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VA CLAIM WORKSHEET

The purpose of this worksheet is to help you keep track of important deadlines/details

 and to help guide you in working on your claim.

 

WARNING: This information is not intended to substitute for advice from a competent

representative. Important laws, rules or procedures may have changed since this guide

was published. Consult a representative for the latest information.

Your Name ___________________________________________
VA Claim #: ___________________________________________
SSN: ________________________________________________
Address, Phone of VARO* handling your case
(The nearest VARO can usually be reached by calling 1-800-827-1000):
_____________________________________________________
_____________________________________________________

Representative’s name: _______________________________
Organization: __________________________________________
Address: _____________________________________________
_____________________________________________________
Phone: _______________________________________________
Date signed Power of Attorney: ___________________________

APPLICATION
Date of first contact with VA: _____________________________
Name of VA employee: __________________________________
Date formal application filed: ______________________________

VA INFORMATION REQUESTS
Date of 1st VA request: __________________________________
Date you mailed to VA: ___________________________________
Date scheduled for VA medical exam: _______________________
Name of examiner: ______________________________________
Did the examiner have your C-file on hand? ___________________
Date scheduled for VARO hearing: __________________________
Date of VARO denial: _____________________________________

AFTER VARO DENIAL
Deadline to file Notice of Disagreement (add one year to date of VA denial) =
Date you filed NOD with VARO: ___________________________
Date VA mailed Statement of Case: __________________________
Date VA mailed Supplemental SOC: __________________________
Deadline to file appeal, VAF 9: (whichever comes later:)
60 days from date VA mailed SOC = OR ______________________
One year from date of VA denial = ___________________________

BVA PROCEEDINGS
Date you mailed appeal, VAF 9, to VARO: ______________________
Date pre-hearing appointment with rep: ________________________
Location of BVA hearing: ___________________________________
Date of hearing before BVA: ________________________________
Date of BVA decision: BVA docket #: _________________________
BVA action: _____ denial _____ allowance ____ remand

AFTER BVA (Board of Veterans Appeals) PROCEEDINGS

Deadline to file Notice of Appeal with U.S. Court of Veterans Appeals
(120 days from date of the BVA decision) = ___________________
Date you mailed appeal: ___________________________________
CVA docket #: __________________________________________

 

*VARO- Veterans Administration Regional Office Representative

Information courtesy of VVA (Vietnam Veterans of America).

 

 



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