The National Veterans Disability Advocates: The Rep For Vets


IF YOU ARE A DISABLED VETERAN, CALL	1-888-	5	REPVET
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The VA works for the government. The Rep For Vets™ works for you.

Please complete our FREE Veterans Disability Form.
One of our representatives will contact you shortly.

Full Name (First, M.I, Last)

* *

Date of Birth

Address, Suite/Floor

City

State

Zipcode:

5 digit

Telephone Number

- -
* If you do not have a phone number, please input all zeros (“0”)

E-mail Address

Are you currently receiving service-connected disability benefits?

If yes, what is your combined rating?

Do you have a service-connected disability case pending?

If yes, did you receive an initial decision?

If you received the initial decision, did you file an NOD
(the Notice of Disagreement)?

If yes, when did you file the Notice of Disagreement?

Are you working?

If no, when did you last work?

Are you unable to work due to your service-connected disability?

Are you receiving Social Security Disability
or Supplemental Security Income benefits?

Are you receiving non service-connected pension?

What service-connected disabilities are you claiming?

How would you like us to assist you with your claim?