDD requires 90-180 days.

Section II - Complete Health History During Service

1 field · 1 citation

Blocks 7-40Every health condition, injury, illness, and treatment during serviceRepeatable

BE COMPREHENSIVE. List every condition, injury, illness, or health issue you have had during military service, even if you think it is minor or has resolved. Include: musculoskeletal injuries (back, knee, shoulder), hearing loss, tinnitus, vision changes, skin conditions, GI issues, respiratory problems, mental health concerns (anxiety, depression, PTSD, adjustment disorder), sleep problems, traumatic brain injury (even mild), exposures to hazardous materials, sexual trauma, dental issues. Conditions not listed here may be harder to claim later.

Example

e.g., Right shoulder instability from fall at training (2019, Camp Pendleton); tinnitus and bilateral hearing loss from firing range since 2017; intermittent low back pain from rucking since 2018; insomnia and anxiety symptoms since return from deployment 2021...

Common mistakes

Not listing conditions because they seem minor or resolved - even old injuries that recur count as service-connected.
Not listing mental health symptoms because of stigma - mental health conditions are fully covered and commonly rated.
Not listing occupational hazard exposures (burn pits, chemicals, noise) - PACT Act presumptions may apply.
Only listing currently active conditions - past conditions that may recur also belong here.

Authority

38 USC 5101 - Standardized form requirement.

Section III - Certification

1 field

Blocks 41-42Service member signature and datePII

Sign and date under penalty of perjury. Part B will then be completed by a DoD clinician based on your Part A and your medical records.

Example

(signature/date)

Common mistakes

Being too conservative out of fear of affecting promotions or military career - SHA-A is for YOUR benefit; the information is used for VA claims, not unit fitness reports.
Rushing through this form - this is one of the most important documents you will complete before separation.

Statutory & regulatory authority

38 USC 5101 - Standardized form requirement.

VA Form 21-2507a

Separation Health Assessment - Part A

IDES (Active Duty Separation)Official VA form on VA.gov

Who fills it

service-member-active

Journey phase

Filing Your Claim

Estimated time

30-45 minutes.

When to file

During the BDD window (90-180 days before your discharge date) or as part of IDES.

You are separating from active duty and participating in the BDD program (90-180 days before separation) or IDES, and VA requires a separation health assessment.

Gather before you start

—Complete list of every health condition you have had during service

—Dates and locations of treatment for each condition

—Medications currently taking and reason for each

—Mental health treatment history

—All injuries sustained during service

Attach with the form

—Service treatment records for any conditions you are reporting

—Current medication list

Section I - Service Member Identification

1 field

Blocks 1-6Name, SSN, DOB, branch, rank, separation datePII

Your active-duty information. Include your expected separation date as this determines the BDD window.

Example

(legal name, SSN, branch, expected separation date)

Common mistakes

Filing outside the BDD window (less than 90 days from separation) - BDD requires 90-180 days.

Section II - Complete Health History During Service

1 field · 1 citation

Blocks 7-40Every health condition, injury, illness, and treatment during serviceRepeatable

Example

e.g., Right shoulder instability from fall at training (2019, Camp Pendleton); tinnitus and bilateral hearing loss from firing range since 2017; intermittent low back pain from rucking since 2018; insomnia and anxiety symptoms since return from deployment 2021...

Common mistakes

Not listing conditions because they seem minor or resolved - even old injuries that recur count as service-connected.
Not listing mental health symptoms because of stigma - mental health conditions are fully covered and commonly rated.
Not listing occupational hazard exposures (burn pits, chemicals, noise) - PACT Act presumptions may apply.
Only listing currently active conditions - past conditions that may recur also belong here.

Authority

38 USC 5101 - Standardized form requirement.

Section III - Certification

1 field

Blocks 41-42Service member signature and datePII

Sign and date under penalty of perjury. Part B will then be completed by a DoD clinician based on your Part A and your medical records.

Example

(signature/date)

Common mistakes

Being too conservative out of fear of affecting promotions or military career - SHA-A is for YOUR benefit; the information is used for VA claims, not unit fitness reports.
Rushing through this form - this is one of the most important documents you will complete before separation.

Statutory & regulatory authority

38 USC 5101 - Standardized form requirement.

VA Form 21-2507a

Separation Health Assessment - Part A

IDES (Active Duty Separation)Official VA form on VA.gov

Who fills it

service-member-active

Journey phase

Filing Your Claim

Estimated time

30-45 minutes.

