For The Brave - Camp Humphreys

Initial Review

Initial Forms & Document:
VA FORM 21-0966 – Intent to File
VA FORM 20-10206 – Rating Code Sheet & Decision Letter
DD 214 – Certificate of Release

Full Name

Sex

Date of Birth

Place of Birth

SSN

Active Duty Dates of Service

Branch Of Service

Contact number

Mailing Address

Physical Address (if different)

Marital Status

Have you ever filed a claim with VA?

If no, please provide us a copy of your DD214

If yes, what is current rating?

If yes, where did you file? (U.S., PH...)

If you're married and/or have children, are they included in your disability if rated?

If not residing in the Philippines, are you willing to travel to the Philippines for the C&P exams?

Place Of Separation

MOS

Have you ever served in the Reserves? If yes, provide service dates

Have you ever served in the National Guard? If yes, provide service dates

Please provide us with any additional information you'd like to add

Who Referred You?