Name
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First Name
Last Name
Email
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Phone
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(###)
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Provide a Brief Description of your Case.
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Do you currently have a representative helping you with your appeal?
Select a Response
No, I do not have a Representative
Yes, an Attorney is helping me
Yes, a Veterans Service Organization is helping me (eg, VFW, DAV)
Are you currently Employed?
Select a Response
Yes, I work full time (35+ hours/week)
Yes, I work part time (fewer than 35 hours/week)
No, but I am seeking work
No, and I am NOT seeking work
Do you currently receive monthly service-connected disability benefits? If so, what is your combined rating?
Select a Response
No, I do not received service-connected benefits
Yes, but I do not know my combined rating
Yes, my combined rating is 0%
Yes, my combined rating is 10%
Yes, my combined rating is 20%
Yes, my combined rating is 30%
Yes, my combined rating is 40%
Yes, my combined rating is 50%
Yes, my combined rating is 60%
Yes, my combined rating is 70%
Yes, my combined rating is 80%
Yes, my combined rating is 90%
Yes, my combined rating is 100%
Yes, my combined rating is less than 100% but I receive Individual Uemployability ("TDIU")
Yes, I receive survivors' benefits/DIC
Is there any additional information we should know?
Please review the three items below. If you agree with the statement, please tick the corresponding box to signify your agreement. After ticking all boxes, please press "submit" to complete your request for a free consultation on your VA case.
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Thank you for submitting your request for a free consultation! We will do our best to review the information you submitted within two business days.
In the meantime, please do not send any documents to our office until you have heard from us. When we speak with you we will let you know if there are any documents that you should send.
Thank you again for your interest in our services, we will be in touch soon!
