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Click ‘Get Form’ to open it in the editor.
Begin by entering the claimant's first, middle initial, and last name in the designated fields at the top of the form.
Input the VA file number and regional office number as required in the respective sections.
In Section I, carefully review and select the appropriate criteria for overturning prior rehabilitation or MRG closure. Provide a detailed explanation justifying your decision.
Proceed to Section II to establish automatic entitlement. Ensure all criteria are checked off before moving on.
In Section III, assess whether an employment handicap exists. Answer each question truthfully and provide explanations where necessary.
Continue to Section IV to determine if a serious employment handicap is present. Again, provide thorough explanations for your selections.
Finalize by selecting an entitlement decision in Section V based on previous justifications and evidence provided throughout the form.
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