Veterans Disability Case Evaluation Form Veterans Disability Case Evaluation Form Last Name First Name Middle Initial Address City State Zip Code Phone Email Date of Birth Branch Served Service Start Date Service End Date Characterization of Discharge Did you have any deployments? If yes, please list the locations and dates What is your current VA Rating and its break down? Do you have a decision that you received within the past year that you are seeking to appeal? If yes, please give a brief description of the claims you are seeking to appeal and why. Do you have any pending/deferred claims? If yes, please list what is pending Are you being represented by an attorney or service organization for your VA claims? Please provide a short summary of what your overall goal is with seeking legal representation for your VA disability case. Submit If you are human, leave this field blank.
