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Click ‘Get Form’ to open it in the editor.
Begin with Part I, where you will enter your identifying information. Fill in your name, Social Security number, VA file number, address, email (if applicable), and daytime and evening telephone numbers.
Move to Part II to specify the type of claim you are filing. Check all applicable boxes for increased evaluation, new disabilities, reopening previously denied claims, or secondary disabilities.
Provide details about your treatment records in sections 8A and 8B. Include the names and locations of relevant VA medical centers or military facilities.
If you have private treatment records, indicate this in section 8C and attach any necessary forms for the VA to request these records.
Complete any additional claims for benefits in section 9 and provide your spouse's information if applicable in section 10.
Finally, sign and date the form in section 11A and 11B before submitting it.

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