A Grave Marker Medallion for veterans who died on or after Nov. 1, 1990, is furnished upon receipt of claim for affixing to an existing privately-purchased headstone or marker placed at the gravesite of an eligible deceased Veteran who is buried in a private cemetery.
The medallion is made of bronze and available in large, medium and small. Each medallion is inscribed with the word VETERAN across the top and the Branch of Service at the bottom. Eligible veterans may receive a government furnished headstone or marker, or a medallion, but not both. If requesting a headstone or marker, use the VA Form 40-1330.
Who is eligible?
Any member of the Armed Forces of the United States who dies on active duty and is buried in a private cemetery in a grave marked with a privately purchased headstone or marker.
Any deceased veteran discharged under honorable conditions, who died on or after Nov. 1, 1990, and is buried in a private cemetery in a grave marked with a privately purchased headstone or marker.
A deceased veteran discharged under conditions other than honorable, who died on or after Nov. 1, 1990, and is buried in a private cemetery in a grave marked with a privately purchased headstone or marker, may also be eligible.
A copy of the deceased veteran’s discharge certificate (DD Form 214 or equivalent) or a copy of other official document(s) establishing qualifying military service must be attached. Do not send original documents. They will not be returned. Service after Sept. 7, 1980, must be for a minimum of 24 months continuous active duty or be completed under special circumstances, e.g., death on active duty.
Persons who have only limited active duty service for training while in the National Guard or Reserves are not eligible unless there are special circumstances, e.g., death while on active duty, or as a result of training.
Reservists and National Guard members who, at time of death, were entitled to retired pay, or would have been entitled, but for being under the age of 60, are eligible. A copy of the Reserve Retirement Eligibility Benefits Letter must accompany the claim.
Reservists called to active duty other than training and National Guard members who are Federalized and who serve for the period called are eligible.
Who can apply
Federal regulation defines “applicant” as the decedent’s Next of Kin (NOK); a person authorized in writing by the NOK; or a personal representative authorized in writing by the decedent. Written authorization must be included with claim. A notarized statement is not required.
Fax claims and supporting documents to 1-800-455-7143. If faxing more than one claim, fax each claim package (claim plus supporting documents) individually (disconnect the call and redial for each submission). Mail claims to Memorial Programs Service (41B), Department of Veterans Affairs, 5109 Russell Road, Quantico, VA 22134-3903. A VA medallion may be furnished only upon receipt of a fully completed and signed claim with required supporting documentation.
The applicant must sign in Block 12A. The applicant must be the Next of Kin or an authorized representative of the decedent or the Next of Kin.
If assistance is needed to complete this claim, you may contact VA’s Applicant Assistance Unit toll free at: 1-800-697-6947, or via e-mail at mps.headstones@va.gov. No fee should be paid in connection with the preparation of this claim. For more information regarding medallion eligibility, affixing procedures, and sizes, visit website at www.cem.va.gov.
The medallion is shipped without charge to the name/address designated in Block 13 of the claim. The Government is not responsible for costs associated with affixing the medallion to the privately purchased headstone or marker. Appropriate affixing adhesives, hardware and instructions are provided with the medallion.
To avoid delays in the production and delivery of the medallion, please check carefully to be sure you have accurately furnished all required information and documents before faxing or mailing the claim. The government is not responsible for costs associated with affixing the medallion to the privately purchased headstone or marker.
Medallions furnished remain the property of the U.S. Government and may not be used for any purpose other than to be affixed to the privately purchased headstone or marker of an eligible deceased veteran buried in a private cemetery. (Source: http://www.va.gov/vaforms/va/pdf/VA40-1330M.pdf | July 2016)