When to file

During the BDD window (90-180 days before your discharge date) or as part of IDES.

You are separating from active duty and participating in the BDD program (90-180 days before separation) or IDES, and VA requires a separation health assessment.

Gather before you start

—Complete list of every health condition you have had during service

—Dates and locations of treatment for each condition

—Medications currently taking and reason for each

—Mental health treatment history

—All injuries sustained during service

Attach with the form

—Service treatment records for any conditions you are reporting

—Current medication list

Section I - Service Member Identification

1 field

Blocks 1-6Name, SSN, DOB, branch, rank, separation datePII

Your active-duty information. Include your expected separation date as this determines the BDD window.

Example

(legal name, SSN, branch, expected separation date)

Common mistakes

Filing outside the BDD window (less than 90 days from separation) - BDD requires 90-180 days.

Section II - Complete Health History During Service

1 field · 1 citation

Blocks 7-40Every health condition, injury, illness, and treatment during serviceRepeatable

Example

e.g., Right shoulder instability from fall at training (2019, Camp Pendleton); tinnitus and bilateral hearing loss from firing range since 2017; intermittent low back pain from rucking since 2018; insomnia and anxiety symptoms since return from deployment 2021...

Common mistakes

Not listing conditions because they seem minor or resolved - even old injuries that recur count as service-connected.
Not listing mental health symptoms because of stigma - mental health conditions are fully covered and commonly rated.
Not listing occupational hazard exposures (burn pits, chemicals, noise) - PACT Act presumptions may apply.
Only listing currently active conditions - past conditions that may recur also belong here.

Authority

38 USC 5101 - Standardized form requirement.

Section III - Certification

1 field

Blocks 41-42Service member signature and datePII

Sign and date under penalty of perjury. Part B will then be completed by a DoD clinician based on your Part A and your medical records.

Example

(signature/date)

Common mistakes

Being too conservative out of fear of affecting promotions or military career - SHA-A is for YOUR benefit; the information is used for VA claims, not unit fitness reports.
Rushing through this form - this is one of the most important documents you will complete before separation.

Statutory & regulatory authority

38 USC 5101 - Standardized form requirement.

VA Form 21-2507a

Separation Health Assessment - Part A

IDES (Active Duty Separation)Official VA form on VA.gov

Who fills it

service-member-active

Journey phase

Filing Your Claim

Estimated time

30-45 minutes.

When to file

During the BDD window (90-180 days before your discharge date) or as part of IDES.

You are separating from active duty and participating in the BDD program (90-180 days before separation) or IDES, and VA requires a separation health assessment.

Gather before you start

—Complete list of every health condition you have had during service

—Dates and locations of treatment for each condition

—Medications currently taking and reason for each

—Mental health treatment history

—All injuries sustained during service

Attach with the form

—Service treatment records for any conditions you are reporting

—Current medication list

Section I - Service Member Identification

1 field

Blocks 1-6Name, SSN, DOB, branch, rank, separation datePII

Your active-duty information. Include your expected separation date as this determines the BDD window.

Example

(legal name, SSN, branch, expected separation date)

Common mistakes

Filing outside the BDD window (less than 90 days from separation) - BDD requires 90-180 days.

Section II - Complete Health History During Service

1 field · 1 citation

Blocks 7-40Every health condition, injury, illness, and treatment during serviceRepeatable

Example

e.g., Right shoulder instability from fall at training (2019, Camp Pendleton); tinnitus and bilateral hearing loss from firing range since 2017; intermittent low back pain from rucking since 2018; insomnia and anxiety symptoms since return from deployment 2021...

Common mistakes

Not listing conditions because they seem minor or resolved - even old injuries that recur count as service-connected.
Not listing mental health symptoms because of stigma - mental health conditions are fully covered and commonly rated.
Not listing occupational hazard exposures (burn pits, chemicals, noise) - PACT Act presumptions may apply.
Only listing currently active conditions - past conditions that may recur also belong here.

Authority

38 USC 5101 - Standardized form requirement.

Section III - Certification

1 field

Blocks 41-42Service member signature and datePII

Sign and date under penalty of perjury. Part B will then be completed by a DoD clinician based on your Part A and your medical records.

Example

(signature/date)

Common mistakes

Being too conservative out of fear of affecting promotions or military career - SHA-A is for YOUR benefit; the information is used for VA claims, not unit fitness reports.
Rushing through this form - this is one of the most important documents you will complete before separation.

Statutory & regulatory authority

38 USC 5101 - Standardized form requirement.